“Access, cost, and convenience: those three things are driving this,” says Peter Antall, M.D., medical director at the Boston-based Online Care Group. Online Care Group is a physician-based medical group that specializes in telehealth care.
Peter Antall, M.D.
“The reality is that it takes 19 days for a patient to get an ill visit for their primary care physician’s office. 19 days. By 19 days, you’re either better, in an ER, or dead. That’s access. For cost, more of the burden is being put on the patient. [Most direct-to-consumer telehealth services] are cheaper than any other visit except at a convenience care clinic. And convenience, we hear from patients who say, ‘I accessed your system within 15 minutes, had a visit, got a prescription sent to my local pharmacy, and I didn’t have to miss work.’ There’s no price on that level of convenience.”
DRIVING FACTORS
Access, cost, and convenience are driving it forward, plus advancement in technological capabilities, says John Jesser, vice president of engagement strategy at Anthem Blue Cross, an affiliate of the Indianapolis-based WellPoint. With Boston-based AmericanWell, which also contracts with Online Care Group, the payer launched a “direct-to-telehealth” service to small- and large-group fully insured customers and self-funded national employers in California and Ohio. UCLA Health is part of the initiative and will make its doctors available for patients.
“Historically, telehealth meant expensive video conferencing equipment in a clinic at one location and expensive video conferencing in a hospital somewhere else. [The technology] now allows doctors to log in and log out easily at their convenience and it allows patients to seek care when they want it, from their iPhone or Android. That’s changed everything,” Jesser says.
The Anthem Blue Cross and Online Care Group telehealth services connect consumers to doctors at any time of day for the price of $49 per encounter. In some cases, Antall says that members are covered for the visit through their employer.
Moreover, payers and providers are linking providers to payers directly through telehealth in more ways than just through a mobile app. Leaders at the Mayo Clinic in Albert Lea and Austin, Minn. have launched kiosks at each location that are akin to the self-checkout machine at a grocery store. The kiosks allow patients to connect with a remote doctor via telehealth equipment. Along with video capabilities, each kiosk is equipped with a stethoscope, scale, blood pressure cuff, pulse oximeter, thermometer, otoscope, and dermascope.
DIRECT-TO-CONSUMER CONCERNS
Because it’s within the confines of a health system, one of the advantages Mayo’s direct to telehealth service has over others is that it’s tapped into the patient’s electronic medical record (EMR). Patient data from the encounter is fully integrated.
The lack of this capability is why not everyone is fully on board with the trend. Some, like Ryan Spaulding, Ph.D. director of the Center for Telehealth and Telemedicine at the University of Kansas Medical Center, have concerns with the impact these kinds of services will have on coordinated care.
“It’s hard to see where that’s going to go. A lot of the patients who are served need to be connected to a health system somewhere. As you know, reimbursement, especially with Medicare and Medicaid, requires everyone have a primary care physician to help manage their care. When you bring in a third party like Google or another service, the care is moved outside the approved gatekeeper,” Spaulding says. He also notes that the access factor, which is driving the trend, still may not reduce the digital divide. Many underserved communities can’t afford to pay for a $40 encounter, he believes.
Ryan Spaulding, Ph.D.
Reimbursement is an issue affecting all forms of telehealth, says Gary Capistrant at American Telemedicine Association (ATA), senior director of public policy. He says there are artificial barriers, both at a federal and state level, preventing providers from being reimbursed for telehealth. In particular, Medicare being a poor payer of telehealth has a downward facing affect on the rest of the industry.
“Not only is it the nation’s largest single payer but many of the lives it covers are the heaviest users of healthcare,” Capistrant says. Antall at the Online Medical Group concurs and says that the biggest challenges for reimbursement his organization faces are with the Centers for Medicare and Medicaid Services (CMS).
GROWING ENTHUSIASM
Even with these concerns and barriers, it’s hard not to see the enthusiasm among providers, payers, and patients only growing for direct-to-consumer telehealth services. Jesser at Anthem Blue Cross says thus far, the service has been a hit for busy moms, college students, and business travelers. He says the payer will launch the service for Spanish speaking patients in the coming months. “It should never replace a person having a relationship with their own primary care doctor but I believe that within three to five years, it will be fully integrated as one of the ways people get care,” Jesser says.
