U.S. consumers, providers and policymakers support expanded telemedicine access, but not without concern about the many unknowns.
Over the past year, millions of Americans have become accustomed to a new way of seeing their doctors: virtually. The shift occurred virtually (pun intended) overnight, as telehealth went from an afterthought for much of the healthcare delivery system to a front door focus. And while rates of telehealth utilization have dropped from their peaks from last spring, they remain more than five times higher than pre-Covid-19.
Now as states ease pandemic restrictions and almost one in four adults have been vaccinated, what does the future hold for telehealth? A set of recent consumer surveys suggests a desire for continued access to care via telehealth, although there are nuances in preferences. And while consumers may value the convenience and access that telehealth affords, policymakers have recently been weighing the cost and other uncertainties of telehealth, and what the nation can afford.
Plato is widely credited with the line “Necessity is the mother of invention”. Given that telehealth technology existed prior to the pandemic, perhaps a more fitting line is “Necessity is the mother of adoption.”
As we return to school, work, and play, what might we expect of telehealth when the necessity for it is (thankfully) removed?
Telehealth adoption was driven rapidly by Covid-19, but recent consumer surveys suggest that virtual ... [+]
Policy Levers And Bipartisan Questions About Virtual Care’s Role
"I've said before the genie is out of the bottle concerning flexibilities and expansion, and I believe this," said Rep. Brett Guthrie, R-Ky, during a recent U.S. House Committee on Energy and Commerce virtual hearing, with members from both sides of the aisle supporting permanent policy measures.
Others, however, raised questions about the budget impact, noting existing structural financial concerns for Medicare.
As a result, recent weeks have seen several new pieces of legislation introduced on Capitol Hill aimed at supporting the expansion of telehealth. They range from the risk averse to the more progressive, including bipartisan bills that provide funding for connected social care networks and a call for permanent telehealth regulatory reform more broadly. Two of the most prominent examples include:
- Telehealth Modernization Act: Introduced in the House and Senate in late February, this act seeks the permanent expansion of The Center for Medicare and Medicaid Services’ (CMS) temporary waivers on geographic and site-related restrictions. Currently, the waivers allow for broad use of both video and audio-only telemedicine, with the latter having been utilized by one-third of Medicare beneficiaries as of the latest data.
- Leveraging Integrated Networks in Communities to Address Social Needs Act (LINC): LINC would give states funding to facilitate better coordination of care in regards to social determinants of health (SDoH). The goal is to increase statewide and regional collaboration through technology that connects community and social service providers with healthcare organizations for better care coordination, outcomes tracking, and resource management.
Additional concerns remain for both providers and policymakers. For instance, fraud and abuse of the technology remains a chief concern for both policymakers and practitioners. And while virtual care adoption has helped providers to continue delivering care during the pandemic, it has not been without consequence, including conflicts and competition that increasingly exist between out-of-state and in-state providers.
Trends in Consumer Preferences And Virtual Care Utilization
Consumers have readily embraced digital health tools and virtual care options since the start of the pandemic, with a variety of recent surveys and data points indicating a much longer-term play for telehealth.
Data from Rock Health and the Stanford Center for Digital Health’s Digital Health Consumer Adoption report 2020 suggests substantial growth in consumer use of live video visits (and other tools) from 2019 to 2020. According to a Journal of Medical Internet Research study published in December, scheduled behavioral health appointments, such as therapy and psychiatry visits, and chronic illness-related appointments made up the largest increase in telemedicine visits in 2020.
Digital Health Consumer Adoption Report 2020
And in a recent study from telemedicine company Hims & Hers, out of 1,000 U.S. adults (the majority of whom were registered voters), 65 percent indicated that they were in favor of legislation that allows for telehealth visits (from a licensed provider in their state) via a secure messaging platform. The study, conducted in partnership with research firm Public Opinion Strategies, also found that a majority of Americans (51 percent) say they have now had some type of telehealth visit, a significant rise from just 10 percent who indicated in August 2019 that they had tried telehealth.
Interestingly, data from Rock Health found that while nearly a third of consumers didn’t use any telemedicine in 2020, most people reported that it was because they preferred discussing health in-person with their doctors, with far fewer people mentioning cost or lack of access to cell service or broadband as an impediment to virtual care. Megan Zweig, Rock Health’s chief operating officer, noted that while it’s important to acknowledge the remaining access barriers that have yielded higher adoption among higher-income, more highly-educated, and urban consumers, the data shows telemedicine use is up across the board.
“Regardless of how we cut the data—by age, gender, income, education, region, race—in all groups, more than half of consumers have used some form of telemedicine (e.g., live video, text, email),” Zweig shared. In other words, most people are acclimating to digital health tools being integrated into their lives, “but innovators will differentiate themselves by building to reach costly, high-need populations that remain less well-served than others,” she said.
Shifting Preferences Drive Market Opportunities
Venture capital has been pouring in to telehealth and virtual care for several years. And while investors can acknowledge that Covid-19 may have driven temporary demand, they also see it as merely priming the pump for longer term telehealth and virtual care opportunities.
Lisa Wu is a Partner at Norwest Ventures
“We think there’s enormous opportunity to address issues around cost, convenience, accessibility and conditions associated with stigma,” said Lisa Wu, partner at Norwest Venture Partners, in reference to the far-reaching impact of continued virtual care adoption. In her role, Wu focuses on seed to late-stage venture companies with an emphasis on consumer technology, digital commerce and next-generation marketplaces. “We try to focus on companies with mass market plays who provide benefits to consumers all across the U.S., not just in the coastal cities.”
One virtual provider that’s seen both impressive adoption growth over the past year is PlushCare. PlushCare offers virtual-first primary care, and connects patients to doctors from the top 50 medical institutions in the country — patients who otherwise might not have access to top doctors. Those doctors, the company says, “then become patients’ go-to person for ongoing care needs, including addressing previously taboo areas of healthcare like sexual health and mental health.”
The company has seen a 300 percent increase in mental health-related appointments since the pandemic began, and a 460 percent increase in patient sign-ups in the last year. Such results were enough for investors, as PlushCare raised $23 million in Series B funding in June 2020.
Ryan McQuaid is cofounder and CEO of PlushCare
Part of how PlushCare seeks to differentiate itself is its focus on winning over not just consumers, but those on the front lines of care delivery as well. “For too long patients have simply felt like a number – so have physicians. This is why we are hyper focused on relationship-building between physicians and patients from the start,” said Ryan McQuaid, PlushCare’s CEO and co-founder.
Relationship-building on both sides of its platform means it’s purposefully chosen to avoid certain tactics that might facilitate even faster growth. “You hear a lot of companies pitching themselves as ‘we’re Uber for healthcare.’ We’re definitely not Uber for healthcare,” said McQuaid, adding that “we’ve found if you want to wow your customers, you need to wow your staff.”
Judging by its reported Net Promoter Score of 90 (versus an industry average of 9), PlushCare seems to be doing well on both counts.
If companies like PlushCare are able to provide high quality care, what else should they be seeking to do to persuade the one-third of people who have not yet tried telehealth?
Awareness, Trust and Literacy: Obstacles To Broader Virtual Care Adoption
“It takes time for awareness to sink in,” said Wu. “People may not be aware they can see a different doctor, one not in their city even.”
McQuaid echoed the importance of awareness; in his own case, it was about getting his own health questions answered. “Because I work at PlushCare, I know how to get my questions answered around how the Covid-19 vaccine interacts with my chronic disease. But most people don’t work in healthcare and may not know where to get answers,” he said, adding that having a longitudinal primary care model in place “helps to build patient/doctor relationships so people have one place to go to gain access to quality clinical and behavioral healthcare and to get their questions answered.”
Awareness of telehealth and frustration about access to care was reinforced in the Hims & Hers study. Approximately 60 percent of respondents said access to medical care is a problem where they live. Among underserved patient populations, the numbers were even higher, especially in communities of color. Black adults (73 percent) and Hispanic adults (78 percent) were much more likely than white adults (54 percent) overall to say they had a problem.
“While it wasn’t necessarily surprising, I did find it very interesting to what extent minority groups were experiencing problems,” said April Mims, Hims & Hers vice president of public policy.
Others suggest that it’s not awareness alone that impedes broader adoption, but issues of consumer trust and digital literacy within communities. For telehealth companies, understanding the needs of different communities can lead to solving issues of awareness, and then, equally importantly, how to engage consumers in ways that work for them and build trust.
Changing Course In An Industry Notoriously Adverse To Change
The recent survey data from Rock Health and Hims & Hers strongly suggest that consumers clearly value the flexibility and convenience that telehealth affords. Indeed, in a highly politically polarized time, the Hims & Hers survey revealed bipartisan voter consensus for expanding telehealth access. And while telehealth utilization has declined since early pandemic peaks, rising awareness and consumer trust in the process (as well as better coordination between telehealth and existing providers) over time presents a compelling case for the future of telehealth.
Investors and telehealth companies themselves are clearly bullish on the opportunities as well, as evidenced by activity in just the past few days and weeks alone:
- Amazon Care rolls out nationally
- Ro raises $500M at a $5B valuation
- Grand Rounds and Doctor on Demand merge
But consumer preference and investor enthusiasm alone may not be enough to overcome a sclerotic healthcare industry. Healthcare institutions, and policymakers at both the state and federal level, tend not to move as fast as investors, and have open questions.
A follow on article later this week will explore four questions related to telehealth’s impact on cost, access, quality, and potential for fraud and abuse. Together, these may address what happens when the pandemic-driven necessity for telehealth ends.
