The 2nd Telehealth Failures & Secrets To Success conference was another awesome event! A big thanks to everyone who came out to support the event and support telehealth. Last year we asked “Why do 95% of digital health startups fail?”
This year, we wanted to think about telehealth adoption in the context of “How can we cut healthcare costs by half?” and how to create a health insurance blueprint that Amazon would love.” Here are 7 key ideas we took away from the 2017 TFSS Telehealth Conference.
1. Patients want telehealth
Most providers don’t like to think about the business side of healthcare, but patients are also health consumers and if they can’t get what they want from one provider, they’ll look for it elsewhere. Savvy providers realize this and are finding ways to get patients what they want. And what patients want is greater involvement in their own care, immediate feedback and anytime access to their providers. As both a cancer survivor and a medical doctor, UCSF’s Aenor Sawyer sees both sides of the coin. She says, “Patients expectations have risen. Patients want real-time feedback [and] access to 24/7 care because they are getting that kind of service in other parts of their lives.”
Karyn DiGiorgio from the University of California (UC) health system also sees this trend and makes it clear that the UC health system sees telehealth as an important strategy for staying competitive in today’s healthcare landscape. She notes, ”We know there is demand for people to be able to access in a timely manner healthcare.” The challenge for them is getting telehealth implemented before other innovators like Cleveland Clinic and Mayo Clinic steal the bread. It’s clear to them that providers who don’t meet these changing patient expectations can expect to lose business.
2. Use telehealth as a marketing strategy
Increased out-of-pocket spending and value-based care is going to start reducing reimbursements and to chip away at current revenue flows, so health systems and providers need to be ready to make up the loss with increased patient volume.
Dr. Steve Ambrose from RED HOT Healthcare explains that this means getting into a consumer mindset. Stop assuming that patients will come to you and start going after patients, even competing for patients. Understand how you can draw patients into your system, what problems you are solving for them such as convenience. While telehealth can be a cost effective substitute for a doctor visit and a great way to coordinate care, it can also be effectively used as part of the overall package to help health systems grow in the future. Use telehealth as a marketing tactic.
Also consider this tale of two hospital call centers examined by executive healthcare consultant and recent Mercy Health VP Cheryl Kreider: Once upon a time there were two hospital call centers with high phone call abandonment rates – one at 15-20% and another at 23-29% (global abandonment rate is 5-8%). By a conservative estimate, these two hospitals combined were missing out on $2 million worth of revenue by simply not returning phone calls. Isn’t that just poor business practice? As health costs rise, hospitals can’t assume patients will simply come to them.
The point is healthcare needs to start rethinking how it acquires and serves the life cycle of a patient by better understanding the patient as a consumer.
3. Use telehealth to build community
Perhaps one of the reasons telehealth isn’t sticky is because we think of them as one-off visits or as 1-on-1 interactions.
DaVita telehealth director Sigi Marmorstein believes that the missing ingredient is community. She proposes that if we can create a community around our telehealth programs, then patients have something important enough to them that they will want to be on your telehealth platform.
She believes we need to create a supportive online space for patients, not simply to see physicians, but to talk about their specific issues and to learn from other patients.
They need a community of health educators, advocates, physicians, and most importantly, patients who have gone through what they’re going through so can feel like they’re not isolated and have a sense of belonging. If we can provide that in a telehealth system, then we have really given patients something of value that they will want come back to again and again.
4. “Workflow is king” for telehealth success
Another key takeaway to getting telehealth growth is putting workflow before technology. We’ve been warned before about implementing technology just because it seems cool or useful (like EMRs).
But even if technology is the best way to solve your problem, you must consider the reality of the people who will actually be using it to successfully implement. It’s necessary to fully understand how does your clinic or facility run? What steps do providers go through to see a patient? How do their staff prep and help follow-up on patients?
CEP American Chief Transformation Officer, Rick Newman, MD emphasizes, “If the workflow of the telehealth technology does not fit into the workflow for patients, for staff, for providers, it’s not going to get used” and that, of course, provides no value to anyone, “The technology needs to fit in with the workflow, not the other way around.”
We tend to make way too many assumptions when it comes to telehealth adoption. While it’s important to think about the patient experience, it’s equally important to think about the doctors, nurses, medical assistants, and staff that are on the other side of the equation.
The more disruption telehealth causes to the established routine and procedures, the less likely it is to get adopted. Harry Rosen notes in his experience with Department of Defense providers, if they can’t use it in 10 seconds or less, it isn’t likely to see much adoption.
Technology needs to be hidden from the workflow.
5. AI & symptom checkers are expanding the telehealth toolset
AI is going to be an essential piece to growing telehealth. This is because of the provider scalability issue. Director of Innovative Surgery at Stanford, Professor Homero Rivas, MD pointed out that the biggest problem with the traditional practice of healthcare even up to today is that it’s not scalable. We have amazing technology that let’s us do surgery from a distance and perform operations without cutting open the body but we have a very limited number of physicians who can see patients and each physician can only see a limited number of patients each day.
With AI, symptom checkers, and automated processes, some pieces of healthcare suddenly become very scalable. Grunt work and repetitive processes can be done by AI, thus freeing up a physician’s availability to see more patients. More importantly, AI has the potential to create greater patient engagement. It allows a physician to engage with a patient right away, to provide the answers and resources to common questions without compromising the quality of care. As UCSF’s Aenor Sawyer, MD explains,
“if we can turn them into engaged patients we don’t have to be giving them information all the time…we can guide them to places, we can set up automated processes to give information pertinent to them and move them from being an overwhelmed patient to the excited engaged patient.”
AI is what makes this possible.
Compassionate AI in Action
An impressive example of this was Lark’s compassionate AI provider for chronic disease management. Lark CEO Julia Hu set out to recreate for everyone her experience with her own childhood doctor. He met with her every week as she was growing up teaching, supporting, and encouraging her how to manage her own chronic health issues.
“But,” she asks, “How do you extend that great relationship that you have with a doctor or nurse and put that in your pocket? How do you have a 24/7 doctor or nurse that’s infinitely scalable and the only way we came up with is AI. You have to do this through AI.”
6. Telemedicine Needs to Find Ways Around the 17-Year Healthcare Implementation Cycle
We need to get a lot more creative about finding ways to make telehealth happen. 17 years is an unacceptably long time to start using a tool that’s available now. We all know that doing telemedicine is not a cakewalk – from getting paid to finding the right technology. But what we’ve learned is that it can be done, and it can be done profitably. However, it takes commitment with a capital “C” as well as community, and a willingness to learn from mistakes.
Alternative Telehealth Revenue Models
Consider Solera Health, which is finding win-win alignments among health plans, plan members, and telehealth services. It has created a many-to-many marketplace that hasn’t existed before. More importantly, it has found a way to eliminate the regulation around allowing telehealth to be paid for by medical claims. It can do this because the payer is paying for a service – that is, they’re paying for a CPT code to deliver a service regardless of how that service is delivered.
7. Use telemedicine to leverage Talent As A Platform (TAAP)
So we mentioned earlier that we have a physician shortage problem. Maybe the problem isn’t a physician shortage issue but a physician time issue.
What if we could somehow harness the time of physician moms who are choosing to stay at home a few years? Or the time of hospitalists during one of their off-weeks? Or the time of physicians who have a no-show? That’s what This American Doc sets out to do.
In the past there was no way to hire physicians in smaller slices of their time and no way to bundle these slices into usable physician services. But with telemedicine, platform technologies, and sharing economy models (such as Uber, Lyft, Airbnb, TaskRabbit…) the time is now ripe for all this to happen.
What if a someone who needs physical therapy could get their physician referral through a telemedicine visit in 10 minutes instead of taking off half a day to schlep down to a doctor’s office? What if we could use telemedicine physicians to divert unnecessary ER visits? What if hospitals could use telepsychiatrists to get ER patients with mental health problems immediately evaluated and transferred to the right facility? That’s what a b2b telehealth physician marketplace, such as This American Doc does.
These are just a few of the problems in our healthcare system that we could start solving when we start to leverage telehealth.