By Eric Wicklund, mHealth Intelligence | August 22, 2019
Many hospitals and health systems are looking to jump into the virtual care arena by launching a direct-to-consumer telehealth service. That may be a mistake.
A direct-to-consumer telehealth platform may seem like low-hanging fruit to a hospital or health system looking to jump onto the connected health bandwagon, but that fruit may not be as sweet as it seems.
A DTC telehealth platform needs to appeal to consumers who might not be familiar with the concept, be easy to use and fit snugly into the workflow for doctors and nurses on the other end. And that’s not as easy as it sounds.
“Often clients don’t really know what they’re getting into,” says Jay Backstrom, Digital Imaging and Telehealth Practice Leader for Chicago-based Impact Advisors. “A lot of people know about it, but they probably don’t know what they should. Don’t lead with it.”
Nevertheless, DTC telehealth is popular. Hospitals and health systems across the country are launching the platform as a means of reducing stress on their Emergency Departments and doctor’s offices, with the goal of shunting unnecessary in-person traffic to a more efficient and convenient venue – the virtual visit. Payers and business owners are on board with the idea as well, and are working with telehealth vendors to create on-demand services for their members and employees.
But for every project that succeeds, drawing in patients, addressing pain points and producing results that satisfy clinical and business goals, another one struggles, or even fails. Often, says Backstrom, it’s because the service fails to attract enough customers.
“It’ll be low, and then it’ll ramp up – but it will still be low,” he says. “There are a lot of variables that just aren’t well thought out. Who will use the service? How do you advertise it or engage with patients? How do you project patient volume?”
It’s not a new concern. At the American Telemedicine Association’s 2017 conference in Orlando, a panel session of telemedicine experts focused on that issue.
“You’re definitely going to be underwhelmed before you’re going to be overwhelmed,” said Shayan Vyas, MD, medical director of telemedicine for the Nemours Children’s Hospital, which launched its CareConnect service in 2015.
“Utilization does take time,” added Peter Antall, founder and chief medical officer of the Online Care Group at American Well, one of the nation’s largest telehealth providers and a partner in platforms launched by Nemours, Intermountain and the Cleveland Clinic. Healthcare providers launching new telehealth platforms, he said, should expect anywhere between 5 percent and 30 percent of their patient population to move to digital health at the onset.
The hardest variable to figure out, says Backstrom, is the consumer.
“They’ll wait in a waiting room for 40 or 45 minutes, but they won’t wait more than 10 minutes on a telephone,” he says.
To that end, DTC platforms have to be designed with ease of use in mind. Make the registration process quick and simple, and shuttle the patient smoothly from that point to a virtual visit. That may be tough with a video-based platform, which requires both patient and provider to be planted in front of a laptop, computer or smartphone at the same time. (For that reason, some health systems are turning to asynchronous, or store-and-forward, telehealth services, which enable patients and providers to work at their own pace and set their own expectations on time).
Backstrom says health system executives also have to spend some time thinking about how they will market the service. The most tried-and-true strategy is to begin with hospital employees and their families, work out the kinks, then roll it out to patients and the general public. Still, there has to be some way to make people aware of the program, and to give them some idea of what it involves and what they’ll get out of it.
Then there’s the cost. DTC telehealth visits used to cost upwards of $75, but with companies like Walmart and Amazon dipping their toes into the market, the price point has dropped to around $40 or $50. And it may go lower.
“It’s hard to figure out what the market will bear,” says Backstrom. “A lot of people really don’t know how to price it right now.”
Another challenge lies in getting support from the doctors and nurses who will be on the other end of the online visit or phone call. Faced with their own staffing issues, some health systems have chosen to outsource the platform to a telehealth vendor, but that route may alienate patients who want to see a familiar face or even their own doctor. On the other hand, with younger generations forgoing a primary care provider in favor of these on-demand services, such a platform might be more attractive.
For those choosing to use their own doctors and nurses, the challenge lies in creating a telemedicine platform that appeals to them as much as it appeals to the patient. Again, scheduling has to be easy and intuitive, so that it fits into a provider’s daily routine and doesn’t leave him or her staring at an empty video screen or waiting for a phone call. And if there’s a sudden surge in business, such as during flu season, the platform has to be able to quickly handle the overflow.
Finally, Backstrom says, the care pathway has to be clear. Identify up front the health issues that can be treated via telehealth, work quickly to identify when a telehealth visit isn’t adequate – and make sure that patient is directed to the right resource, whether it be their own doctor or the nearest hospital.
“Providers want to show continuity of care,” he says.
For all the variables to consider in developing a DTC telehealth platform, Backstrom suggests that hospitals and health systems who haven’t tried the technology yet start with a small program in another department, and build from there. Know all the questions to ask and where to find the answers before stepping into this arena.
“The ROI isn’t great,” he says. “It’s probably one of the least successful (telehealth lines) out there right now. Look for better services and a captive audience that will really benefit. Find a service that shows sustainability.”
Eventually, he says, when a health system has reached a point where telehealth is accepted and standardized, and the business plan for a DTC telehealth service is clear, then it’s time.
“Do it for the right reasons and at the right time,” he says.