In the midst of a global pandemic, millions of people have experienced telehealth with a virtual exam for the first time this year. I did. It was enlightening. I completed my patient intake online, waited in the virtual lobby for a few minutes, had a quick introductory consultation with my doctor, and I was done. The only question I had at the end was, “what will I do with the extra 90 minutes I saved?”
As a telehealth architect, I am thrilled when I hear stories like this from patients, but what might surprise you is that creating a delightful and convenient patient experience is only part of the idea, and it’s not the reason why we pitched it, sold it, built it, and now, bank the ROI on it. Today, I want to share with you the business case for telehealth with the bigger payback opportunity, and why I think the play has extraordinary potential beyond healthcare. At its core, telehealth is an extension of an omnichannel strategy and a rewarding approach for optimizing resource utilization.
To explain, we first must acknowledge how the year 2020 and the COVID-19 global pandemic have impacted the consumer climate, probably forever.
Three years ago, my colleague Dan Izzo and I helped a client through an omnichannel transformation and lived to write about it in a 3-part series where we discussed the shift to a digitally connected, omnichannel culture. In short, the overall gist of the article is that omnichannel takes foundation and discipline to achieve a winning formula:
Consumer Demand = What I Want + When I Want It + How I Want It
If your business embarked on the journey toward omnichannel utopia before “social distancing” became part of the world’s vernacular, kudos to you. It means you’re in the game, and it’s probably time to recognize the fruits of your labor. Businesses that were able to seamlessly support multiple customer interaction channels, especially contactless experiences or transacting from home, are well-positioned to weather the pandemic storm, or possibly even surge through it.
The results are in. Walmart and Target, both models of omnichannel and grandmasters at delivering on the “how consumers want it” part of the equation, recently crushed 3rd quarter earnings. Target, for example, wildly exceeded investor estimates with a 155% surge in e-commerce sales, a number that includes their curbside DriveUp offering.
Then there are less obvious examples like my recent experience closing on a refinance of my mortgage from the driveway of my home. I put this type of experience in the category of “why haven’t we done it this way all along?” (i.e. smart and pleasant surprises that are not hard to implement)
What does omnichannel and shifting consumer expectations have to do with Telemedicine? For starters, I believe the term “telemedicine” is somewhat of a misnomer. I prefer to think of it as “remote service.” When you frame health delivery from the perspective of a retailer, then consider that:
Customers = Patients
Stores = Medical Offices
Products = Exams / Consults
In this way, telehealth is simply an extension of the evolving omnichannel equation:
Consumer Demand = What I Want + When I Want It + How I Want It
The same equation restated for remote care:
Patient Needs = Quality Care + Flexible Schedule + Remotely Serviced (from home + socially distant)
In April of 2020, Forrester estimated that over 1 billion telehealth virtual “visits” would be completed by the end of the year, with 900 million or more directly tied to the fight against COVID-19. Additionally, the paradigm shift is expected to grow past the point of crisis to the tune of $155B by the year 2027 (Grand View Research).
Yep, $155 with a B. That’s what I call “white space,” and the ballooning number does not account for how telehealth, or “remote service,” principles could be applied to other verticals outside of health care.
For quick consults, follow-ups, and visual screenings, virtual exams are a no brainer. Patients can more flexibly schedule their appointments and save the trip (and all the waiting) of an office visit, and health care providers can see more patients in the same amount of time, without possible exposure to COVID-19. Win. Win. Win. Still, for those focused on running a practice as a business, remote care offers a bigger opportunity.
At its core, telemedicine is a resource utilization play
Take any medical practice and reverse sort their income statement, and doctor payroll and real estate cost will bubble to the top. Find a way to better utilize those costs and win big. Telemedicine does both.
The key word is “utilize.” You can’t reduce your payroll costs when doctor salaries are fixed, but you can lower the cost per exam by enabling doctors to conduct more exams.
In a traditional office visit scenario, doctors rely on patients making appointments, filling the book, and patients showing up. Then life happens and there are peaks and valleys in the schedule, or perhaps the office is located in a smaller market and it’s a slow day. I don’t enjoy talking about people as resources, but doctors are expensive, and it’s not cost effective if they aren’t seeing patients.
With a telehealth platform in place, especially one with on-demand resource matching capabilities, there are many ways to reduce the cost per exam by enabling doctors to do more exams per day or optimizing doctor down time.
Performing screening, follow-ups, or quick consults over video conferencing
When the doctor-patient relationship matters and a patient is expecting to see a particular person, using doctors interchangeably is off the table, but there are still incremental efficiencies to be gained. Video conferencing for follow-ups and screenings can minimize buffer time between appointments that are typically needed for cleaning, wipe downs, and ushering the patient through the office. This is the simplest and most common model, but it also offers the smallest gains.
Enabling doctors to cover more locations and hours
When a patient is indifferent about who they see, opportunities emerge to leverage doctors more interchangeably and dynamically deal with balancing doctor supply and patient demand. The data shows that the most desired appointment times are before/after work, lunch, and weekends. When do health care providers want time off? You guessed it: before/after work, lunch, and weekends. If the goal is to serve patients on their schedule, telemedicine can keep the practice taking appointments during times when traditionally the book would be closed or when there is an unexpected absence / planned vacation. The onsite doctor can take their lunch break while an available or part-time remote doctor takes telehealth appointments.
Not requiring a permanent onsite doctor in low volume locations
The most common form of telemedicine is when a patient takes a video call from home with a doctor at the clinic. However, the opposite is also true and opens even more doors for leverage. Consider a model where health care providers work from home and serve patients who are at the clinic. This is especially necessary when sophisticated diagnostic or imaging equipment is needed to perform an exam. In retail optical for example, remote Optometrists (OD) can see patients from home while the patient comes to the store for their exam and to select frames. The OD uses a digital platform on the cloud to access high resolution imaging taken in the exam room, and he or she can take remote control of diagnostic equipment to perform a subjective refraction and examine the anterior chamber of the eye.
When the doctor is centralized remotely, the business benefits.
- The doctor can serve multiple locations without traveling between clinics. This is valuable for low volume or rural locations where it’s difficult to fill the schedule or find a doctor to work
- While this model doesn’t offer the patient the convenience of “how I want it” in the omnichannel equation, it does expand vital access to care in locations and times that were not previously possible
- It continues to drive traffic to the clinic for consultative selling (important in the case of optometric care where there is a retail component)
I find this reverse model especially unexpected and interesting for extending the principles of telemedicine (or remote service) beyond health care.
Leveraging doctors that are already in the clinic but not engaged with a patient
Last, once a network of licensed providers is established and the technology is in place, there’s opportunity to better utilize resources during the times when one location has extra capacity and another location is backed up with patients becoming increasingly impatient with their wait. In this model, a provider that is inactive (i.e. between patients) at Clinic “A” can serve in-person patients virtually at Clinic “B.” Keys to success in this model depend on dedicated overflow remote exam space and building a suite of software, diagnostic equipment, and processes that are standardized.
“Standardized” is not usually a word used to describe our health care system. I actually chuckled to myself as I wrote it. We have a long way to go, but seriously, it’s happening. To all of our benefits, a consortium of technologists, software companies, equipment manufacturers, insurers, etc. (largely all unaffiliated) are working toward a common goal to integrate together, drastically reducing the barriers to entry.
On the technology front, telehealth no longer requires breakthrough invention and is mostly an integration effort of commercially available technology:
- New digitally enabled exam rooms with diagnostic equipment capable of sending data to an API
- Rapid adoption of EMR (Electronic Medical Records) and PACS (Picture Archiving and Communication System)
- Advances in video conferencing technology with cost-effective high-resolution cameras
- Dramatic increases to readily available bandwidth capacity
- Sophisticated on-demand scheduling where doctors and patients are matched dynamically
We also see much greater acceptance by patients and doctors alike because of a shift in behavior associated with the COVID-19 outbreak. Methods of care that minimize contact in a clinical setting are now generally embraced. Prior to the pandemic, insurers, regulators, and governing health provider associations were divided in their support for telemedicine because of a claim that the technology would shortcut quality of care or even eliminate jobs.
The climate ahead is unpredictable, but we can get into position to ride the next wave. I have a wise friend that likes to tell me, “stay near the hoop and look for the ball.” What personally excites me is thinking about how concepts of telehealth and remote service can be applied to other underutilized resources outside of healthcare. Patients and consumers alike will continue to seek out convenience and demand more, and our challenge is to harness that change behind the scenes to grow the bottom line.
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 Doug McMillan – Walmart CEO Quote