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The Future Of Telemedicine Doesn’t Depend On Health Plans Anymore

Posted on December 6, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

For as long as I can remember, the growth of telemedicine depended largely on overcoming two obstacles: bandwidth and reimbursement. Now, both are on the verge of melting away.

One, the availability of broadband, has largely been addressed, though there are certainly areas of the US where broadband is harder to get than it should be. Having lived through a time when the very idea of widely available consumer broadband blew our minds, it’s amazing to say this, but we’ve largely solved the problem in the United States.

The other, the willingness of insurers to pay for telemedicine services, is still something of an issue and will be for a while. However, it won’t stay that way for too much longer in my opinion.

Yes, over the short term it still matters whether a telemedicine visit is going to be funded by a payer –after all, if a clinician is going to deliver services somebody has to pay for their time. But there are good reasons why this will not continue to be an issue.

For one thing, as the direct-to-consumer models have demonstrated, patients are increasingly willing to pay for telemedical care out-of-pocket. Customers of sites like HealthTap and Teladoc won’t pay top dollar for such services, but it seems apparent that they’re willing to engage with and stay interested in solving certain problems this way (such as, for example, getting a personal illness triaged and treated without having to skip work the next day).

Another way telemedicine services have changed, from what I can see, is that health systems and hospitals are beginning to integrate it with their other service lines as a routine part of delivering care. Virtual consults are no longer this “weird” thing they do on the side, but a standard approach to addressing common health problems, especially chronic illness.

Then, of course, there’s the most important factor taking control of telemedicine away from health plans: the need to use it to achieve population health management goals. While its use is still a little bit lopsided at present, as healthcare organizations aren’t sure how to optimize telehealth initiatives, eventually they’ll get the formula right, and that will include using it as a way of tying together a seamless value-based delivery network.

In fact, I’d go so far as to say that without the reach, flexibility and low cost of telehealth delivery, building out population health management schemes might be almost impossible in the future. Having specialists available to address urgent matters and say, for example, rural areas will be critical on the one hand, while making specialists need for chronic care (such as endocrinologists) accessible to unwell urban patients with travel concerns.

Despite the growing adoption of telemedicine by providers, it may be 5 to 10 years or so before it has its fullest impact, a period during which health plans gradually accept that the growth of this technology isn’t up to them anymore. But the day will without a doubt arise soon enough that “telemedicine” is just known as medicine.

E-Patient Update: Naughty, Naughty Telehealth Users

Posted on March 17, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Wow. I mean, wow. I can’t believe the article I just read, in otherwise-savvy Wired magazine yet, arguing that patients who access telemedicine services are self-indulgent and, well, sorta stupid.

Calling it the “Uber-ization” of healthcare, writer Megan Molteni (@MeganMolteni on Twitter) argues that telemedicine will only survive if people use it “responsibly” – apparently because people are currently accessing care via direct-to-consumer services because their favorite online gambling site was offline for system maintenance.

In making this claim, Molteni cites new research from RAND, published in the journal Health Affairs, which looked at the impact direct-to-consumer telemedicine services had on overall healthcare costs. But the piece goes from acknowledging that this model might not reduce costs in all cases to attacking e-patients like myself – and that’s where I got a bit steamed.

In structuring the piece, the writer seems to suggest that if consumer behavior doesn’t save the health insurance industry money, we need to stop being so gosh-darned assertive about getting help with our health. Then it goes further, arguing that we should just for-Pete’s-sake control ourselves (apparently we’re either hypochondriacs, attention-seekers or terminally bored) and just step away from the computer.  Why can’t we just say no?

First, the facts

Before we take this on, let’s take a look at the journal article which the writer drew upon as a primary source and see what assertions it makes. Facts first.

In the abstract, the authors note that demand for direct-to-consumer telehealth services is growing rapidly, and has the potential to save money by replacing physician office and emergency department trips with virtual visits.

To see whether this might be the case, the authors gathered commercial claims data over 300,000 patients covered by CalPERS Blue Shield, which began covering telehealth services in April 2012. During the next 18 months, 2,943 of those 300,000 enrollees came down with a respiratory infection, one third of which sought services from direct-to-consumer telehealth company Teladoc.

Once they had their data in hand, the research looked at patterns of care utilization and spending levels for treatment of acute respiratory illnesses.

After completing the analysis, the authors found that 12% of direct-to-consumer telehealth visits replaced visits to other providers, while the remaining 88% represented new care utilization. Net annual spending on acute respiratory illness grew $45 per telehealth users, researchers found.

The researchers concluded that because it offers more convenient access, direct-to-consumer telehealth may increase utilization and healthcare spending.

It should be noted that Molteri’s article doesn’t look at whether increased utilization was excessive or ineffective. It doesn’t ask whether patients who accessed telemedical care had different outcomes than those who didn’t and if those new patients saved the health system money because of the interventions that wouldn’t have happened without telehealth. It doesn’t address whether patients who used telehealth in addition to face-to-face care were actually sicker than those who didn’t, or had other co-existing conditions which affected overall costs. It just notes a pattern for a single group of patients diagnosed with a single condition.

Also, it’s worth pointing out that we don’t know whether Teladoc’s performance is better or worse than that of rivals like HealthTap, MDLive and Doctor on Demand. And if there are meaningful differences, that would be important.  But the piece doesn’t take this on either.

So in summary, all we know is that using one provider for one condition, a health plan paid a little bit more for some patients’ care when they had a telemedicine consult.

Consumer indictment

But in Molteri’s analysis, the study offers nothing less than an indictment of consumers who use these services. “For telehealth to fully deliver on its promise, people have to start treating their health care less like an Uber you summon in a thunderstorm,” she asserts, while citing no evidence that people do in fact access such services too casually.

All told, the piece suggests that the people are accessing telehealth for trivial reasons such as, I don’t know, kicks, or as an easy way to find an online buddy. Really? Give me a break. Even when it’s delivered online, people seek care out because they need it, not because they’re lazy or, as I noted above, stupid.

To be as fair as I can be, the article does note that direct-to-consumer healthcare models have unique flaws, particularly a lack of integration with patients’ ongoing care. It also concedes that some providers (such as the VA, which has slashed costs with its telehealth program) are using the technology effectively.

It also notes that telemedicine can do more to meet its potential if it’s used to manage chronic disease and engage people in preventive care. “Telehealth has to be integrated fully into a total care system,” said Mario Gutierrez, executive director of the Center for Connected Health Policy, who spoke with Molteri. As a patient with multiple chronic conditions, I couldn’t agree more. Anything that makes care access easier on one of my bad days is a winner in my book.

Ultimately, though, the author unfortunately bases her article on the assumption that the real problem here is patients accessing care. Not the gaps in the system that prompt such usage. Not the unavailability of primary care in some settings. Not the 15-minute fly-by medical visits that perforce leave issues unaddressed. Not even the larger issues in controlling healthcare costs. No, it’s e-patients like me who use telehealth to meet unmet needs.

Please. I can’t even.

American Well Patents Are Unenforceable

Posted on September 13, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Good news today for the telemedicine industry as the federal courts ruled that American Well’s telemedicine patents are unenforceable in their case against Teladoc. Here’s an excerpt from Mobi Health News on the decision:

It’s looking more and more like the path to victory in the major turf wars of digital health will not be through patent litigation.

Earlier this week, a Massachusetts federal judge Indira Talwani ruled that American Well’s telehealth patents, which the company had sued Teladoc for allegedly infringing, were unenforceably broad. She cited the same Supreme Court precedent, Alice v. CLS Bank, that an ITC judge used to invalidate Jawbone’s patents last month in the tracker company’s battle with Fitbit.

I love the way Jonah Comstock from Mobi Health News described the decision. The path to victory won’t be based on patent litigation. Let’s hope that Jonah is right since patent litigation is an awful way to create a market. That’s true for telemedicine and the health sensor market. There’s a supposed PHR patent out there which needs to be invalidated the same way.

As you can see, I’m not a huge fan of software patents. It’s pretty hard to make the case for the innovation that you’re really trying to accomplish. Plus, far too many software patents are held by patent trolls. In this case, it’s a bit better since American Well has built a legitimate telemedicine business and isn’t just relying on their patent. That’s a good thing and it’s healthy to have Teladoc, American Well, MDLive and others battling it out in the market.

I’m glad to see the federal courts ruling on this. American Well is looking to appeal the decision, so it’s not over yet, but I’m hoping the result of their appeal is the same. We’ll all be better with that patent being unenforcable.

Connecting Wireless, Mobile and the Future of Healthcare: Healthcare Honchos Address Issues Head-on

Posted on April 23, 2011 I Written By

There are tons of conferences out there relating to healthcare, and an increasing number are related to technology and specifically to mobile healthcare.  This conference focuses specifically on taking advantage of the opportunities that wireless and mobile healthcare provides.  Plus, it is in San Diego so you can’t really miss there.

Convergence Summit Runs May 10-12, 2011 in San Diego

How will advances in mobile technology improve access to healthcare in the U.S. and globally? What role will wireless technology play in improving productivity in healthcare? Will the new regulations outlined recently by the Health and Human Services department regarding Accountable Care Organizations (ACO’s) play a role? Wireless and mobile healthcare may well form the basis for new methods of healthcare delivery—for instance, “to treat an individual patient across care settings—including doctor’s offices, hospitals, and long-term care facilities” (CMS Office of Media Affairs).

These and other wireless healthcare issues are to be the star subjects of the Convergence Summit, a three-day event to be held May 10-12, 2011 in San Diego, hosted by the Wireless-Life Sciences Alliance (WLSA) and its partner TripleTree, LLC.

Featured speakers include:

  • Paul Jacobs, Ph.D, CEO of Qualcomm, who is slated to give the opening-day keynote on May 10, 2011;
  • Bill McGuire, M.D., the former CEO of United Healthcare, who is to open the second day of the summit on May 11, 2011;
  • Harry Greenspun, M.D., chief medical officer at Dell, kicks off the final day on May 12, 2011.

A post-lunch keynote on May 12 is to feature Dan Buettner, the New York Times best-selling author of, most recently, Thrive: Finding Happiness in the Blue Zones Way (National Geographic, 2010).

The Convergence Summit is an exclusive gathering of executives, investors, developers and policy makers who come together annually to address issues of advancing innovations in wireless and mobile healthcare technology. Other speakers include John Kelliher, The Marwood Group; Richard Migliori, Optum; Preetha Reddy, Apollo Health Systems; and Tien Tzuo, Zuora.

“Wireless coverage is nearly ubiquitous within the U.S. and many parts of the world. This opens up opportunities for advancing healthcare globally in ways we haven’t even dreamed of,” says TripleTree senior director and chief marketing officer Chris Hoffmann.

WLSA organizers devote each day to a forward-looking theme about uniting wireless and healthcare. Conference themes for this, the sixth annual Convergence Summit, include “Defining a global platform for wireless and mobile health” (Day 1), “Best approaches for streamlining patient-doctor interactions” (Day 2) and “The convergence of mobile and cloud, and the simplification of healthcare solutions” (Day 3). Day 2 also features the presentation of the third annual I Awards, sponsored exclusively by TripleTree, for innovation in wireless healthcare.

Several lively forums dovetail with the conference themes; the forums are open exchanges, with executives, innovators, investors and others brainstorming the topics. No PowerPoint presentations allowed!

Conference participants for the three days of forums include representatives from large and small companies on the cutting edge of the convergence of wireless and healthcare. A sampling of participating companies includes Appirio, Ascension Health, AT&T, Banner Health, CareFusion, Dell, EmpowHER, Healthagen, InstyMeds, WhiteGlove House Call, Johnson & Johnson, Jitterbug, Mental Workout, Optum, Procter and Gamble, RehabCare, Teladoc and Telcare. A total of 300-400 participants are expected to attend the summit.

“When we put all these people in the same room—innovators and users, entrepreneurs and HMO chiefs, technology wizards and policy wonks—the mix is exhilarating,” TripleTree’s Hoffmann says. “The future of healthcare swirls into shape before your eyes.”

The WLSA is an international nonprofit think tank that puts CEOs from the world’s most innovative wireless and mobile health companies together with global leaders in healthcare and technology and financial sponsors.

TripleTree, LLC, a founding member of the WLSA, is an independent investment bank and strategic advisor providing growth companies in healthcare and other technology-enabled vertical industries with merger and acquisition, private capital and principal investing services.

For more information about the 2011 WLSA Convergence Summit, go to