Telemedicine: The evolution of consumer-driven care

By Jonathan Nelson

Today’s patients prize access to care above all else. They want their care when and where they choose, and the more of that care they pay for out of their own pockets, the more demanding they become.

In a recent webinar on trends and projections for health care delivery, athenahealth executive vice president and COO Ed Park said consumerism among patients is driving disruption in how, when, and from whom patients seek care.

“If you ask patients what they care about in this day and age where everything is moving at hyper velocity, patients care most about access and convenience, even more so than service and affordability. Those certainly come into play but access is the dominant factor that explains why a patient will go to a certain location, particularly for primary care services.”

In an Advisory Board study published last year on the rise of consumerism in health care, patients consistently rated access and convenience higher than quality, affordability, and other attributes when deciding on a primary care physician. Of the practice characteristics respondents reported they cared most about, six out of 10 were tied to access. What statement received the most votes?  “I can walk in without an appointment and I’m guaranteed to be seen within 30 minutes.”

That is the defining characteristic of a retail health clinic. Is it any wonder the numbers of retail clinics, urgent care centers, and free-standing emergency centers are booming? Well-funded venture capital and investment firms are pouring money into these delivery models, but Park thinks this is just the beginning.

“What we see is that retail urgent care is just the first salvo. The next salvo coming along is telehealth, which is coming of age.”

The new generation of telehealth platforms is rapidly increasing in sophistication, with many offering instant high-definition video consultation. Companies like Doctor on Demand, American Well, meVisit, CirrusMD, and Teledoc—which went public this past summer—are rolling out marketing campaigns and negotiating partnerships fueled by significant private and venture capital investment. According to Ken Research, the telehealth market generated $9.6 billion in revenue in 2013, up 60 percent from the previous year, and the market is expected to generate annual revenue of $38.5 billion by 2018.

As patients get more comfortable receiving acute care services through telehealth interactions, the complexity of those visits is certain to increase. Couple these advancements with a burgeoning market for integrated personal health apps for smartphones and tablets like EKG monitors, blood pressure tracking, and more, and it’s a short hop to imagine the use of telemedicine to manage conditions like chronic diabetes.

“To see CVS partner with American Well, Doctor on Demand, and Teledoc tells you something,” Park said. “This is a market reaction, a capitalist reaction to real demand. … Developing an intentional strategy for how to meet these patients as consumers—patients as shoppers—where they are will be crucial.”

TAFP CEO Tom Banning agrees. How family physicians in Texas can incorporate telemedicine and compete in a consumer-driven market is top of mind for the Academy. “There are tremendous disruptive, competitive forces coming to the fore that doctors are going to have to deal with,” he says. “Physicians have an opportunity right now to start looking at this technology, how to implement it, put it into their office, how to engage their patients in using it before some very well-heeled entities come in and compete against those doctors.”

If implemented and utilized correctly, telemedicine could be a powerful tool to help physicians improve the quality of care they give patients while increasing their efficiency. Many patient visits in the exam room could be handled remotely via telehealth or mobile technology, saving resources and time for the patient and the doctor.

“To see CVS partner with American Well, Doctor on Demand, and Teledoc tells you something. This is a market reaction, a capitalist reaction to real demand. …Developing an intentional strategy for how to meet these patients as consumers—patients as shoppers—where they are will be crucial.” – Ed Park, COO of athenahealth

“Think about the inefficiencies and the cost of having a patient with a chronic problem who has to come into the office repeatedly for treatment, and what if that patient is fragile? Coming to a doctor’s office is not always easy,” Banning says.

As the health care industry moves away from fee-for-service toward value-based payment, telemedicine holds big potential for expanding access to after-hours care and keeping patients out of high-cost settings, which can be a huge help in achieving shared savings goals and other efficiency measures.

On the other hand, the speed of telemedicine’s growth and adoption constitutes a threat to physicians’ status quo. “When you look at where retail health is moving and the commoditization of health care services, there is a lot of interest from hospital systems, from private companies to move into the primary care sphere and essentially carve up services that I would argue should be maintained by the patient’s primary care doctor.”

Banning predicts as patients use more telemedicine and realize the benefit of not having to leave their home or office to go to a doctor’s office or even a retail health clinic, telehealth could render retail health obsolete. “How physicians get ahead of this trend is going to be critical going forward.”

TAFP is committed to helping family physicians realize the opportunities telemedicine offers. First, the Academy is working with health plans to ensure that physicians who want to provide telehealth services are compensated appropriately for doing so.

“There is no less cognitive skill used whether the patient is in your office or you’re treating them over a mobile or telehealth device,” Banning says. “The liability still exists.”

Secondly, TAFP will continue to ensure that patient safety is first and foremost, whether care is delivered in person in a clinic setting or via the use of telehealth technology. “Patient safety must be the cornerstone,” Banning says. Within that boundary, the Academy will work with the Texas Medical Board and other regulatory agencies to make sure physicians have the flexibility to determine what each patient needs, whether he or she can be treated using telehealth or whether the patient should come into the office.

“I think the real challenge is that the technology is growing at such a rapid rate that the regulations, the laws, and the reimbursement are having trouble keeping pace. But as of now the medical board has written very thoughtful rules that emphasize patient care and the importance of continuity.”

Lastly, TAFP will monitor the telehealth market and seek to evaluate vendors and technologies to help family physicians make confident decisions when implementing telehealth products and services.

For years the concept of telemedicine was stuck in a mire of regulation and technical impracticality, relegated to the list of potential solutions for delivering care to poor folks in far flung rural areas. With the rise of consumerism in health care, those days are over. Patients want instant access and they’re willing to pay for it. For them, telemedicine offers the greatest convenience. Physicians will have to find ways to embrace this disruptive technology to engage their patients in a new virtual paradigm.