Virtual care grows in popularity

In December, CAA Club Group introduced a new benefit to employees — free access to virtual health care through its employee assistance program (EAP). Workers can now reach doctors 24-7 by text, email, apps or video through a laptop, smartphone or tablet for advice, diagnoses and prescriptions

It’s meant to be another tool for employees to use in their wellness journey by reducing the stress and worry of scheduling a doctor’s visit. And the response was impressive — almost half (45 per cent) of the company’s 2,000 employees registered for the service within the first month, and 200 used it in the first two months, says Mara Notarfonzo, associate VP of compensation and benefits at CAA Club Group in Toronto.

“I’m welcoming the high usage rates because that just means that they’re getting the care that they need quickly. So, instead of taking three days off to recover, they may only take one day off.”CAA’s new offering lines up with a recent survey by Mercer that found that more than half (54 per cent) of Canadian employers say they are likely to invest in digital health in the next five years (with 17 per cent very likely and 37 per cent somewhat likely)

“It’s still early days, but it’s growing really fast because the unemployment rate is quite low in Canada, so employers need to find a way to differentiate themselves, to keep their employees, to engage them and so forth,” says Julie Duchesne, Mercer Marsh Benefits leader in Montreal. “Their number one challenge right now is attracting and retaining employees, so I think it’s going to grow really fast.”

Making the case
The case for virtual care has become a no-brainer, says Zack Brown, VP of sales at Dialogue in Montreal, provider of telehealth services. While we’re fortunate to live in a country with universal access to care, there is an accessibility problem and virtual care is a great way to relieve the public system, while adding value to the payer, meaning the HR professional and the employee, he says.

“This is why we’ve seen such a great uptick in demand.”

Virtual care as a service allows employees more free time and helps with absenteeism. On average, employees using the platform said they save more than four hours per consultation, he says.

The main value proposition is about absenteeism and reducing unnecessary absences.

“That’s the ROI piece for employers who are looking to invest in this,” says Christy Prada, VP of business development at telemedicine provider Maple in Toronto.

“[It’s about] instant and direct connection to a physician in less than two minutes. So what that means is employees who historically maybe needed to take half the day off to go to the walk-in clinic for something that is an emergent primary care issue or go and spend the night in the emergency room when their child is screaming with an infection. Now we give them the access to a doctor right away from their phone.”

When it comes to cost, most employers take advantage of the unlimited model whereby they’ll pay Maple a monthly fee per head, and the employee has unlimited access for themselves and their family, she says. There are also employers with a reduced budget that prefer a capped model with a limited number of visits per year.

The price might range from $5 per employee per month at a larger employer to $10 at a smaller employer, depending on the service selected, says Brown. But if employees are empowered to be proactive about their health and wellness, “it’s pretty easy to imagine how a service like this could curb costs related to short-term and long-term disability.”

The perceived value of virtual health solutions is also high, he says. Providing employees and their families with unlimited access to a virtual clinic 24-7 may sound like the employer is paying a lot more for the service than they really are.

“That allows this to be a really effective recruitment tool.”

In looking to enhance its offerings to both attract and retain top talent, Samsung Canada added Dialogue’s virtual health-care platform to its benefits program in January 2019 so Canadian employees could access a doctor from virtually anywhere, for free, says Anna-Lisa Prencipe, senior director of human resources and corporate affairs in Mississauga, Ont.

“This was an exciting addition to our total rewards offerings because this cutting-edge technology allows us to support employee wellness and encourages employees to take a proactive approach to their overall health. Employees can also share this benefit with their family members,” she says, adding the service should also help reduce absenteeism and presenteeism, while increasing productivity.

The services offered through the platform cover a range of health issues such as: feeling sick (such as nasal congestion or fever); pain or injury (such as joint pain); stress and wellness; prescriptions; and referrals. And employees are taking advantage, most often for dermatology, ear, nose and throat (ENT) and gastrointestinal issues, says Prencipe.

Retention benefits
Nearly four out of 10 (39 per cent) employers believe promoting or sponsoring digital health solutions will help with staff retention — although 46 per cent believe it will make no difference, found Mercer’s global survey of 15,564 workers and 1,300 senior decision-makers (including 1,066 and 100 in Canada, respectively).

And more than one in four (26 per cent) of workers say they are more likely to remain with their employer if it offers digital health solutions — although 54 per cent say it makes no difference.

One out of four is a big number, says Duchesne.

“If you think about that and look at the turnover rate, if you just decrease it by one per cent, for example, that’s going to have a big impact on your financials... It’s hard to quantify the impact, but if you think about it from an engagement perspective, from having a more productive workforce, and even just simply the turnover rate, if you can have an impact on one person, out of those 26 per cent, this is huge. So, it’s really a matter of value for investment; that’s what we’re looking at.”

Offering this benefit is a really interesting way to attract and retain talent, says Brown.

“It’s a great way for an employer to further position themselves as a top employer who cares deeply about the health, wellness and well-being of their employees and, equally importantly, about the family members of those employees,” he says. “Many of these employers are actually calling this out in their job descriptions, for example. So they might say, ‘Get a competitive salary, greater benefits and access to a telemedicine service.’”

A recent survey by RBC Insurance also found that almost three-quarters (72 per cent) of working Canadians would perceive their employer in a more positive light if virtual care or telemedicine was part of the benefits package.

For CAA, the virtual care benefit — offered through a joint partnership with telemedicine platform Maple and Morneau Shepell — is not necessarily a measurable benefit when it comes to the overall value proposition, says Notarfonzo.

“If we measure intermittent absences, probably over the span of a year, we’ll make up that money very quickly. Because for someone to have to go and make an appointment and go and see their physician, it’s at least a half a day, if not a full day,” she says.

“Wellness, overall, is very important to CAA. It’s a huge part of our culture, ties into our attraction and retention strategy... You’ve got to look at the future and think about the cost — will the recovery of the costs show up in other ways? I have no doubt that we’ll be able to measure this and the ROI on this program within a year.”

Potential downsides
Despite the potential benefits, virtual care has its doubters. Among workers who are not willing to try digital health innovations, the most common concern is a lack of human attention (44 per cent) followed by “I don’t see a personal need” (41 per cent), “I don’t trust their data privacy or security” (40 per cent), “I don’t trust health-care computerized algorithms” (40 per cent) and “I’m satisfied with the health-care services that I have” (29 per cent), found Mercer.

For employers, the most common reasons are: difficulty in quantifying the cost benefit (50 per cent), complexity of administration (40 per cent), more important priorities (40 per cent), data privacy and security risks (40 per cent) and the complexity of analyzing the options (35 per cent).

But Samsung is confident of the quality and continuity of care provided, says Prencipe.

“Dialogue is very thorough in their interactions with employees and conduct extensive followup with anyone that uses the service. Of the employees that have used Dialogue, we have received a high 88-per-cent satisfaction score.”

When it comes to quality of care, Dialogue has been selective in the people it hires to join its team, says Brown.

“Even though there aren’t millions of physicians in Canada, we’re still very selective in the way in which we bring people onto our team... And baked into our product is a focus on continuity of care. So, for us, we’re absolutely not in the business of providing transactional virtual care consults.”

Maple also has a very robust physician screening program, says Prada.

“We do a review of medical training; there’s an interview between the physician and our medical team. We also make sure that they are put through... a virtual care training program... because physicians aren’t taught how to do virtual care. So, we wanted to make sure that we’re equipping them with the right tools and tips and tricks and practices for shifting care into a virtual environment.”

Any concern about the risks of being an employer providing this service is minimal, says Notarfonzo, based on the ailments or conditions that are being shared by employees.

“For someone that is very ill, they will not receive that kind of help here, they need specialization and that’s not what this virtual care program is set up to be.”

Quality, continuity concerns
Discussions with various stakeholders have found that, although patients, families and caregivers are excited about virtual care and the potential for it to improve access and deliver more timely care, they did not want to lose that human connection, says Gigi Osler, past president of the Canadian Medical Association in Winnipeg.

“Canadians see the benefit of it, but also they don’t want their health-care providers replaced by AI or technology.”

There’s also a preference for virtual care to be delivered within an established physician-patient relationship or health service, she says.

Maple has always said this service should never replace a family physician relationship, says Prada.

“We’re huge proponents of that. This is meant to give you access to a doctor in those moments where you don’t have access, and you’d be going to the emergency room or a walk-in clinic where, arguably, care is a little more fragmented and disjointed in those environments.”

Another concern? While the technology is available in Canada, it’s siloed and varies by province or territory.

“What our patients and our clinicians are telling us is that that type of care isn’t being linked back to their established physician or health-care provider. And it’s providing episodic care, but it’s not supporting and continuing the continuity of care that people also want,” says Osler. “Patients don’t want fragmented care — they want care that continually improves their health.”

If we do want to achieve the goal of enhancing care for patients in Canada to ensure that it is safe, effective, timely, efficient and equitable, we will need to find ways to ensure that whatever care is provided in the private system could somehow be integrated into the public system, she says.

“Patients don’t want their health information fragmented. And so that is part of the discussion that we’re having in terms of having a national framework and a framework that ensures that covers the standards and the policies and legislation in all the different areas to really ensure that the care that’s delivered protects patients, is efficient and provides quality care,” says Osler.

“We need a framework nationally with governance standards, legislation, to ensure that care that’s provided virtually continues to be safe, effective and helps continue that continuity of care.”

Dialogue is built around the continuity of care, says Brown, and to that end it has put in place several initiatives, including: the possibility to speak with the same medical professional; personalized followups after a consultation; electronic care plans that can be shared with the patient’s family doctor; and doctors and health-care practitioners using the same electronic medical record (EMR).

Maple has also built up a comprehen-sive virtual medical record-keeping sys-tem, says Prada.

“Not only can patients go in and add their own medical information to the platform, but there’s a full proper formal consultation summary generated at the end of every visit. And that can be directly faxed to the family physician at any time by the employee.”

Getting the word out
When it came to rolling out the new offering, CAA did an intensive communication launch to generate some buzz, says Notarfonzo. The actual launch provided an overview of the program, including how to access it and register.

“Then our CEO — who’s so behind this — talked about it at one of his town hall meetings, how important it is for him to ensure that our associates are provided with these types of services and to make their lives easier.”

Prencipe says Samsung communicated to employees through: in-person and online information sessions; email communication; information on large-format displays throughout the offices; and company-wide meetings.

“It’s a big communications exercise,” says Brown, citing one large employer with 10s of thousands of employees that didn’t have the email addresses of employees so direct mail was used to reach people. He says lunch-and-learns, promotional materials and an onboarding playbook are also effective.

“That allows us to be uniquely positioned to drive awareness, drive engagement, drive utilization, and all those things together are what leads to the outcomes that everybody in HR is after when they’re investing in health benefits.”

QUALITY OF CARE IMPORTANT
Top factors in choosing where to get health care

• quality of care 97%
• cost 95%
• reputation of medical care provider/access to treatments/location 96%
• wait times 95%

Source: Mercer

RETENTION BENEFITS OF VIRTUAL CARE
Would virtual care make you see your employer in a more positive light?

• 72 per cent of working Canadians  
• 78 per cent of workers aged 18 to 34
• 60 per cent of workers 55 and older

Source: RBC Insurance

APPS, ELECTRONIC RECORDS POPULAR
The most valuable digital health solutions

• an app that finds the right doctor or medical care (42 per cent workers, 41 per cent employers)  
• electronic medical records (41 per cent workers, 36 per cent employers)
• telemedicine (36 per cent workers, 40 per cent employers)
• self-managing health conditions using wearable tech (36 per cent workers and employers)  
• an app to find an expert doctor based on a diagnosis (35 per cent workers, 43 per cent employers).  

Source: Mercer