Last spring, doctors’ offices across the country were eerily quiet. Almost overnight, patients stopped coming in as COVID-19, and the fear that the novel coronavirus begat, spread through communities across the country.
Healthcare providers quickly adapted. “We were able to pivot to using telemedicine as another mode in terms of connecting with patients,” recalls Thomas Caprio, M.D., a professor of medicine and geriatrics at the University of Rochester Medical Center in New York.
In-person visits didn’t stop altogether, of course, but they dropped precipitously while telehealth visits rose. In Q1 2020, telehealth appointments increased by 50%, according to the Centers for Disease Control and Prevention. In the last week of March alone, they were up 154% compared to the same period a year earlier.
As the weather warmed and cases declined, the telehealth spike deflated somewhat; the number of virtual appointments declined while in-person visits ticked upward. But with the arrival of colder weather and a second COVID wave, telehealth surged anew.
Despite the unprecedented number of confirmed cases in the U.S., more people are opting for in-person visits compared to the spring, when less was known about transmission. With widespread vaccination distribution in sight, the question becomes: What’s the long-term state of the telehealth union? Is it where its boosters or skeptics believe it to be, or somewhere in between?
“Our prediction is that the market has fundamentally changed,” says Peter Alperin, M.D., an internal medicine doctor in San Francisco and VP of product at Doximity, a social network for physicians.
According to Doximity, before COVID-19 less than 10% of doctor appointments were virtual. In its 2020 State of Telemedicine Report, the company predicted that telehealth appointments will account for 20% of all medical visits in 2020, representing $29.3 billion of medical services. Doximity projects that figure to increase to a whopping $106 billion by 2023.
Caprio’s personal experience broadly aligns with this. While telehealth usage remains elevated compared to pre-pandemic levels, during the summer and into the fall most of his patients wanted to come see him in-person. His wife, a nurse practitioner, has noticed a similar trend among her patients. Overall, telehealth has proved itself to be, if not a game changer, then “another tool in our toolkit,” Caprio says.
With the long-term impact of telehealth still very much open to debate, marketers in and around the field are navigating a new landscape. For some, including brands firmly in the telehealth space, the moment presents a golden opportunity.
In September, SmileDirectClub, which sells teeth-aligners online, partnered with Meredith’s Foundry 360 content studio to launch Telehealth Explained, a mostly unbranded platform that provides information on telehealth offerings. The aim was to “explain to people what is available and normalize it,” says SmileDirectClub CMO John Sheldon. “We wanted to make sure that it wasn’t someone just shoving a product down their throat. We worked hard to be pretty subtle about our brand in that mix.”
The transition created different types of challenges for others. Point-of-care marketers and networks, which traditionally relied on in-person office visits, came up with a variety of telehealth offerings. For example, Health Monitor Network sent condition-specific educational material directly to patients, while InStep Health put QR codes on in-office material so people could pull up relevant educational and promotional information on their phones.
Mesmerize took a slower approach. Currently, the company is experimenting with virtual telehealth offerings, including banner ads and targeted messaging that plays before virtual visits. It’s not selling them to clients yet, in large part because the telehealth market is so fragmented.
According to Mesmerize president and chief revenue officer Craig Mait, video platforms vary widely across hospital groups and individual practitioners, making it virtually impossible to offer clients telehealth marketing solutions at scale. “There are so many variables that need to be determined before we can understand how best to roll out this type of solution,” he explains. “It’s too early on our end to think about doing it in any meaningful way.”
How much marketers will need to adapt and invest in these solutions hinges on long-term telehealth adoption, which remains an open question. For providers and patients, it’s often a matter of personal preference.
When it comes to his patients, Caprio has yet to find a formula for determining who is or isn’t open to virtual visits. Ostensibly revealing indicators such as digital literacy and medical history don’t seem to have much of a determinative effect. Many patients who are tech-savvy and have a straightforward question prefer in-person visits; others who are less comfortable with computers and have complicated medical histories have few reservations about making the transition to telehealth.
Before COVID, Caprio was “ambivalent” about telemedicine. Now, he sees its distinctive advantages and believes that, for many medical needs, the visits can be just as informative as in-person ones.
“There is a lot I can do by observing patients on camera,” he says, pointing to depression screenings and cognitive tests. He adds that new patient visits rarely pose a problem, particularly when the patient provides a detailed medical history.
What’s more, Caprio has seen firsthand telehealth’s ability to increase access. Patients who were unable to make early morning appointments because of the commute or who might have canceled during poor weather conditions can now log in from home.
“We can meet with a patient and family and come up with recommendations and care plans,” Caprio continues.“I don’t want to do 100% telemedicine practice, but I can see this being a significant portion of what I do in the future.”
Of course, it’s important to note that telehealth doesn’t eliminate issues around access. A significant percentage of Americans, particularly those in vulnerable demographics and in rural communities, lack adequate broadband connection to support video visits.
And then there’s the question of coverage. In the spring, payers agreed to cover the full cost of a range of additional telehealth services. According to David Lindeman, director of health IT firm CITRIS Health, many of these provisions were enacted as waivers. As a result, it’s unclear whether they will evaporate once vaccines become readily available.
“It depends on whether the Centers for Medicare & Medicaid Services, the state governments and providers work together to make many of the changes permanent,” Lindeman notes. While a number of private payers “have moved in that direction,” Alperin adds, “Medicare is the 800-pound gorilla.”
Mental healthcare has proven a natural fit for a from-afar approach. On the other end of the spectrum are specialties such as oncology, which never saw a significant drop in in-person visits even during the spring of 2020. As for general practice, well, it falls somewhere in the middle.
Even a telemedicine booster such as Caprio can’t entirely hide his reservations. “I do have a sense of a loss of not being in the same room as the patient,” he says. “I can connect with them and I can see them, but it doesn’t quite feel the same as being in the same room.”
Trained in the art of physical examination, Caprio typically uses all his senses when examining a patient. “I’m not doing that to the same extent with telemedicine,” he continues. “There are trade-offs.”
Still, for Caprio, telehealth’s benefits — as a complement to, if not an outright replacement for in-person care — outweigh the costs. Going forward, he expects many providers and patients will opt for a hybrid approach.
Lindeman agrees. “I do think telehealth is here to stay. We have shown how effective it can be.”
What this means for medical marketers is that they’re unlikely to get a clear read on telehealth’s future anytime soon. While Mait and Mesmerize believe that in-person visits are a crucial component of any patient’s care regimen, he notes that the pandemic has forced the company to consider telehealth point-of-care offerings in a way it hadn’t before.
At this point, Mait adds, there are just as many questions as there are answers. “It’s a new frontier.”
A patient weights in on the benefits of virtual therapy
In the summer, I went to get my annual physical in-person; I needed to get some bloodwork done and the risk of traveling to my doctor’s office seemed worth it.
But ever since my therapy sessions migrated from in-person visits to telephone calls in March, I haven’t been back to my therapist’s office.
Overall, I haven’t found myself minding much. While I sometimes feel the loss of body language and the immediacy of sharing the same physical space with my provider, the phone lends an unexpected intimacy to our conversations.
For her part, my therapist has found virtual sessions more effective than she originally anticipated, both for individuals and, more surprisingly, couples. There are real benefits: In addition to the obvious convenience, many patients like conducting therapy sessions from the comfort and familiarity of their homes. There is also less of a need for transition. Because patients aren’t rushing to her office from the crush of midtown Manhattan, she can dive into the meat of a session more quickly.
Once vaccines are widely available, some clients will inevitably want to revert back to in-person sessions. But a significant number, my therapist suspects, will continue remotely. – LE
From the February 01, 2021 Issue of MM+M - Medical Marketing and Media