By Albert DiPiero MD MPH
Everyone is pushing telemedicine as the best solution for convenience and cost in healthcare. As this article notes, Walmart has reduce the cost of telemedicine visits for its employees from $40 to $4 per visit. And “Eighty percent of mid-size and large U.S. companies offered telemedicine services to their workers last year, up from 18 percent in 2014…” (Telemedicine in this article mostly means patients connecting directly with a clinician through a secure video link). In addition, drugstores such as CVS and Walgreens are “promoting apps that let customers connect to doctors,” and insurers such as Oscar are offering telemedicine visits for free to its members. But patients are not taking this up! Only 8 percent of eligible employees used telemedicine at least once in 2017, most recent figures show. What is going on? In a world of Amazon, Lyft, Netflix, why would people continue to drive into to mostly dysfunctional doctors’ offices in order to get care that could be one-click away, in the comfort of their homes? Based on our personal experience running clinical businesses that included telemedicine, I believe the reasons are multifactorial and hold real lessons for healthcare entrepreneurs: first, in the examples above, most telemedicine care is being pushed by employers, insurers and other companies (such as drug store chains) who are not the epitome of beautiful user experience. These pushers of telemedicine also have serious ulterior motives for fostering telemedicine, and I suspect patients sense that. In addition, telemedicine in these cases are provided by third-party companies that distinct from a patient’s usual source of care. In fact, we know that some insurers will not reimburse a patient’s primary care doctor for video visits because the insurer has an exclusive contract with a third-party telemedicine provider. Until telemedicine is fully integrated into a patient’s usual sources of care, I believe the barrier to trial and switching will remain higher. Next, barriers to implementation remain high: state laws and insurance reimbursement for telemedicine have not yet caught up with the technology. Insurers continue to oppose any expansion in supply of care through misguided beliefs that giving patients more care options will just lead to increased spending. Result: your doctor is not going to take up telemedicine. Finally, maybe video is not the killer app in this case. There are probably other version of “digital” delivery of care which should be explored. More on this later. But despite all of the barriers, I remain very bullish on the eventual future of digital methods of receiving care. For the appropriate clinical scenarios is better for patients, better for providers, and can be delivered at a reduced cost. Most of my faith in this method of care rests on my belief that healthcare entrepreneurs will address the challenges and invent a superb experience that is integrated into usual sources of care at a novel price. (This article is also a great source for list of the top providers of telemedicine vendors).