- Is direct-to-consumer telehealth really that good for health systems?
Commercial on-demand platforms may be all the rage these days, but some critics contend they disrupt healthcare far more than they should, and end up hindering health systems who want to build and maintain a strong patient base.
“Telehealth is best used as part of a continuum of services,” says Ralph Derrickson, president and CEO of Carena, a Seattle-based company that works with health systems to develop their own telehealth platforms. “We should be thinking of handling a patient in the context of the entire healthcare system.”
Derrickson and Robert Bernstein, MD, MPH, Carena’s vice president of clinical affairs, argue that commercial or stand-alone virtual care leads to more siloed services and fragmented healthcare, primarily because the provider has no incentive to build a rapport with the consumer. A health system with its own virtual care platform, on the other hand, uses it in addition to its brick-and-mortar operations, creating a care management plan that features both telehealth and in-person care.
“When people do not feel well, they turn to their health system, their health provider, their doctor,” says Derrickson. “They have a trusted relationship, and it’s up to the health system to build on and preserve that relationship.”
Derrickson took particular issue at the recent American Telemedicine Association conference with telehealth companies trumpeting platforms that connect a consumer and doctor no matter where they’re located – what some are calling the Amazon approach to telehealth. Such a service, he said in a blog, “disconnects patients from the local health systems they know and trust, while promoting the idea that the only virtual care brand that is necessary is one that attracts patients from across the country.”
“This model also builds major stumbling blocks for local health systems and hospitals implementing value-based care and managing risk populations,” he wrote. “By moving patients to a national marketplace, local health systems lose the ability to coordinate and respond on a patient’s terms while reducing costs and managing risk.”
Derrickson says health systems are starting to realize the power of the branded virtual visit, and are creating platforms that compete with retail clinics and commercial telehealth providers. That means selling a health system that combines online with in-person care.
“Healthcare has always been a brick-and-mortar provider,” he said, adding that even Amazon is complementing its online empire with actual storefronts.
Earlier this month, Carena officials released data from the company’s health system partners that argues that integrated virtual clinics do a better job at providing healthcare than stand-alone or commercial clinics.
According to the company, integrated virtual clinics offer 20 minutes of time with a physician, compared to on-demand clinics that promote interactions of anywhere between two and 15 minutes.
“A longer visit means a better understanding of a patient’s needs and better care outcomes,” Bernstein says. “While a large part of telemedicine is about convenience and immediacy, it’s crucial to slow down and give patients proper, thoughtful attention.”
Also, integrated virtual clinics offer a lower prescription rate – 48 percent at Carena’s sites, compared to a 77 percent rate advertised by one telehealth provider. Bernstein contends that commercial telehealth providers over-prescribe antibiotics, while integrated clinics have a better relationship with the patient and look for other means of treatment. “we want lasting, positive outcomes, not quick, temporary fixes,” he says.
Finally, there’s the care management rate, or a focus on continuity of care rather than episodic healthcare. According to Carena, commercial clinics have a virtual management rate of some 93 percent – better than nine out of every 10 visits are concluded in that one encounter. Integrated virtual care visits have a 68 percent care management rate, meaning that roughly one-third of the visits end with referrals for additional or alternative care, thus keeping the patient in the health system.
“In virtual care, a higher referral rate means health systems stay engaged in the patient’s care episode, and they are being directed to specific in-person care when it is required,” Bernstein says.
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To be sure, both sides of the argument have compelling cases. Commercial telehealth providers and retail clinics are serving a very real demand for real-time healthcare, particularly for consumers who don’t have the time or resources to go to the doctor’s office or clinic. They’ll argue that this is what the market is demanding.
Derrickson and Bernstein feel that healthcare providers are missing the point with that theory – and they’re missing the opportunity to gain the patient’s trust. Amazon might be a great place to buy a book, but should it be held up as the model for long-term health management?
“Improve the care journey for both the provider and patient,”: says Derrickson. “That’s what technology makes possible.”