Benefits firm taps into telemedicine

For some clients of Springfield-based Employee Benefit Design LLC, saving money on health care and insurance premiums is as simple as picking up the phone.

Since spring 2010, EBD has offered its clients access to telemedicine services from Florida-based Consult A Doctor, which offers telemedicine via a nationwide network of board-certified physicians – bringing potential cost savings for employers and employees.

“In the last 12 months, it’s really picked up steam,” said EBD partner Dan Ruggeri, estimating that his company has added roughly 500 covered employees at multiple client companies as a result of the Consult A Doctor 24/7 program.

Add those to employees at existing client companies that expanded their benefits to include the telemedicine program, and there are more than 2,500 southwest Missouri employees with access to Consult A Doctor 24/7, he said.

The potential for cost savings comes at a time when health premiums are continuing to rise. According to the latest Employer Health Benefits Survey by the Kaiser Family Foundation and Health Research and Educational Trust, family health premiums rose 9 percent to $15,073, with employers footing the bulk – nearly $11,000 – of that expense. That survey was conducted in the first half of 2011.

According to past survey findings, worker-only health coverage premiums have jumped 147 percent since 1999, landing at an average of $5,429 last year. And since 2001, family premiums have jumped 113 percent, far outpacing increases in workers’ wages, 34 percent, and inflation, 27 percent.

Combating costs
Ruggeri was unable to connect Springfield Business Journal with a client using Consult A Doctor 24/7 by press time, but as an example of how the program works, he pointed to one employer group that has 242 primary members and 70 family members.

In a recent quarter, that group had 21 telemedicine calls where they left messages to have  phone calls returned, 51 primary calls where they called and spoke to a provider, three e-consults, and three appointments to speak with a doctor by phone.

Those contacts brought roughly $21,000 in savings to the unnamed company’s health plan, and Ruggeri said that represents roughly $84,000 in annualized savings.

Ruggeri said EBD learned of the Consult A Doctor 24/7 program through its membership in United Benefit Advisors, a group of 144 independent employee benefits advisory firms that pool together to negotiate lower rates for services and programs.

Ruggeri said the telemedicine program can help companies – particularly those with self-funded health benefits – save on health care costs.

“Let’s say it was a $90 primary care visit that would hit your experience, meaning that once an employee has paid the deductible for the year, the employer’s actually going to see that cost,” Ruggeri said. “If they can get more of their employees to use telemedicine, it’s going to be a big savings … to the employer.”

The telemedicine program also can help companies with other types of benefit plans to keep insurance premiums down, Ruggeri said, because many renewal rates are based on utilization – and telemedicine does not count against the employers’ loss ratio.

“If we could move tens of thousands – if not hundreds of thousands – of dollars away from people having to go into an office visit setting … to over the phone, all of those claims don’t count against their utilization,” he added.

For employees, especially those whose employers have high-deductible health plans and no doctor visit co-pays, there also is potential for out-of-pocket savings with use of the telemedicine program. With the plan available through EBD, for example, Ruggeri said once employees are enrolled by their employer, they don’t have to pay to use the program.

“It might be anywhere from $70 to $150 to go in and see a physician. If it’s something that (the employee) thinks could be handled over the phone and not cost me anything, (the) incentive is to use telemedicine,” he said. “The employee has no payment, only if there’s a prescription.”

Costs to add Consult A Doctor’s program to a benefits plan varies, Ruggeri said, but he noted that through United Benefit Advisors, EBD’s clients pay an estimated $3 to $5 per employee per month – but not necessarily.

“In most of the cases on the larger accounts, I was able to convince the underwriter to reduce the renewal to offset the cost for Consult A Doctor,” Ruggeri said.

Karen Thomas, president of Advanced Telehealth Solutions and Oxford HealthCare in Springfield, serves on the advisory board for the Healthcare Technology Association of America and has testified about telemedicine before the federal office of National Coordination. In August,  Thomas told SBJ that insurance companies are still somewhat resistant to embracing telehealth coverage, but their interest is increasing, likely because companies recognize that they need to do something to lower costs.

“As the work force ages, the cost of health care is not going to go down, even if nothing else changes,” Thomas said at the time. “As time goes on, I think you’ll see more (insurance companies) work with (telehealth).”

Access to care
Dr. Douglas Smith, a Minneapolis-based family practice physician and chief medical officer for Consult A Doctor, said employees who are enrolled in the program can seek medical help from a nationwide network of providers – mainly primary care doctors –  not only by telephone but also through e-mail and video consultations.

“We have licensed physicians in each state so that if there’s a prescription that ends up being written, the doctor who writes the prescription is licensed in the state the patient’s residing in,” Smith said.

In Missouri, for example, prescriptions are handled by a physician in Dexter.

While the program doesn’t put limits on what doctors will address with patients, Smith said providers mainly handle immediate and specific needs.

“Most patients who call in are calling for acute medical conditions – ‘I think I’ve got a sinus infection,’” Smith said, adding other examples such as sore throats and earaches.

Smith noted the program’s providers aren’t focused on prescription refills, though they will provide them in some cases, and they don’t prescribe controlled substances such as narcotics or pain medication, or lifestyle drugs such as Viagra or Cialis.

Both Smith and Ruggeri emphasized the telemedicine program is designed to complement – not replace – traditional medical care.  

“There’s a time when a patient does need to be seen by a doctor. But there are also times when it becomes more of a nuisance and isn’t as necessary, and that’s where we try to fill in and ease some of the access burden for patients,” Smith said.