Tag Archives: care

How Telemedicine, AI Are Transforming Care

Dr. David Dantes, a retired ER doctor in his 70s, still manages to work six hours a day starting at 6:30 am and sees about 20 patients per day. His lifetime of medical experience would be ending if he hadn’t joined a telemedicine platform earlier this year. Meanwhile, after a long day of flu-season patients, Dr. Linda Anegawa also uses a telemedicine system to talk to three more patients who couldn’t meet in person. As a doctor on a virtual platform, she’s been able to build amazing trust with many patients who keep coming back for her.

Both Dr. Dantes and Dr. Anegawa are Stanford-trained physicians who believe in providing quality care and convenience to patients. Primary care is often not accessible for seniors and busy patients, and a visit to the ER can be traumatic and expensive. Telemedicine can solve these pain points by bringing care to patients wherever they are and whenever they need it, while smoothing out the logistics of scheduling and traveling, so doctors can focus on their top priority of delivering care. Similarly, health AI holds the promise of increasing efficiency in the care process for improved care outcomes and better time management.

Telemedicine – Bringing Top Quality Care to Patients Conveniently and Efficiently

Telemedicine is not new. There are a large number of companies including Teledoc and other well-funded private companies such as American Well, MDLive and Doctor on Demand that offer telemedicine solutions. Many of the hurdles facing these companies are related to lack of focus on physician quality and low utilization due to patient education, and rolling out services through employer insurance programs doesn’t help. Multiple research and studies have shown that only two out of every five consumers have heard of telemedicine. Utilization rate is even lower at less than 5% across the industry and less than 2% in many companies.

If telemedicine truly delivers on the promise of bringing quality care and convenience to patients, why are adoption rates so low? This past summer, I conducted a survey with 561 participants across the U.S. and found that although 95% of respondents have never used telemedicine, 57% are interested in trying if key concerns could be addressed. Topping the concerns is the quality of physicians, which suggests that telemedicine providers with high-quality physician networks are much better positioned to have high adoption and utilization rates.

PlushCare (GGV portfolio company), the telemedicine platform where both Dr. Dantes and Dr. Anegawa operate, has addressed this issue by building a physician network that only includes doctors from the top 50 medical schools in the U.S. This patient-centric approach with an emphasis on physician quality is seeing a dramatic uptick in both adoption and repeat visits.

See also: Telemedicine: Fulfilling the Promise  

Now that we’ve outlined the needs and primary adoption barrier of consumers, let’s look at what motivates doctors to use telemedicine, because ultimately doctors are the key to the quality of the service. Beyond the scheduling flexibility, companies like PlushCare also offer a suite of tools to help doctors operate more efficiently — from handling the back-end administrative work to streamlining the front-end patient visits — so doctors can focus on what they do best and enjoy doing the most, delivering care to patients. That’s why we see physicians like Dr. Dantes bringing his years of experience back to practice through telemedicine, and others like Dr. Anegawa taking online patient visits beyond her practice.

A common misperception about telemedicine is that the primary target audience is either those who live in rural/underserved areas, or millennials who seem to do everything online. In reality, telemedicine has much broader applications for consumers beyond these groups. Most telemedicine users fall in the age of 35 to 45, with busy work and travel schedules and families with multiple kids. Telemedicine can provide a hassle-free way of seeing a doctor with a lot of flexibility in time and location.

The use cases can even be extended to schools, which are often understaffed with onsite medical professionals, or nursing homes when the seniors have acute symptoms. Instead of sending the patients to ER or waiting for a family member, telemedicine can address many of the problems within 10 to 20 minutes and involve family in the discussion in a three-way call. Most importantly, the convenience doesn’t need to come at the cost of quality.

AI – Doctor’s Silver Bullet to Boost Productivity and Improve Outcome

While telemedicine drives the much needed efficiency to healthcare by simplifying logistics around the care process, health AI targets the care process directly to increase productivity. At the current stage, health AI may not be able to displace doctors and originate treatment plans independently, but it’s more than ready to help doctors allocate time more efficiently depending on individual patient needs, and keep tabs on patients post-visit to improve outcomes and lower readmission rates.

For example, start-up company Lemonaid Health provides a “traffic light” system using an AI model developed by physicians to do the first round of screening on patient cases. Cases are categorized into three pipelines upon screening: “Green,” or straightforward, cases account for 80%; “yellow,” or complex, cases account for 15%; and “red,” or extreme, cases account for the remaining 5%. This categorization allows doctors to spend less time on straightforward cases and focus on patients with more complex situations.

Another example is Carbon Health, which leverages AI to examine and triage patient cases pre-visit through a chatbot interface. Based on the complexity of the cases, Carbon’s AI assistant books an appropriate amount of time for the visit and shares the pre-visit synopsis with the doctor so he or she can dive right into the problem during the visit. The AI assistant also follows up with patients post-visit to keep track of key indicators and resurface cases to the doctor when anomalies are detected.

See also: It’s Time to Embrace Telemedicine  

I am excited to see consumer-centric digital health companies that are providing broader access and better quality of care, and bringing efficiency to the process. Consumers are increasingly engaged in issues about their health and are expecting healthcare tech improvements. Meanwhile, tech innovators are continuously disrupting the status quo. I believe consumers are at the forefront of these changes, and innovators behind consumer-centric digital health companies can win big in this market.

If you are a healthcare founder making solutions to transform consumer experience, I’d love to talk to you.

Has Auto Insurance Become a Commodity?

A boomerang kid lost his job and moved back home with his parents. While driving his mother’s car, he negligently struck another vehicle, causing several thousand dollars in property damage. The mother’s insurer denied the claim on the basis that the driver’s residency was not reported to the carrier within 30 days of his return home.

Fifteen minutes can save you 15%, anyone? Actually, the latest online ads say you can get a car insurance quote in only 7 ½ minutes.

Buying insurance may not be a pleasant task for most people, but neither is getting a root canal, and you wouldn’t choose a dentist based on how fast he or she can complete a procedure where your health is at stake. Yet consumers routinely risk everything they own and much of what they might earn in the coming years by choosing the fastest, lowest-cost insurance with the cleverest advertising campaign.

The denial of the boomerang kid’s claim arose from an exclusion in the insurer’s policy for accidents involving undisclosed household residents, unless the insurer had been notified within 30 days of the residency. What insured would think to report something like this to his or her auto insurer? If an “ISO-standard” policy had been in place, that wouldn’t be necessary.

At a rapidly accelerating rate via TV advertising, online “ease of use” promotion and proliferating media articles, consumers are being duped into believing that personal lines insurance is a commodity, with the only significant difference being price. Nothing could be further from the truth. While a lower price doesn’t necessarily imply lesser coverage, that is often the case.

In the words of sales legend Morty Seinfeld, “Cheap fabric and dim lighting. That’s how you move merchandise.”

What Does the Caution to Compare ‘Apples to Apples’ Really Mean?  (Hint: Nothing.)

Recently published studies by firms like McKinsey, A.M. Best, Nomura Equity Research and Gartner proclaim that auto insurance is now officially a commodity. Some of their conclusions predict the demise of the insurance agent, as the direct sales model wins the commodity war. Have any of these researchers ever read their own auto policies, much less compared the coverages in multiple policies?

The media perpetuate the myth. The typical “How to Save Money on Car Insurance” article cautions consumers to make sure they compare “apples to apples.” Translation: Make sure you’re getting quotes on premiums for the same liability, uninsured motorist and medical payments limits and physical damage deductibles. It’s as if broad coverage categories, limits and deductibles were the only differences between auto insurance policies.

A Wall Street Journal article, “Car Insurance Rate Shopping Can Pay Off,” says, “The Consumer Federation recommends consumers shop around to get quotes from insurers that don’t use agents, such as Amica Mutual Insurance and USAA (for families with military ties), and then ask an agent to beat the best price.” Not a word about any coverage differences—only the price.

More Proof That the ‘All Car Insurance Is the Same’ Mantra Is an Illusion

A Florida insured’s auto was in the shop, so she rented a car and later loaned it to someone, who loaned it to someone else, who had an at-fault accident that killed a child and seriously injured other children. The claim against the operator and named insured was denied by the insurance company on the premise that the vehicle was not a “temporary substitute” and that the operator was not a “permissive” user, as defined in this insurer’s personal auto policy.

The son of a friend of an agency owner was street racing when he crashed, seriously injuring himself and his passenger. The claim was denied by the insurance company based on its interpretation of its personal auto policy’s “racing” exclusion.

A church allowed a member to park his car in its heated “bus barn.” While exiting, he wrecked the car, causing structural damage to the building. The claim was denied by the insurer, citing the “care, custody or control” exclusion in the personal auto policy.

What do these claims have in common, other than denial from the insurance company? Each of them would have been covered if the policyholder had purchased an “ISO-standard” personal auto policy rather than the policy in question.

With regard to the Florida claim, the ISO personal auto policy defines “temporary substitute” and “permissive use” much less restrictively than the policy that was in force. The named insured might have saved 15% in 15 minutes when she purchased her auto policy, but it proved to be a bad deal when she had to take her claim to the Florida Supreme Court to recover. The Supreme Court did reverse the Court of Appeals ruling that favored the insurer, but the rationale was less about the policy language and more about Florida’s unusual dangerous instrumentality doctrine.

In the street racing example, the ISO personal auto policy excludes injury that arises from accidents that take place “inside a facility designed for racing,” while the auto policy in question excluded almost any racing activity, including on a public street. Fortunately, the father of the injured child had a Trusted Choice independent agent to aggressively advocate on his behalf by pointing out to the insurer that the exclusion applies only to organized racing activities, not impromptu street racing. More than a dozen coverage opinions from the Big “I” Virtual University Ask an Expert service supported the agent’s efforts. Do you think someone who purchased insurance online from “a guy in khakis” would enjoy the same advocacy?

Like the ISO personal auto policy, the “bus barn” claim also involved a “care, custody or control” exclusion. But the ISO policy makes an exception for damage to a private garage. The policy in question has no such exception—not to mention the fact it’s unlikely that the barn was actually in the driver’s care, custody or control. So both the policy itself and the insurer’s interpretation of the exclusion were faulty from the insured’s perspective—rendering the carrier’s slogan, “same coverage, better value,” untruthful.

12 More Nails in the Coffin of the ‘Insurance Is a Commodity’ Myth

Here are a dozen auto insurance exclusions or limitations you won’t find in the “ISO-standard” personal auto policy:

  1. Undisclosed household residents are excluded.  How many families have “boomerang” kids living at home whom they have not told their auto insurer about? An exclusion of this type was just recently added to the auto policy of one of the major TV advertisers.
  2. Business use of autos you don’t own is excluded.  Have you ever borrowed a neighbor’s car or made a business stop in a dealer loaner or rental auto?
  3. Business use of ANY auto is excluded.  Do you ever run to Staples or the post office on business for your employer?
  4. Use of ANY auto you don’t own is excluded.  Better not drive anyone’s car but your own.
  5. Vehicles weighing more than 10,000 pounds are excluded.  Have you ever rented a U-Haul truck or an RV for personal use thinking your liability coverage extended to the rental? With an “ISO standard” policy, it does; with some auto insurance policies, it doesn’t.
  6. Any type of delivery is excluded.  Denied claims include pizza, newspapers, Mary Kay cosmetics and, yes, even the delivery of insurance policies to customers by an agency producer. Google pizza delivery auto accidents and take a look at the catastrophic nature of some of them. Was that $50 you saved to buy a policy a good deal?
  7. Permissive users only get minimum limits.  This can apply to people who borrow your car or even unlisted household drivers.
  8. “Street racing” is excluded.  Google “street racing” and see how often people are killed or critically injured in the process. Does the auto policy covering your testosterone-fueled teenage son cover street racing? The “ISO standard” auto policy does.
  9. Criminal acts are excluded or limits reduced.  DUIs or even speeding tickets may preclude coverage.
  10. Medical payments only include licensed physician fees.  One insured incurred a $25,000 “life flight” helicopter fee that would not be covered, even in part, by a policy with this exclusion.
  11. Theft without evidence of forced entry is excluded.  One insured had a four-figure vehicle theft loss denied because he left his keys in the car. No such exclusion exists in the “ISO standard” personal auto policy.
  12. Sales tax is not covered under loss settlement.  This cost one “You get the SAME COVERAGE, often for less” insured more than $2,000 out of pocket for sales tax on a replacement auto.

Do you still believe what you’re told on the TV ads that the auto policy you’re getting a quote on is just like every other auto policy in the marketplace?

Accept the Challenge and Dispel the Myth

The differences between auto insurance policies are many, varied and potentially catastrophic. As insurance educator John Eubank, CPCU, ARM, says, “The bitterness of no coverage is remembered long after the sweetness of low price has been forgotten.”

Don’t be sold a bill of goods by TV advertising and consumer articles that state or imply that the only material difference between insurance policies is the price. It is time for insurance professionals to dispel this destructive myth. Innocent consumers experience catastrophic uninsured losses every day because they bought into the illusory proposition that their risk exposures can be identified and addressed cheaply and within 7 ½ to 15 minutes.

Failure to get this message to the consuming public is likely to lead to increasingly stripped-down insurance products that enable competitive pricing. Arm yourself with the information necessary to educate your clients, and bust the myth that insurance is a commodity.