This article was published on April 16, 2018 on Forbes, written by Leah Binder. Photo Source: Shutterstock, Forbes.com article
In most industries, if consumers like a new innovation in the market, no matter how disruptive, it can survive attacks from competitors. Traditionally in health care the opposite is true: disruption dooms an innovation to failure. Competitors will bury it under a mountain of regulatory barriers. That’s because the patient isn’t the prime consumer in health care, payors like Medicare and health plans are. They in turn focus on the views of health care providers, who keep them in business and wield enormous political and economic influence. Market disruptors aren’t popular with them. The patient is not a player.
But somewhere along the line, the game changed. Over the past decade, patients began paying far more of the doctor bill out of their own pocket, and suddenly they became more of a consumer.
The best example of the emerging new influence of the health care patient as consumer is the phoenix-like rise of telemedicine. Despite endless efforts over decades to make it die from a thousand regulatory cuts, people want to be able to consult physicians—and nurses—via ubiquitous communication technology like teleconferencing and email. Large employers have been interested in this for a long time, but only recently removed enough regulatory hurdles to systematically offer it for employees at a national level. According to a new study by the Employer Benefits Research Institute (EBRI), 96% of surveyed large employers plan to offer telemedicine for employees in states that allow it. More than half (56%) offer telemedicine benefits for behavioral health.
According to Annette Guarisco Fildes, president and CEO of the ERISA Industry Council (ERIC), the key advocacy arm for employer benefits policy in Washington, D.C., employers seek out telemedicine because it improves access to care. “It’s a peace of mind issue. We want employees to know that they and their families are going to get access to high quality care regardless of where they live.” It’s often cumbersome and time-consuming to make an appointment and take time off to visit the doctor, and the difficulty is compounded when the patient is elderly or disabled, or when a parent is caring for a sick child.
Employers appreciate the impact on productivity and well-being. It also seems to encourage people to seek care before a condition worsens. “Telemedicine is particularly good for identifying health issues earlier and avoiding complications later,” said Guarisco Fildes. Employers view telemedicine as a supplement to traditional primary care, not a substitute, and one that removes some of the stress of accessing health care.
Barriers are coming down everywhere. Public interest in telehealth is rapidly gaining traction. Last month, President Trump signed into law a funding bill that expands use of telehealth under Medicare Advantage, expecting to impact 19 million Americans. Many hospitals and hospital systems are investing in telehealth with truly disruptive ideas, like creating “virtual hospitals.” For instance, in Utah, Intermountain Healthcare just announced a new virtual hospital model built on telehealth technologies, with 500 caregivers offering basic medical care as well as advanced services such as stroke evaluation, mental health counseling, intensive and newborn critical care. There’s even a new specialty emerging, the “medical virtualist.”
The effort to bury telemedicine in regulations is still alive and well. It just seems to be making less headway. Guarisco Fildes says that the ERIC battles in statehouses across the country to preserve access to telehealth, a battle not waged across traditional party lines. Efforts to impose barriers to telemedicine have been strong In both blue (e.g., Connecticut) and red (e.g., Texas) states, where medical boards lobby to impede access to telemedicine with requirements like insisting patients meet their provider in person before using telemedicine for any kind of appointment, or restricting telemedicine visits to designated sites. These unnecessary barriers are especially onerous for national employers aiming to provide quick access to provider visits for all their employees across state lines.
One telemedicine opponent told Guarisco Fildes that “you can’t build a physician-patient relationship via telemedicine.” If such views prevailed, progress would grind to a halt for far more than routine health care. NASA might ground U.S. astronauts from the International Space Station, which uses advanced telemedicine, as did every prior mission to orbit the planet and make it to the Moon.
Physicians nervous that telemedicine will threaten their income need to reinvent their practices, not try to get the government to shut down their competitors. What’s unusual is that in health care normally what consumers want doesn’t matter, and the regulators would win this one. The fact they aren’t winning is a sign consumers are.
And one more factor will assure consumer triumph: the growing influence of millennials. Try telling them there’s a state law forbidding an appointment on your smartphone. By population, they are now a larger generation than Baby Boomers, and as they see one or two gray hairs, they are realizing they are not immortal and health care matters. They will not go quietly into that dark night, certainly not without a GPS, and their doctor on the screen.
