What’s the Deal with Telemedicine Through the Pandemic

Mike
Hello and welcome to Healthcare on the Rocks - Employee Benefits with a Twist. I'm Mike Pattengale, Senior Account Executive for Channel Sales.

Jennifer
And I'm Jennifer Jones, Population Health Practice Leader at Springbuk. We're back after an extended break from the holidays, and this episode launches a mini series on important trends in employee health care, benefits and management.

Mike
Today, we're talking with one of our fellow Buks, Chris Gagan, who is the Senior Director of Analytic and strategic Consulting here at Springbuk. He's with us today as one of the co-authors, along with my co-host, Jen, of our recently published 2022 Employee Health Trends report.

Jennifer
Over the last 20 years, Chris has developed, implemented, maintained, and enhanced predictive models within the healthcare industry. Throughout his various positions, he's gathered experience across collaborations with business leaders, product managers, data scientists, and software engineers to define and solve healthcare business problems. In 2019, Chris brought his expertise to Springbuk. Thank goodness, we're happy to have him joining the team as senior analytics subject matter expert. Chris, thanks for joining us today.

Chris  
Hi, Mike and Jennifer. Thanks for having me. Glad to be here.

Mike  
Yeah, absolutely. It's cool. I didn't want to be a co-author of the report. I guess I wasn't cool enough to make the cut. But in all seriousness, great work. It's an incredible piece of research and analysis. Congrats on that. So while there are four primary trends within the report today, we want to look at one of them in particular. So let's hear it Chris, what's the deal with telemedicine?

Chris  
Yeah, thanks, Mike. It was a very fun project, a lot of fun to work on and getting into the details of some of these key trends. But to go back a little bit with telemedicine, you know, early on in the pandemic we published some thoughts on the downstream impact of COVID-19. And one of them was the increase in telemedicine services and that they could be here to stay. Then in our 2021 Employee Health Trends report, we studied the impact a little deeper and found that the rate of visits per 1000 members increased 12-fold on average. And that mental health was the driver of these visits, accounting for over 40% of them.

So this year, we wanted to follow up on that trend, with another year of data under our belt. And we found that although the visit rate is still much higher than the pre-pandemic levels, it's on the decline, down around 50% from the peak in April 2020.

Jennifer  
So what can you tell us about who's using these services? And is that consistent across demographic segments?

Chris
Yeah, I can. We did look at who's using these services and thinking about who's using them and what they're using for. And given our findings last year, we want to see if that decrease was in fact across the board. Was it all demographics? Was it all services? And what we found there was at the mental health visit rate, which also peaked in April 2020, has remained relatively stable through late 2021, which is our analysis time period.

In fact, all other visit types have been decreasing somewhat dramatically. Bring the overall rate down, but hidden in that trend is the stable mental health telemedicine rate, which we refer to as telemental. And in June of 2021, for the first time, we saw telemental visits outpace all other telemedicine visits combined.

Jennifer  
So Chris, then it sounds like telemental services are here to stay. Is that what we could extrapolate from this year's findings?

Chris  
Yes, so far, it sounds like that. It may have found the sweet spot. And there are a number of reasons for this. First of all, there was a somewhat forced adoption of the technology that was previously a barrier to video conferencing. So during the pandemic, people of all ages seem to adapt to this form of communication. I know personally in our house, all of our kids from high school down to third grade got used to having virtual gatherings with classmates, friends, teammates, coaches, teachers, cousins, and even thier grandparents.

These types of visits seem to line up well with the technology offering a chance to communicate directly, virtually face to face for check-ins. And it's very convenient for both parties, cutting down on time off of work or school and the cost and burden of the transportation. And then finally, the pandemic has brought on more stress, anxiety, and mental health concerns in general. So the demand of a smart, efficient solution is really only growing.

Jennifer  
What do you think is so unique about the telemental services that they were able to achieve such high numbers and maintain that in comparison to the all other visits? Is there something unique about the delivery or those providers to make that so sustainable?

Chris  
I think it is, I think it's amenable to that kind of interaction. Because if you think about going to a visit like that, you're sitting down talking face to face. And now you can just do that on a video. And you don't really need to be inspecting a wound or talking about how your flexibility may be impaired. You're having conversations and can see each other face to face to read those conversations as well. So it suits that kind of visit very well.

Mike  
So Chris, could you go in a little bit more into who's using these services and who isn't using these telemedicine services?

Chris  
Sure. So that's a big part of the paper that we put out. And there were some interesting findings when we look at some basic demographic measures, because not everybody's using telemedicine the same. For example, if you're a child under 18, the utilization is about the same whether you're male or female. And that makes a lot of sense, because you're probably more guided by your parents.

And in April 2020, there was significant variation among adult men by age. So right when this happened, the age groups of men reacted differently, but over time, they all seem to get in line. And overall, they're trending down at a very similar rate together and not a lot of variability.

For females, it was actually quite the opposite. There was very similar adoption by adult age groups in April 2020 at the beginning, but higher variability on the decline, where women aged 18 to 35 are still utilizing at a very high rate. In fact, the highest rate and interestingly, this is the age group in men that was among the lowest in the option.

There are also very interesting findings when looking at the age, gender interaction with telemental health versus all other. For every age group and gender combination, telemental seems to be generally stable after 2020. So no matter which age group or gender you've kind of stabilized no matter what that peak was in April. But telemental is not necessarily the same driver it is for all. For example, telemental is the most obvious driver in females aged 18 to 35, but also the leading cause for telemedicine visits for both genders, aged 35 and under. So if you're age 35 and under, the leading cause of your telemedicine visits is really telemental health visits. And then to varying degrees, other telemedicine visits were driving the over-35 age group, so even more dramatically in the 50-plus group. And this makes sense, as you'd expect other health conditions and therefore other needs to be more prevalent in older age groups.

Jennifer  
Oh, interesting. So you mentioned a little bit ago as far as how telemental services, or mental health services in general, are a little bit more conducive to this mode of care. But what do you think that means for traditional healthcare delivery services? Can we or should we expect to see any impact on those knowing that there's some progress with elemental services?

Chris  
Yeah, that's a great question. Something we're very interested in finding like the silver linings that may come out of the pandemic in terms of health care services. For example, lower ER visit rates, suggesting appropriate use of the ER, given that there's an opportunity to move to some lower acuity visits to the telemedicine setting.

And what we're seeing so far is that although the ER rates dropped for a short period early on in the pandemic, they do seem to be trending back up towards pre-pandemic levels. So that’s not the greatest news or the silver lining we are hoping to find there. However, the low-acuity ER visits for things such as ear infection, sinusitis, other things that can generally be treated elsewhere. Those did drop and they continue to decrease and currently, they're at a rate that's about half of what they were at the pre-pandemic level.

Mike  
So it sounds like telemedicine could be a good option moving forward. Would you agree, Chris?

Chris
Yeah, I do think it's a good thing. The telemedicine trend in general is a good thing. I think it's very positive when you provide efficient alternatives and options to patients. You know, it might not be for everyone for every service, or it might not be for all services for a single person. But when you can find lower-cost settings that provide quality outcomes and high patient satisfaction, it's all good. I think we can encounter some setbacks if patients are forced or grossly incentivized to use telemedicine, especially if it interferes with the relationship they have with their trusted primary care docs. But there are plenty of options to at least have a mix of in-person and telemedicine calendars.

Mike  
Yeah. And would you think that employers should expect these trends to continue?

Chris  
I think they should. I think the jury's out, but I would hedge my bet in the direction of yes. Although upcoming policy changes could impact the utilization and progress that that's been made so far. We see that patients have accepted and adapted to the technology. And actually, so have employers. So we saw that 97% of our Healthiest Employers offer telemedicine options to employees and 94% have programming in place to support mental health. When you consider those things, it's a little bit in the direction of yes. We're also seeing employers have much more interest in adopting other virtual solutions for things like MSK and physical therapy, cardiac care management type disease, and chronic kidney disease. So not only are they more interested in these now, but they're also the employers that are also more willing to drive the delivery system change, then sit around and wait for it. So those things, you know, together, I think we kind of make me guess that it will continue, although we will be tracking it again over the coming months. And also doing this kind of reporting for our employers and showing them their trends and how it how it's continuing.

Jennifer
And I think it'll be interesting to that point, as far as knowing where we are today with a lot of the restrictions being lifted, how we'll see telemedicine, specifically the elemental component progress over the remainder of the year. One additional question I have for you, Chris, just because it might be something our listeners are thinking about when we are capturing these telemedicine services. If a group does have like a Headspace or some other like point solution that they're driving members to as far as for access for mental health, even like an EAP? How are we defining a telehealth service or telemental service in that capacity? Does it include those kinds of visits as well?

Chris
There are a number of options for defining this. And it really does depend on whether your telemedicine is coming through on your claims? Is it coming through one provider that you've carved out? Are you paying a PDPM fee for a service. And so it's you're also not getting the claims and just have a direct relationship with that carrier. Or if it's an EAP, all of those have different levels of data that are available for reporting. So it really does depend on the type of setup that you have as an employer to be able to tell what kind of services are being leveraged?

Jennifer  
Alright, well, Chris, thanks for coming on, and going into some of the research and findings from the employee health trends report. But before we let you go, we always ask our guests, what's the biggest twist you've seen in employee benefits during your career?

Chris
The biggest twist? I think this is one of them that we're seeing right now, you know, this shift to virtual care and all of the things that go with it. So something to consider, you know, that we've seen in the past is that we already have some disparities in health care access. For example, people living in rural areas that don't have the same access to quality providers and others do. And telemedicine can really help with that issue, which is really positive, you know.

However, we do need to be careful not to recreate those disparities, like a digital divide. For those that might have poor wifi or might lack quality devices with video or have limited data plans, you know, all of those things that we're kind of moving towards. We just want to be careful not to recreate some of those issues that we've seen in the past and be conscious of those. So it is a big twist that's coming. And we just need to be careful to not leave anybody out. In fact, I did. I was just read an interesting statistic from the Pew Research Center. Do any of you guys know how many people, adult Americans, as a percent in the United States have cell phones? What would you guess?

Mike    
67

Jennifer  
I would guess 80 something.

Chris  
it's about 97% of all adults have a cell phone. But only 85% have smartphones, which are kind of needed for this to really advance. And of those 85%, it's the age groups that are above 50, where it's closer to 60 and 80%. So the older the age group, the less the percentage of smartphones, and if you're under I think it was under 50, you are generally at about 95% of having cell phones. So as that, you know, cultural shift happens at the employer, you know, there's just gonna be more and more access to this kind of thing. And especially with the way that privacy may not be as important for younger generations coming up on devices, there's all kinds of opportunity there.

Mike  
Yeah, I was way off with my guess there of 67. I don't know, you know, I was thinking of those, you know, above 55 folks with a smartphone. That's right.

Jennifer  
You just were one step ahead.

Mike  
Yeah, exactly. I was reading the script. Anyways, Chris, thanks so much for coming on. This was great, really great insights. So thanks for being a part of it.

Chris  
Thanks for having me on. Nice talking to you guys.

Mike  
In our next episode, Janet Young will join us to talk about some of the overlooked impacts of COVID-19 and the ongoing burden of specialty drugs. She has some amazing statistics to share. So don't miss that episode.

Jennifer  
Yes, for sure, Janet uncovered some really fascinating nuggets of data. And she has recommendations as far as how employers can make use of that data as well. So you can download your own copy of the full Employee Health Trends report at springbuk.com/resources. But until then, this is a wrap on another episode of healthcare on the rocks employee benefits with a twist. Thanks for listening.

Mike  
If you enjoyed this episode, please take a moment to rate us or leave a review on your favorite podcast platform. I'm talking to you, Mom, I have not seen it come through yet. You'll be able to find other people for the show. But then, remember to hit that subscribe button so that you don't miss an episode. To find previous episodes, you can visit our website springbuk.com/podcast. Until next time, cheers!

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