Looking for more proof that telehealth has truly become a global trend in healthcare delivery? Our “man-on-the-street” in Italy, Roberto Ascione, CEO of Healthware Group, offers a detailed state-of-play on virtual care uptake across Europe, including how policy-makers, entrepreneurs, and investors are playing much more significant roles in spurning an increasingly “digital friendly” healthcare ecosystem in the wake of covid-19. On the eve of Frontiers Health 2020 — one of Europe’s leading health innovation conferences, of which Roberto is Chairman — we find out how those backing healthcare’s quickly evolving “tele-everything” revolution are planning to come together to push this agenda even further.
Note: Frontiers Health takes place THIS WEEK, on Thursday November 12 and Friday November 13. Check out the full agenda at www.frontiers.health. Fans of WTF Health get a discount! Just use code FH20WTF25 for 25% off registration fees. See you there!
It’s the telehealth market reality check you’ve been waiting for! “Rogue” digital health consultant Dr. Lyle Berkowitz unpacks the numbers and the market potential for virtual care from the unique vantage point of a primary-care-physician-turned-health-tech-entrepreneur with nothing to lose. Having been 1) a clinician, 2) the Director of Innovation at Northwestern Medicine, 3) the founder of a health tech startup (Health Finch) that successfully exited to Health Catalyst, and 4) the former Chief Medical Officer at one of telemedicine’s biggest players, MDLive, few can boast such a wide-reaching, deep understanding of the inner workings of both the innovation and incumbent sides of the virtual care market — AND have a willingness to talk about it all with complete candor!
This is an analyst’s perspective on the telehealth market — with a twist of insider expertise — so expect to hear some good rationale behind predictions about how much care will remain virtual once hospitals and doctor’s offices return to normal, how “real” health system enthusiasm is for building out telehealth capacity to execute on the “digital front door” idea, and whether or not all these well-funded telehealth startups will have what it takes to win market share from traditional care providers.
BONUS on Primary Care: Is this the area of medicine that’s going to be the “battleground” where digital health and virtual care companies will be going head-to-head with incumbents for market share? Lyle says 50-plus percent of primary care “can and should be automated, delegated, virtualized, etc.” and boldly predicts that in 10-20 years we won’t even have primary care physicians anymore. Tune in to find out why starting at the 8:00 minute mark, where we shout out Crossover Health, Oak Street Health, Iora Health, and more.
Telehealth die-hards, don’t think for a second I’d miss this chance to also get some input on Teladoc-Livongo, Amwell, Doctor On Demand, SOC Telemed, the impending IPOs there, digital first health plans, virtual primary care, health systems (who Lyle hopes “don’t shoot themselves in the foot” with their opportunity to jump into the space) and, ultimately, who’s really going to ”WIN” in virtual care moving forward. For this, jump in at 17:00 minutes and hold on!
JUST before the Teladoc-Livongo merger was announced, I had a chance to catch up with Doctor on Demand’s CEO, Hill Ferguson. The future for telehealth, he said, is “bright green” — and I’m pretty sure it’s looking even greener now! Doctor On Demand has stood out among telehealth companies for being particularly early on virtual primary care and it sounds like they’re going to continue developing that line of business — in which they have key partnerships with Humana and Walmart — with the $75M series D funding they just received.
Add to that a brand-new, first-of-its-kind telehealth program for the Medicare Part B population, and crazy consumer-focused type UX features like same-day scheduling for behavioral mental health care (yes, that’s right, dynamic scheduling for healthcare is here, folks!) and you can start to see how DOD is strategizing to pull away from the pack.
With the competitive landscape shifting, especially after Teladoc-Livongo, how does Hill view the onslaught of new entrants like digital health companies who added telehealth in reaction to the COVID-19 pandemic, or potential unicorns like Ro or HIMS, who are focused on tying the prescription drug business into virtual care delivery? It’s the insider insight you’ve been waiting for in this era of ‘tele-everything’ healthcare.
Imagine three months from now when the predicted ‘second wave’ of COVID-19 is expected to resurge and we’re still without a vaccine. Telehealth has become the entry-point to care, widely adopted by patients both young and old. Now, when an elderly diabetic patient wakes up in the middle of the night with a dull ache on her left side and back, she doesn’t ignore the symptom, like she may have during the first COVID outbreak. Instead, she logs online to her local hospital’s website from a cell phone and accesses a simple questionnaire to report her health history and presenting symptoms. The whole process takes just a couple of minutes and she immediately hears back from her health provider with the suggestion to schedule an in-person appointment for further testing to rule out any kidney issues.
This patient doesn’t become one of the nearly 50% of Americans who delayed care during the initial COVID pandemic. She was able to access care without having to download an application or wait to schedule a virtual appointment during normal business hours. She receives virtual asynchronous care on-demand, coordinated to sync with her electronic health record. The next day, she receives a follow-up call from her primary care doctor to ensure her symptoms were alleviated with the over-the-counter pain medication she was prescribed.
I applaud the article written by Paul Grundy, MD, and Ken Terry, “Primary Care Practices Need Help to Survive the COVID-19 Pandemic,” in which they called on Congress to make health policy decisions that will provide immediate financial relief for primary care practices. We must mitigate the real risk we face: the highly possible shutdown of our healthcare system. Amid the coronavirus pandemic, the U.S. healthcare system has taken an enormous financial hit and primary care practices have been especially affected and are struggling to survive. As the authors point out, telehealth has taken the spotlight to fill the acute need for an influx of patients needing to access care under social distancing practices. Telehealth can increase access to care, relieve provider burden, reduce costs to systems, and improve patient outcomes. However, this is only possible with on-demand telehealth, or asynchronous care.
With about one month left on the existing 90-day Public Health Emergency that’s eased regulations and improved reimbursement to help make telehealth, remote monitoring, and other virtual care services easier for providers to implement and patients to use, health tech companies across the US are wondering what it will take to make these changes permanent. One of digital health’s few ‘DC Insiders,’ Livongo Health’s VP of Government Affairs, Leslie Krigstein, gets us up-to-speed on what’s happening on Capitol Hill and what we can expect moving forward. What changes will (literally) require an Act of Congress? And what can be handled by HHS and CMS? From codes and co-pays to e-visits and licensing, Leslie breaks it down and tells us whether or not we can continue to expect a ‘health tech-friendly’ agenda in Washington DC.
Telehealth has been a lifeline for many doctors and patients during the pandemic, and the decisions of CMS and many private payers to cover telehealth visits—in some cases, at full parity with in-person visits–has helped physician practices stave off bankruptcy. Assuming that these policies remain in effect after the pandemic, I agree with the commentators who assert that telemedicine will become a much larger part of healthcare.
Nevertheless, what that means is still far from clear. To begin with, telehealth visits may be adequate for some purposes but not for others. Historically, the technology has been used mostly for diagnosing and treating minor acute problems. Physicians were generally reluctant to take on more complex cases or treat chronic conditions without seeing patients in person.
Pre-pandemic, most telehealth encounters took place between patients and doctors who had never treated them before, using services such as Teladoc, American Well and Doctor on Demand that usually didn’t communicate with the patients’ personal doctors. Some larger physician groups had begun to use the technology with their own patients; but even in those groups, certain doctors were often assigned to conduct virtual visits with patients who were not necessarily their own.
Clearly, the latter barrier has been broken down, with nearly half of U.S. physicians in an April survey saying they were using telemedicine in patient care. While it’s unclear what kinds of cases these doctors are diagnosing and treating, it’s likely that the scope of practice for telehealth has been expanded to include some chronic disease care.
The main barrier to this expansion is that, in telehealth encounters, physicians don’t necessarily have the data they need to make sound medical decisions. To manage hypertension, for instance, the physician needs to be able to measure a patient’s blood pressure. If the patient has a digital blood pressure cuff at home, that data can be transmitted to a physician’s office; in fact, a smartphone app could show the trend of the patient’s hypertension over time. Right now, however, only a small fraction of patients have this kind of remote monitoring equipment.
Omada Health put to use part of their recent $57M funding round to acquire Physera, a musculoskeletal care company that uses telehealth and digital interventions to deliver ‘virtual physical therapy’ to those suffering from back, knee, and neck pain. How does the acquisition fit into Omada’s growth strategy? WTF Health’s Jessica DaMassa chats with both Omada Health’s CEO, Sean Duffy, and Dan Rubinstein, CEO of Physera, about the acquisition, the IPO buzz that continues to swirl around Omada, and whether or not the opportunity that COVID-19 has created for digital care will be lasting as we move forward.
A year ago, if you’d
used or even heard about Zoom, you were probably in the tech industry.
Today, if you haven’t used Zoom, your friends or colleagues must not like you
very much. COVID-19 has made most of us homebound most of the time, and video
services like Zoom are helping make that more bearable.
healthcare is finally paying attention.
Zoom was founded in 2011, poking along under the radar for several years, overshadowed by competitors like Skype or WebEx. For the entire month of May 2013 it only had a million meeting participants. Even by December 2019 it could boast “only” 10 million daily users.
Then — boom — COVID-19 hits and people start staying at home. Daily users skyrocketed to 200 million in March and as many as 300 million in April (well, not quite). Daily downloads went from 56,000 in January 2020 to over 2 million in April. Zoom is now used by businesses and families alike, drawn by its simplicity and ease of use.
By all rights, we should
be using WebEx for business video calls and Skype for personal ones. Both
had been around longer, offered credible services, and still exist. But
both were acquired along the way, WebEx by Cisco, and Skype ultimately by
Microsoft. As with its acquisition of Nokia, once acquired Microsoft
didn’t quite seem to know what to do with it. Each left openings that
Zoom plunged through when the pandemic hit.
“The mental health system was completely broken before COVID. The supply-demand imbalance was wildly upside down. Now, that’s just all exacerbated.”
On-demand mental health startup Ginger has watched usage of their app climb 130% over the last 4-week period. The conversations people are having with clinicians are growing more intense (there’s an internal metric for that) and amid all of this the late-stage startup has re-run its ‘Workforce Attitudes’ survey to find out what’s really going on with the mental health of the employee populations it serves.
CEO Russell Glass dives into some of the findings of that report, which are pretty revealing in terms of understanding how we as a population are dealing with our stress around COVID-19 when we’re seeking professional help with it. Nearly 70% of respondents confessed this was the most stressful period of their career — five times more stressful than the financial crash of 2008 — and there are some surprising differences with how this is all unfolding across gender lines, especially with working from home.
With inbound interest from employers up 4X over the past month, we get Russ’s input on whether or not the demand for telehealth will sustain once the crisis is over and if the temporary regulatory and reimbursement changes will become permanent. Says Russ: “This is like a great experiment of the efficacy of telehealth versus non-telehealth.”
As healthcare systems around the world grapple with the coronavirus, ‘virtual-first healthcare’ is fast becoming the global response of private and public healthcare systems alike. In Australia, the federal government recently committed to investing $500M to built out its country’s ‘virtual-first’ healthcare infrastructure, so we caught up with Louise Schaper, CEO of the Australasian Institute of Digital Health (AIDH), to find out what that means for telehealth, remote monitoring, and digital health companies looking to capitalize on the market opportunity in Australia.
With a population of 25 million people (roughly the number of people in Florida) and a set of newly-minted reimbursement codes that makes telehealth available to all of them via the government-funded public healthcare system, the appetite for investing in new health tech solutions has grown ravenous.
Says Louise, “Anyone who has solutions that are already market-tested and approved, I’d actually expand your networks globally now. There’s not a section of the globe that hasn’t been impacted by [covid19] and we’re all needing to work out how to deliver healthcare differently.”
As in other parts of the world, the government codes reimbursing telehealth and other virtual-first services are temporary (Australia’s are set to expire September 30, 2020), but organizations like the AIDH, the Australian Medical Association, and others are advocating for their permanence and are optimistic.
The prevailing sentiment is that, like in the US, the benefits of virtual care to healthcare consumers and clinicians are going to be difficult for the government to ignore. Add to that the potential of linking virtual care to the Aussie government’s AUD$2 billion dollar build of its MyHealthRecord system — a centralized, cloud-based EMR that holds the healthcare data of 90% of all Australians — and the prospect grows even more appealing.
Join us as we talk through the basics of the Australian healthcare system and get an insider’s look at the demand for digital health, remote monitoring, and telehealth Down Under.