The evolution and adoption of telehealth these past few months has been fascinating to watch. It illustrated many of the built in biases many healthcare organizations had towards in person visits. It also highlighted times when an in person visit is far superior to an online visit. While we’re starting to see a roll back to more in person visits with new social distancing, COVID-19 has certainly thrown the doors open to telehealth in a way that could have never been imagined possible 6 months ago.
Even before COVID-19, there were a number of direct to consumer telehealth companies who were offering telehealth options for a special set of visits. No doubt that’s exploded in the current environment and in many ways has started to compete with health systems for visits. I expect we’ll continue to see this area of telehealth to continue to grow as these direct to consumer companies can create a really convenient patient experience. Plus, we’ve got at least another year or more until people feel really comfortable going back to in person visits.
Along with these direct to consumer telehealth models, a massive number of telehealth companies are providing the tools and technology needed to provide doctors the opportunity to do telehealth on top of their existing medical practice. We’ve written a lot about this as many were forced to convert their scheduled appointments to online telehealth visits.
While both of these areas of the video telehealth visit are interesting, I wonder if there’s an opportunity here that I haven’t really seen before. Will we start to see telehealth only doctors and medical practices?
Certainly some doctors have been doing only telehealth visits on the direct to consumer telehealth platforms, but that’s different than owning your own medical practices and patients saying that you’re their PCP (Primary Care Provider). Doctors can make a living doing telehealth only on these platforms, but the telehealth vendor owns the relationship with the patient, not the doctor. Is there a new model where the doctor could be all virtual, but still own the relationship with the patient the way they would with a bricks and mortar practice?
I’ll admit that I don’t fully know the answer to this. I just have to think that doctors would love to get out of the high overhead situation that a medical practice represents. A medical office is expensive. Exam tables are expensive. All of the medical supplies and other equipment is expensive. Staff for the medical practice is expensive. Could a doctor take out all of that overhead and go completely virtual?
Obviously, one of the challenges of this approach is that there are some visits that require an in person visit. It’s hard to stitch up a wound virtually as just one obvious example. Plus, there is value in the physical exam that would be lost. However, could a doctor that takes this all virtual approach work with another doctor who has an office? They could refer patients to them much like they might do a specialist. Or would the other doctor not want all the challenging patients that couldn’t be cared for virtually?
The other major challenge I see is how are they going to drive patients to their practice and what are the economics? Lower overhead is great, but this also places you in direct competition with the direct to consumer telehealth companies. Can you provide a better offering than them? If you don’t have a physical practice that influences many patients’ decision to choose your practice because of proximity, can you really attract a panel of patients?
One idea to consider is what if this was a direct primary care option that was all virtual? Is there a reason to have an in person office to offer direct primary care? Could the monthly fee model of direct primary care work virtually?
Obviously, I’m still rolling this idea around in my head. I’m interested to hear your thoughts on this. It won’t take over healthcare and it won’t revolutionize things as we know it, but there does seem to be an opportunity here for an enterprising doctor to take the risk (ie. overhead of an office) out of the equation while still building long term relationships with their patients in a way that most direct to consumer telehealth companies don’t do.
Let us know what you think in the comments. Is this something we’re going to see? Is this a bad idea? Why is it a bad idea? I look forward to hearing and learning from you as we look at what new models telehealth might enable in healthcare.