Highmark: Insurers should embrace telemedince

Pittsburgh-based Highmark recognizes the importance of technology. That's why the insurer decided to cover online visits via Iagnosis, a tele-dermatology solution, for 5.2 million of its members

While insurers are slowly incorporating telemedicine into their health plan offerings, many doctors worry the increased use of online visits with patients could lead to wrong diagnoses

FierceHealthPayer spoke with Donald R. Fischer, M.D., (pictured right), Highmark senior vice president and chief medical officer, about the insurer's decision to cover this service, as well as some of the obstacles that may plague insurers who want to follow in Highmark's footsteps. 

FierceHealthPayer: Why did Highmark decide to include telemedicine in its health plans?

Donald Fishcher: We wanted to improve both access to care and the patient experience. Technology allows better access if we capitalize on it. If the health plan isn't going to pay for it, providers won't adopt technology. The first forray we made was provider-to-provider consultation, using telemedicine to evaluate stroke patients in hospitals.

First and foremost, doctors must determine if it's a stroke due to bleeding or if it is caused by a clot. If it's a clot, you can rapidly improve the condition by giving a drug to make the clot dissolve. But to take action quickly, you need communication with the doctor. We wanted to include telemedicine so it's convenient for everyone and so the patient receives care in a timely manner.

We wanted patients to be evaluated in real time.  

So, since our telemedicine work started out with stroke patients, we then moved on to wanting the average person to be in communication with their doctor. Through our plans, members can get consultations in a timely manner.

FHP: Why have insurers been slow to adopt telemedicine in their plans?

Fischer: Some insurers are ready to adopt telemedicine and some aren't. Some are thrilled that this is another service their dependents can access. In the best of both worlds, it would be tied to all practices and not just what's tied to your service plan. There needs to be more technology to link everyone together.

I also think that with the rise of telemedicine, insurers worry their members will want to see their doctors all the time because of the easy accessibility. But it's important to get rid of this barrier and embrace the technology so plans can give their members more benefits.

FHP: How else can telemedicine benefit patients?

Fischer: We recognized that dermatologists are in short supply and included that service in our plans. Because they know their field and they can recognize a skin lesion pretty quickly, they know what they're looking at and what the patient will need. We figured they could do all this via telemedicine and short-circuit the whole process by having the patient upload a photo of their lesion. The dermatologist can then take a quick look, identify the issue and solve it. Just like that.

We felt strongly about this field in particular. So many people delay getting care, and this is a quick and easy way to do it. We're a very mobile society now--people travel constantly. Just because we're always on the go doesn't mean we shouldn't be able to access the same quality of care.

FHP: What should insurers keep in mind when deciding to partner with a telemedicine vendor?

FischerThere are a number of parameters you must take into account. Most importantly, look at the technology. Make sure it satisfies standards.You must have a system that adheres to privacy standards and one that can produce high quality images. 

There aren't a lot of systems out there right now that can do what we want them to do. But down the road, I think this will change. Health plans definitely can help move the market.

Several years ago, only a few vendors would meet these standards. Then, suddenly, there were double the number of vendors. 

It's multi-factoral. You need the right technology that is relatively easy to use and the provider must embrace change. If that provider is stuck in a certain methodology and thinks that the only way to go is an in-person doctor visit, then that's a huge barrier. Overall, the patient has to feel comfortable. Everything must align--the standard of both provider and insurer. I think we're still scratching the surface. 

FHP: How can an insurer successfully incorporate telemedicine into their plan?

Fischer: There are a lot of policies and benefits that won't pay for anything but a face-to-face visit. There are some benefits out there that the insurer will pay and some that they insurer will pay only a certain amount per year for services that are medically necessary. We believe telemedicine should happen. But it's hard because we wonder how much we'll pay for telemedicine. Will our claims go through the roof because we decided to cover this? It's all about making sure you can tackle these barriers to incorporate the service so that it's cost-effective for everyone.

FHP: What is the biggest challenge insurers face when deciding to cover telemedicine?

Fishcer: There is definitely a stigma to overcome, since telemedicine covered by an insurer is still new, and not many companies are including it. There's obviously the concern about risk and payment abuse, as well as waste. There's definitely internal culture to overcome as well, since this has never been done before. And of course, there's concern about risk of payment and abuse. Then there are the doctors who don't want to offer it, the patients who don't want to use the service and all the regulatory issues that surround it.

For telemedicine to advance, the whole industry needs to be on the same page--we need to spark the right balance.  

Editor's note: This interview has been edited for length and for clarity