Gallagher Student Health and Special Risk

As we look to see if Telemedicine is increasing in popularity and utilization as a treatment delivery method among students and the rest of the population, it is necessary to consider the issue with a critical eye. Revisiting the August 2017 newsletter edition, Understanding the issue: Is Telemedicine the future of higher education healthcare?, we can still only answer that question with a “maybe.”

We know that the virtual aptitude of all generations is rising every day and that Telemedicine provides privacy, ease of access, comfort and immediacy to a culture where that’s valued above all. Yet based on the results of a survey we conducted of all the major insurance carriers only a very small percentage of students are accessing these services, despite its widespread availability on Student Health Insurance Plans.

In this edition of the newsletter we will explore how Telemedicine is being accessed, perceived and utilized by the student population, the future of Telemedicine and the overall impact to the student health industry. Additionally we will discuss the challenge of marketing these remote medical and behavioral benefits to students to increase adoption on Student Health Insurance Plans.

Survey Insights

As we look at the topic of Telemedicine in student health, we find little research on how the college student demographic is accessing and using benefits. Recognizing the lack of quantifiable data, we conducted a survey of all the major health insurance carriers in the student health insurance marketplace. We discovered some interesting facts:

1. Less than 5% of covered students are currently using Telemedicine benefits
2. More students are using Telemedicine for behavioral health than medical conditions
3. 50% of Student Health insurance carriers are using Teladoc as their Telemedicine provider
4. 87% of Student Health insurance carriers that offer Telemedicine cover these services as In-Network benefits
5. 100% of Student Health insurance carriers say their biggest challenge with Telemedicine access is marketing the program to students

Patient Access

A report sponsored by Avizia (2017), a Telemedicine company owned by American Well, found that two-thirds of the patient respondents said they did not know if Telemedicine is covered by their insurance. The majority of respondents said they would be interested in accessing care through Telemedicine for the time savings and convenience, perceived faster access to service and shorter wait times. Better access to specialists and feeling at ease were other factors cited when considering Telemedicine as a vehicle for accessing care.

Our carrier survey found that only 5% of students on the student health insurance plan are accessing Telemedicine services, and of those students, 75% indicated that use for behavioral health conditions was equal to or greater than medical conditions. This is an impressive statistic supporting what we already know, student mental health care demand is on the rise. Students need care for their mental health and its becoming more relevant that schools bulk up their resources so students can access the care they need. The Association for University and College Counseling Center Directors (2019) published a report that found the average wait for a first-time appointment among all college counseling centers is about seven business days. Telemedicine is a tool that's available on most insurance plans that can fill the gap between when students request care and when they receive it. Based on our review of the topic and the findings of our survey, there is a clear opportunity for continued growth in student awareness.

Provider Access

While student awareness and utilization grows, providers must offer care delivery for student members to access Telemedicine. The Avizia survey for providers also examined their adoption of Telemedicine services. Seventy percent of provider responses indicated the ability to increase access to patients was the main reason for offering such services. Other reasons for using Telemedicine services are to improve outcomes for patients, reduce costs and consumer demand. As we look at ways to increase access to Telemedicine services, we also need to look at barriers to access.

Licensing

The Center for Connected Heath Policy (2019) has looked at barriers to expanding access to Telemedicine services. One major barrier that is referenced is licensing. When accessing Telemedicine the care is considered as being delivered at the location where the patient, not where the provider is. This means providers must comply with the laws and professional licensing board regulations of the patient’s state. Applying for licenses in multiple states is costly and time consuming for providers.

Mandates

Another consideration is the differences in State Private Payer Mandates (2019). For example, in some of the larger states in the student health insurance market; California, New York and Texas, the mandates vary considerably.

• In California, private payers cannot require in-person contact before payment is made for covered services and health plans cannot limit the settings where services are provided.
• In New York, Telemedicine cannot be excluded from a health plan if the services received would otherwise be covered under a policy.
• In Texas, each issuer of a health benefit plan must adopt and display in a conspicuous manner on their website the policies and payment practices for Telemedicine services. And a health benefit plan cannot exclude a covered service delivered as Telemedicine solely because the service is not provided in person.

Regulations

Other issues for providers to consider are state regulations. States may have mandates on standards of care, requiring that Telemedicine meet the same standard of care as in-person services. The Health Insurance Portability and Accountability Act (HIPAA) is another area of concern to the continued adoption of Telemedicine, as it may involve the electronic transmission of protected health information (PHI). Providers of Telemedicine must ensure they are able to address any applicable HIPAA requirements to avoid disallowed disclosures of PHI. Additionally state law may specify that providers must give informed consent on any risks or limitations of Telemedicine to their patients.

While there is evidence to support both patient and provider interest in expanding access to Telemedicine services, the uneven landscape of licensing and legal requirements across the country continue to provide challenges in the availability of Telemedicine.

Impact

Receiving care via Telemedicine can impact patients in a number of ways. Anecdotally, savings can be achieved in fuel costs, wages and time when less travel is required and time away from work or school to receive medical care is reduced.

A February 2018 study published by the Journal of Medical Internet Research (2018), a peer-reviewed open-access medical journal, provided a number of direct impacts.

• 91.6% reported satisfaction
• 82.7% perceived quality similar to an in-person visit
• 86.0% scheduled video visit made it easier to access care
• 87.6% estimated saving at least 1 hour of time
• 40.8% estimated saving >3 hours of time
• 86.7% agreed/strongly agreed easy to use
• 90.0% would use it again

This study concludes that telemedicine improves access to care and results in positive patient experiences. With these positive outcomes, there is a need to look at student perceptions and awareness of telemedicine benefits when considering how to expand usage of the available benefits.

Student Perceptions

Students, traditionally a younger and healthier group, may use health care less overall due to a lower incident of illness. However, as leaders in the adoption and use of technologies, these younger adults are likely to face lower barriers to the adoption of new methods of health care delivery. Their perceptions of Telemedicine as they begin to direct their own health care choices will have significant impacts on the future use and development of Telemedicine technologies and trends.

A Journal of Internal Medicine (2016) study titled, Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies, looked at why students use Telemedicine services and concerns that might limit their adoption of these services.

There are three main perceptions on why students are most likely to seek care through Telemedicine services:

• When Telemedicine systems work efficiently,
• if the services are convenient to access, and
• to obtain services that might otherwise be difficult to access.

The study also found that students seeking care through Telemedicine services allows them to discuss their health more comfortably and to be more honest when discussing their health concerns. Our own survey of the student health insurance marketplace also found that use of Telemedicine for behavioral health services is more substantial than use for medical conditions, which appears to support this perception. The same study also looked into perceptions on the disadvantages of Telemedicine. The key limiting factors were issues of security and privacy and the impersonal aspect of care delivered remotely. Students also expressed concerns on the costs of Telemedicine services. This highlights the need for continued education on the coverage available on student health insurance plans, including expanded awareness that Telemedicine benefits offered by all the major carriers include an in-network level of coverage.

Challenges

Challenges remain in the ongoing adoption of Telemedicine. Today some of the most immediate obstacles to be overcome are legal and licensing requirements and, as our survey highlights, student familiarity with Telemedicine as an available benefit.

Is Telemedicine an effective tool for Student Health and Wellness Centers to improve access to care?

Telemedicine is effective, affordable and an attractive complement to the services at the Health & Wellness Center. We predict that Telemedicine will continue to grow in the coming years and play a large role in improving access to care. The flexibility available through Telemedicine services is an effective tool to help Colleges and Universities improve a diverse student population’s access to care, including

• Older Students
• Online Students
• Part-time Students
• International Students

A report released by Persistence Market Research (2019) found the market value of Telemedicine is expected to increase more than five times in the next 10 years. It is clear from the available research and our own survey of carriers in the student health insurance marketplace that Telemedicine benefits are available and people are interested in using it, when they are aware of the availability of the benefit.

Marketing Telemedicine to Students

According to our survey of all the major student health insurance carriers in the market, we found the biggest challenge to be student awareness of the Telemedicine benefit. Insurance in general is difficult to explain and hard to educate students on the topic. So what are some ways to communicate to students that Telemedicine is available? It’s important to make sure you have multiple touchpoints to the student, such as:

• Website - including easily accessible information about Telemedicine on your website
• Social Media - posting about it on social media
• Text Messaging & Email - sending out informational texts or email blasts
• Orientations - talking about it at orientations and events
• Materials - having flyers or posters around campus
• Video - an explainer video on how to use it would help too
• Training – education for on-campus Medical and Behavioral Health staff on how telemedicine can bolster resources and support efforts to care for students

Telemedicine can help students and Health & Wellness staff by triaging digital treatment to the facility, and can be especially helpful at crowded Health Centers or if there is no Health Center at all.

________

SilverCloud digital mental health platform is a resource available to colleges and universities to increase the reach of campus counseling services without increasing staff. Its programs enable students to access care for Anxiety, Depression, Stress, Body Image, Resilience, Sleep, and Alcohol Misuse on their own time in a relatable and accessible format. The platform provides a choice between self-directed or supporter-assisted care delivery, and offers engaging and clinically validated Cognitive Behavioral Therapy content and tools on any device, at any time.

________

We strongly encourage all industry partners to familiarize themselves with Telemedicine access and how your students are utilizing it; contact us with any outstanding questions for further clarification.

Additional Relevant Publications

As research best practices indicate, multiple sources/opinions should be evaluated in any major change or decision-making process. To that end, below is a list of scholastic and media publications examining the topic of Telemedicine, its current trends, possible changes and the potential impact on the health care industry:

1. mHealth Intelligence: TeleHealth Gives College Students a Discreet Path to Counseling
2. Campus Safety: Telemedicine: A Prescription for Campus Mental Health Services
3. Chiron Health: Patients Are Demanding Telehealth from Primary Care Providers
4. Becker’s Hospital Review: Health plans increasingly cover Telemedicine services, despite low adoption
5. Kaiser Health News: Office Chatter: Your Doctor Will See You In This Telemedicine Kiosk     

Appendix

1. Dietsche, Erin. “82% Of Consumers Do Not Use Telehealth, Survey Says.” MedCity News, 22 Dec. 2017, https://medcitynews.com/2017/12/consumers-telehealth/.
2. Heikkila, Andy, “Why Telemedicine IS the Future of Healthcare.” The Doctor Weighs In, 22 Jul. 2018, https://thedoctorweighsin.com/why-Telemedicine-is-future-of-healthcare/.
3. Polinski, J.M., Barker, T., et al. “Patients' Satisfaction with and Preference for Telehealth Visits.” Journal of Internal Medicine, 31 Mar. 2016, https://www.ncbi.nlm.nih.gov/pubmed/26269131.
4. Powell, R.E., Stone, D., et al. “Patient and Health System Experience with Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study.” Journal of Medical Internet Research, 13 Feb. 2018, https://www.ncbi.nlm.nih.gov/pubmed/29439947.
5. Sperance, Cameron. “Telemedicine Makes The Living Room The Next Frontier For Healthcare Real Estate.” Bisnow, 4 Jun. 2019, https://www.bisnow.com/boston/news/healthcare/with-most-us-doctors-online-Telemedicine-guaranteed-to-upend-healthcare-real-estate-99268?rt=69524?utm_source=CopyShare&utm_medium=Browser.
6. “State Telehealth Laws and Reimbursement Policies Report.” Center for Connected Health Policy, 2019, https://www.cchpca.org/sites/default/files/2019-05/cchp_report_MASTER_spring_2019_FINAL.pdf.
7. “Telehealth Policy Barriers.” Center for Connected Health Policy, Feb. 2019, https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH%20POLICY%20BARRIERS%202019%20FINAL.pdf.