Telehealth integrated with hospitals and retail health is the wave of the future

Telehealth isn’t new, but tightly integrating it with existing brick-and-mortar-based services is a new approach that can pay dividends for health systems and patients alike.

The basics make that clear.

With most regions of the country facing shortages of primary care providers, and pressure mounting on hospitals and health systems to move to value-based care and capitated models, there’s a growing crisis in terms of access to primary care. Patient demand substantially exceeds provider supply.

One important way to solve this crisis is for health systems to implement a new generation of telehealth or remote care services, infused with artificial intelligence (AI), and tie them closely with the rest of the organization’s services and strategies.

A smart remote care program that links to existing hospital and clinic services, as well as affiliated medical practices, can free up primary-care clinicians’ time to focus on patients with the most urgent, time-sensitive needs — as well as meeting the needs of patients with less critical needs quickly and efficiently.

The reverse is also true: If a health-care organization fails to deliver on basic primary care, it can lose the opportunity to treat affected patients when they have more serious issues, because they’ll go somewhere else.

A telehealth strategy can also enable nearly cost-free expansion of a hospital’s reach, or catchment area. While a new brick and mortar clinic can serve a two-mile radius, a smart telehealth program can scale to serve an entire state (or beyond).

All of this also works toward helping to build patients’ loyalty to their provider, allowing the provider to retain patients and deliver continuity of care through higher-end services in the future.

Opening up 20-minute slots for higher value, higher revenue care that requires an in-person visit, such as a minor dermatology procedure — which has a high reimbursement rate and takes little time to perform — makes practical sense.

Linking bricks and clicks

Some health systems have taken a traditional, different and quite expensive route, spending a great deal of capital or annual operating dollars on new clinics, without integrating them effectively with online and telehealth options. The result in some cases: urgent care or ‘retail’ express care clinics that often operate at as little as 30 percent of capacity, costing the system significant revenue, slamming margins and exacerbating the access crisis.

Delivering on what I call “convenience care” requires the strategic integration of online and remote services such as new-generation remote care, with traditional forms of care — integrating bricks and clicks in a seamless network.

With the right tools in place, a virtual visit takes about two minutes of a clinician’s time, compared to 20 minutes for a typical in-person primary care visit. That 10X reduction in time spent dealing with routine cases gives providers the tools to expand their patient panels without asking them to work any more hours or any harder.

In addition, when bricks and clicks are effectively linked, the organization can prosper by freeing up primary-care capacity so clinicians work at the top of their licenses. Smart, AI-enhanced solutions can expedite care to patients with more routine illnesses or injuries, and seamlessly escalate more complex care to the right bricks and mortar venue.

As a result, organizations can use smart remote care tools to boost the return on their investment in “brick” sites such as urgent care or express care clinics.

It’s an elegant solution to an often vexing problem for many health care systems, freeing primary care doctors’ time to focus on more complex or higher margin cases, where their time is best spent and where reimbursement rates are far higher.

To put some real world numbers behind this, one of the delivery systems using’s SmartExam (disclaimer: I’m a co-founder at, recently reported what some might call an astounding return for Q1/2018. The system was able to complete 1,738 virtual visits, resulting in patients regaining at least 8,690 minutes that would have otherwise been spent in and en route to a doctor’s office. This equated to an estimated $185,270 in patient wages that would have been lost due to absences for doctor visits, but instead were regained because the patients did not have to take time off work to visit their primary care doctor. Importantly, this also freed up 29,546 minutes of clinician time to attend to more urgent care and patient needs.

A smart telehealth strategy paired with a solid medical practice via a traditional integrated delivery network carries many benefits and negligible downsides, which might include the time it takes to learn a new system and the resources spent on the initial integration. For example, our clients are seeing higher adherence to evidence-based medicine, and much higher patient (and provider) satisfaction, all of which become increasingly important as you move into the capitated model.

In this next evolution of digital telehealth solutions, I’m bullish that the future looks bright for everyone involved: Patients, clinicians, administrators alike. But I’m even more convinced that a smart telehealth strategy, when properly executed, will become a powerful tool that helps providers and health systems delight patients and improve both access and profitability.

By Ray Costantini, M.D.
CEO and co-founder,

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