I had the opportunity to go to the American Telemedicine Association’s annual conference in Minneapolis a few weeks ago – it was great to see how many innovations are still coming to the sector – and if anyone doubts that telemedicine is establishing itself in the market, just look at how much the ATA grew in the last few years.
That said, there continue to be challenges and growing pains that both healthcare systems and telemedicine vendors are going to have to work through: how to drive utilization and awareness; deliver value to patients and providers; and promote better continuity of care?
One of the somewhat disappointing things we continue to see in the market is the embrace of the fee-for-service payment model – even amongst the newer vendors – as we shift towards a higher percentage of covered lives falling under shared risk contracts.
Fee-for-service telemedicine doesn’t make sense because it’s proven to misalign the interests of the physician, the patients, and the payer – which we are seeing play out in a couple different problematic ways for the industry. More and more, we’re seeing products allow providers to be reimbursed without a patient having to come to the office. This doesn’t promote a more efficient management of a patient population and, more importantly, it doesn’t scale the doctor’s time in any meaningful way. Whether a doctor spends 15 minutes in the clinic with a patient or on a video chat, they are still only able to see one patient every 15 minutes. Although these approaches are good for improving a patient’s continuity of care, it doesn’t do anything to remedy the massive physician shortage and access to care problem.
The more troubling dynamic comes from virtual care companies looking to manage populations in a fee-for-service workflow where there is no relationship between the patient and provider and the payment model incentivizes the physician to churn and burn their way through patients. This misalignment of interests comes about when a doctor gets paid $25, for example, per phone call or video chat with a patient, encouraging the doctor to work through as many patients as possible in an hour to optimize their revenue. Not only does this lead to poor customer service and low quality of care for the patient, it also leaves the provider to potentially engage in risky behavior such as over prescribing antibiotics because it’s faster to just give the patient what they ask for than to explain why an antibiotic isn’t the right treatment for the symptoms. Their goal is to get through the encounter as quickly as possible and move on to the next one.
CirrusMD believes telemedicine should be done at a population level while also improving access, promoting continuity to the physical brick and mortar clinic and keeping the patient’s primary care provider in the loop about virtual encounters. Our focus on value-based care, means providers have continuous access to the patients allowing for ongoing managed care. This way the doctor doesn’t have to make a quick, potentially risky decision. Instead the physician is encouraged to keep in touch with the patient so they can be monitored over a series of hours, or potentially days, to ensure they get the best care possible. By changing the economic model, we’ve removed the fee-for-service dynamics that lead to churn and burn, so physicians are able to provide real value to patients.
As a result, we see significantly better utilization and reutilization than the industry average because we’re able to offer an exceptional patient experience while also enabling doctors to practice good medicine.