Insurance

Online healthcare and virtual doctor visits: Are we there yet?

Phillip Nones Uncategorized , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Online Physician ConsultationsThe harsh realities of cost are driving healthcare providers, insurance carriers and government agencies to implement policies designed to encourage consumers to take better control over their own health.

More healthcare plans and programs than ever before are including incentives for making lifestyle changes, undergoing preventive care routines, “do-it-yourself” testing as well as online consultations with physicians.

In this regard, it seems everyone is completely on the bandwagon … except perhaps the consumer.

Why is that the case? One reason might be because of what we’ve trained people to expect in the delivery of healthcare services.

For decades, American consumers weren’t given any meaningful incentives for engaging in preventive care or in making lifestyle adjustments. Several generations of Americans were acclimatized to seek out healthcare services when they needed it – and that was when something was wrong. And the billing for those services was sent directly to the insurance company for payment.

In such an environment, preventive health or cost control was the last thing on people’s minds.

I recall being hospitalized for six days back in the early 1980s, along with being given a battery of medical tests conducted by health specialists of every stripe. I’m sure the invoicing associated with my hospitalization and treatment was astronomical … but I never saw a copy of the bill to really know.

My only out-of-pocket expense for the entire week? Thirty dollars for using the television set in the hospital room.

What was surprising to me, even at the time, was that I was kept in hospitalization far longer than I felt I needed to be – my symptoms of infection were gone after just a day or two. If I had been responsible for paying for even a portion of my hospitalization, I’m sure I would have been talking with anyone I could find about how quickly I could be discharged!

Today of course, people are far more aware of skyrocketing healthcare costs – not to mention their concerns about ever-rising health insurance premiums, higher deductibles, and bigger co-pays. Still, when asked about adopting new ways of interfacing with healthcare providers, American consumers seem somewhat ambivalent about them.

A recent online survey of ~1,000 Americans age 18 and over conducted by marketing and research firm Euro RSCG Worldwide found that only ~42% of respondents are comfortable with the idea of having online consultations in lieu of personal visits with their doctors.

[Men are more receptive to this idea (~58%) than women are (~37%) … but women are the ones more apt to make healthcare decisions for their families.]

On the other hand, here’s an interesting additional insight from the survey: When told that having an online consultation with their physician might result in lower expenses, ~77% of those same respondents reported that they’d be open to trying it.

What about the concept of “do-it-yourself” testing? Close to half of the respondents in the survey (~48%) reported that they’re receptive to the idea of using mobile apps to run their own tests and checkups at home. Checking blood pressure was the most popular DIY test, along with tracking and reporting on symptoms.

Of course, as time moves forward, technology is no longer the big obstacle it once was for turning “virtual visits” and “remote care” into a reality. Instead, it’s consumer attitudes and a willingness to adapt. And to accomplish that, the purveyors of modern healthcare must try to undo several generations of “learned” behavior that’s nearly the polar opposite.

Denise Murtagh, a planning director at Euro RSCG, mentions another factor as well: the doctors themselves. “A lot will depend on how facile physicians are with the technology, and how comfortable they are with it.”

And let’s not forget age demographics, too. The survey underscores that Gen-X and Gen-Y consumers are far more comfortable with the idea of physician remote care (47% – 52% positive) than Baby Boomers and those born earlier are (only 33% – 39% positive).

It looks like we’ll need to give this trend a bit more time to come into full flower.

Insurance Fraud: The $80-billion Elephant in the Room

Phillip Nones Uncategorized , , , , , , , , , , , , , , , ,

Insurance FraudIn all the debating about health insurance over the past two years, issues of consumer access and allowing pre-existing conditions have been at the forefront of the discussion.

One aspect that’s been much less reported is the issue of insurance fraud. Recently, I read some eye-popping statistics from the Coalition Against Insurance Fraud (CAIF). This not-for-profit organization estimates that the level of annual insurance fraud amounts to the equivalent of ~$950 for each household in the United States.

Moreover, the Insurance Information Institute estimates that fraud accounts for ~10% of the losses in the property and casualty insurance segments, while the National Health Care Anti-Fraud Association reports that ~3% of the U.S. health care industry’s expenditures are due to fraudulent activities.

So we’re not talking chump change.

Insurance fraud to the tune of $80 billion per year doesn’t happen just because of a few bad apples out there. What’s happening is far more serious than that. Indeed, there are highly organized fraud rings operating throughout the country engaging in everything from staging dangerous accidents to setting up bogus medical services.

The problem goes beyond merely the added cost being borne by consumers. CAIF contends that lives can be endangered, too, due to staged auto accidents, arson incidences, and “medical procedures” being performed by phony physicians.

Is it any wonder that insurance companies like GEICO have well-staffed special investigations units devoted to ferreting out illegal insurance activities wherever they can find them.

Insurance fraud has surely been a problem since the dawn of time, because at its heart is the opportunity for financial profit. In response, a plethora of national and state laws aimed at controlling fraudulent activities have been on the books for years (although surprisingly, insurance fraud is a crime in just 48 of the 50 states – what is it about Virginia and Oregon, I wonder?). Most states maintain their own fraud bureaus as well.

But like so much else the government tries to control or influence, all of these earnest efforts to stem fraudulent activities don’t seem to be adding up to much or getting us closer to a fraud-free world.

Now here’s an idea: Let’s pass some more anti-fraud laws!