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Will the Covid-Induced Telemedicine Scramble Change Primary Care Forever?

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By HANS DUVEFELT, MD

After my posts on telemedicine were published recently, (this one on Manly Wellness before the pandemic and this one after it erupted, on A Country Doctor Writes, then reblogged on The Health Care Blog, KevinMD and many others), I have been asked about my views on telemedicine’s role in the future of primary care.

Things have changed quickly, and a bit chaotically, and there is a lot of experimentation happening right now in practices I work or speak with.

Before thinking about telemedicine in Primary Care, we need to agree on some sort of definition of primary care, because there are so many functions and services we lump together under that term.

Minor Illnesses

Many people think of primary care mostly as treating minor, episodic illnesses like colds, rashes, minor sprains and the like. This is an area that has attracted a lot of interest because it is easy money for the providers, since the visits tend to be quick and straightforward and such televisits are also attractive for the insurance companies if they can keep insured patients out of the emergency room. With the technical limitations of video quality and objective data such as heart rate and rhythm, I think this is an absolute growth area for telemedicine. However, with all the other forms but mostly here, fragmentation of care could become a complicated problem. To put it bluntly, if we still expect a medical professional or a health care organization to keep an eye on reports from various sources, such as hospital specialists, walk-in clinics or independent telemedicine providers, they are going to want to get paid for it.

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InTouch Health’s CEO on B2B Telehealth Demand & Post-Covid Virtual Care Market | WTF Health

By JESSICA DaMASSA, WTF HEALTH

“I never anticipated — and no one did — the level of uptake and the level of scale.”

It says a lot that Joe DeVivo, CEO of Intouch Health, who’s worked with hospitals and health systems on standing up B2B-focused telehealth programs for years (and whose company was acquired by Teladoc Health for $600-million dollars in January) is surprised about the uptake of virtual care during the COVID-19 pandemic.

“Historically, I look at virtual care as a bell curve,” says Joe. “On one side of that small tail of the bell curve are the virtual care companies. Teladoc dominates that space for D2C. There’s millions of consultations a year, and we’re seeing a subset of that. On the opposite side of the bell curve is high-acuity, and what InTouch has been doing for critical care.”

“This crisis, and the changes in reimbursement, have opened up the middle of that bell curve. The core, everyday transaction of healthcare is now being impacted by virtual care. And the big question that everyone has is, “is this going to stick? Is this a crisis management tool and we’re going to go back to the ways of the past, or is that genie out of the bottle?”

We put Joe on-the-spot with his own question, find out what he thinks it will take to enable the permanent shift to virtual care at-scale, and dig in on how demand for telehealth within hospitals has changed as a result of the pandemic, where its not only being used to expand access to specialists, but has also been adapted into a PPE-hack to help frontline hospital workers distance themselves from infected patients.

And what of working with Teladoc? While waiting for the paperwork to finalize (all on-schedule for the end of Q2 as originally announced), the two have organized a co-selling agreement to be able to “hit the market fast” and bring their “hospital-to-home” end-to-end virtual care offering to those who need it now.

Health in 2 Point 00, Episode 116 | Telehealth $$, Layoffs and Rock Health’s Q1 fundraising report

Today on Health in 2 Point 00, Jess and I run through a lot of telehealth investments including Doctor Anywhere raising $27 million, 98point6 raising $43 million, Tyto Care raising $50 million, SilverCloud Health raising $16 million, SteadyMD raising $6 million, and Aktiia raising $6 million. In addition, there’s a company called Air Doctor which matches people when they’re traveling to doctors on the ground which raised $7.8 million despite the inauspicious timing. On the flip side, there have been a slew of layoffs in the space, and Jess and I give our $.02 on Rock Health’s Q1 fundraising report which was just released. Don’t miss our tag-team interview of Livongo’s Glen Tullman, and check out these episodes in podcast form on Spotify and iTunes. —Matthew Holt

The Tipping Point for Telehealth

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By ALEXA B. KIMBALL MD, MPH

The tipping point for telehealth just happened. Many ways of doing business will change forever after the experience of the COVID-19 pandemic, and health care, too, will never be the same. 

Between the release from some HIPAA requirements announced by President Trump this month, shifts in payor policies, and mandated insurance coverage of telehealth visits, innovation and adoption are taking off like wildfire. As patients and outpatient-based physicians hunker down at home, they are rapidly experimenting, and improving the way care is being delivered remotely. 

Our institution, which had no prior program, faced with an imminent shut down of elective activity, developed an enterprise-wide telehealth program in days, rendering hundreds of visits as soon as we launched it. This activity is being replicated all around the country. 

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Blue Cross NC Chief Medical Officer on “Flipping the Switch” To Telehealth at Parity | WTF Health

By JESSICA DaMASSA, WTF HEALTH

In the early days of the U.S. COVID-19 outbreak, BlueCross BlueShield of North Carolina (Blue Cross NC) stepped up as one of the first health insurance plans to announce reimbursing telehealth visits “at parity” with face-to-face office visits for all providers and specialists. Chief Medical Officer Rahul Rajkumar talks us through the strategy behind that decision to “flip the switch” for telemedicine — which was made in just one meeting (!) – and what metrics and outcomes the Blue plan will be looking at post-pandemic to decide if the switch remains on.

Conversation Highlights:

  • Changing reimbursement policies to cover ALL COVID-19 testing and treatment
  • 6:45 min: The role of virtual care during COVID-19 and reimbursement at parity
  • 11:11 min: How will telehealth be evaluated post-epidemic?
  • 13:58 min: Telehealth innovation, B2B use, remote monitoring (looking to providers to lead the way)
  • 17:25 min: What’s going to happen with healthcare costs in 2021?

For more on how health tech companies in digital health, telehealth, remote monitoring, health data, and more are responding to the COVID-19 crisis, check out the other interviews in this special series at www.wtf.health/covid19.

Health in 2 Point 00, Episode 115 | Olive, Bright.md and AristaMD

Today on Health in 2 Point 00, we have a no-nonsense April 1st episode—with deals this time! On Episode 115, Jess asks me about Olive raising $51 million for its AI-enabled revenue cycle management solution, Bright.md raising an $8 million Series C for its asynchronous telemedicine platform, and AristaMD raising $18 million for a different sort of telemedicine, eConsults, which allow primary care physicians to consult with specialists virtually. —Matthew Holt

Covid-19 & Digital Health in Italy: “10 Years of Evolution in 10 Days” | WTF Health

By JESSICA DaMASSA, WTF HEALTH

“It’s fair to say that, in Italy, we are doing 10 years of digital health evolution in 10 days.”

Our “man-on-the-street” in Italy (well, man-sheltered-in-place in Italy) Roberto Ascione, CEO of Healthware, reports in on the Covid-19 outbreak and what’s happening with digital health startups, health system partners, and hospitals as Italians continue battling at the forefront of the coronavirus outbreak.

A few weeks ahead of the U.S., there are many things to learn about Covid-19 testing, treatment, outcomes, and timing from the experience in Italy, including some foresight on how pathways for telehealth and digital health continue to evolve as conditions become more serious and the outbreak progresses. (For all you Gretzky fans, this is “skating to where the puck will be” kind of stuff…)

Some navigational guidance on this chat which took place March 26, 2020:

  • Update on Italian Covid-19 outbreak from health industry insider
  • 10:25 minute mark: Digital Health startup case study, Paginemediche, self-triage chatbot data from 70K Italians, data sharing with Italian government & WHO, telehealth model flipping to give overwhelmed physicians opportunity to triage and “invite” patients based on needs
  • 19:10 mark: How to work with Italian digital health startups to advance Covid-19 work
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Telehealth Startup CEO On How Covid-19 Is Changing Telemedicine Use In Hospitals | WTF Health

By JESSICA DaMASSA, WTF HEALTH

Jamey Edwards, CEO of one of the larger in-hospital B2B telehealth startups in the US, Cloudbreak Health, is already seeing changes in the way hospitals are using his company’s telemedicine services in the wake of COVID-19.

From a noted rise in the rate of infectious disease consults, to “quarantine rooms” where telemedicine equipment is cleverly deployed to practice “clinical distancing” to minimize risk to front-line healthcare workers (and also preserve PPE), Jamey talks about what he’s seeing among hospital clinicians and what they seem to need most right now from telehealth providers amid the COVID-19 outbreak.

With changes to licensing regulations, HIPAA policies, and reimbursement changing the very infrastructure around telehealth, will we finally see virtual care become a true part of the healthcare system at-scale?

“One of the hardest things to do in our healthcare system is match cost to acuity,” says Jamey. “I’m not going to say we’ve overvalued the in-person encounter, but we certainly have been very hesitant to step away from it.”

“The fact of the matter is that that’s a bias. And so it’s up to us to look at these biases and say, ‘Well, no. What is the right way to do this?’”

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Behind the Big Deal: Teladoc Health’s Acquisition of InTouch Health | Joe DeVivo, InTouch Health

By JESSICA DaMASSA, WTF HEALTH

It was a seminal moment in virtual care as Teladoc Health acquired Intouch Health for $600 million, effectively taking its mostly direct-to-consumer telehealth platform directly into more than 2,500 care providers — or, as they say, “from hospital to home.” We caught up with InTouch Health’s CEO, Joe DeVivo, to hear his thoughts on the deal, including what it means for the further advancement of virtual care and for the digital health industry at-large.

Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020

THCB Spotlights: Scott Shreeve, CEO of Crossover & Jay Parkinson, Founder of Sherpaa

Today on THCB Spotlights, Matthew chats with a couple of the OGs from the original days of Health 2.0—Scott Shreeve, founder and CEO of Crossover Health, and Jay Parkinson, founder of Sherpaa, who were the first ones doing something different in terms of doctors figuring out this digital health stuff. The two of them ask the question, what would happen if you married the physical world with the online world and created a new care model that exceeds at both? While Scott was putting in onsite primary care clinics to employers like Apple and Facebook, he realized Crossover wasn’t reaching 70% of the people they were contracted with because many employees were geographically remote. Meanwhile, Jay was doing something similar with virtual primary care—which differs from traditional telehealth in that his model enables a true relationship between patient and provider—and the rest is history.

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