Weekend Big Read: will telemedicine do to retail healthcare what Amazon did to retail?

Updated. Our past contributor and TelehealthWorks’ Bruce Judson (ATA 2017 coverage) has penned this weekend’s Big Read in the HuffPost. His hypothesis is that telemedicine specifically will disrupt location-based care, followed by other digitally based care–and that executives at health systems and payers are in denial. More and more states are recognizing both parity of treatment and (usually) payment. Telemedicine also appeals to three major needs: care at home or on the go, with a minimal wait; maldistribution of care, especially specialized care; and follow-up/post-acute care. His main points in the article:

  • Healthcare executives are being taken by surprise because present digital capabilities will not be future capabilities, and the shift to virtual will be a gradual process
  • Telemedicine will address doctor shortages and grow into coordinated care platforms embedding expertise (via connected diagnostics, analytics, machine learning, AI) and care teams
  • Telemedicine will eventually go up-market and directly compete with large providers in urban areas, displacing a significant amount of in-person care with virtual care
  • Telemedicine will start to incorporate continuous feedback loops to further optimize their services and move into virtual health coaching and chronic care management
  • Telemedicine platforms are also sub-specializing into stroke response, pediatrics, and neurology
  • Centers of expertise and expert platforms will become larger and fewer–centralizing into repositories of ‘the best’
  • Platforms will be successful if they are trusted through positive patient experiences. This is a consumer satisfaction model.

Mr. Judson draws an analogy of healthcare with internet services, an area where he has decades of expertise: “A general phenomenon associated with Internet services is that they break activities into their component parts, and then reconnect them in a digital chain.” Healthcare will undergo a similar deconstruction and reconstruction with a “new set of competitive dynamics.”

It’s certainly a provocative POV that at least gives a rationale for the sheer messiness and stop-n-start that this Editor has observed in Big Health since the early 2000s. A caution: the internet, communications, and retail do not endure the sheer volume of regulatory force imposed on healthcare, which tends to make the retail analogy inexact. Governments monitor and regulate health outcomes, not search results or video downloads (except when it comes to net neutrality). It’s hard to find an industry so regulated other than financial/banking and utilities. FierceHealthcare also found the premise intriguing, noting the VA’s ‘Anywhere’ programs [TTA 9 Aug] and citing two studies indicating 96 percent of large employers plan to make telemedicine, also with behavioral health services, available, and that 20 percent of employers are seeing over 8 percent employee utilization. (Under 10 percent utilization gave RAND the vapors earlier this year with both this Editor and Mr. Judson stinging RAND’s findings with separate analyses.)

ATA2017 dispatch: Catalyzing telehealth innovation in hospitals

Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the second article this week from the ATA floor. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar]. His discussion with ATA’s Jonathan Linkous on business models for telehealth is here.

Orlando, April 25. At the ATA show, I stopped at Mercy’s booth, and spoke with Keela Davis, who is Mercy’s Executive Director, Innovation and Product Development. In the booth, was a large, inspirational display of Mercy Virtual’s high-tech, widely-reported $54 millionhospital without beds.” The facility is the nerve center for Mercy Virtual’s telemedicine programs, which include TeleICU (remote monitoring of ICUs by Mercy specialists) as well as multiple other remote services for patients in hospitals and at home.

A great deal has been written about Mercy’s groundbreaking service and large investment in this facility. I asked Davis what led to the decision to build “the hospital without beds.” She said that first, a lot of experience in telehealth proceeded the investment decision. Undoubtedly this experience was required to simply decide what should be built in a facility designed for the technology that exists today and that will undoubtedly accommodate new technologies as they arise. Second, she also said, that it reflected “a visionary” decision on the part of Mercy’s leadership to make this commitment. Now, in her words, the facility has become “a symbol of our work.”

As a student of innovation, our discussion was notable on several fronts:

First, Davis noted that now that the facility exists it serves as a catalyst for innovation. Mercy is actively considering, as might be expected, a range of new telehealth services. While Davis was quick to point out that the facility was not the only source of telehealth innovation at Mercy, she did indicate it’s the hub for innovative ideas and discussions. Organizations build on their experience, their successes, and the demonstrated commitment of management to move forward with good ideas. Mercy’s facility now provides the tangible place that facilitates ongoing growth. In short, after conquering the first level of innovation, Mercy is poised to march forward with new, groundbreaking services.

Mercy’s facility is also a warning to organizations that see the telehealth future, but hesitate to act. As Mercy gains experience, it will have a team that understands the many, complex aspects of assessing and bringing new services to market. Plus, many of the underlying capital and investment requirements associated with creating these services have already happened. In short, it will soon be difficult for other healthcare entities eyeing services in the same arenas to match Mercy’s innovation machine.

A analysis–and challenging takedown–of the RAND telehealth cost study (updated)

A must read on telemedicine and telehealth cost. One of our Readers, Bruce Judson, commented on our earlier coverage of RAND Health’s new study published in Health Affairs [TTA 8 Mar] finding that telemedicine virtual visits (here called telehealth) drove up utilization of care by 88 percent and cost by $45 per year for respiratory illnesses that typically resolved on their own.

He has written his own analysis based on the full study. Telehealth Costs: RAND’s Questionable Rant (Huffington Post), considers the full study and compares it to a 2014 RAND study by the same authors. Mr Judson notes inconsistencies in sampling and definitions; the illogical attachment of a waiting period cost (77 minutes=$30) to a telehealth visit (perhaps to level it with an office visit?); the misinterpretation of results; small sample size; and the fact that the CalPERS sample is ancient (2011-13), representative of a time when telemedicine (here provided by Teladoc) was a new notion. There are inconsistencies with an earlier RAND study based on the same data! (He does not count in costs outside the study such as lost time at work or the cost of spreading infection to co-workers.)

Mr Judson, after many years in publishing, digital marketing and strategy (from when it was called ‘new media’), and currently an advisor to a UK firm investing in IoT, has cast his lot with us in health tech, heading a firm in the Hudson Valley of NY, Telehealthworks, which markets an employer telemedicine and wellness program called freshbenies. While he discloses that he’s not a disinterested observer or researcher, he has that in common with most of our Readers, who are very interested in determining the truth about costs and savings. He gives many reasons to be skeptical of the RAND findings.