Sept 2018
Issue No. 95
In this issue
 

 

About Us  
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  A not-for-profit ministry of
Church of the Brethren Benefit Trust Inc.

Church of the Brethren Insurance Services provides the following products: dental, vision, basic life and accidental death & dismemberment, supplemental life and AD&D, dependent life and AD&D, long-term disability, short-term disability, voluntary accident insurance, and Medicare supplement for eligible Church of the Brethren employees .
 
Dental, vision, and Medicare supplement coverage may also be available for eligible retired Church of the Brethren employees.
 
For eligibility information, call Connie Sandman at 800-746-1505, ext. 3366, or contact your human resources representative.
 
Medical and ancillary plans (named above) may be available to Brethren-affiliated employer groups.
 
Long-Term Care Insurance is available for all members of the Church of the Brethren, their family and friends, and employees of Church of the Brethren-affiliated agencies, organizations, colleges, and retirement communities. 

Contact Us 
1505 Dundee Ave., Elgin, IL 60120
800-746-1505
  www.bbtinsurance.org 
  

 
This month we consider how technology can be a boon in an area that is traditionally highly personal. If you are a senior citizen, you may remember the days when doctors made house calls. Depending on what part of the country you grew up in, you may remember house calls from even more recent times. But everyone at all ages can recall dozens of times when you have been to the doctor. Increasingly, nurses and other medical professionals handle much of the office visit, and you see the doctor for only a short time.
 
Now, doctors are beginning to use something called telemedicine, which removes them even further from the concept of the old-time house call, but toward a modern day version of a house call. It's now possible for you to have a "virtual" doctor's appointment. Did you ever think something like this might happen during your lifetime?  Telemedicine has definitely arrived.
 
It happens that insurance companies are beginning to offer telemedicine benefits. So, this month's insurance emphasis will ask you to consider the telemedicine possibilities offered by Brethren Insurance Services, and will encourage you, if you are not a client of BIS, to talk to your own agent to find out what might be available.
 
This new development in medicine has already caught the cartoonist's eye, so our LOL section is given over not to jokes but to cartoons. And don't miss the brain puzzle.
 
This month's issue will arrive in your inbox as the summer season is winding down, your children and grandchildren have started back to school, and the leaves are beginning to turn. The hot days of summer are transitioning, bringing us cooler nights and earlier sunsets. May the end of the growing season bring you good harvest from vegetable and flower gardens, and may the beginning of the school season fill you with new energy.
 
When telemedicine becomes medicine
  

Everywhere we look, digital technology seems to be changing life as we know it. Medicine in particular is one area where the new technology not only offers more advanced diagnostic procedures and sophisticated surgical techniques and instruments, but is also bringing innovative changes to the doctor/patient relationship itself. This growing medical field is called "telemedicine."
 
Picture a patient with a computer screen and a high definition camera connected through a secure network to a physician many miles away, who is in a lab or clinic, also in front of a screen and camera. The doctor can view the patient's symptoms, ask the patient questions, even take vitals if the patient has a kit of diagnostic tools connected to the computer. The doctor makes a diagnosis and e-mails a prescription to the patient's nearby pharmacy.
 
Or picture someone having a stoke in a remote area. With something as serious as a stroke, the quicker the treatment the less the damage. The local doctor is not a neurologist or stroke specialist, but she makes a "virtual" connection with a large medical center miles away, where a specialist comes on screen. With the help of the local doctor and what can be seen in high definition on the screen, the specialist is able to direct the start of treatment right away, before transferring the patient to the medical center to complete the process. The patient has a much better chance of recovery than if treatment had been delayed until he or she could reach the medical center.
 
Let's say you have a medical emergency in the middle of the night. Suppose you are able to talk to a doctor by video conference, and he figures out what is wrong, reassures you, and tells you what you should do. You may have just saved yourself the disruption,  as well as the cost, of going to the ER or urgent care clinic.
 
Telemedicine could be invaluable to a person living in a remote area where there are no local doctors, but there is a virtual connection to an e-care network that enables him or her to receive regular check ups in real time on screen. It also would be helpful for the assisted living facility too small to have a doctor on duty. A resident could get up in the morning, use digital instruments to take her blood sugar level and check her oxygen, put on a blood pressure cuff, and climb on a digital scale. All these readings would then be sent to a clinic that monitors her health.

 

Each of these is an example of telemedicine. It refers to any instance where a physician and patient or two medical professionals are connected at a distance, in real time, on screen, for consultation and diagnosis. Another broader term is "telehealth," which, in addition to telemedicine, includes all other uses of electronic information and telecommunications technologies to support and promote long-distance clinical health care, health education, and public health administration.
 
A recent publication by a video conferencing company named Vidyo asserted that more than three-quarters of all health delivery organizations (hospitals, clinics, physician's practices, etc.) are using telemedicine solutions or plan to use them in the near future.
 
Through telemedicine, patients do not spend as much time or money on doctor and ER visits. There are no travel costs. It is not necessary to arrange for childcare. Patients are not exposed to potentially contagious conditions they might find in a doctor's office or ER. There are fewer missed appointments. The most important benefit is that specialized medical care once possible only though travel is now at a patient's fingertips. And follow-up is easier since patients don't have to drive to their doctor's office.
 
There are some downsides. A certain level of technical proficiency is needed at both ends of the telemedicine connection. Some expensive technology may have to be purchased. If patients are connecting to an e-care network, they may not always get the same physician. And they will not have actual human, face-to-face interaction.

 

However, as important as face-to-face contact is, there may be many aspects of a doctor's care that do not require it. For conditions or situations that do, patients can still go to the office or ER. And the virtual connection does actually offer face-to-face contact; it's just on a screen.
 
An example of the effective use of telemedicine is the telemedicine services of Avera, known as Avera eCare, a network of 33 hospitals, 208 clinics, six regional centers, and 40 senior living facilities, as well as sports and fitness facilities in parts of a five-state area in the upper Midwest. Many of the nearly 1,000,000 people who live in this 72,000-square-mile area are far from one of these facilities, and Avera eCare has greatly improved their medical care.
 
Though telemedicine is especially associated with remote or rural locations, there are also applications in urban areas. Think how long patients have to wait for an appointment, and then how long they sit in the waiting room to see the doctor. Since 2014, the wait time for new patient appointments in 15 metropolitan areas has increased by 30 percent, according to a study by healthcare professional placement company Merritt Hawkins. It now takes an average of 24 days for a patient to make an appointment with a physician in these markets compared to 18.5 days just a few years ago. Telemedicine contacts, on the other hand, can be direct and immediate. 
 
Telemedicine is still in its early stages. Vidyo claims that 2018 is the year when "telemedicine" will become "medicine." That claim may be a bit ambitious, but it is very likely that within 10 years, most people will, at least some of the time, be communicating with their doctor by video screen.

Three telemedicine stories

A world of difference

Donald Hixson, living in The Dalles in central Oregon, had a stroke and was rushed to the nearby Mid-Columbia Medical Center Emergency Department. The staff at MCMC consulted via a telemedicine connection with Dr. Wayne Clark, a neurologist and stroke specialist at the Oregon Health Sciences University in Portland, 85 miles away. Hixson remembers nothing of the night of his stroke, but Dr. Clark was there, beamed into the MCMC emergency room via technology, enabling him to examine Hixson as though they were in the room together. Dr. Clark could see both his patient and the MCMC ER physician, and they could see Dr. Clark, and they all could communicate easily.

"Based on the exam and what I could see, I was able to pinpoint that the stroke was caused by a clot in Mr. Hixson's brain stem," recalls Dr. Clark, who directs the Oregon Stroke Center at OHSU. "That is one of the worst strokes you can have. Without timely treatment the mortality rate can be as high as 70 percent."

Dr. Clark prescribed a brain-saving drug that broke up the clot causing the stroke. Then Hixson was transferred to OSHU in Portland, and by the time Dr. Clark saw him in person, the clot was beginning to dissolve. Over the next few days, Hixson showed great improvement.

A benefit of telemedicine, Dr. Clark says, is not only facilitating the rapid diagnosis and initial treatment of patients before transferring them to OHSU, but also determining when a patient doesn't need to leave MCMC. "About half of the time we can determine that a patient does not have to leave their community hospital."

Though Hixson was taken to Portland and OHSU, he has not had to leave The Dalles since. The telemedicine technology that facilitated his quick diagnosis and initial treatment has made it possible for Dr. Clark to make follow-up "visits."

"It sure made a world of difference to me," says the 76-year-old Hixson, a retired highway patrolman and sheriff's deputy. "It's not easy for me to travel, so I would have had to arrange special transportation if I had to keep going back to Portland."

Even one encounter


(Click on picture above to view video.)
 
John Armstrong, who lives in the remote desert community of Joshua Tree, California, found at age 59 that he had diabetes. After several years , his efforts to control it with over-the-counter insulin were no longer working. He was receiving primary care at a nearby clinic, but he needed to see a specialist. The closest endocrinologists were 90 minutes away. John was an IT specialist working at home, where a number of family members depended on him financially. With the long wait times at those clinics, it probably made more sense to drive the two hours to Los Angeles. Either way he would lose a day of work, and it would be very expensive.

The telemedicine coordinator at the nearby clinic explained that John could be seen by one of the best endocrinologists in the country through a virtual visit. John could schedule the appointment promptly and be seen in real time by the distant specialist while in the clinic near his home, supervised by his primary care doctor.

John scheduled the appointment for the following week. Even though the endocrinologist was located in San Diego (170 miles away), she was responsive and confident, and she took plenty of time to understand John's condition. With just a single specialist consultation , John had new information that transformed his treatment. Now his blood sugar levels are where they are supposed to be, better than they have been for years. He says, "Just the opportunity to see a specialist in the local office is unbelievable." He continues to utilize telemedicine to visit his new endocrinologist as needed. But even one encounter made a huge difference.

Now going on 66, John would like to utilize telemedicine to access a cardiologist. He says that he prefers telemedicine. He says he can stay in his surroundings where he knows everyone. Thinking about his stabilized blood sugar, John says, "I consider myself very lucky."

Telemedicine for urban kids

Telemedicine is often thought to be most relevant for patients in remote or rural settings, but urban populations stand to gain from the technology as well. Virtual visits can introduce new modes of care to metropolitan populations where, in many cases, patients may find it difficult to make it to the doctor's office. Wait times for appointments have gotten longer, and there are delays at the doctor's office.

Children with asthma in the Rochester City School District who received a combination of telemedicine support and school-based medication therapy were almost half as likely to need an emergency room or hospital visit for their asthma, according to new research from the University of Rochester Medical Center (URMC).

One in 10 children in the United States has asthma, making it the country's most common chronic childhood disease. Though symptoms can be managed through medication, children must first be diagnosed, and then must take their medication. This does not always happen for minority children living in poverty. As a result, these children suffer preventable and potentially dangerous asthma flare-ups, which can lead to expensive emergency room visits.

The new study, published in JAMA Pediatrics, enrolled 400 students between the ages of 3 and 10 from the Rochester City School District. Half were given their asthma medication by their school nurse; these students had an initial asthma assessment as well as up to two follow-up school-based visits with primary care clinicians via telemedicine over the course of the school year, to determine the appropriate asthma treatment. The other half of the students were given recommendations for preventive care and advised to schedule follow-up visits with their primary care clinician; these students were not enrolled in the school-based medication program, nor were follow-up visits scheduled by telemedicine.

Students in the first group had more symptom-free days than those in the second group, and only 7 percent of them required an emergency room visit or hospitalization for asthma over the course of the school year, compared with 15 percent in the second group.

"Clinicians and researchers across the country are designing similar programs, using resources available in their communities to reach underserved children with asthma and help them get needed assessments," said Jill Halterman, M.D., M.P.H., Chief of the Division of General Pediatrics at URMC and the study's lead author. "The integration of telemedicine with supervised treatment through school provides one model to ensure that children receive consistent, effective asthma treatment."

BISTelemedicineAre you a client of 
Brethren Insurance Services?

Telemedicine options for you: 
Amwell and Doctor On Demand

Clients with medical insurance from Brethren Insurance Services have a telemedicine option built into their policy. Setting up your account is easy:
  1. You have the choice of two providers. Visit amwell.com (video or phone) or doctorondemand.com (video only) and follow the instructions to register or download their mobile apps. You can use either or both of these services.
  2. Select "Sign Up" or "Join Now."
  3. Enter your name, address, etc.
  4. Complete the brief online health history form.
  5. Enter your health insurance information. 
Pick the type of care you want:
  1. With Amwell, you choose from medical, children's medical, adolescent therapy, and psychiatry.
  2. With Doctor On Demand, you choose medical for adults and children.

Choose the doctor you want by looking through the doctor profiles and clicking on your selection. In some instances, a doctor may be assigned to you.
 
Explain the reason for your telemedicine visit and whether it is for you or a family member.
 
Begin your live video visit.
 

After the online video consultation, you will receive a quick response:
  1. You will be able to view the doctor's notes and diagnosis.
  2. Prescriptions, if needed, will be sent directly to your pharmacy.
 
Telemedicine if you are not a client

If you do not have group insurance with Brethren Insurance Services, you would be wise to inquire if your health insurance covers telemedicine. Ask your insurance agent. As you can see from the foregoing articles, telemedicine is growing as a way to provide medical services. Even if you currently prefer a face-to-face encounter with your doctor, the time may come when you will find telemedicine very useful - if you are incapacitated, if you are in a remote area, or if you are in need of attention but not able to get to the emergency room.
LOL



Medical Mix-up

There are four doctors who all work out of one medical building: Dr. Adam, Dr. Rob, Dr. Warren, and Dr. Meredith. They must all share space in the facility. Each gets one day of the week from Monday to Thursday. But as luck would have it the facility's schedule got mixed.

They are a cosmetic surgeon, a podiatrist, a vet and a dentist. Their patients are Spot, Joe, Kate and Sid. Their bookings were for nasal hair removal, neutering, tooth filling and foot fungus removal.

Dr. Adam works only on Mondays and never on animals as they give him hives.

Kate requires a filling because she's a Krispy Kreme addict.

Fortunately, Joe was not neutered.

Dr. Rob had scheduled surgery, but not on Thursday or Wednesday; that's when he had nasal hair transplant classes.

Dr. Meredith never took patients named Sid or ones with mushrooms protruding from their toes, and she liked pets but felt her husband was enough.

Sid was booked for cosmetic surgery on Tuesday because Wednesday he had to take his dog to be neutered.

Dr. Warren didn't mind nasal hair, but preferred his patients to have hair all over. He also played golf Thursday-Sunday.

So can you reschedule everyone?

For Your Long-Term Care Needs
Brethren Insurance Services offers Long-Term Care Insurance all through the year
 
If you're interested in purchasing coverage, you should know that e ligibility for benefits is determined by the inability to meet at least two of these six activities of daily living -- bathing, eating, dressing, toileting, continence, or transferring. Cognitive impairment can also trigger benefits.
 
It's difficult to think about the fact that a debilitating condition or a disabling injury might leave you unable to care for yourself, or that when you reach your twilight years, the time will come when you will need some extra care. Long-term care insurance makes sure that you will get the care you need. It helps assure that the cost of your custodial care will not eat up your savings. Finally, and this is one of the best things about LTCI, it can help protect your children and other relatives from having to use their resources to care for you.
 
Brethren Insurance Services offers Long-Term Care Insurance for all members and employees of the Church of the Brethren and their family and friends; and also for employees of Church of the Brethren-affiliated agencies, organizations, colleges, and retirement communities and their families and friends.
 
If you are interested in obtaining this coverage, contact Brethren Insurance Services at  insurance@cobbt.org or 800-746-1505 for a free, no-obligation proposal.