Give consumers the telehealth option they really want: Virtual visits with their own doctor

A recent survey by telehealth company American Well found that 64 percent of consumers are willing to see a physician via a video telehealth visit, and 20 percent of consumers would switch physicians to get access to video visits. The percentage willing to switch is even higher in people under age 45. Among those 35 to 44, 30 percent would change physicians for the convenience of video visits.

The only surprising thing about this survey is that it took this long for someone to ask the question.

Americans do everything from home these days. We shop, bank, visit with friends, eat gourmet food from our favorite restaurants and even search for a new romantic partner, all without having to leave the comfort of our own couch (except to get up to answer the door when the delivery arrives).

It's not a bit surprising that we want to skip the hassle of making appointments and the hour spent driving to the office and cooling our heels in the waiting room, all to spend 15 to 20 minutes with a face-to-face physician encounter. While some physician exams involve serious health issues, most are routine visits to refill prescriptions and see to minor illnesses and infections, needs that can easily be met with video chat.

Telehealth, once a great idea with little support from insurers, has exploded in the last two years. A 2016 survey of employer-sponsored health plans found that 60 percent of large employers now cover telehealth. Most health plans now provide coverage for telehealth as well. Cost is a big reason why. A telehealth visit costs about $40, versus an in-person visit for $125.

But most of that surge has been in the realm of third-party vendors, like Teladoc and American Well, which are solely dedicated to providing video visits. According to American Well's report, only about 5 percent of primary care practices in the U.S. are equipped to offer telehealth.

The reason behind the slow adoption of telehealth by primary care physicians is two-fold: not enough time to figure out the details and a lack of budget and IT resources to make it happen. The simple truth is that most physician practices — especially small ones — don't have the expertise to know which telehealth system will work best for them or the time to set up appropriate protocols for scheduling, documenting and billing telehealth visits.

So telehealth providers have stepped in to fill the gap.

A good stop-gap measure but not the model that will take us into the future

While telehealth vendors provide a very useful service — indeed, in rural areas where access to care can be difficult, it can be a lifesaving service — it is a continuation of the "episodic care" approach that we are trying to leave behind. While the occasional use of a telehealth service unconnected to your primary care provider is no big deal, it becomes a problem when it becomes your main source of care or if the telehealth provider isn't tightly integrated with the patient's primary care provider.

A telehealth doctor or nurse practitioner can give great episodic care, but those episodes don't look at the whole patient. Patients also need someone who looks at their risks for chronic disease, such as obesity, type II diabetes and high blood pressure, and guides them toward lifestyle choices that prevent those diseases. And patients also need someone who can connect the dots — a provider who knows and understands their history and can view current symptoms in the context of the patient's overall health. That's tough to do if you see a different provider every time, especially if that provider does not have access to your records when he or she writes a prescription or suggests a treatment. It's why emergency rooms are not a good place to get primary care — not only is it expensive, but the doctors often lack access to critical information.

To avoid telehealth becoming a cheaper version of emergency room care, we need to connect telehealth to patient centered medical homes. And while that may be possible with a vendor, a better choice is to make telehealth technology a part of primary care practices.

Whether this should mean a vendor providing services under the direction of a primary care physician, or a physician practice making telehealth just one of many ways to interact with the practice's physicians, remains to be seen.

I suspect we'll see some version of both these models in the near future, though eventually I think we'll see telehealth become a ubiquitous part of primary care. Some colleagues of mine here at NTT Data are working with a large health system to pilot a standardized, secure telehealth system based on Skype for Business that could be used by any physician in the system.

The health system is taking a smart approach, because it overcomes the current barriers. The health system has the IT expertise and budget to set up a telehealth system, and also has the time and staff to establish protocols and best practices for all the clinical and administrative details involved. Once they work out these details, they can provide an out-of-the-box telehealth solution that is easy for physician practices to adopt.

And once that happen, consumers will have what they really want: virtual visits with their own primary care physician.

More articles on telehealth:
UC Riverside to pilot telemedicine program for multiple sclerosis
Extend telehealth beyond on-demand care: What health systems need to know
McLeod Health unveils telehealth program


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