The Benefits of Telemedicine

Workers’ Comp Via Remote Access

Remote access to care could revolutionize workers' comp case management and patient care.
By: | February 28, 2014 • 8 min read

Nevada is considering implementing rules pertaining to the use of telemedicine in the state’s workers’ comp system. It is among just a few states to do so.

Advocates say telemedicine could address several challenges in the workers’ comp system, especially cost and access to care. With the potential shortage of physicians to care for injured workers stemming from the implementation of the Affordable Care Act, some say the time is ripe for the system to embrace the opportunities telemedicine creates.

The Scope of Telemedicine

“Broadly defined, telemedicine is basically the delivery of health care using telecommunications technology,” explained Jonathan Linkous, the CEO of the American Telemedicine Association. “The key is the delivery of health care. It’s not an administered internal system in a hospital; it is not an X-ray machine or an electronic health record. It is actually providing services to a real person at a distance.”


Telemedicine can include a variety of services. The ATA identifies the following examples of delivery systems that can be used:

  • Networked programs that link tertiary care hospitals and clinics with outlying clinics and community health centers in rural or suburban areas, using dedicated high-speed lines or the Internet for telecommunication links between sites. The ATA estimates there are approximately 200 such networks in the U.S. providing connectivity to over 3,000 sites.
  • Point-to-point connections using private, high-speed networks that are used by hospitals and clinics that deliver services directly or outsource specialty services to independent medical service providers. Examples include radiology, stroke assessment, mental health, and intensive care services.
  • Monitoring center links used for cardiac, pulmonary or fetal monitoring, home care and related services that provide care to patients in the home. Landline or wireless connections are often used to communicate directly between the patient and the center while some systems use the Internet.
  • Web-based e-health patient service sites that provide direct consumer outreach and services over the Internet.

The ATA estimates around 10 million Americans had a medical service provided remotely in 2013 although most were likely unaware of it. “It’s under the radar; you don’t even know it,” Linkous said. “It’s a seamless part of healthcare delivery.”

Telemedicine is most prevalent in the use of imaging. Often a radiologist reading an X-ray or MRI is located off site, even in another part of the world.

“Another example is neurophysiological monitoring for a patient undergoing back or brain surgery, people who look at brain waves,” Linkous said. “It’s not done in a hospital surgery room, it doesn’t need to be. It is done at a distance.”

About half of the physicians in the U.S. use a mobile app program that allows them to determine whether a medication they are considering prescribing interacts well with other drugs a patient is taking. That program, called Epocrates, is one of the more basic examples of telemedicine.

Some retail pharmacies that offer nurse-staffed mini clinics that provide checkups are beginning to offer them at a distance to avoid long waits. Someone with a rash, for example, can be seen remotely via technology by a physician who might be able to give a diagnosis.

“It has advanced far beyond software, to provide the ability to see,” said Kimberly George, senior vice president, senior health care advisor, Sedgwick Claims Management Services Inc. “With Face Time and Skype, you can have a physical exam with the technology.”

Access to Care

The ability for health care to be provided without the requirement of a face-to-face meeting with a physician could potentially revolutionize health care delivery in the workers’ comp system. It provides several benefits.


“Top of the list is the Affordable Care Act and access to care,” George said. Telemedicine, she said, could be part of the answer to the potential shortage of physicians available to treat injured workers that could accompany implementation of the ACA — particularly in areas with few physicians.

“I’m from a rural town, and for years I’ve know how telemedicine is helpful for determining where the patient would be taken,” George said. “Rural is something that is definitely important in workers’ comp, and the timing of appointments, not just for seeing the occupational health [physician], but whether he should be seen by a specialist, and getting him there and [avoiding] the wait, and delayed return to work.”

Rather than having to wait to see various specialists such as physical therapists and orthopedic surgeons, telemedicine can expedite the process. Workers in the fast-food industry, for example, could be treated much more quickly via telemedicine.

“Burns are a potential need to be seen [by a specialist], but it may just need cream or ice while another may need to be seen,” George said. “With this technology, it’s a great way to say ‘does this patient need to be seen.'”

George also believes the ACA may create better educated health care consumers — yet another reason telemedicine could aid the workers’ comp system. “As we start to think about that whole level of efficiency and patients become more engaged as consumers, they become more demanding. So they aren’t necessarily going to sit back and wait for that visit.”

States that are more spread out geographically stand to gain the most from telemedicine at the moment. Nevada officials said with essentially only Las Vegas and Reno as areas with concentrated groups of physicians and specialists, telemedicine may provide health care delivery services more efficiently and cost effectively.

Team Advantage

Telemedicine offers even more than the ability to enable exams among providers and injured workers. It also provides an opportunity for multiple providers to confer about a claim.

“You could have the case manager, the physician, the physical therapist, and the patient — a live care plan conversation. … We are not too far away from being able to get there,” George said. “It’s really about access to care, but also that ability to have an efficient and timely visit by a specialist, and then the key stakeholders can really benefit from timely care and the patient feels ‘I’ve got the best providers and a system that is helping me get better,’ and avoiding delays.”

Technology offers workers’ comp the ability to move to the next level in the delivery of health care, especially for certain types of employers. The trucking industry is one example.

With 24/7 nurse triage, “what if that nurse has a physician that can do an evaluation within minutes to determine if the patient needs to be seen?” George said. “If you’ve got the right environment, where the truck driver is on the road and needs more than what the nurse can triage, could the equipment be in the truck or trailer and allow for medical review?”

Companies with on-site clinics could coordinate them with remote orthopedic or other occupational specialists. “A lot use nurse practitioners, but there are times you may want or need to have a physician. Could you block out time of telemedicine visits with occupational health specialists,” George said. “Those are opportunities.”

Chronic Health Conditions

The ability to monitor patients with conditions such as advanced diabetes, chronic obstructive pulmonary disease, or congestive heart failure can help prevent emergencies. That could potentially help injured workers with comorbidities.

“Often people with workers’ comp issues [and comorbidities] are in and out of emergency rooms once a week,” the ATA’s Linkous said. “There are many circumstances when people don’t go to a physician or at least get their vitals checked because they are in a far away location. This allows you to get that access.”

People with unchecked chronic diseases can wind up on disability or in rehabilitation facilities. “The potential cost savings through the use of telemedicine are huge for people who have chronic diseases,” Linkous said. “If you could monitor their condition on a regular basis, you could save lots of money.”


Sedgwick’s George takes it a step further and says telemedicine could help employers prevent the onset of chronic diseases among their employees. “Many people with chronic diseases or even pregnant women are using telemedicine and various mobile tools to focus on not just sick care but well care,” she said. “We’ve got to be thinking about that as employers.”

That goes to another potential benefit of telemedicine, the engagement of the employee, according to George. “Everybody wants an engaged employee — to show up, be well, participate in his recovery if injured,” she said. “The thought is that a telemedicine program could help improve engagement. It’s also believed it will reduce health care costs and needless disability tied to a decrease in costs in fewer ER visits.”

Ongoing Concerns

Despite the potential benefits, there is little discussion about telemedicine in the workers’ comp system. About 16 states have adopted mandates for the coverage of telemedicine with few considering it specifically for their workers’ comp systems.

“Health care compared to other industries is a late adopter of technology,” Linkous pointed out. “On the other hand, there is resistance to change. Physicians are paid quite well, and any type of change like this is perceived as a threat.”

There is also the issue of privacy. Face Time and Skype, for example, are not HIPAA compliant.

“It’s one thing to have a talk when a patient instigates that on their own,” George said. “But if a payer facilitates it, you have to make sure the equipment is secure and appropriate.”

There is also the issue of interoperability. “The equipment could be at the employer’s, and the physician doing the exam must have the [right] equipment,” George said. “With the provider and patient link, who pays and how do you get the patient and provider together?”

George said Sedgwick is addressing those issues and is nearly ready to roll out a pilot program. Despite the concerns, advocates believe it is incumbent on workers’ comp practitioners to embrace telemedicine.

“There are so many advancements in medical care. Telemedicine is a part of those advancements that, while unique to workers’ comp and evolving, is a major part of consumers today,” George said. “They may be going out to find information on the Web, they may be going to a health group website and getting medical information. So it’s an advancement in medical care that is not going to go away.”

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.


Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.

R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.


We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?


Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.


Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now an where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.


More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]