Photo credit: Duane Storey/Creative Commons
Telehealth’s potential to transform and enhance healthcare delivery reads something like a top-ten list of no-brainers: convenience, timeliness, and cost savings, to name but a few. At times it sounds almost too good to be true. So does the experience live up to the promise for all parties? Better yet, could telehealth become an evolutionary pathway for something even more profound?
Telehealth is generally defined as remote interactions between providers and patients, usually delivered via a videoconferencing platform on a connected device or a computer. Although the practice is still in its early stages, it’s building momentum — with good reason.
“In the U.S. it takes 21 days to see a doctor,” says Mike Putnam, SVP, consumer marketing at American Well. “With our system, you can see a doctor generally in less than five minutes.”
American Well is one of a clutch of telehealth companies offering their platforms and services as a benefit via the various health systems, health plans, and employers with which they partner (although some also offer a direct-to-consumer solution).
“We view this as partnering with systems and plans, not disrupting them,” says Putnam. “So we integrate with many existing parts of their core practice, whether it’s EHRs, billing and payment systems, or claims eligibility.”
That’s no easy undertaking. In fact, there have been, and continue to be, a number of obstacles to building scale in the sector, not least of which is the regulatory landscape. Just a few years ago, telehealth for urgent care was legal in only 15 states. Today American Well delivers services to 47.
“Although it’s seen as having low barriers to entry, it’s really a challenging industry to scale, and especially to scale in a way that meets consumer expectations,” says Stephany Verstraete, Teladoc’s CMO.
See also: Point of Care: Point of Where?
Teladoc was the first company to offer telehealth solutions, way back in 2002, and Verstraete saw the benefits of the platform firsthand when her son became sick and was seen remotely in the middle of the night.
Her story is typical for first-time users, whose initial experience is oftentimes to seek off-hours urgent care. But another potential benefit of telehealth is reducing the volume of unnecessary ER visits, which obviously translates into significant savings.
In fact, Teladoc estimates that it saved its client partners a total of $387 million in 2015 by eliminating thousands of such visits. And at the employer level, Teladoc says it saved Penske Truck Leasing $1.023 million and EMC Corporation $627,000 in 2015.
CHALLENGES BIG AND SMALL
Both Putnam and Verstraete point out that consumers are still largely unaware of the availability of telehealth services, but when they try it for the first time they are usually impressed. Teladoc claims a 95% satisfaction rating among customers and reports that it is on track to clock around 900,000 consults this year (versus 575,000 in 2015). So the needle is moving.
One well-publicized hurdle to building scale has been the relatively low participation of physicians, particularly as telehealth services continue to expand from primary care and urgent care to specialties such as dermatology and behavioral health. Aside from time constraints, one root cause may be reimbursement issues. In a recent survey by the AAFP and the Robert Graham Center, nearly nine in ten family physicians said they would use telemedicine as a tool to treat their patients if they were compensated for it.
Then there is the question of insurance coverage for patients, although that too seems to be gaining momentum. “The market has gone from less than a million covered lives to more than 40 million in just the past couple of years,” notes Putnam.
But telehealth holds greater potential than merely offering a substitute for in-office consults. Milton Chen, CEO, VSee, a telehealth engineering company, believes the true magic happens when you can plug devices (read: data) into the interface.
“It’s about transforming every aspect of the healthcare system into digital,” Chen explains. “You need to combine the consult with devices and [extended] care, then you have the complete telehealth experience.”
When it comes to handling data, Chen is a proponent of machine learning. “It’s not practical to have people look at this data,” he says. “Artificial intelligence must look at the initial crunch, then you introduce people.” (VSee is the exclusive provider of telehealth services to NASA’s International Space Station.)
ON THE VERGE?
Chen believes that in the next two to three years, telehealth will become an everyday experience and that every system and every plan will offer it.
“To build scale,” Verstraete adds, “we must continue to make the system more robust, commoditize cheap and accessible devices, and integrate them.
“The promise of telehealth is that it flips healthcare on its head as we go from a provider-centric to a consumer-centric model,” she notes. “The value and the services that are delivered today are really the tip of the iceberg. What’s exciting to us as marketers is the opportunity to apply predictive analytics — to really look at the marriage of analytics and digital.”
This type of forward thinking has been a primary focus of PatientsLikeMe in serving members of its patient platform over the past decade. Rather than replacing one-to-one consults, CEO Martin Coulter sees telehealth as an integral part of connected health. Indeed, he views it as a technological pathway for reinventing how care will be delivered someday and for evolving toward an ecosystem of data-driven continuing care based on characterizations of patients.
“The synchronous one-to-one model is going to feel almost as outdated as leech therapy,” he predicts. “We’re going to start seeing how the different data sets that characterize each one of us can begin to form the basis of machine learning.”
Combining experiential data with biodata will give physicians and patients powerful tools for delivering effective continuous care — a game-changer, particularly for patients with chronic complex conditions.
“It won’t be much longer,” says Coulter, “when we’ll realize, ‘Gosh, there is a way of monitoring people as a health avatar,’ and that becomes the thing that everybody can relate to. It will feel as easy as the first time you used Airbnb or Uber. The question is, How democratized will this information be? And how empowered will the patient be in terms of having access to this information and being an active piece of that continuous care puzzle?”
Another question that has yet to be answered: Where does pharma fit into this equation? “Pharma is trying to figure out both how to play in the current system and how it might play a role in this continuity care model,” says Monique Levy, SVP, head of customer strategy and value delivery, PatientsLikeMe.
“In the near term, [companies] are concerned about being disintermediated from that point of care,” Levy continues. “They are trying to figure out how to get as close as possible to that digital consult. The fundamental question? How will a marketer interact in a world where we are basing decisions on predictive analytics and database decision-making?”