Telehealth News, Making Sense Out of Telehealth - Healthcare News Brief
Depending on the day, you’ll either hear that telehealth (aka telemedicine or telecare) is heading into a decline or that it's booming - or both. Part of that is because we’re not segmenting telehealth companies properly. While telehealth, three years ago, might have been a largely undifferentiated concept, practice types and areas have split up rapidly.
What we call telehealth is really a set of market segments, addressing different areas in healthcare: chronic disease management, mental health in a variety of severity segments, occupational health, follow-up monitoring, etc. There’s been attempts to classify these markets, mostly by tagging “tele-” in front of everything - teleradiology, telepsychiatry, telecardiology, etc. - but that probably misses the real market segmentation.
The market segmentations are by cash flows. Are they attempting to replace a cash flow, as in mental health, or attempting to create a new market, as in follow-on care or high-risk pregnancy?
Some of the activity happening in the telemedicine category is a little concerning. Medical practice is getting divided up into profitable and unprofitable segments, and some gigantic companies are apparently determined to skim the profitable work. This isn’t anything that hasn’t happened before in medicine, it is similar to the growth of small private specialty hospitals, which the ACA stamped out. I’m not even sure Amazon is ready to take on the AMA and giant hospital systems.
There’s not a patient shortage, and not a lot of niches where telehealth wouldn’t make often dramatic improvements in care. Investment in telemedicine remains strong, the articles about the decline of revenue growth in telecare are mostly related to what we suspect to be unreasonable standards and extremely short-term investment horizons. There’s also the failure to understand that telemedicine is not a stand-alone product - it is part of a care provision and payment system that will be slow to change.
The news and changes in telehealth, systems adoption, and reimbursement are moving rapidly.
Telemedicine Consumer Interest And Adoption
The pandemic dramatically broadened access to and interest in telehealth. As restrictions on in-person healthcare are eased, the necessity driving that telehealth boom has waned, meaning that telehealth now has to justify its continued existence. Doctors have expressed concern that, should patients only seek healthcare online, issues that would be noticed in an in-person physical might slip by unchecked.
The Carolina Journal - the objections to telehealth are mostly practical, not philosophical - Telehealth Genie Escaped the Bottle
On the flip side, telehealth broadens access to those who might not otherwise seek care - a study by Pain Management Nursing saw a huge 83% decrease in missed doctors visits amongst veterans who were offered telehealth. The AARP found that a third of adults above the age of fifty were, post-pandemic, still "extremely or very" interested in telehealthcare for themself or a loved one.
AARP - older patients like telehealth - Interest in Telehealth Services is Holding Steady
Investment and Development in Telehealth
The two types of development in telehealth are systems development and monetary investment. Both are occurring at a rapid pace. Hospital systems and practices are working to integrate telemedicine options, as well as open new contact avenues between patients and physicians. At the same time, investment in telemedicine services, stand-alone or practice-integrated, continues to rise.
Government Technology - Windber, Pa., Hospital Is Creating 'Telehealth on Steroids'
In certain areas, telecare is already proving viable as a physican-extender, allowing more direct and more frequent follow-up care or condition management.
HealthcareIT News - Telehealth Can Be a Safe Technique in High-Risk Pregnancies, Study Shows
In the US as well as globally, dozens of funding deals and investments occur quarterly, with some big numbers attached, to restructure providers into telehealth, or in new startups. These are not $2m or $5m deals, they're $30m, $50m, $250m.
Austin Business Journal - Tele-psychiatry Startup Iris Telehealth Raises $40M
Big Money Attracts Big Players
The stream of gigantic companies wanting to get into healthcare is both beneficial, and concerning. Beneficial because national and global reach. Walmart's entry into diabetes management may give more heft to the needs and costs of patients, and provide care in areas distant from big hospitals, but come with practitioner and systems risk. Other entrants into telemedicine appear to be little more profit skimming.
Newsweek - How One Retailer Is Redefining Healthcare
TechTarget - Amazon Takes its Telehealth Offering Nationwide
Becker's Hospital Review - Antitrust Advocates are Worried about Amazon's Telehealth Push
Healthcare IT News - Providers' Best Weapon Against the 'Retail Revolution'? Digital Health Transformation
Love Them or Not, Wellness Brands Are Seeing Growth
Him & Hers, sibling apps and websites targeted towards the line between medicine and wellness, is a venture capital darling company. It doubled its revenue between its IPO in 2021 and first quarter 2022, and dominates (according to their CEO) the charts on the Apple App Store - though such succes still brings it shy of profitability.
Some might say this is the democratization of healthcare happening before our very eyes. Others might worry that these types of brands are marketing drugs like essential oils. Either way, the train does not appear to be stopping any time soon.
Fierce Healthcare - Consumer Telehealth and Wellness Brand Hims & Hers Ups 2022 Revenue Outlook Driven by Strong Q1 Growth
While Early Problems In Telehealth Relate to Competitive Barriers and Prescriptions
It's not shocking that the telehealth industry has been inundated with startups in the wake of the COVID-19 telehealth boom - nor is it shocking that those startups are now fighting to survive as the influence of the pandemic wanes. Teladoc CEO Jason Gorevic bemoaned the phenomenon, saying that while Teladoc was well-positioned to weather the storm, it was getting lower-than-expected yield on customer conversions due to "smaller private competitors pursuing what we think are low- or no-return customer acquisition strategies in an attempt to establish market share." In plain terms, the issue is the typical new tech startup method: burn investor capital until you're too much of an institution to go under (hopefully).
PYMTS.com - Teladoc Says Overcrowded Telehealth Field Is Slowing Growth for Fittest Players
PYMTS.com - As Telehealth Spike Slows, Providers Seek Innovation to Increase Engagement and New Use Cases
Alas, telehealth is not the same as social media platforms or food delivery apps; these aggressive expansion methods can lead to critical issues, such as the mass-prescription of controlled substances like Adderall. While mental health becomes the telehealth industry's new focus as COVID profits peter off, so waxes government interest in regulating the prescription of mental health-related drugs through these telehealth platforms. Big players such as Walmart and CVS also jockey for space here, notably blocking prescriptions for Adderall from the ADHD startup Cerebral dues to concerns about Cerebral's over-prescription controversy.
Input Magazine - Controversial ADHD startup Cerebral stops prescribing Adderall
Axios - The Trouble with Telehealth Prescriptions
Systemic Resistance from Government and Insurers
A big question for those on either side of healthcare - patients or providers - is how telehealth ought to be compensated. Part of President Trump's initial response to the pandemic was to direct the Center for Medicare and Medicare Services to add a bevvy of telehealth services to its coverage, to be reimbursed at the same rate as in-person care, ie payment parity. Now that the urgency of the pandemic has dropped off, and demand for telehealth has settled into more sedate numbers, the question stands: should telehealth cost as much as an in-person appointment?
Providers would say yes - they're doing mostly the same work - and those who are paying might prefer otherwise. Here targeted parity might be best, where the parity is determined by the service provided. Regardless, the telehealth industry could stand to mature further before legistlators get involved, as a solution that works now might be inapplicable even five years down the road, in such a rapidly developing field.
Jamestown Sun - Reimbursement Rates May Be a Barrier to Providing Telehealth
As ever, the issue of "who's going to pay, and how much" evokes fierce contention between insurers, patients, and the government - telehealth is no exception.
Fierce Healthcare - Plaintiffs Push for Review of Decision Overturning Landmark Mental Health Parity Ruling Against UnitedHealth
They're Coming for the Pets!
People are offered the chance to buy antidepressants and the like off of apps such as Him & Hers - pets get specialized supplements in the form of treats, and online veterinary consultations.
Pet Food Processing - Pet Telehealth Company Scoops Up Pet Supplement Brand
Which, granted, not spending all day Saturday at an animal hospital office because your cat ate something is a big plus. Weirdly, restrictions on vets for prescribing to pets via telehealth are more stringent than restrictions on prescribing to humans. No word on when we can get online therapists for the cat.
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