In 2002, I joined a startup called MyDoc.com. The venture was Roche-backed and had the mission to enable patients to interact virtually with physicians via the internet. Patients could use an internet browser to connect to a system that would triage their condition and then enable a real-time chat with a physician that could lead to a diagnosis and potentially a prescription sent to a preferred pharmacy. Our solution was ahead of its time but foretold a future in which patients could use technology to improve access and, ultimately, outcomes.
Fast-forward to 2020 and telehealth is no longer pie-in-the-sky. With the onslaught of COVID-19, telehealth in general and the subset of telemedicine has become a necessary reality as the world has worked to slow the pandemic while still providing care to patients in need. Telehealth broadly refers to the use of technology in healthcare while telemedicine is a means of delivering medical professional services via electronic communication systems and software.
For employer-sponsored health centers, the implications are profound. Telemedicine provides patients enhanced access and convenience. And right now, a sense of safety. In a recent wellness panel discussion, an executive from a major clinic management company described their shift to a “virtual first” model and said that 80% of their patient encounters over the last few months were via telemedicine. Considering that they did not even have a formal telemedicine model prior to April, those numbers are staggering.
Though not as dramatic as the anecdote above, we’ve seen clinic groups move 33% or more of prescriptions dispensed at worksite clinics to home delivery facilitated through thousands of virtual visits. The rapid acceptance of telemedicine visits as “real care” and the need to reach patients wherever they are, has altered, and will continue to alter, the care delivery landscape.
Increasing Acceptance
According to an MDPI study published in January, 89% of patients accept telemedicine as a sufficient form of medical care. That pre-COVID number suggests wide acceptance before the pandemic hit the United States. Most younger patients (74% of millennials in one analysis) prefer virtual visits to in-person care. A recent study conducted by Neurology found that 93% of clinicians view telemedicine as “acceptable” and 60% view it as “very effective” for patient care. Telemedicine was headed toward broad acceptance and COVID-19 secured its place as a staple of patient care.
With virtual visits now standard practice out of sheer necessity, what will telemedicine adoption look like once the dust settles with COVID-19? Andre Zimiles of Doctor.com writes that “83% of patients expect to use telemedicine after the pandemic resolves.” For self funded employers and their clinic management partners, patient and provider acceptance of telemedicine reflects a “new normal” that is permanently changing how patient care is delivered.
Increasing Impact
With improved access come more opportunities to impact patient health. Telemedicine extends the reach of a traditional clinic and eliminates time and geography as limiters to care. Employees that don’t have practical access to an onsite or nearsite clinic can tap into the value of that benefit through the click of a mouse. Employees with access to an employer-sponsored clinic can choose the best access point based on their situation. In the article referenced above, Mr. Zimiles claims that patients using virtual care can save 100 minutes of time relative to an in-person visit. Even if the real number is half his claim, it is significant. Faster access = faster recovery = lower costs.
Impact opportunities also exist in a hybrid model in which in-person access and virtual access blend to provide enhanced services to patients. A 2020 study revealed that Veterans Administration virtual visits resulted in 25% fewer days spent in inpatient care and 19% fewer hospital admissions for veterans. At an average cost of nearly $4000 per day for a stay in the hospital, reducing inpatient days by a quarter is a substantial number. Whether virtual visits are improving communication, compliance, or the intervention, something powerful occurs with improved patient access to care.
Though the claim of reduced per visit costs (10%-15%) is meaningful, that number is small compared to the potential downstream impact of better care, better patient compliance, and better outcomes. Telemedicine appears to be quite effective in supporting all of the above.
Coming of Age
Telemedicine appears to be here to stay. A Ziegler white paper shows that 5% of practitioners used telemedicine in 2015 and 22% used it in 2019. Another 2020 survey showed that nearly half of all physicians are now using telemedicine. Meanwhile, consumer adoption of virtual visits in 2020 has jumped to 49% from 11% in 2019. (McKinsey) Technology has come a long way since MyDoc introduced virtual visits in 2002. More importantly, patient and provider attitudes toward virtual care have changed dramatically.
Telemedicine has definitely come of age and care delivery has improved because of it. The benefit trajectory of virtual visits portends good things ahead for patients and those who care for them. It also promises good things for those who help fund that care. That sounds like a win for all of us.
