The telehealth market in the United States finds itself at a crossroads. Direct-to-consumer (DTC) telehealth has matured to the point that on-demand services are (in very broad terms at least) available to most Americans, either via a smartphone app or a kiosk at a retail clinic or worksite.
At the same time, the market needs to pivot from episodic to chronic care. The former is more lucrative; the desire for disruption and access is greater, as more traditional healthcare organizations (HCOs) have set the bar so low. However, the latter is poised to be more transformative, lowering overall care costs and improving care continuity – provided that HCOs, payers, employers, vendors, and patients can all figure out what they want and, more importantly, who will pay for it.
The partnership between American Well and Samsung illustrates telehealth’s dilemma quite well. American Well’s telehealth service is now integrated with Samsung Health, the health app formerly known as S Health that is also now available for all Android devices. Within Samsung Health, users who navigate to the Experts tab can initiate a video visit with an American Well doctor. The app will verify insurance information on the spot, and the visit costs $59, which is what American Well normally charges.
The partnership shows how much DTC telehealth has matured, as it’s now available to anyone with an Android phone. It also shows how hard it is for telehealth to pivot, as both vendors indicated on a recent call with analysts that the partnership will initially focus on episodic and urgent care. A shift to chronic care is inevitable – if for no other reason that few doctors enter the profession to spend all day diagnosing strep throat or looking at weird rashes – but the timeline is unknown.
A big deal, but only if…
American Well and Samsung think their partnership can be the starting point for a multi-channel telehealth platform, one where text messages and video visits are standard components of a longitudinal care plan and integration with electronic health record (EHR) and care management solutions is common.
Whether it is in fact possible to marry clinical and consumer telehealth depends on a number of steps forward that are largely out of the control of American Well and Samsung – more consistent regulations, standardized credentialing, cooperation from EHR and care management vendors, expanded insurance coverage (especially from Medicare), and HCO acceptance of virtual care as a viable substitute for in-person care in certain scenarios.
The biggest factor, though, is payment reform. With more than 80 percent of care in the U.S. still covered under a fee-for-service (FFS) model, for example, American Well and other telehealth vendors (as well as their shareholders) can be forgiven for favoring low-acuity episodic care over untested and unproven chronic care – unless frequent users of episodic visits present an opportunity for member acquisition. (In this case, we mean follow-up chronic care as opposed to in-hospital chronic care such as telestroke or teleICU, where both the use case and the value proposition are much less uncertain.)
A recent commentary wondered if the telehealth sector is headed for a bubble – and another pointed to the dearth of late-stage startup funding deals in telehealth. Add to that clinical studies with differing conclusions about access and ROI, as well as a hodgepodge of regulations, and it might be time to pause and take a breath.
If nothing else, it might be time to admit that telehealth is getting pretty good at broadening access to episodic care but still struggles to address chronic care. The former works for healthy patients who don’t have (or even necessarily need) a longstanding relationship with a primary care physician (PCP). The latter, meanwhile, depends on such a relationship; that’s hard to build if a patient consistently sees different physicians and there’s no record of those visits in a PCP’s EHR. With their partnership, American Well and Samsung are certainly trying, and other vendors would be wise to try as well, but they face an uphill climb.
All that said, telehealth’s dilemma is no different that the healthcare industry’s “one foot on the dock, one foot in the boat” conundrum: Initiate value-based care when and where it makes the most sense, or has been mandated, but stick to FFS in all other scenarios. Framing the telehealth discussion in this larger context should provide some clarity about what must happen to leave the dock and get into the boat.