Remote patient monitoring allows patients to securely transmit health information electronically to healthcare providers, and wearable devices can collect and transmit useful information that includes heart rate, blood pressure, oxygen saturation and blood glucose levels. Following up on these general observations, Glenn Dean, president and CFO of MeMD, adds, “As technology is developed and these monitoring devices become less expensive, usage among consumers will increase, giving healthcare providers real-time access to important health information, thereby improving care while bringing independence to patients.”
Technology, however, is not the only frontier spawning innovation in healthcare. An important arena of innovation is our attitude toward the use of healthcare and an expanding openness toward broader issues that affect health and well-being.
Mind Matters
Mental health, in particular, has begun to shed some of its stigma. Dale Parsons, L.C.S.W., director of therapy services of St. Luke’s Behavioral Health Center, observes, “With one out of five Americans living with a mental health condition, there is a strong probability that employers will be impacted by its workforce’s mental health issues.” The health of a company’s workforce and the company’s bottom-line are inextricably linked, he says, pointing out that mental illness is the single greatest cause of worker disability in the U.S., 62 percent of missed workdays can be attributed to mental health conditions, employees with untreated mental health conditions use non-psychiatric healthcare services three times more than those who do get treatment, and depressed employees are 20–40 percent more likely to become unemployed because of their condition.
Mental Health America recently launched an Arizona chapter, and its executive director, Kristina Sabetta, reports, “According to research by Harvard University Medical School, untreated mental illness costs the U.S. at least $105 billion in lost productivity each year.”
Barriers between employees and treatment for mental health and substance use disorders were created by annual and lifetime visit or dollar limitations, frequent denials and obsolete rules, Parsons relates. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act of 2008 (www.hhs.gov and www.cms.gov) was passed to ensure that health plans and insurers offer mental health and substance use disorder benefits comparable to their coverage for general medical and surgical care.
Sabetta and Parsons offer concrete steps employers can implement to promote mental wellness care in the workplace. These range from helping employees recognize they’re experiencing a mental illness to creating an environment that eliminates bullying and stigmatizing of co-workers with mental health issues. Employers can offer reasonable accommodations in the same way they accommodate an employee with a back injury, Sabetta says, such as providing a safe work station or approving a leave of absence. Parsons suggests employers develop a company culture that recognizes employee and team contributions, and openly communicates appreciation to workforce members for meeting targets and goals.
Mental Health America of Arizona offers these suggestions to employers, to support people living with mental illness.
- Talk about it. Bring in an expert who can discuss mental health, along with stigma associated with it.
- Learn to recognize it. It is important that employees learn to recognize they’re experiencing a mental illness. If they don’t recognize it, they will continue to suffer in silence. Employees can take advantage of a free, anonymous mental health screening (mhaarizona.org).
- Assist employees in addressing mental health issues.Create policies that support emotional wellness and treatment. Provide employees with available resources. Bring in an expert who can train managers on supervising those with mental illness.
- Foster and model a healthy environment. Encourage exercise, offer stress reduction workshops, allow for breaks and discourage the need to respond to work-related email from home. Management should model a healthy environment for their team.Create and enforce work-life balance policies.
- Provide easy access to Employee Assistance Programs (EAPs). EAPs can support employees in dealing with mental health issues, along with stress related pressures.
- Make reasonable accommodations. Just as we accommodate an employee with back injuries, we need to accommodate those with mental health needs. Some accommodations could include switching around their work schedule, providing a safe work station or approving a leave of absence. We need to learn how to create an environment that works for people who have special needs.
- Check company insurance coverage. The Federal Parity Law requires health insurance plans to provide coverage to cover behavioral health benefits and physical health benefits equally. Cutting dollars for mental healthcare can often increase overall medical costs.
St. Luke’s Behavioral Health Center offers these suggestions toemployers, to promote mental wellness care in the workplace.
- Remember that mental health conditions are common and treatable.
- Create a healthy workplace; a negative work environment can lead to physical and mental health problems, harmful use of substances or alcohol, absenteeism and lost productivity.
- Implement policies and practices that promote and protect the health, safety and well-being of all employees.
- Develop a company culture that recognizes employee and team contributions, and openly communicates appreciation to work force members for meeting targets/goals.
- Offer health benefit resources that include no cost/low cost mental health consultation, such as Employee Assistance Program (EAP).
- Implement management and staff training programs designed to increase acceptance and eliminate bullying/stigmatization of co-workers with mental health issues.
- Lead by example. When leaders and employers speak up about mental illness, they send a powerful message to employees that it is OK to get help.
- Seek feedback from the employed workforce. Design formal and/or informal procedures to obtain employee input and feedback on company’s mental health benefits, access to covered services, and awareness campaigns.
- Create a workplace where mental health conditions are not stigmatized and seeking help is encouraged and supported.
- Increase awareness. Offer “brown bag luncheons” for employees featuring presentations by mental health/substance abuse subject matter experts.
- Support recovery. Coordinate onsite support and recovery meetings (AA, NA, CA, Al-Anon, etc.) for employees and local community members.
Telehealth Counseling
MeMD’s Dean sees online therapy as the next frontier in telehealth, explaining it fills a critical gap in counseling services. “According to Kaiser Family Foundation, more than 100 million Americans live in areas where behavioral health services are severely limited. Oftentimes, people must travel long distances or wait months to see a provider. Telehealth changes that,” he says. “Not only does it remove geographical barriers, but it increases confidentiality and decreases time away from work. This is why employers are now jumping on board, offering online therapy as a part of their benefits packages.” Online therapy connects patients with licensed behavioral health professionals via a computer or mobile device, 24/7. Patients can speak with a therapist about a variety of emotional and mental health concerns, including depression, anxiety, trauma, substance misuse, marital and family problems, grief, eating disorders and more. “The service can help improve productivity, satisfaction and loyalty. It enables employees to remain present and productive in the workplace and at home,” Dean says.
The fact that urgent-care medicine has become accepted as a trusted method to receive quality care has made it more likely that those seeking behavioral health services will utilize telehealth for the convenience and privacy it provides, Dean says.
Another issue for those seeking therapy is measurement — and Dean notes this is not limited to virtual solutions. To address this, MeMD utilizes a scientifically developed measurement and outcome-based model to assess progress and track improvements over time. “With MeMD, those who request a therapy session are prompted to complete the Behavioral Health Screen. This is a multi-dimensional assessment tool that allows patients to self-report issues, and the advanced scoring mechanism uses algorithms to rank their symptoms and risk factors across 16 domains,” Dean says. “MeMD members can complete the assessment before treatment commences, once therapy is complete and at any time during treatment, allowing members and their providers to measure progress and track improvement.”
Focus on the Framework
Another category ripe for innovation is musculoskeletal disorders (MSDs), according to Kathleen Gramzay, founder of Kinessage® Self Care, who cites the United States Bone and Joint Initiative’s The Burden of Musculoskeletal Diseases in the United States, Third Edition in pointing out that one in two adults — or 126.6 million — are affected by MSDs. “That’s twice the rate of those with chronic heart and lung conditions, and seven times the 18.8 million diagnosed with diabetes.”
She works with businesses to include a holistic, non-drug, self-care approach that applies a philosophy similar to improving cardiovascular, respiratory and diabetic conditions by focusing on nutrition and exercise. “Many chronic musculoskeletal pain and mobility conditions can be alleviated by self-activating the body and mind’s innate intelligence to reset itself,” she says. “Empowering individuals with the knowledge to partner with the body and mind gives them the ability to release chronic pain and tension at the moment as well as release long-held chronic tension patterns to prevent injury and help prevent them from reoccurring.” This also, she notes, makes them better partners in their own healthcare, as they know what they can do on their own and when they need to see a professional. “The innovative shift is one from old-model conditioning that relief comes from outside the body — such as drugs or office visits — to one of working with the body and tapping into its built-in pain relief and self-healing system.”
Disrupting Delivery?
Direct Primary Care is a form of healthcare delivery model spreading around the country that Redirect Health co-founder and Chairman of the Board David Berg, D.C., believes would disrupt a lot of huge money — if it ever got big enough. “More and more forward-thinking companies realize that DPC needs to be the foundation of their employee health plans,” he says. “These are the companies that are aware they need to protect themselves from the perverse profit incentives in healthcare. “
Apple, Bezos, Buffett and JP Morgan were in the news earlier this year for their stated objective of starting a healthcare company for their own employees that would focus on simplicity and transparency. But Dr. Berg, while noting, “There are a lot of good people, but they work in a system that preys on the employer’s wallet when one of their employees is sick, injured or just scared,” points out, “Did you notice the 5-percent loss of healthcare share prices and the entire DOW the next day? JP Morgan had to backtrack because of its insurance and healthcare clients. I believe Jeff Bezos has a better chance of disrupting healthcare than anyone. However, I doubt Warren Buffett would want to do it because it would harm Berkshire’s share price – and he has a fiduciary to his shareholders the last I heard. I can’t even imagine how JP Morgan can do it.”
According to Dr. Berg, a new DPC software platform by Hint.com combined with new communication software like Spruce Health is allowing that trend to accelerate. The DPC model allows member patients to avoid much of the irritation and nickel-and-dime-ing seen with traditional insurance-centric care. Add chiropractic, labs, proactive outreach programs for common chronic conditions and 24-hour concierge access in multiple languages, and you’ll see huge disruption of traditional healthcare cost structures by lowering the need to pay insurance co-pays and deductibles, and hospital costs that typically go down 30-50%.
While predicting that technological advances will transform in the fields of stem cells, genomics, proteomics, AI, robotics, 3-D printing, quantum computing, VR and many more exponential technologies, Dr. Berg asserts, “But healthcare delivery model disruption that bypasses the big healthcare status quo companies, as DPC does, will be the most fought against.”
He founded his company on the approach he had implemented successfully as CEO of Arrowhead Health Centers, simplifying healthcare for its target customer of small and medium-sized entrepreneurial companies by removing complexities — notably, co-pays and deductibles. “And when we did,” Dr. Berg says, “along went the associated irritation. But also the expense of a credit card machine, and the merchant account fees, and the cash drawer, and the time needed to balance the cash drawer, and the codes for the charges, and the statements, and the envelopes, and the person licking the stamps for the envelope, and the billing department, and the billing computer, and the audit protection, and the recoup risk. Even the customer service calls trying to explain a bill or explanation of benefit statement from the insurance company goes away.”
‘Wellness’ Expands
Emily Noll, national director wellness solutions for CBIZ, speaks to trends she sees in employer wellness in 2018, which include a continuing focus on enhancing corporate culture, delivering management training, and expanding programs to cover multiple facets of individual well-being — Purpose/Career, Physical Health, Financial Health, Community and Social Health — to provide employees with a personally meaningful experience and supportive work environment. Specific programs that employers are offering are communication and resiliency training, education on how to be a savvy healthcare consumer, financial education, more flexibility or subsidies for health programs that fit with employees’ work/life schedules and help them master and enjoy skills, workplace policies and design that encourage movement, access to healthy fuel for their bodies, and a balance among privacy or quiet space and social interaction.
“Companies shouldn’t underestimate the value of employee input and the development of champions across job functions within the organization,” she says. “Employee well-being committees with an executive sponsor, defined membership requirements, training, and recognition, are more effective than those led by an HR team member simply delegating tasks.” Managers, too, play a decisive role in well-being programs, and can make or break their effectiveness, so a critical element is tools and training for managers on how they can help their employees thrive.
Key to any successful well-being program is collaboration, and this includes vendor partners, such as dental carriers, Employee Assistance Programs, financial advisors and health plans. She cautions employers, however, to keep control of their own strategic plan. “Employers who pivot to any one vendor or give up ownership of their strategic plan can easily lose their identity and be forced into a box that limits opportunities for members of their workforce,” she says.
Noting that employees are facing stress on many levels, Noll observes that, when their company acknowledges that challenge, reduces the stigma associated with getting help and fosters intrinsic motivation, their workforces engage in well-being programs at a higher level. While a recent AARP lawsuit against the EEOC raised concerns among employers about regulations that impact their ability to offer incentives in exchange for participation in wellness programs, Noll suggests employers seek guidance from their benefits consultants and legal counsel on these matters and begin exploring if and how parts of their well-being programs may need to be tweaked to continue to comply with EEOC and several other laws that regulate these programs with the goals to include everyone in opportunities to improve health.
“There has been credible research that shows employees stay with companies, and supervisors, that care. Employees do their best work, they are more creative, productive and have better customer relations, when they show up to work happy and with the energy needed to perform at optimal levels.”
Some Say Virtual Doctor Visits Won’t Work. Here’s Why They’re Wrong.
In 2017, a well-publicized RAND Corporation study presented a startling conclusion. It found direct-to-consumer telehealth may not save money because it may increase health care utilization due to ease of access. In fact, researchers estimated an 88 percent increase in the use of specific healthcare services among patients studied.
With findings that seem contrary to years of other research, the study got a lot of play, raising important questions for corporate health benefit programs: Should our company promote plans that offer telemedicine (often called telehealth, virtual visits or remote care)? Or should we urge people to stick with in-person care?
But it’s important to put the findings in context of the study’s methodology:
- RAND compared medical claims costs for telehealth users with costs for people seeking in-person care within just one diagnosis group (respiratory illness). The telehealth user group amounted to fewer than 1,000 patients over a 10-month period.
- The study did not look at the bigger picture of telehealth’s holistic benefits, including workplace productivity and time savings for patients and care providers.
- The study also did not consider telehealth’s role in addressing a doctor shortage that is expected to be nearly 50,000 by 2020 and more than 100,000 by 2030.
Telemedicine No Longer Means Telephone
Originally, telehealth or telemedicine meant just that: healthcare delivered over a telephone line, and mainly to people in rural areas with few hospitals or specialists. Even in 2011, the year RAND’s study started, some of today’s most successful direct-to-consumer telehealth services didn’t exist. Neither did much of the technology that enables video visits.
Today, though, people can go online or log into a special medical app on their phone, tablet or computer for a private, secure, face-to-face online visit. Using live video, a doctor, physician assistant or other clinician sees and hears the patient’s concerns and symptoms and prescribes treatment or other steps. Care can happen anywhere with Wi-Fi or data access, at the consumer’s convenience and, in many cases, 24/7. Whether the consultation is with a national telehealth service or a personal doctor, today’s telemedicine enables people to get an unexpected health concern or chronic condition addressed in just a few moments.
Where Virtual Visits Pay Off
Thousands of studies have looked at the value of this kind of remote care, especially for chronic conditions, follow-up after hospitalization and some types of behavioral health. The cost savings have prompted the federal government and all 50 states to adopt at least some telehealth care for Medicare and Medicaid beneficiaries.
Virtual visits make sense when an in-person medical appointment is inconvenient or impossible, such as during the employee’s workday, after physician office hours or on the weekend. Virtual care can help with minor, non-emergency medical conditions like a bladder or urinary tract infection, respiratory or sinus infection, pinkeye, rash, stomachache, diarrhea or migraine headache. For those with chronic conditions like diabetes or heart disease, telehealth can make regular check-ins with their personal doctor easier, helping them stay on top of their health. Tele-behavioral health is in particularly high demand due to the added privacy of being “seen” in one’s own home.
Several benefits are fueling the growing demand for virtual care.
Time savings: There is no travel time, and little to no downtime from work. Citing a time-usage study published in JAMA, American Well points out that virtual visits save 106 minutes per visit on average, compared to in-person care.
Affordability: Most consumers pay about $50 to $75 for a virtual visit. If their health plan covers the visit, their plan provisions typically apply, including co-payments or co-insurance. Their payments also may count toward their annual deductible. That’s far less expensive than a $150 visit to an urgent care center or a trip to the ER, which generally costs $1,700 or more.
Shorter wait times: When NewYork-Presbyterian’s Emergency Department rolled out an on-site virtual care option, the wait time for lower-urgency ER visits plummeted from 2.5 hours to 40 minutes.
Lower ER usage: Doctor on Demand, a telehealth provider, says about 50 percent of its patients would have gone to an emergency room or urgent care if they hadn’t accessed a video visit. Such costly and time-consuming care settings are best avoided for non-urgent situations.
Why Virtual Visits Will Flourish
The earliest telemedicine technology involved a telephone or spotty video connection. Today’s virtual technology, however, enables care providers to clearly see symptoms like rashes, for example, and take note of body language and a person’s appearance.
Moreover, virtual care helps people get the care they need when they need it, instead of second-guessing themselves — and possibly waiting until they need more serious treatment. The distracted worker who wonders if her kid’s cold is actually bronchitis can ask a professional online and then get back to business while the child rests at home. She’ll avoid taking a half-day to drive to urgent or emergency care — and spending significantly more — to be told to wait it out.
More importantly, the person who does have bronchitis can get symptoms checked right away, day or night. He’ll be alerted to visit his regular doctor in person promptly — possibly avoiding having his condition degenerate into pneumonia and require a weeks-long recovery.
How Telehealth Can Help Businesses
The upshot? When it comes to care utilization and cost, it’s important to look at the big picture, not a single study. Numerous studies have drawn conclusions that differ from those of the RAND research. In fact, data analyses of a much larger population (1.8 million people) found that virtual care saves money — while resolving people’s health issues with just one visit in 90 percent of cases.
Telehealth’s possibilities are especially compelling for employers. Unplanned employee absences can amount to more than 20 percent of payroll costs each year.
Thomas J. Biuso, M.D., MBA is senior medical director for the West Region of UnitedHealthcare and a practicing hospitalist at Tucson Medical Center
