Amid GOP pushback, Michigan Legislature OKs $1B spending plan targeting biz incentives

Is forced telemedicine the future of health care?

Ron Hurtibise
Sun Sentinel

Would you take unlimited 24/7 access to primary care doctors via smartphone, tablet or computer, with zero out-of-pocket co-pays, if it meant you’d have to pay a lot more money to see your regular doctor in person?

Welcome to the future of telemedicine, also known as telehealth.

Insurance giant Humana is betting many will be happy with such a trade. The company has partnered with a telemedicine provider called Doctor on Demand to offer a discount-priced teledoc-based health insurance plan it calls On Hand.

Modern technology and ultrafast connectivity is undoubtedly changing how health care is delivered around the world. The internet makes it possible for specialists on the other side of the globe to participate in complex, delicate surgeries, as well as for surgeons to examine patients being treated by paramedics in an ambulance or on a living room floor.

Yet, online examinations have been widely available for several years now, but analysts say we’re just not warming up to the idea as they expected.

Humans, it seems, prefer face-to-face visits with their physicians.

That’s why Humana’s new plan raises the ante. By making visits free to the patient and throwing in most common lab work and prescriptions for $5 while making in-person doctor visits comparatively pricey for consumers, Humana, and other insurers, is hoping to compel sick people to consult teledocs.

Services vary, but most companies tout their ability to easily treat colds and flus, allergies, skin infections, asthma, upper respiratory infections, stomach viruses, fevers, sinus infections, headaches, irritable bowel syndrome and joint pain.

Long-term chronic ailments are also conducive to long-distance monitoring and prescribing, including conditions such as diabetes, thyroid problems, high cholesterol and high blood pressure, and weight management.

Psychiatric and behavioral issues are especially suited to telemedicine because they rarely involve invasive therapies. Most of the major telemedicine providers offer treatment options for issues such as addictions, depression, PTSD, eating disorders, insomnia, anxiety and postpartum depression.

Some patients might feel more comfortable seeking treatment by telemedicine for issues they might be embarrassed to discuss in person, such as erectile dysfunction or hair loss. That’s one reason specialized services have popped up for these issues.

Doctor on Demand lists the following conditions they don’t treat: Traumatic brain and spinal cord injuries, chest pain and/or numbness, vomiting or coughing blood, lacerations, loss of consciousness, broken bones, severe burns or pediatric ear infections. And sorry, forget about opioids, except under limited circumstances, and medical marijuana.

Insurers believe costs for telehealth visits should be lower than in-office visits. In Florida, physicians wanted the law to require insurers pay the same amount for either type as they must in 36 other states. The state’s new law leaves it to doctors and insurers to negotiate reimbursement rates.

That’ll keep telehealth from growing at the “explosive” rate it has in other states because it reduces incentives for physicians to invest in the necessary technology and training, says Thomas Ferrante, a Tampa, Fla.-based attorney for the law firm Foley & Lardner LLP, who specializes in helping telehealth businesses comply with state and federal laws.

Telehealth will improve patient access to physicians, advocates say. The U.S. is facing a severe shortfall in the number of physicians available to an increasingly large population of baby boomer seniors. By 2030, the nation will need 121,300 more physicians than it will have, according to the Association of American Medical Colleges.

UnitedHealthCare said more than 90% of users rated their visits five out of five stars.

Lyle Berkowitz, MDLive’s chief medical officer and executive vice president for product strategy, says 43% of the company’s expected million visits this year will be repeat users.

“Once they use us once, they are going to continue to use us on a repeat basis,” Berkowitz said in an interview.

Consumers give the service a net satisfaction score of 80 out of a possible 100, Berkowitz said, because they like the convenience of connecting with a physician in 10 minutes or less for consultations that generally last no more than 10 minutes. “It’s convenient, easy, and as wonderful to use as Netflix is compared to going to Blockbuster,” he said.

Telemedicine is still an optional service for most people on employer-funded plans, and an affordable option (along with urgent care centers) for the uninsured. An MDLive visit costs $75 to any consumer, and rates are similar from competitors such as TeleDoc and Doctor on Demand.

If insurers want to increase use in the future, they’ll increase the number of plans that offer it as the most financially palatable choice.

Ferrante doesn’t think we’ll be required to use telemedicine services any time soon, but he sees health plans and providers increasing incentives to move patients along.

“It’s not a question of if, but of when,” he said. Physicians who are reluctant will eventually buy in, he said. “It will be driven by market demand. Some will do it earlier than others. Some will be really successful and others, not so much. Some will refuse to change and retire or be driven out of business.”