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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.

Telemedicine: Fulfilling the Promise

Virtually every group health insurance agent and employee benefit professional has encountered telemedicine, as have many human resource professionals. In fact, telemedicine is almost exclusively marketed in conjunction with employee benefits. The argument for including telemedicine is simple: By teaching employees to use telemedicine instead of going to the doctor’s office, urgent care center or emergency room, healthcare claims will be reduced. thus helping the employer get control of his long-term costs. Unfortunately, many of those who have come into contact with telemedicine have been disappointed with the end result.

In talking with benefit professionals that focus on groups of 100 employees or more, there is near universal disappointment in terms of actual utilization. Teledoc said on March 2, 2016, that it had 573,000 visits out of 12.2 million members. While that may sound like a lot of visits, the number only represents a 4.72% utilization rate. In terms of a company with 250 employees, that would mean that 12 employees chose to use telemedicine vs. a face-to-face appointment. How much real savings can be created?

See also: It’s Time to Embrace Telemedicine  

There are two approaches to pricing the telemedicine product in the employee benefit marketplace. The first approach, which is found in most health plans, is to charge the member a copayment of $39 to $49 per visit. Unfortunately, for most employees, any copayment represents an impediment to utilization. The second approach is a fee per member per month. The real value of this approach is that it eliminates the copayment at the point of utilization. In theory, this should increase utilization, but the approach requires continual communication, which is often lacking. One would think that there would be a greater effort to drive utilization by all parties involved, such as the group benefit professional, the human resource leadership and the telemedicine provider, but, alas, that is not the way it is.

Realizing the Promise of an Improved Bottom Line

There are three simple strategies that can have a major impact on an employer’s bottom line.

  1. Increasing utilization of the telemedicine product should reduce the claims paid. For every urgent care visit eliminated, the health plan saves approximately $155 (according to a study in Annals of Internal Medicine), and for every emergency room visit avoided the plan saves an average of $1,300. According to MSNBC: “While it’s true that out-of-pocket costs can be as low as zero for the uninsured or just a small co-pay for insured patients, we know that most emergency room visits really cost an average of $1,233.
  2. Make the telemedicine product available for emergencies. When a member calls virtually all of the current telemedicine providers, the first sound that she hears is a recording stating: “If this is an emergency, please hang-up and dial 9-1-1.” For the average employee, it is easier to hang up and head to the emergency room or urgent care center than make the determination of whether there is an emergency. If the telemedicine program is equipped to engage in medical triage, the program can make the determination and call for the ambulance if needed while staying on the line with the member/patient. This approach would provide two cost saving benefits. First, the member would actually get care quicker than left to her own devices, resulting in lower medical bills per occurrence. Second, the approach would increase utilization of the telemedicine program because employees would not be required to try to determine if the situation is a medical emergency.
  3. Create a telemedicine pathway for workers’ compensation claims as a first step in dealing with an obvious non-emergency for an on-the-job injury. Of course, where there is an obvious medical emergency, calling 9-1-1 directly is the better choice. But for 80% of on-the-job injuries the telemedicine program equipped for medical triage can save the employer hundreds of dollars per occurrence by avoiding emergency rooms and urgent care centers. Equally important is the fact that this immediate response results in an employee’s sense that the employer actually cares, and this improves outcomes.

See also: Triage, Telemedicine Change Work Comp  

These three simple strategies will result in measurable savings for an employer. Beyond the obvious financial savings generated by these three strategies is the less obvious but very real financial gain resulting from increased employee satisfaction with the employer. Providing a good telemedicine program will markedly improve morale and productivity as employees become the recipients of the application of employer empathy. Equally important is the fact that providing a no-copy telemedicine plan helps offset the impact of increased deductibles, coinsurance and copays as well as other cost-shifting strategies for dealing with increased health insurance premiums.

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