Are we overhyping telemedicine?
Virtual care can do a lot - but there’s still a need for brick and mortar
With Michelle Killoran
Telemedicine has seen a huge wave of new users in the past year. It’s not surprising. With the pandemic, more people than ever before opted to see their doctors online. The numbers were staggering, especially at the outset. Take Ochsner Health in Louisiana, which conducted more than a 120,000 virtual consultations in the space of a few months in early 2020. That was up from 3,300 in all of 2019.
But we also witnessed the limitations of virtual care. There are still plenty of reasons why it’s better for a patient to get treated in person.
So what does the future hold? Will we see more of a hybrid?
My colleague Michelle Killoran and I have been spending the past few weeks talking to a wide range of experts on that exact topic. We talked to doctors across a variety of specialties, real estate experts, and entrepreneurs. Here’s our overview:
What’s next for brick and mortar?
Health care is still at its core about human relationships. And sometimes that relationship can be augmented by technology. The beauty of telemedicine is that the patient often ends up taking the call or video visit at home, so a clinician can get a potential glimpse into how they really live. That can feel far more intimate than a sterile room at a hospital or clinic.
That said, a face-to-face interaction or a physical exam is sometimes required to get to the root of the problem. So let’s not go overboard in predicting that the future is all digital.
After talking it over with the experts, our strong sense is that we’ll be doing more telemedicine than we were prior to the pandemic even once the crisis has passed. Ryan McQuaid, the founder and CEO of Plushcare, told us that Covid-19 created a “new baseline” for telehealth. What would accelerate that trend even further is regulation to support virtual visits, as well as reimbursement from health plans.
Moreover, many providers are planning to continue offering telemedicine. When we polled them on their plans post Covid-19, about half of almost 800 respondents said they anticipate that a quarter of their practice would remain virtual.
Medical experts like Dr. Farzad Mostashari, founder of Aledade, shared in response to the survey results his guess that it’ll be normal for providers to see about 10 percent to 30 percent of their patient panel virtually. Providence Ventures’ Aaron Marton noted that his team thought about 20 percent of visits would be digital. Of course, there will be wide variations here - but it should give you some sense of where we’re headed.
Another big factor in telemedicine’s favor is that many clinicians seem to like it. Dr. Eve Bloomgarden, an endocrinologist, is among them. She’s shared on Twitter that she’s now doing the bulk of her patient visits via telemedicine. And that it offers a lot more convenience.
Covid-19 also proved to be a catalyst for physicians to try out telemedicine in new ways. Premise Health’s president Jami Doucette told us that the pandemic allowed for digital physical therapy, self acupressure, and plenty of at-home tests that would never have been considered previously at many practices.
But we still think that the levels we saw in the spring of 2020 are an anomaly. Instead, we think we’re moving towards a future that’s more of a hybrid. Some health plans are likely to stop offering payment for telehealth visits at the same level as in-person. For many hospitals and clinics, it’ll be more lucrative to have patients to come in once it’s perceived as safe.
Still, more blended models can often offer the best of both worlds. Here’s an example: Ochsner has a program for pregnant patients called Connected MOM. Patients who sign up get a blood pressure cuff, a wireless weight scale, and they can even do urine protein tests at home. Ochsner, by offering this program, can reduce the number of visits to the obstetrician’s office. But it won’t scale them back entirely. Far from it. Pregnant moms still need to be physically examined; they still need ultrasounds; and they still need to get labs.
Likewise, there are fast-growing women’s health companies like Tia Clinic and Maven Clinic that are helping patients with their most pressing pregnancy-related questions outside of the obstetricians’ office: “Can I eat sushi? Is aspirin safe? Is this headache normal?”
That said, it’s important to keep in mind that there are patients who will choose to go to the doctor’s office even when there’s a perfectly acceptable virtual option. For seniors, for instance, their clinical team can become a source of much-needed companionship. Some physicians told us that their elderly patients will dress up in a suit and tie for the encounter and look forward to it all week.
“Most people still want to see people,” said Dr. Jordan Shlain, a San Francisco-based primary care physician and founder of Private Medical. “And that goes both ways, with the doctors and the patients.”
As Dr. Chitra Akileswaran (a must follow on Twitter) reminded us in a thread this week, telemedicine tends to appeal to patients who are “English-speaking, educated… with working phones and access to the internet.” In person, she notes, it’s easier to access an interpreter.
So even if telehealth is a better option for some, let’s not assume it’s the best option for everyone.
And of course, there are physician specialities where it makes very little sense to shift to telemedicine, such as anesthesiology or ophthalmology.
To give you a physician sentiment around telemedicine, some of the best data we came across comes from this Doximity report:
What will the doctor’s office of the future look like?
With more virtual offerings on the table, there may be a push to improve the in-person experience. We may see more spa-like atmospheres and no waiting rooms (or wait!). That’s already a big part of the appeal of high-end, concierge practices today. Some clinicians might also redesign their spaces to make it easier to do virtual consults.
That said, there’s some big question marks about how important it is to offer a high-end design. Does the experience matter equally or more than the actual quality of care received? “I would go to someone’s basement if that is where the best doctor is,” said Sprout Therapy’s CEO Yury Yakubchyk.
We tend to agree, but nonetheless, here are some new models that we see emerging:
There’s been a lot of talk in real estate circles about what the office will look like when we go back to work - and what companies can do to make the commute back to the office feel worth it. One way to do this is through amenities. Landlords could provide pop-ups to make better use of the excess office space. “There is clearly more interest from the medical and wellness community to lease space or create a partnership with the landlord to position themselves as an amenity for a building or amenity for a neighborhood,” said Adam Frazier, VP Head of New York Leasing at Oxford Properties, in a call with us.
Two fascinating health care companies partnering with employers and landlords include Suite Tooth and Eden Health. Another timely pop up idea that we expect to see more of is Covid-19 testing centers.
Flexibility will be the main trend for the future. Post pandemic, we could see many employers giving their workers a membership to a co-working facility. We might see more of these shared spaces including on-site primary care services (One Medical), dental (Tend) or fertility (Kindbody). “The world of offices will continue to get more and more niche. Right now, most buildings are comprised of companies with little to no affiliation,” said David Cairns, a senior vice president of office leasing at CBRE. “But by 2030, I expect we’ll be able to point to many more examples that fulfill a specific purpose for a specific customer persona.” Cairns said there’s already coworking for manicurists, salon owners, chefs, and more. “The future of the office will be all about sharing economies,” he added.
Other real estate experts expect to see a lot more focus on the patient experience - and that can only be a good thing. During Covid-19, there was a push to minimize the amount of time that patients would spend sitting inside packed offices. “We definitely see some efficiencies that are here to stay,” said Lorie Damon, a managing director for Cushman & Wakefield, who specializes in the health care sector. “We’ll see more efficient scheduling systems because no one wants to spend time in a waiting room.”
Some big developers are scooping up abandoned mall spaces across the country and reconfiguring them as facilities for entertainment, work and health. Shane Connor, the vice president of senior housing at Bull Reality, said he’s seeing developments that include stores, restaurants, gyms, independent living facilities and primary care. For seniors, that’s a huge benefit. “You don’t need to drive or get an Uber, you can just walk downstairs,” said Connor.
The shift to the home
Another related shift is the idea of receiving care in the home. The ‘house call’ could become more of a trend in the wake of the pandemic. “There’s a lot of experimentation happening today,” Sprout’s Yakubchyk told us. His company provides at-home medical care to children diagnosed with autism. In his experience, that setting is often more comfortable.
All of these trends will ultimately lead us to system of care that’s administered outside of the four walls of a traditional doctor’s office.
Our conclusion? The future of health care will be more distributed than ever.
Agree/disagree? As always, we’d love to hear from you. Reach out at @michekilloran and @chrissyfarr on Twitter.
COOL JOBS ALERT!
Want to make a difference? Pew Charitable Trusts is looking to hire an officer of health information technology. The ideal candidate has some experience with public health, and has worked on health data challenges. Pew’s Ashley Ashworth rightly pointed out on Twitter that there’s no better time to be working on these problems - and we agree!
Interested in a job in venture? Our friends at 7wire are on the hunt for an analyst focused on digital health to join the team. The fund is looking for a candidate with a passion for health care and an analytical background.
Got a pulse on digital health? PandaHealth is looking for a director of category growth to stay up to date on the big trends in digital health, and maintain close relationships with health systems.
Want to impact millions of users? Apple has an opening for a senior iOS systems engineering to work on Health and HealthKit. It’s an opportunity to bring health data to iPhone users around the world.
Care about health data exchange? MoxeHealth is recruiting a VP of Marketing with some experience in health-tech, who has previously built out a marketing team. According to CEO Dan Wilson, there are more than 20 openings for folks who are willing to work remotely or relocate to Madison, Wisconsin.
Ready for the C-suite? Maven Clinic is looking for a chief medical officer to drive its clinical product strategy and provide better quality care for women and families. The ideal candidate has experience at a high growth start-up.
Believe that “health care is local?” Cityblock Health is hiring a director of engineering for its population health business. We love the mission and the values, particularly the idea of “leaning into discomfort.”
AND TO LEAVE YOU ON A DEPRESSING NOTE
Way more of you seem to think that we’ll be more likely to travel to Mars than fix U.S. health care.
So maybe the next hot venture-backed business will bring health care to Mars?
Christina - loved this. I am building a hybrid virtual/in-person model at Cityblock and would love to jam on this idea. Will you shoot me a note at firstname.lastname@example.org or let me know how I can get in touch?
Interesting how the opposite of telemedicine is "bricks and mortar". As a practitioner, we consider the opposite of telemedicine to be "hands on". Physical exam is still important for making the correct diagnosis. I can't tell you how many patients I have seen with delayed diagnosis because of telemedicine visits. Delayed diagnosis leading to lost time and increased cost. Who is tallying that!?