Field Notes I Benefits Consultant I TDOC / Livongo - Blue Collar Employers are a Tough Bunch

Additional Background: Our contact was previously a small business owner and dealt with all the issues that come with providing benefits to employees.  Realizing the cost savings available and what brokers did/didn't bring to the table led to the career change -> business development at the independent agency.  His focus has been on blue-collar employers. 

Are Teladoc and Livongo used by any of your companies? If so, how's utilization?

• Yes. A few. And a few of the groups are north of a couple thousand people. They have Livongo but really don't use it. The problem is that most people barely using anything. People just go to the doctor; they are doing what they’ve always done.

• Many diabetics don’t manage themselves in the first place. An app to help control blood pressure, etc. always sounds/sounded great to employers, but the practical ROI is low, especially given the PMPM fees.

• With Teladoc and for telehealth, competition is rampant. Every hospital, every practice is out offering telemedicine: "Our doctors can do it (e.g., Ochsner has been aggressive recently)." The local primary care physicians (PCP) want their patient flow and exam rooms full again. I think people want to see their doctors too. Overall utilization of telehealth is very low - LSD%. 

• TPAs – They are the ones connecting people and hooking it up. Half the time, the apps have poor data, sometimes the devices don’t work, and if/when people get frustrated, they disengage. Livongo is a big gimmicky. There are incentives to use it (the device test strips, etc.) but I just don't see a lot of adoption. 

Why is utilization so low? If telehealth isn't working, how do you try to impact plan costs?

• Mix is really important - the population. It might be just that I see more blue-collar employee bases, but they don't know how to use apps, people aren't educated, etc. There's a lot of friction there. A fair estimate is 3-5% of a population will cost a company 50% of its spend, on average. A car dealership might have a higher proportion of diabetics in there, but that tends to hold regardless of company size (an exception might be a tech company with a lower average age - lots of high 20s, low 30s.

• Just the other day I had a 35-year-old woman tell me, “I don’t use apps!” at a car dealership.

Have you pitched the Ochsner plan/option to anyone?

• No, but they are pushing really hard and want to be included as an option. 

But they are just white labeling Amwell, no?

• They must be because they are using their own doctors for this.

• We do try to advise employers on cost and explain how to analyze what they are doing, use captives, etc. But even when they see the data on ER visits or something else, it's hard. 

OK, what about the way(s) to impact plan cost?

• There are really only a couple of ways. One big one is Rx, on the drug side. There's a ton of meat to take off the bone there. It's so complex and convoluted.

• How do you get at that Rx cost for them?

• True Rx is a good one - they helps. There are other companies that do this too, but they carve out the prescription drugs for a self-insured plan, make sure that the company is getting the right rebates, provide clarity on the process, get coupons where available, etc. It's hard to tell your employee not to go to Walgreens or CVS - they won't listen even if they'll save X%. Look at something like Duexis - it's essentially Advil and Prilosec, but costs $3k. You can get a coupon for the whole thing, but the next time you need it, there might not be a coupon.

• I deal with a lot of high claimants - the ones that impact that spend the most. If you're an employer, it's hard to know who or what is driving that spend (is it cancer or diabetes?). Of that 5% I mentioned earlier, my opinion is that it's MSD% - maybe 6-7% of people with diabetes that do something about it.

• So if you're dealing with a 3k employee group, even if it's 10%, that's 300... but it's often 5% or 150, and then you're slashing that to maybe 75? Where's the ROI?

• Exactly my point. There's no ROI on that.

• There are other services out there that we've learned a lot about and like. White glove/concierge patient advocate services like Quantum Health ... we/I find those more interesting. We often recommend Quantum - they do a great job with cancer, for example. If you get cancer, they are there: "We're sorry, we're here to help, etc." Everyone loves them.

If there's no ROI, how do people have these, Quantum, Livongo, etc.?

• A couple of the captives I put clients in - captives work for companies that aren't big enough on their own. Group the smaller companies, then buy stop loss. Those have grown a lot recently. Another big issue is that the BUCAs won't give you the data - the real, helpful data - if you're not big enough. Captives help.