Delivery of care remotely with the use of telecommunications is a rapidly growing segment of the health care market.
According to the American Telemedicine Association, there are about 200 telemedicine networks in the U.S., with 3,500 service sites.
A host of private companies sell telemedicine services that offer around-the-clock access to physicians who can provide remote medical exams and prescribe medications.
Companies such as Doctor on Demand, American Well, MDLive and Teledoc market directly to consumers but are also increasingly included as part of benefits packages offered by employers and insurers.
Health systems use telemedicine in varying degrees to provide care in remote parts of the country and around the world, as well as to augment care and convenience for existing patients.
For example, the University of California-Los Angeles is making its physicians available through LiveHealth Online via mobile phone, computer and tablet. Like many remote physician services, the goal is to provide convenience to busy patients with minor ailments who don’t have time to get into a doctor’s office.
Beyond its recent participation with LiveHealthOnline, the UCLA health system has for some time been deeply involved in telemedicine for a wide range of specialties, including psychiatry, pediatrics, addiction medicine, cardiology and neurology. Home monitoring for patients with chronic illnesses, such as COPD and soon for late stage liver disease, is also part of UCLA’s offerings.
“For population health, it gives us the ability to expand our reach but in a convenient way,” Peter Kung, director of strategic technologies for the UCLA Health System, said. “People don’t have to drive in L.A. traffic for a cold and cough and we can uphold quality.”
The health system has been deeply involved in telemedicine for a wide range of specialties, including psychiatry, pediatrics, addiction medicine, cardiology and neurology. Home monitoring for patients with chronic illnesses, such as COPD and soon for late stage liver disease, is also part of UCLA’s offerings.
“We use telehealth as a supplement and not a replacement of delivering health care,” Kung said.
Consumers Want Convenience, Fixed Prices
Health systems, insurers and private organizations are all responding to increasing consumer pressure for convenient, affordable alternatives to the traditional doctor’s office visit.
“Over the last 10 to 12 years, we’ve been on a big wave that is helping to get certain visits out of the doctor’s office,” said John Backus, founder and managing partner of Reston, Va.-based venture capital firm New Atlantic Ventures.
Services offered to consumers through private companies either directly or through their insurer generally come with a flat fee of $40 to $50 for a 15-minute visit.
Patients are able to connect with a licensed physician, usually within a few minutes, by smartphone, tablet or computer. During the visit, a doctor can evaluate symptoms, offer a diagnosis and provide a prescription if needed.
The predictable costs and convenience of these services are a hit with consumers.
“The consumer voice is very clear,” said Roy Schoenberg, CEO of American Well, which powers and provides remote on-demand doctor visits. “Most people say, ‘Where have you been all my life?'”
Adam Jackson, CEO of San Francisco-based Doctor on Demand, said he has consistently seen the same enthusiasm from users of his service. “From a consumer stand point there is a ‘wow’ factor. Reviewers say, ‘I can’t believe that worked,'” he said.
Saving Money, Providing Access
In a world of increasing health insurance deductibles and other out-of-pocket expenses, the predictable cost of online treatment for common ailments is appealing to consumers. And it may well be that a flat-rate $40 online visit with a primary care doctor is less expensive than heading to the office of a physician contracted with a patient’s health plan.
Telemedicine also has the potential to save the health care system money. According to a recent report by consulting firm Deloitte, globally there will be about 100 million e-visits by the end of this year, which could possibly save $5 billion compared with the cost of in-person doctor visits.
ATA notes that PubMed includes more than 12,000 citations of published works related to telemedicine or telehealth. Compared with traditional approaches to care delivery, most studies find that telemedicine saves money for patients, providers and payers.
In addition to cost savings and convenience, when incorporated into work-based health benefits, telemedicine helps to shift care to lower-cost health care settings and improve employee productivity, experts say.
“In some areas where there aren’t a lot of options, people will go to the emergency [department] for sinus infections. Our $40 visit is a lot better than a $200 urgent care or $1,000 [ED] visit,” Jackson said.
Online access to medical services also can help to offset the effects of limited access to physicians in many places around the country. According to a recent report by physician search firm Merritt Hawkins, the average cumulative wait time to see a family physician in 15 markets is 19.5 days. Many commercial telemedicine services are able to connect consumers with a primary care physician in less than two minutes.
Jackson says there are benefits for both employers and workers in addition to direct cost savings by treating people in less expensive settings.
“If you think about a telemedicine solution like ours, it’s really providing care in some cases for a condition that may have gone untreated, which really dramatically increases productivity,” he said. “There are all kinds of great productivity gains associated with providing employees better access.”
The Long-Term Picture
As a sign of this quickly shifting market, Schoenberg pointed to new telehealth recommendations passed earlier this year by the Federation of State Medical Boards, which outlines how patient/physician relationships can be established via telehealth and how doctors can deliver quality care through this medium.
The American Medical Association quickly followed FSMB’s lead, and these steps changed the landscape, Schoenberg said. “We have medical boards all over the country embracing those guidelines and you see clarity surfacing everywhere. Twenty years from now if we look back I would argue … that completely changed the ability to use technology to deliver health care.”
Most experts agree that the potential for telemedicine is great and predict rapid expansion both in terms of new companies entering the space and its use to treat and monitor patient health for a wide range of conditions.
Most of the commercial telehealth services today offer access to primary care, but many companies expect to expand their reach in the near future.
Patients appreciate the convenience, payers increasingly see the value of telehealth for its potential to help patients access care in more appropriate, and often less expensive, settings and doctors appreciate the simplicity of the business model.
“Primary care docs, I think, will embrace this big time, especially the cash component because they are all trying to figure out how to get more cash business in the door and less insurance business,” Backus says.
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