While the word “telemedicine” was once considered a catch-all term for any type of healthcare service administered remotely, it’s become evident over the last decade that the word can be applied to the myriad virtual care services, tools and companies out there today. So in effort to get an idea of where the industry is heading in the next few years, a panel at the American Telemedicine Association’s conference in Orlando this week put three CEOs heading very different companies in the hot seat to get their take on the future.
“We can look around and see a lot of hype, so many amazing ideas and innovations, but when you push, you have to ask how many patients are actually treated through telemedicine. A lot of companies are still in their infancy,” moderator Dr. Ateev Mehrota, who is a professor of medicine at Harvard and a hospitalist at Beth Israel Deaconess Medical Center, said. “But online consultations are showing some real numbers, with a million or a million and a half visits conducted in 2016. But as great as that sounds, in the grand scheme of things, we have around 1 billion in-person visits per year. So how does telemedicine grow and catch up to that level?”
Scott Decker, CEO of telemedicine platform provider MDLive, said the main macro-level challenges affecting the telemedicine industry are the same as those in traditional healthcare, with cost barriers and a lack of primary care providers. From there, he says, telemedicine companies can rise up to expand the ideas people have around how to manage their wellness.
“We take this low-acuity business we started, but now we need to start thinking about how to push the envelope,” Decker said. “How comfortable can we make people? That comes from trying things and seeing if [users] are satisfied with new technologies like connected devices. I don’t think people get excited to go to the doctor or hospital, just like I don't think people get very excited about going to the bank or the mall, but they will embrace new tools to do these things. I think we're just at the cusp of saying telemedicine is proven, but I think now is the time we can be bullish and start to get aggressive about seeing what consumers might be interested in.”
For Hill Ferguson, CEO of app-based telemedicine provider and platform Doctor on Demand, his company is heavily focused on building their own brand and being seen as the main contact point for their services. Rather than just providing the technology, they want to be synonymous with quality healthcare and ongoing value.
“Our mission at Doctor on Demand is to take what is a transaction based consumer experience and evolve it into a relationship-based one that keeps building,” Ferguson said. “One of the things I do every morning, without fail, is go through all of our customer reviews. One of the themes emerging is, ‘That was great, I wish all doctors, etc.’ This is becoming more and more frequent, because people try, and they are like, ‘Hey, this actually works, it’s not just a doctor, but a good doctor, and how can I start engaging in my health more?' So our vision for the next three to five years is you will be doing more and more visits.”
On the opposite end of the spectrum, American Well CEO Dr. Roy Schoenberg says while his company is certainly riding the wave of telemedicine growth, they don’t see themselves as the primary face of the service. Rather, American Well seeks to be a technology provider that allows for integration of new devices, virtual visit modalities and information systems.
“I do agree that branding needs to be in the front, because the brand is something that creates trust, legions, and becomes something that people come to expect more from. And I think that's fine and healthcare should come with a brand, but I just think the brand shouldn't be a software company. I think the brand of healthcare should be all healthcare entities,” he said. “As long as what you offer is incredibly new and different that has never been done by traditional healthcare entities, then I think it's ok for us to do it under our brand. But really simply, in the world where every health plan is beginning to offer virtual healthcare services, I think the use of those healthcare services under a software company brand becomes gradually less important.”
That being said, Schoenberg does believe the industry itself will continue to grow, but perhaps not in the way some may foresee.
“I don't think growth will be directed to telehealth products. I think the way growth is going to come, is the integration of telehealth services, which will more and more represent the usual suspects of healthcare,” he said.
As technologies get better and more widely adopted, Schoenberg thinks people will interact with them more and more not as standalone device or telemedicine technology brands, but through their familiar insurance providers, health systems or hospitals.
“Technology will retreat to the back as an enabler for Americans to interact with those institutions of healthcare,” he said.
Given the different perspectives on what’s to come, Mehrota asked the panel how all the different companies acting in the space go about developing their own business models.
For Decker, MDLive is embarking on plans and partnerships to allow for more data collection, analysis and sharing.
“I think we will see more integration, seamlessness, which will give us ability to do more data-driven models of delivery. Population health, right?” Decker said. “You are going to be able see massive amounts of data, you'll be able to sort through it and use it, you will have healthcare-oriented data companies that help us do that. I think it's a natural extension for telehealth companies, at least with our model. From a business model standpoint, I think that data moves us out of a transactional process to more of a value-building place.”
Ferguson said he would like to see better devices designed with the consumer in mind and smoother integration with existing workflows. As his company employs full-time physicians as well as part-time, he doesn’t like the idea of growing a large, disparate provider network so much as getting better tools that enable his own workforce to be more efficient. A big part of that would be integrating a remote version of services that need to be in-person, like lab tests.
“We’ve talked about the limitations of telemedicine, but we need to be realistic. Ask a different question: what is the resolution rate? Think about the fact that less than 10 percent of sore throats are strep throat. We don’t need to order enough for every kid, just 10 percent of them,” Ferguson said. “But we do need to build capabilities so when doctors feel that more testing is appropriate, we can get that done. “
Schoenberg pointed that many things will still need to be done in-person, and noted that telehealth cannot solve for all fragmentation problems.
“There are better ways of ensuring how that can happen, like with expanded physician networks, but I think the issue is actually much bigger. It's not about dispatching, who’s coming in, who's coming back. The biggest issue we have is that if a patient is seen by a clinician and any additional other procedure has to be done to establish a diagnosis. And forget telehealth, this is in all healthcare settings,” he said.
That being said, he thinks the growing sophistication of connected devices or at-home testing kits are definitely indicative of an evolving telemedicine industry that we can count on to keep moving forward.
“As technology improves, and more and more of these tests are valuable to the telehealth transaction, some of those tests become innovative enough and low cost enough to be able to do them in the home," he said. "I think the devices coming in and everything, these are the reflection: all of these devices wouldn't exist unless telehealth had grown in the last 10 years so that it made sense for a company to invent a telehealth-purpose device. The same thing is going to go for lab tests. You are going to see telehealth-purposed home kits for strep throat and UTI and a variety of diagnostic devices are going to surface, and that's going to be driven because of the telehealth industry.”