Observations from the Floor: What I saw at the ATA

In the lead-up to ATA2017: Telehealth 2.0, the American Telemedicine Association boasted of how the industry is “rewriting the rules” of how care is delivered. But as I walked the exhibit hall floor this week, I noticed that many players in the industry are following the exact same rule book they’ve been using for years.

Perhaps the starkest observation I heard came from the mouth of a healthcare investor who remarked on a panel the desire to, “pick the entire exhibit hall up and shake it, to see if a rational consumer experience falls out.”

At the end of the day, no major paradigm shift has occurred within the mainstream conversation at the ATA. The current generation of telehealth companies, whether they be mom and pop shops, startups, or established firms, like the Big Four, seem to be following the same theme: selling video visits.

While these vendors, numbering in the hundreds, are all offering similar synchronous solutions, none of them have found the secret to escaping what seems to be an invisible barrier to higher utilization rates—most are maxing out at 3-4 percent annualized utilization among members covered by their health plan or employer. So long as this barrier remains, it will be impossible for the telemedicine industry to meaningfully change the way health care is delivered.

By now we’ve proved that the technology exists to do almost anything. It isn’t about technology anymore as it is about economics, and a sensible clinical workflow. My observation on the showroom floor and the lecture halls is that the current players in the telehealth space have improved access and convenience a little, and they’re expending monumental effort to try to improve it a little bit more. They’ll do this while they fine tune existing low use services for efficiency.

Conversations focused on billable events, reimbursement, and engines that can populate billing codes from natural language. However, game changing conversations about the transition to value-based care seemed to be few and far between. Despite ongoing chatter about the future of how doctors will be paid in that hopeful model, many companies seem entrenched in the fee-for-service environment—possibly because that’s the only way doctors in a fix me model have ever been paid.

At CirrusMD, we focus almost exclusively on asynchronous communications which means doctors can see at least twice as many patients in an hour. In some cases, that number rises to nearly three times as many patients without having a negative impact on the quality of care. Additionally, our partnerships with health plans and health systems around the country are rooted in value-based care which means for doctors, an economic environment that fosters relationship-based care, rather than the practice of billable-event medicine.

By allowing patients and doctors to connect with the technology they’re most familiar with, text messaging, and removing the fee-for-service barrier, we are seeing the majority of our clients experience a 10 percent (or higher) utilization rate with little marketing. Is it any surprise that people will use a service that gives them free, unlimited, ongoing access to doctors within their health system, who are on duty expressly to be helpful, and can make things happen within the system?

One of our clients that has seen success in providing this type of access is Kaiser Permanente Colorado with their Chat with a Doctor program which launched in November 2016. Dr. Ari Melmed, Medical Director for the program, spoke about his experience implementing CirrusMD at the ATA in a speech which was noted as being one of the Top Takeaways from the conference according to HealthcareDIVE.

As we move forward from this week’s conference, my hope is that telemedicine providers, as well as our potential clients (health systems, health plans, employers, etc.), will hold the industry to a higher standard, one that can meet the public’s demands for virtual care, a standard CirrusMD is already living up to.

Blake McKinney, MD

I'm the Co-Founder and Chief Medical Officer of CirrusMD.

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