North Carolina health system Cone Health argues telehealth rapidly becoming table stakes

By Jonah Comstock

Remote medical visit services are rapidly becoming commoditized, according to Dr. John Jenkins, VP of Telehealth and Executive Managing Director of that Primary Care Collaborative at Cone Health, a health system in Greensboro, North Carolina.

“How many of you ever went to a hotel before there was free internet?” he asked the crowd last week at the mHealth and Telehealth World Congress in Boston. “How many of you would be irritated now if you had to pay for internet in a hotel? Right now it’s moved from a pleaser to a satisfier. And it’s moved almost to the line where the absence is an irritant. What we find now in healthcare is that access and convenience are a satisfier, and they will soon move to the point where their absence is an irritant.”

Since telehealth is rapidly becoming table stakes, Jenkins offered advice about rolling it out, based on Cone Health’s own experiences. 

“Your strategy should be integrated,” he said. “You have to make sure telehealth isn’t a standalone strategy. It is directional. You need to have a takeoff point, milestones, and a destination for where you’re taking the organization to be financially successful. And it has to be open-ended. You have to leave room for the unknown unknowns. Because somebody might come along and create Siri for healthcare and that’s going to be a game-changer.”

Cone Health started with acute care and started their acute care infrastructure with asynchronous eVisits that were already built into their Epic EHR. Then they hired a consulting firm to help them select a vendor for video visits, ultimately settling on MDLive.

“We want to build, this is very important, a seamless customer experience,” Jenkins said. “So when you land on any of our pages, you have options. If you can’t have call-ahead seating at a retail clinic that suits you, you can have a video visit. If a video visit is inconvenient because there’s a lot of people around you, you can have [a written exchange or] an eVisit. And so we wanted to have options for our consumers, and our consumers feel we provide them with the care that they need.”

They priced their video visits at $30, toward the low end of the market, because they banked on making the money back via cost avoidance. And that strategy seems to be working — surveys of patients using the telehealth services show that 61 percent of those who received telehealth care would otherwise have gone to an ER, urgent care, or walk-in clinic. And because some of the telehealth services are embedded in Epic MyChart, promoting telehealth also helped the hospital increase patient portal adoption.

Cone Health doesn’t plan to stop with acute care. Jenkins outlined an extensive ongoing future strategy for telehealth including kiosks, apps for chronic disease management, and remote monitoring with wearables. One  small 12-week trial, using an app for diabetes management, led to an average of 1.35 reduction in A1C, an average 12 pound weight loss, average increased steps from 2,000 to 3,400, and increased medication compliance from 45 to 74 percent.

Jenkins also talked about remote monitoring using devices from iHealth and Withings as well as smart inhalers for COPD and asthma. 

“When I manage a diabetic, I get an A1C and a fingerstick,” he said. “When I manage a diabetic virtually I get longitudinal data for their readings for a 30 to 90 day period and I can compare it to other data — 'hey, your glucose went up when you’re activity went down.' I can help patients see their treatment and I can help them see the answers to their problems. And that’s what we call fully connected care.”