What is Telehealth, Telecare and Telemedicine?

What is Telehealth, Telecare and Telemedicine?

Telehealth, Telecare and Telemedicine are new terms that the healthcare consumer will need to understand.  These new terms and subsequent services are starting to gain visibility and traction for the healthcare consumer.  The healthcare consumer needs to understand what it is all about and how it will affect management of their personal/family healthcare.

Definitions

For purposes of this section, we are going to define all three types so that the healthcare consumer has a rounded working knowledge and understanding.

 

Telehealth

An all-encompassing term that refers to services such as health education, remote monitoring of basic services, remote physician/doctor consultation.

Telecare

Is the term that refers to technology that enables patients to maintain their independent living safety while remaining at home. Medical alerts is a perfect example of Telecare.

Telemedicine

Refers to the use of information technologies and electronic communications to provide remote clinical services to patients.  Video consultations, evaluations and imaging are examples of Telemedicine.

Services provided by Telemedicine

To fully understand what Telemedicine is all about, we are going to the review the services provided.  The following is a list of services provided through telemedicine.

Telephone consultations; Primary Care and Specialty Care

Video consultations; Primary Care and Specialty Care

Imaging; Radiology services

Behavioral health

Dermatology

Infectious disease

States Mandating Telemedicine

29 states and the District of Columbia require private insurance payors to reimburse telemedicine services.  The following is the list of states:

AZ, AR, CA, CO, CT, DE, DC, GA, HI, IN, KT, LA, MO, MT, NV, NH

NM, NY, OK, OR, TN, TX, VT, VA, WA

This list can change quickly.  If your state was not listed, check you states’ web site to determine if legislation has been enacted.

Insurance companies paying for telemedicine services

Many big insurance payors are now covering Telemedicine services.  The following is a list of companies:

Blue Cross/Blue Shield

Aetna

Cigna

United Healthcare

Oscar Health

Medicare has very limited coverage for Telemedicine services.  They are for behind the other companies.

Many healthcare consumers are utilizing Telemedicine.  This year alone, 15 million consumers have used telemedicine.  This is a 50% increase compared to 2013 according to the American Telemedicine Association.

Consumer survey data

A recent consumer survey by HealthMine showed the following:

Why Consumer are not using Telemedicine

Reasons for not using Telemedicine Percentage
Prefer to see traditional Doctor 42
Don’t know when it is appropriate to use 28
Don’t trust a virtual doctor to diagnosis/treatment 14
Not sure if it’s covered by my insurance 14
Other 11

 

When Consumers would consider using Telemedicine

Medical Service Percentage
Follow-up care for acute illness 44
Symptom tracking/diagnosis 44
Medication management/prescription renewal 44
Follow-up for a chronic condition 34
Remote monitoring of vital sign 31
Behavioral/mental health 24
Nothing 11
Other 1

 

Some Facts About Telemedicine

  • Tech savvy consumers do not understand telemedicine. In a recent survey, 39% have not heard of telemedicine.
  • The healthcare consumer is starting to use telemedicine. The most commonly use is dermatology.
  • Since Medicare has not embraced telemedicine, they have paid out clams totaling only $17.6 million in 2015. The amount will grow over the next 5-10 years.
  • By the end of calendar 2017, about 32 states will have legislation pertaining to telemedicine.

Telemedicine; Pro’s/Con’s

Pro’s

  • Lesser cost for services; $50 telemedicine visit versus a $120 to $150 traditional doctor office visit or a $200 to $600 Urgent care or Emergency room visit
  • In remote locations, a good way to start or follow up on medical conditions
  • Healthcare consumers can us their video or send pictures to communicate to physicians; good for patients with chronic condition

Con’s

  • Unproven; will healthcare consumers accept the new process; traditional versus on line
  • Healthcare consumers do not trust the telemedicine process
  • Consumers do not know how to access or use telemedicine services
  • Legislation is lacking governing how telemedicine works between states
  • Quality versus convenience

What the Healthcare Consumer Needs to Know

Since telemedicine is relatively new, healthcare consumers need to ask several questions to insure they fully understand the medical process and clearly know their financial responsibilities. The following is a guide for the healthcare consumer to utilize:

 

Question about Telemedicine Consumer Action
Does my insurance cover services Call your insurance company
Is there a special billing process for the doctor to follow Call your insurance company, then your Doctor
What services are covered Call your insurance company, then your Doctor
What is my out of pocket expense Call your insurance company
Does my PCP/Specialist participate Call your insurance company, then your Doctor

To conclude, telemedicine is a new healthcare service that is not fully implemented, tested and accepted by federal and state legislation.  Healthcare consumers need to be cautious.  Healthcare consumers need to ask many questions before participating in any telemedicine services.  Lastly, this new service has significant promise and should be used when appropriate.

 

 

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