In the argument of whether telehealth increases or decreases utilization, Anthem is squarely on the side of the latter and has been ramping up its efforts to expand virtual services to members.
Employers want it because it saves money and telehealth can keep employees on the job rather than leaving work to see their primary care doctor or go to urgent care or the emergency room, according to Maria
Proulx, regional vice president Sales, Anthem Blue Cross Blue Shield of New Hampshire and former VP of Segment Solutions.
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"I absolutely tell you, employers love it," Proulx said. "It's the idea of trying to meet members where they're at. They recognize the cost of care savings associated with telemedicine and for employees who can't leave during the day."
Anthem has decreased the copay for these visits to $5, compared to a $25 to $35 copay if a member visits their primary care doctor.
An Anthem HealthCore study of claims analysis for utilization of acute, non-urgent care found telehealth saved 6% in episode of care costs by diverting members who would otherwise have gone to the emergency room.
The savings were $201 per episode of care in 2014 and 2015 dollars, which would be about $242 today, for 11 conditions.
Total costs per episode were $36, $153, $1,735, and $162, respectively, at rural health clinics, urgent care clinics, the ER, and primary care physician services.
"Early on, we saw this was a way to save on costs," Proulx said. "Integration of telemedicine is key is to how we deliver cost of care savings. We're working hard to increase engagement and utilization."
Anthem works with retail health clinics and is making strides to bring providers into telehealth. The virtual care also covers behavioral health visits.
The study findings also showed less use of imaging, lower lab rates and antibiotic use, said study co-author Wallace Adamson, vice president, Population Health, LiveHealth Online at American Well and former Anthem executive.
The follow-up rate suggests adequate clinical resolution and that patients are not using virtual visits as a first step before seeking in-person care.
And consumers want telehealth.
"From a Medicare Advantage standpoint, Anthem recognized early on its value to the senior population," Proulx said. "The Medicare population is embracing telehealth."
WHY THIS MATTERS
Opponents to telehealth, and this has included, until recently, the Centers for Medicare and Medicare Services, is that its use will not stop most patients from also heading off to see their doctors.
"When HealthCore looked at three weeks of an episode of care, it puts to bed the notion that telehealth is an additive cost," Adamson said. "I've been doing this over six years now, I still run into those biases everyday."
CMS has loosened regulations on the use of telehealth. More states have adopted its use since the insurer began looking at it over six years ago.
"There was a lot of rigidity," Proulx said.
Traditional Medicare still highly regulates telehealth, Adamson said.
But Medicare Advantage plans are using regulatory flexibility to promote telehealth's cost savings.
"We think of telehealth as eliminating time and distance," Adamson said.
In the beginning, he said, "I thought we were serving the medical homeless, people who didn't have a physician."
THE LARGER TREND
Insurers are embracing telehealth for the cost savings and some providers see it as a way to manage scarce physician resources.
Telehealth can compete with the convenience of urgent care and the ER because it's open all day and night.
In this, it can also be a threat to providers. Data released last year by the Advisory Board, citing Health Care Cost Institute analysis, found office visits to primary care doctors decreased by 18% from 2012 to 2016, even as specialist visits increased.
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Focus on Reducing the Cost of Care
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