Guest editor Sarianne Gruber (@subtleimpact) attended May’s d.health Summit on Aging in NYC. She reflects on moderator Christina Farr’s (immediately prior) direct experience with a virtual visit (convenience, proactive care–and utter frustration with her payer) and what the telemedicine ‘next gen’ provider panelists see as their advantages in fixing a fractured healthcare system.
Christina Farr had a “Next Generation” house call for the first time. The on-demand doctor’s visit provided her care and resolved the possibility of a trip to the emergency room, and best of all she felt great. Ms. Farr, an award-winning health and technology journalist, happen to have had her encounter just days prior to the d.Health Summit. Coincidentally, she was to be the moderator for a panel of prominent telehealth business leaders on this very topic. Curious after having had this experience, she wanted to know whether most cases were like hers wondering if they should go to ER, or were the visits more for routine things like coughs and colds, or did people just want a prescription. The d.Health panelists included Damian Gilbert, Founder & CEO of TouchCare (@touchcarehealth), Oscar Salazar, Chief Product Officer and Co- Founder of Pager (@getpager), Dr. Ian Tong, Chief Medical Officer of Doctor on Demand (@drondemand), and Dr. Roy Schoenberg, Co-Founder, and CEO of American Well (@americanwell).
Urgent Care: Convenience, Comfort and Access to More Services
“Most people say it’s easier to get service from a pager than an appointment from their primary care doctors,” shared Oscar Salazar. He sees “two buckets” why people connect to his services – convenience and comfort. For example, a single parent of two kids may have one that is sick would need a doctor to come to the house. He also sees people who are scared about a diagnosis like cancer and don’t know what to do so they go on WebMD, then use Pager to access a doctor in real time. “Think about it,” explained Salazar, “you want to get health care, and this is what people are used to living in this country. So from our experiences, they want answers to a problem. They want to feel that there is somebody outside that cares about their health care. There is a human psychological factor that plays an important role with this. People keep coming back.”
In the context of a broken healthcare system, Dr. Ian Tong’s patients are usually informed consumers looking for convenience or those who are scared and worried about their medical condition. They look for apps for very quick and easy access to high-quality medical care. Right now, Doctor on Demand practices is expanding as patients have begun using them for more complicated, complex medical problems and a boarder spectrum of medical problems. Having beginnings in urgent care, now they have psychology and psychiatry services for their patients. “They are telling us they want more things through this model and platform to improve their access,” stated Dr. Ian Tong.
Failure and Frustration at Integration
Ms. Farr tried to integrate the house call with her insurance company. She kept texting and messaging, but her attempts were not working. She called the customer service line and asked how come you can’t check if United will cover this, and the rep replied with a rather spurious answer that United Healthcare Services tends to go down on weekends. She did get a medical record sent to her from this one visit, but it did not integrate with her existing medical records. She asked the panel should we be trying. Dr. Roy Schoenberg addressed the question. He acknowledged the challenge is when you try to integrate those things into the way the health plans work and in some cases into EMRs. He explained that these systems were never really built to live in the day and age of immediate service, or immediate transfer information. Integrating is extremely expensive. That’s why organizations going into telehealth need funding in the hundreds of millions of dollars to create this new way of care delivery. “It is not an easy thing to do. The good news, however, literally in the last year or two, is that the people who run those giant organizations have stood up on stage and said yes we will connect our systems. This is going to be part of our future and is going to be part of healthcare delivery, both for urgent care as well as follow-up care. If we are a large insurance company than we are going to do it quicker than the other guy, we will prevail in the market. So the message is, the music is now going the right way, changing the systems usually another take a year or two,” concluded Dr. Roy Schoenberg.
Next Generational Care: Experience or Technology
What does it mean to be next generational? Will it depend on experience or technology? Here are some notable comments:
Damian Gilbert sees the next generational piece as how it works for the mobile consumer, whether it is the provider, the nurse, the midlevel or the patient. TouchCare thinks mobile consumers have to be in tune with it. His stance is not to go build some enterprise software suite that requires 100s of thousands of dollars of consultant implementation, but you want to be Dropbox and or Box then a rack of Microsoft exchange service. He added, “That’s the way to think about the world.”
Dr. Roy Schoenberg predicts we will begin to view telehealth very differently as more new generational telehealth solutions surface. Telehealth will become an extension of the traditional healthcare system; much closer to the patient. The healthcare we like and trust, the brands we know, and the physicians with whom we have relationships is delivered via telehealth. From his perspective, telehealth has the biggest ROI but it will take heavy lifting to get coverage, and in reality, this is the biggest challenge. Dr. Schoenberg maintains that “right now, telehealth has to somehow escape from the notion that telehealth is all about convenience and care getting a physician like a blind date and getting a Z-Pak. But gets to the understanding that telehealth is an extension of healthcare that through technology gets to where we all are. In the end, the health care system is there to serve us all.”