Blue Promise: Why Aren’t People Using Telemedicine?

Two-thirds of Americans are interested in using telemedicine. So why is only 8% of the population scheduling virtual visits? In this episode of Blue Promise, Matthew McCredie, SVP of Enterprise Client Organization at MDLIVE, explains why people are slow to adopt these services. 

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What Is Blue Promise?

Blue Promise is a podcast and online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. 

Show Transcript

DAN : Two thirds of Americans are interested in using telemedicine but only 8 percent actually do. Why are people so hesitant to use it? Tune into this episode of blue promise to find out why virtual visits are slow to be adopted in health care. Thanks for tuning into Blue Promise I'm Dr. Dan McCoy and I'm the president of Blue Cross and Blue Shield of Texas we're filming in Austin Texas today as part of the Texas Tribune Festival. We've got a live crowd here in our office beside the Capitol building where we have a special guest joining us Matthew McCredie who is the SVP of Enterprise Client Organization at MDLive.  Thanks for being here Matt.   

MATT : Well thanks for having me.   

DAN : So before we get started we have a special relationship BlueCross BlueShield Texas does with MDLive. We partner with you to help deliver some virtual business to our members. Right off the bat, what is telemedicine and what's a virtual visit? What's telehealth. These are all kind of confusing terms.    

MATT : They truly are. But really when you really boil it down it's the ability to have a doctor consult or a therapist consult not in person but actually where you are. So whether you're at home whether you're at work whether you're at vacation you can have it online or on the telephone. Having this access and this ability to a board-certified physician or a licensed therapist wherever you are.   

DAN : OK so a lot of times people refer to telemedicine as where they're talking to a healthcare provider patient to a provider and sometimes telehealth that's where you're going through a doctor to get to see a specialist or things like that. So we're going talk a little bit today about the slow adoption. So I'm gonna come clean with you. I wasn't in favor of telemedicine when it first came out. I don't know if it was the physician in me but I felt like you had to have that face to face kind of evaluation to be able to make that happen. But I've I've changed actually because my my forefathers got use the fax machine so I figured I could do telemedicine. So today it seems like most of my my my kids both have access to. So what's the challenge it seems like that once people do it and use it to access it for it they get used to it. It's exciting technology and get to get that what's wrong today. Why aren't more people using it?   

MATT : Well fundamentally it comes down to awareness. It's not that people are making a conscious decision that you know do I really want to have an online visit? It's no they really don't know that that is an option. So what often happens is that someone is making a decision you know oftentimes a working parent "Oh my gosh you know my my child is sick it's, it's four thirty in the afternoon. I'm not going to be able to get into my primary I'm not sure you know the thinking should I go to any urgent care or an E.R. I'll call my primary and just try to get in and try to you know sweet talk the nurse." That's what they're thinking or should I just maybe you know ride it out. They don't really actually have ingrained yet that there is actually a phenomenal option right there that they can speak to a board-certified physician within minutes and oftentimes their employer or their health plan actually has it baked into their benefits. It's just not part of the thinking yet and that's what we're trying to change.   

DAN : And I think also people that look from the outside into telemedicine they always bring up the question of quality. Is this a quality solution but ofttimes they don't counter the fact that if you don't have access to care that's a quality issue too?   

MATT : Absolutely in fact about 40 percent of Americans do not have a primary care physician. So now what we're trying to do with virtual visits is not replace the primary care but if you do not have a primary care you should get one. That's the most important message here. However when you're primary care is not available you weekends you're on trips holidays. There's there's lots of times where your primary care is not available and having an option in rural areas as we talked about earlier. Another important part not everyone has easy access or even has any access to our primary care. And that's why this is such a great option and a really extension of what's out there in the health care.   

DAN : Okay. So before our live audience before we get started today at the podcast Hilarie who helps us out here she walked the audience through using a QR code and being able to tweet and promote the podcast. Walk people through exactly how to do a telemedicine visit how easy is it?   

MATT : I mean it's real simple and that's kind of the big thing is you have to remove all that friction. The first part about it is you know whether it's you know with Blue Cross or anywhere is really knowing you know what your benefit is. You can talk to your insurance carrier your customer service you can talk to your employee benefits. There is a very very great chance that you actually have that benefit. Now for us it's very simple we use a text based process. You simply just text doctor to see it's 6 3 5 4 8 3 and it's a text based very interactive at that point you're putting your name you're identifying it and it's just taking you all through the process. Now what to expect is if you're looking for an online on demand physician typically you'll be seeing a physician within five to 10 minutes on a normal day. That's pretty good. Board certified quality physician. Most of them actually you know a good portion of them live right here in Texas. Many of them actually graduated from the universities right here in Texas. Been practicing more than 15 years. They're actually real doctors which is one of the big kind of myth busters you know like what is this you know are these these doctors in the cloud you know who are they you know they can't really know me.   

DAN : Like an artificial doctor.   

MATT : You know like an artificial doctor or something? Right. Which you know the word virtual visits sometimes you know inhibits that when in reality, it's not virtual at all. It's very real.   

DAN : So you're not talking to like Siri doctor here you are actually these are actually real docs.   

MATT : No Siri no Siri. Absolutely these are these are physicians and they're physicians that are come from all different you know kind of aspects of their lives. Some of them were really busy own their own practices for you know 20 years and then you know it just kind of the grind kind of wears down on them but they still love medicine and they still love to talk to patients. So they're able to come into you know our network be able to interact and kind of get in and get out and still get and do what they love.   

DAN : And I guess one of the big solutions on telemedicine is the fact that I can't get you a solution virtually right? So it's assessing the fact that you might actually need to go to the emergency room or,   

MATT : Absolutely.   

DAN : Go to another physician.   

MATT : Absolutely. You know so virtual visits can't solve everything. It's not meant to solve everything but you know the power of being able to have access to a board certified physician who's been in practice for you know probably 15 years to be able to look at a picture maybe of a skin condition a rash from mole you know be able to talk you through and do you have the cold or do you have the flu? You know maybe you have a urinary tract infection. You know real easy to diagnose. Have a conversation and then that physician can have a script sent to your local pharmacy within 15, 20 minutes and you're on with your life. You're not missing work you're not pulling the kids out of school you're able to move on because you know I mean life is is pretty busy these days and being able to see a quality physician you know on demand pretty good.   

DAN : So I know this is going to vary by insurance company and payer but do most of your benefit plans cover telemedicine these days?   

MATT : You know they really do. That's this is this is part of the magic. It's the best kept secret but it shouldn't be. Almost all of our major carriers and all of our major employers especially all the major employers here in Texas really actually have this benefit already here for the most part. Some of the employers have even gotten really aggressive and actually taken all the copay out of it. They're really trying to encourage their employees to use this service.   

DAN : So who uses it today? So I'm going to take a wild guess. In both my kids are kind of post millennial they're younger group they're they're comfortable dating getting in a car with a stranger hey yeah riding a bike without a helmet.   

MATT : Right.   

DAN : So are they comfortable with telemedicine or who uses it today? Is it more common in millennials?   

MATT : You know that's that's you know again another great myth. You know you have to be technically sound you to be a Millennial. The reality is and the demographics show from the usage that we have it is all across the board. I would say if we did have one kind of power user it's the working parent who has kids going to school especially this time of year. This is when you know the crud going around in school. They have a job. They have a kid. The kid's getting sick. It takes about four hours plus or minus out of your day to leave your work.   

DAN : You know that's really optimistic.   

MATT : And everything yeah. Yeah. Not with the traffic here right? That's right.   

DAN : I can tell you that's pretty optimistic. For the most part. Yeah it's an all day.   

MATT : It really is and so you know you're your employer is losing out on your you know ability in the workforce. You know you're taking care of your your kid. You know it's an it's stressful. You know you're in traffic you're you know trying to juggle a lot of things. So the ability and the peace of mind to be able to have that visit on your couch you know with your child right next to you on a video or on the telephone and you know the physicians interacting with you and the child it's great. The other big time users are, you know when you're traveling or it's on weekends again. Primary care is really where you want to be your local primary care. But if you don't have one where and when they're not available then you know this is this is a tremendous option. We also had the the big storm. Right? So Harvey we just had a few on the East Coast tremendous weather happens situations happen to where doctors appointments get canceled access is very difficult. And here's this benefit right here so if you had a routine doctor's visit that was being canceled, now you have the opportunity to get on the phone and have it on demand on the couch.   

DAN : So I want to talk a little bit about that. So a lot of what you alluded to were acute urgent visits. So I've got the flu or upper respiratory but the future telemedicine value may be in chronic care behavioral health. Those sort of areas. Can talk a little bit about that?   

MATT : Yeah. I'm so glad you brought up behavioral health too because we've been talking a lot about you know the acute things. And by far that's where we get our lion's share of feedback of why you save me so much time. You know this was so inexpensive and and it was kind of the wow factor. What does not get enough time is behavioral health. So we also offer behavioral health to most of our people who have our benefit as well. And this is a very different value property proposition because in here it's hard. First of all as you know unfortunately we have a behavioral health crisis going on it's very real. People have daily issues you know stress they are depressed maybe they've lost a loved one there's a lot going on having access to a therapist again from your couch you're not driving in and you know go into the parking lot of maybe a small town where you might feel a little apprehensive maybe "someone will see me go in there." I mean if you're going to be able to make the decision that "yes I'm going to get help." Having that ability to have a therapist pick a therapist and have an ongoing relationship online in a secure environment that is covered through you know in a lot of cases your employer or your health plan benefits is just amazing.   

DAN : So what's been the response of the provider community. The old brick and mortar got to come into my office?   

MATT : A lot like you. Know the first was "wait a minute that that can't be can't be right. There's a quality issue." But they have absolutely coming around. First of all a lot of them are actually trying to build in their own telehealth solution which is great. And by the way our our company actually encourages that and we power them in a lot of cases. So we.   

DAN : So so theoretically you could see your own doctor through a telemedicine portal right?   

MATT : Absolutely. And if your doctor has that capability and it's built in you know that's great. Unfortunately as it turns out telehealth pretty hard to run it's a higher standard than in-person care and it needs to be for all the reasons we kind of talked about.   

DAN : Yeah. So in a prior life I'll come clean. I really made it hard from a regulatory standpoint to do what you're doing right. We were really hard with the laws but. And so the regulations changed. We're here in Austin today. As part of the Texas Tribune Festival. What policies need to be changed? Are you in a good spot with regulation?   

MATT : You know what? We're in a pretty good spot for regulation and I have to give a lot of credit to the politicians the employers the health plans they have all come around especially here in Texas. You know we're telemedicine telehealth was very limited just a few years ago.   

DAN : Thank you very much.   

MATT : Yeah I appreciate that help. No. But honestly the the health plans have embraced it. The employers have embraced it. The politicians have embraced it. You know the one area where we like to see you know a little bit of help maybe is in the high deductible health plans we would like it so that this is easy access to care. You know they don't necessarily have to pay their full you know out of pocket expense because they're truly you know doing something that is is really taking a burden off of the entire workforce. When you look at how many providers are out there I mean it's scarce. So the ability to have people have this access and leave you know the in-person doctors to do what they're really good at which is complex issues is great for everyone.  

DAN : I think patients were a key role in that. The access challenges and the idea that this was a solution for a problem that is incredibly challenging for most families. They drove a lot of that policy change. So.   

MATT : Yeah I really do believe. And you know one of the things that I just love to do our our chief medical officer sends out a weekly list of our top 10 surveys and it is it is such a joy to get that e-mail because you read it and it's the real patients obviously de-identified but it's just their comments in unsolicited that they send back. And it just makes you feel good that you are providing a service that is just making a difference in people's lives. And it's everything from the mom saying "My gosh you know it just it saved my life." It was Friday night and I had you know a big weekend plans and nowhere to go. To the college kid you know again you know the parents saying "You know what?" You know my kids are in college. I love them. But you know it's their first year and you know I'm just you know hopeful they can get the class. They don't know how to get health care. I got them the app through my benefit and they were able to see some see a provider real time in college. So that's one thing I would encourage anyone who is sending their kids to college for the first year should always make sure they have telehealth you know hey they'll know how to download an app right that's one thing that college kid knows how to do. Get them to download an app off of their insurance of whatever then.   

DAN : Including transfer money over the app.   

MATT : Oh they're real good at that right now. Yeah sure they'll know exactly I don't know about Venmo and then all those great things.   

DAN : I'm more of a sender than a receiver.   

MATT : Typically a one way. So if you can mix it in. "Hey before I send this download this app." Little you know.   

DAN : Well thanks for being here and you've really educated on telemedicine. Thanks for joining us for this episode of Blue Promise.  

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