Telemedicine, or remotely delivered health services, is gaining popularity thanks to consumer demand, a doctor shortage and greater insurance coverage. (Photo courtesy of Humana).
Telemedicine, or remotely delivered health services, is gaining popularity thanks to consumer demand, a doctor shortage and greater insurance coverage. | Photo courtesy of Humana.

A small medical office on the ground floor of Humana’s corporate headquarters in Louisville has no doctor — but you can see one anyway, on a high-definition screen. And with a remotely controlled camera that tilts and rotates, the doctor can see you.

Dr. Mike Noble can even examine your ears, throat or nose, take a close look at your skin, and listen to your heartbeat via high-definition cameras and audio equipment that instantly transmits information to his office – about six blocks away in another downtown Humana building.

The insurance company’s high-tech, doctor-less doctor’s office represents a rapidly growing portion of the healthcare industry: telemedicine, or remotely delivered health care services.

From accessing doctors thousands of miles away to real-time monitoring of heartbeats from thousands of patients – telemedicine services are expanding nationwide, because of consumer demand, a shortage of doctors and cost savings for providers and patients, according to the American Telemedicine Association, a nonprofit that advocates for the use of such services.

Coverage

Humana, too, is expanding its telemedicine offerings: The company this year made such services available to 65,000 HumanaOne members in Georgia and Michigan. And on Jan. 1, the company will offer a telemedicine component in 54 Medicare Advantage plans in 13 states including Kentucky. At that point, more than 1.5 million customers will have telemedicine services through Humana. The company’s offerings include teledermatology and telepsychiatry in some health centers and remote monitoring of some patient health data.

Humana is partnering with two national providers, MDLIVE and Doctor on Demand, to offer some of the telemedicine benefits, which will allow consumers to interact with doctors on mobile phones, PCs or tablets. The services are included in the cost of the current plans.

Other providers, too, have launched such benefits: Kentucky One Health launched a phone and video chat-based medical service, Anywhere Care, in late 2013. And in the summer of last year, Anthem gave its customers LiveHealth Online, which works with smart phone, tablet or computer.

It’s the modern version of a doctor’s house call – except that you don’t even have to be in your house. You can see the doctor while sitting on the sidelines of the soccer field, or you can call her on an evening walk or during a subway ride – if you don’t mind sharing your medical information with your fellow commuters.

Consumers increasingly want round-the-clock on-demand service in all aspects of their lives, from TV and banking to package delivery and medicine, said Gary Capistrant, chief policy officer of the ATA.

Applications

Telehealth is as diverse as health care: It can range from people getting information about which pharmacy is charging the lowest price for a drug to the remote monitoring of chronic conditions. Sometimes patients lack patience and don’t want to wait for weeks to see a doctor, so they call one with their cell phone. At other times, they may be too afraid to wait: When a child is crying Friday night, a parent will understandably be reluctant to wait until Monday morning, so they might contact one via their home PC.

As more people have obtained health insurance through the Affordable Care Act and Medicaid expansion, insurers and providers have relied on telemedicine to help take care of the growing number of patients.

And, Capistrant said, better technological capabilities, such as high-resolution cameras on cell phones, are making telemedicine services more viable.

Twenty-nine states now have laws that require insurers to cover telehealth services, Capistrant said, but the quality and availability of coverage varies widely. The ATA estimates that about 15 million telehealth services are provided annually, though numbers are difficult to pinpoint because some providers, such as Medicaid, do not keep track of such services separately, while some private insurers deem the figures proprietary.

Rising popularity

But telemedicine services are increasing, Capistrant said. The U.S. Department of Veterans Affairs, for example, remotely monitors up to 30 medical conditions for about 120,000 people, up 50 percent from last year. Conditions the VA monitors include blood pressure, blood sugar and heartbeats. The information can be uploaded to a patient’s phone, which transmits the data automatically to a doctor’s office.

Capistrant predicts that telemedicine will become as ubiquitous as automated teller machines. After the introduction of ATMs, it became clear very quickly that people preferred the machines to having to drive to a banking center during certain hours to withdraw some cash. And today, people don’t even want ATMs anymore, as they just want to do their banking on their phones.

Once consumers understand the benefits and convenience of telemedicince services, their popularity is going to increase even more, Capistrant said.

Demonstration

For Humana, the local remote office is as much a perk for about 9,000 downtown employees as an opportunity to show health care providers that such services can make sense, particularly if a company has offices that are far apart.

(Courtesy of Humana)
Courtesy of Humana

Dr. Noble said the remote clinic at Humana works just like a regular doctor’s office, with patients making appointments or walking in and providing background information before they see the doctor. Humana essentially treats the remote clinic like an extra room at the clinic where the doctor is based. If the company had added an actual fourth room at that clinic, costs would have been higher, Humana officials said, though they could not say how much.

Patients quickly adjust to seeing the doctor only on a screen, and almost all have given the company good feedback, Noble said.

Patients describe their conditions, equipment provides the doctor with more information, and Noble can describe to the patient what’s normal – and what’s not.

The doctor can prescribe medications and, most important, answer the patient’s questions.

While the setup has other obvious benefits – it reduces the risk of spreading some infectious diseases – Noble said it also has limitations: Diagnosing a sprained ankle via video camera would prove challenging.

“I need to actually feel the joint,” Noble said.

And, he said, he would recommend the service only for seasoned doctors who have developed a good bedside manner and can make patients feel at ease – even from far away.

Nonetheless, the doctor believes that telemedicine services will expand as more people use them, and as technology improves.

While the days of doctors using remote robots to perform surgeries on patients far away are still a ways off, Noble said capabilities are advancing quickly: He said he keeps joking about soon appearing before patients as a hologram.

Boris Ladwig is a reporter with more than 20 years of experience and has won awards from multiple journalism organizations in Indiana and Kentucky for feature series, news, First Amendment/community affairs, nondeadline news, criminal justice, business and investigative reporting. As part of The (Columbus, Indiana) Republic’s staff, he also won the Kent Cooper award, the top honor given by the Associated Press Managing Editors for the best overall news writing in the state. A graduate of Indiana State University, he is a soccer aficionado (Borussia Dortmund and 1. FC Köln), singer and travel enthusiast who has visited countries on five continents. He speaks fluent German, rudimentary French and bits of Spanish, Italian, Khmer and Mandarin.


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