1. eMedToday
TeleHealth & TeleMedicine
in the U.S.
1
HOW TELEHEALTH IS DEALT WITH BY THE
HEALTH INSURERS
Simply a series of tools, facilities and procedures
that enables and enhances the delivery of
healthcare
November 2013
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2. Definition of TeleHealth and TeleMedicine
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 Telehealth is the use of telecommunications and
information technology to provide access to health
assessment, diagnosis, intervention, consultation,
supervision and information across distance.
And, more narrowly,
 Telemedicine seeks to improve a patient’s health by
permitting two-way, real time interactive communication
between the patient, and the physician at a distant site
Copyright © eMedToday 2013

3. US Government Insurance Programs
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 Medicaid and Medicare
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two governmental programs that provide medical and health-related services
to specific groups of people in the U.S.
Although the two programs are very different, they are both managed by the
U.S. Department of Health and Human Services.
 Medicare is a social insurance program
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serves more than 44 million people
Medicare is a Federal health insurance program that pays for hospital and
medical care for the elderly.
 Medicaid is a social welfare program
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serves about 40 million people
Medicaid is a means-tested health and medical services program for certain
individuals and families with low incomes.
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4. US Government Insurance Programs and
Telehealth
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 When seeking government compensation for telehealth services,
providers have three options
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Medicare, Medicaid and private insurance companies
 Under Medicare and Medicaid (“M&M”), telemedicine reimbursement
is on par with reimbursement for the same service when provided faceto-face.
 For M&M payments to occur
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interactive audio and video telecommunications must be used, permitting
real time communication between distant medical practitioners and the
patient
The patient must be present and participating in the telehealth visit and in
designated rural areas
Medical practitioners can include physicians, nurse practitioners, clinical
nurse specialists, etc.
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5. Insurance Cover of Telehealth Services
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 The most common path for US states to cover telehealth services is by
the Medicaid program
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42 states now provide Medicaid reimbursement for telehealth services
 Another avenue is for states to require private insurance plans to cover
telehealth services
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17 states require private insurance companies to cover telehealth services
that are considered medically necessary and would otherwise be covered
when provided by face-to-face.
 130 private insurance companies are reimbursing for telehealth
services.
 The Centers for M&M Services list 30 services (CPT codes) which will
be reimbursed to providers for using telehealth.
 10 million Americans were served by telemedicine in 2012.
 15 percent of large employers used telemedicine in 2011, and another
39 percent are considering it.
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6. Patients Perspective of Telehealth
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 50% say it will change the way they manage chronic
conditions
 76% say they would choose Telehealth over human contact
 80% say they want to consult with a doctor by email
 70% of all doctor visits are for information only or for
matters that could easily be handled over the phone
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7. Some Key U.S. Facts
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 76% of the time doctors offices are closed during week
 3 weeks average wait time to make a doctor appointment
 23 minutes average wait time in physician’s waiting room
 Top 3 ER visits in 2012 were Ear, Sinus, Upper Respiratory Infections
 4 of 5 of all ER, urgent care, and doctor office visits could be better
handled over the phone…safely and effectively
 92% of consultations with Consult a Doctor doctors are resolved
without the need for a follow-up
 By 2015 Industry experts realistically foresee 100 million
individuals/year accessing virtual care services like telemedicine
 Within 36 months all major health plans in 50 states will cover
Telemedicine
Copyright © eMedToday 2013

8. 4 Case Studies
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 Showing 4 of the major health insurance providers that cover over 100
million members
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Wellpoint
Highmark
Cigna
Aetna
 Covering 4 telehealth services providers that use 4 different digital
solutions platforms
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American Well
Teladoc
MDLive
Consult a Doctor (owned by Teladoc)
Copyright © eMedToday 2013

9. Case Study #1
WellPoint
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 WellPoint is one of the US largest health insurers
 Allows its health plans' members in California and Ohio to
consult with doctors via live two-way video
 Following the launch of the telehealth program in these two
states, WellPoint plans to expand to the entire country.
American Well, is providing the technology for WellPoint.
 WellPoint plans cover nearly 36 million people with 68
million people covered by its subsidiaries
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10. Case Study #1
WellPoint (Cont’d)
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 Anthem Blue Cross, WellPoint's California affiliate, and Anthem Blue
Cross Blue Shield of Ohio offer the new online care service, LiveHealth
Online, to small- and large-group fully insured customers and selffunded national employers.
 Anthem Blue Cross members are able to initiate online encounters
from their home or workplace via live audio/video and secure chat.
 Doctors are available for consultations from 7 a.m. to 11 p.m. daily,
including holidays
 Patients use desktop or laptop computers with webcams; later, they'll
have the option to use computer tablets and smartphones
 Online visits to primary care doctors cost $50, which is less than
consumers (or their insurers) pay for a retail clinic visit, and much less
than for an ER or urgent care visit.
 WellPoint expects LiveHealth Online to be a money saver.
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11. Case Study #1
WellPoint (Cont’d)
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 Patients are asking for more anytime, anywhere access to physicians
 More people are comfortable interacting with physicians’ online.
 Within the secure LiveHealth Online application, policyholders can
share medical information with the attending physician
 Well Point reimburses for online visits after patients pays for co-pay;
patients can file claims on line
 WellPoint pays doctors for each consult, with the claim automatically
generated through LiveHealth Online.
 The patient fee is based on an office visit. But since WellPoint assumes
that physicians are accessing the system from home, fees are
discounted to reflect no office-related costs on the physician’s part.
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12. Case Study #2
Highmark
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Highmark Inc., one of the largest Blue health insurers in the US, has
launched a telehealth service for its members allowing them to conduct
long-distance virtual visits over the Internet with a physician using
telehealth provider, Teladoc.
 Highmark Inc. is a national diversified health and wellness company
based in Pittsburgh that serves 33.5 million people across the US
through its businesses in health insurance, dental insurance, and vision
care and information technology.
 Highmark members call a U.S.-based, board-certified physician via
phone or arrange for a video consultation online through the Teladoc
website.
 Upon requesting a consultation, members receive a call back from a
doctor licensed in their state within an average of 22 minutes. There is
no time limit for the consultation which costs $38.
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13. Case Study #2
Highmark (Cont’d)
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 In order to use the service, members register online and create a
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Teladoc account. They then complete a medical history disclosure
form in order to populate an electronic health record (EHR) to store
their information. Patients can update their EHR at their convenience.
Teladoc's physicians have access to the member's EHR at the time of
their consultation.
During the visit, the physician reviews a member's medical history and
any prior consultations, as well as update the EHR with details of the
current consultation.
If medically appropriate, physicians prescribe medication that can be
sent to the member's pharmacy via phone, fax, or electronically.
With patient approval, the Teladoc system also can send a record of
the consultation to the patient's primary care physician.
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14. Case Study #2
Highmark (Cont’d)
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 Access to these doctors online after hours prevents unnecessary visits
to the emergency room or urgent care facilities, thus reducing
healthcare costs.
 Convenience is also a benefit for members, who would normally have
to take time off from work to visit a physician's practice.
 Teladoc platform is a proprietary, encrypted point-to-point video
connection between the member and a Teladoc physician.
 Patients pay a charge or co-pay similar to visiting a doctor's office -insurers would save by not paying out claims for more costly
treatment in urgent care centers and hospitals.
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15. Case Study #3
Cigna
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 Cigna is largest US national insurer to sell telehealth to employers.
 Cigna offers MDLive’s telehealth services to its self-insured customers
nationwide.
 Cigna operates in 30 countries, has approximately 35,800 employees
and manages around US$53 billion in assets.
 Cigna members in these self-insured plans request online video,
telephone or e-mail consultations with primary care physicians for nonurgent care needs such as cold and flu, rashes, and headaches.
 MDLive doctors are available 24/7 and respond to requests within an
average of 11 minutes.
 MDLive's telehealth services enable increasingly mobile and timeconstrained customers to schedule a virtual consult with a boardcertified physician and resolve a non-emergency medical issue in less
than one hour.
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16. Case Study #3
Cigna (Cont’d)
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 MDLive integrates directly into the insurer's consumer platform,
MyCigna.com, and also features Cigna's new mobile app, which helps
members locate and select physicians and urgent care centers.
 MDLive offers its customers -- mainly self-insured employers -- the
ability to send summaries of telehealth encounters to their employees'
primary care doctors.
 If a self-insured business offers the MDLive service to its employees,
the consults will be part of Cigna’s regular negotiated rates and co-pays.
 If a patient doesn't have a primary care physician and needs a follow-up
visit, MDLive recommends one from Cigna's directory.
 Cigna sees this large-scale application of telehealth as a validation that
"telehealth is now accepted for population health management."
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17. Case Study #4
Aetna
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 Aetna provides health care, dental, pharmacy, group life, disability, and
long-term care insurance and employee benefits, primarily through
employer-paid insurance and benefit programs.
 Membership includes 22 million medical members, 13 million group
insurance members, 1 million health care professional and 5,300
hospitals.
 Aetna and telehealth provider, Consult a Doctor are teaming to provide
a 24/7 Telemedicine.
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This partnership has been designed to help employees get better access to
resources that help improve their health.
 The Consult a Doctor Plus is a program that allows employers the
ability to drive health care costs down by providing these companies’
employees with help and support for their health care needs at any time
they would like.
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18. Case Study #4
Aetna (Cont’d)
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 The Consult a Doctor program allows users to contact a certified
physician, either through phone or email whenever they need.
 Consult a Doctor meets the need of Aetna members for primary care by
providing high quality care at an affordable $38 per visit.
 The Consult a Doctor program is powered by Telecare 3.0 which offers
several customized versions to their customers.
 In late 2013, Consult A Doctor was purchased by Teladoc.
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Teladoc is the largest provider to telemedicine services with 9 million
members
Copyright © eMedToday 2013