Much has been written in the past month or so about how COVID-19 has contributed to a long-anticipated growth spurt in telehealth, a field that, for years, has been full of nascent opportunity with respect to its potential to screen, diagnose, treat and manage a myriad of health conditions.  However, until now, telehealth has been unable to break from the confines created by heavy regulation, reimbursement challenges and inertia among those who are comfortable with more established ways of doing things.

Prior to the COVID-19 outbreak, only 16% of patient visits were conducted remotely. As of early April, the average share was up to 60%[1].  Additionally, the American Telemedicine Association projects that 50% of healthcare services in the U.S. will be conducted virtually by 2030.

As the proverbial levee containing telehealth breaks, many players will vie for leadership or their own niche positioning in a market that, in theory, has plenty of demand to go around.  For patients and providers alike, the COVID-19 pandemic may be a catalyst for the widespread trial of telehealth, but only time will tell which models are best positioned to generate loyalty.

Below we examine several telehealth value propositions, along with potential opportunities and challenges in the longer term.

Screening the Worried Well & Triaging the Sick

To address those concerned about COVID-19, but not sick enough to justify a trip to the hospital, many existing leaders in telehealth have developed online COVID-19 screening tools based upon CDC and other institutional guidance, adding to their arsenal of screening tools for other physical and behavioral health conditions. Some of these screening tools are powered by artificial intelligence. For example, instead of a nurse, a bot starts the screening process and hands patients off to a human as needed. Others are powered by human intelligence.  Both models are meant to be a first step for the “worried well” or for those suffering non-emergent symptoms.

This image shows two case studies. The first is Bright.MD and says 'Bright.MD offers a free COVID-19 screening tool to health systems that directs those deemed at high risk to the appropriate hospital department. At the same time, the technology also offers options for those suffering from other, low-acuity conditions to seek care from the safety of their own home.' The second is Conversa Health and says 'Conversa Health Chats offers free conversational AI tools for people looking to learn more, stay on top of public health alerts, assess their risk or find local testing or care.'

Platforms like these can be accessed directly by patients, who can choose to pay out of pocket or enter their insurance information to determine coverage eligibility.  Or, in some cases, these platforms are offered via health plans and health systems hoping to ensure that care is delivered in a way that optimizes quality, costs, and convenience for patients.  For COVID-19, these entities also aim to keep people out of the hospital for both health and economic reasons to avoid overloading the hospital system.

  • Opportunities
    • Potential to reach a wide base of people who, in the long run, may find telehealth as a safer and more convenient first step
    • Providers and payers can integrate population health data and AI to increase epidemic preparedness
  • Challenges
    • Low touch, low frequency, and reliance on a broad array of physicians who may or may not be connected to the patient may limit the ability to tout all-important doctor-patient relationship as a benefit
    • Converting one-time triers into regular, loyal users of telehealth platforms and/or loyal users of the providers who license the platforms as a backbone

Routine Visits

While it may seem that COVID-19 is usurping all health system capacity worldwide, the sad reality is that other conditions have not gone away to make room for it.  Those who are ill from other conditions—including conditions that put them at higher risk of COVID-19 infection—still need to see a doctor!  To say nothing of healthy people who are advised to get regular checkups.

 

This image shows a case study for AmWell and Teladoc. It says 'Leading telehealth platforms AmWell and Teladoc are increasingly filling the gap for chronic conditions that can be monitored remotely (at least on occasional) or well visits that can leverage remote tools for measuring vitals. While Teladoc, AmWell and others can provide COVID-19 screening and triage, they also continue to provide everyday care, mental health services and wellness and prevention - not only through their own network of doctors, therapists, and other medical experts, but also through the providers who license their systems. COVID-19 may just provide the 'nudge' needed to establish new habits for those seeking everyday care.'

  • Opportunities:
    • Positioning platform as an alternative to in-person visits for other conditions may help to reframe telehealth as an ongoing, long-term option for treating and managing a range of conditions
    • Licensing platforms to health plans, private practices and health systems provide greater continuity of treatment and do not disrupt relationships
  • Challenges:
    • May require extra focus on the customer experience to increase engagement (during and between virtual visits) and foster loyalty
    • Potentially niched between urgent care (high acuity, high touch) and physicians’ offices (for regular care)

Monitoring Remotely (including suspected COVID-19)

But what of those conditions that require a physical exam to collect vitals to send to labs and the use of complex devices?

Some digital health companies use remote, peripheral devices to capture physiological data such that they can monitor those at low enough risk to stay home, while others such as Doctor On Demand–which can be accessed directly or through contracted health plans and employers– partner with diagnostic labs to easily direct patients to labs and review results.

This image shows two case studies. The first is TytoCare and says 'After several passengers from the Diamond Princess cruise ship returned home, Israeli startup TytoCare partnered with others to monitor the vitals of those with and without symptoms. TytoCare was able to to this via an all-in-one remote medical examination solution allowing physicians to remotely connect with quarantined patients. The Tyto device includes an exam camera that connects to a stethoscope for monitoring heart and lung sounds remotely, a thermometer, an otoscope for ears and a tongue depressor.' The second is Vivify Health and says 'Vivify Health works with insurers, integrated health networks, and home health agencies to deliver remote monitoring kits to COVID-19 patients that include telemedicine platforms and connected devices such as thermometers, scales and pulse oximeters. Vivify and its partners had already seen the necessity of home-based care for some populations and have reacted quickly to take care of a wider population.'

  • Opportunities:
    • Can be positioned to providers and payers alike as an opportunity to engage patients and increase adherence to treatment
    • An additional tool for patients to give them control over their own health
  • Challenges:
    • Patients, caregivers and even providers wary of “Big Brother” may need reassurances about privacy and how data will be protected and de-identified such that it can’t be used against patients
    • Platforms need to partner closely with patients’ regular physicians to ensure that remote monitoring is positioned as a value-add and not a replacement for doctor visits

The current pandemic is tearing down the regulatory and reimbursement barriers that have prevented telehealth from realizing its full potential to date.  With those barriers down, telehealth providers may finally enter the next stage of growth allowing them to focus on overcoming cultural or behavioral barriers to continued adoption by patients and providers alike, followed by improving the overall customer experience and generating loyalty.

[1] “COVID-19 HCP Sentiment Survey,” SERMO, April 2020