3 Things….the telemedicine edition
This week was the American Telemedicine Association convention. I know, right, telemedicine — the future and so 2014 at the same time. As with any new technology it has huge numbers associated with it (158m visits forecasted 2020!), but people are struggling with implementation reality (what’s the business model, how does it scale) and thinking that maybe it isn’t a thing but rather a category of things.
Here are 3 things from the convention
1. From sore throats to chronic disease management
Teledoc is looking at how to extend into chronic disease management (American Well eluded to something similar). Makes sense for lots of reasons — drives sustained use, opportunity to show actual cost benefits and a better use case for providers to state a few. The company is deciding whether their first foray will be into diabetes or heart disease.
2. So, about those cost savings…
When talking about employer interest in telemedicine as a benefit, UnitedHealth indicated that most (90%) of employers were interested in telehealth, but not really as a stand alone subscription. Because people don’t seem to really use it. And “employers understand that the cost differential between a virtual visit and an urgent care or primary care visit may not be as substantial as the cost savings they might see from presenteeism.” Presenteeism is when you go to work even though you’re sick and kind of worthless.* So it sounds like the benefit that they’re seeing isn’t on the cost side but is on employee productivity — a fuzzier, harder to quantify and attribute metric.
3. Expanding the reach of provider brands
American Well talked about their new marketplace. They white-label their telemedicine service. The marketplace helps insurance and providers negotiate rates so BCBS Illinois, for example, could give you access to a Mayo doctor. A multi-state licensure pact soon to be agreed to facilitates providers offering services across state lines.
Bringing these 3 together, maybe a year ago there was an article talking about how large employers, like Walmart, were flying employees to centers of excellence for specific conditions. They found that getting employees to best in class care decreased the overall health cost enough to cover the cost of a flight and lodging. I start to wonder if we’ll see something similar happen with telemedicine, where employers and patients chose the provider who does the thing I need the best.
If that happens how does value-based payment or population management work in a world where patients are distributed? How should providers think about their strategy — specialize vs acquire?