Providing benefits to any workforce can be a challenge. Providing
Kyle Longton knows this well. As chief operating officer at the American Foreign Service Protective Association (AFSPA), which provides benefits to federal employees who work within foreign affairs, Longton is charged with delivering comprehensive care options to a
“The people in the U.S., about 60-65% of our members, are the easy part — there are a lot of programs that are U.S.-centered,” Longton says. “It’s the 35-40 % of members who are overseas in 172 different countries including Germany, Japan, South Korea, and the U.K. where we have to design benefits to be as flexible as possible.”
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One way AFSPA has recently done that is by embracing smart digital healthcare tools and expanding
Providing care to members in nearly 200 countries does not sound easy. What’s your approach?
Healthcare can be cheaper overseas, but in other cases, our members may end up in high-cost areas, and that’s not their fault. So we try to be flexible, and accept whatever overseas provider bills as our plan allowance, so we don’t essentially penalize members with an added out-of-pocket cost.
Especially through the pandemic, how have you found ways to add additional flexibility?
In 2017, we started to utilize the digital diabetes solution from Livongo and saw great results and utilization. With the diabetes program, we see about 28% of eligible members who are diagnosed with diabetes using it, engaging with it on average 25 times per month, and that’s really what we like to see. That comes with clinical results too: On average, our members saw their A1C blood test levels come down 1.35%, and for people with A1C of greater than 10 on average, they’re coming down almost 4%. So in 2020 [when Livongo merged with virtual healthcare company Teladoc], we started utilizing Teladoc as our telehealth provider, because they have an overseas telehealth solution.
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Prior to 2020, did your members embrace telehealth?
Before the pandemic, it was rare to hear of a member using telehealth services. If I ever got an email about it or saw something about telehealth on a Facebook comment, I would literally call that member to ask them what their experience was, because it just wasn’t being used. With the pandemic, we saw an explosion in utilization. Our team says they went from receiving fewer than 100 calls a day to thousands. Our utilization from 2019 to 2020 for telehealth services increased by more than 2,000%.
Are you expecting that utilization to stick, or is there a chance that people will revert to their old habits when we get back to a more normal place with the pandemic?
We absolutely expect to see that continue, and we’re really seeing it on the mental health side, serving behavioral health needs. Just for the first half of 2021, we had almost 1,600 behavioral health visits through Teladoc Health. But what strikes me about that is the feedback we get from our members: 38% of those people who engage in the mental health solution claim they would not have sought treatment if they didn’t go through Teladoc Health. Which tells me that, both stateside and overseas, we’re able to reach people who would otherwise just be coping or waiting for something to get worse. And I’d rather them get the care, in whatever form they feel that they need it.
Aside from improving access to care, what does telehealth and telemedicine do to the bottom line, and the cost structure of benefits?
There’s no question that it’s saving us money. We’re seeing emergency room visits go down significantly from year to year. We’re seeing people turn to telehealth rather than going to an urgent care or convenient care setting. This lowers costs, but we’re also seeing people get the care they need more quickly, and as part of our wider mission, that means they’re able to stay what we call “mission ready” and can get back to their job. They’re back to serving their country more quickly — or at least with more information about what’s affecting them.
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It sounds like you get a lot of direct feedback from your members. How do you proactively create that kind of conversation?
We’re based in Washington, but we don’t stay in Washington. We get out there and go see our members to know what they need. I have sat in rooms where only six people show up — and if you do, the per capita cost of flying to South Korea for two weeks to get feedback from six people, it’s a lot. But we get such good information and true feedback. We’re also very fortunate to have the reports from surveys that Teladoc Health does, and our goal is generally to be in front of our members. I get direct feedback via email from members, we share a newsletter with a column where I address questions received from members, and we also do webinars with partner organizations and other educational webinars, with member attendance ranging from about 20 people to north of 200. It’s just another opportunity to answer everybody’s questions.
