The notion that “Access to Care is a Human Right” is one I can very much wrap my mind around and throw my support behind.

In Germany, where I was born and grew up, there is neither Universal Care nor Socialized Medicine. Rather, there are three key mandates: everybody has health insurance, the insurance premium is a percentage of one’s salary, and the cost of insurance is equally split by the employee and the employer. This approach greatly enhances access to care within the “standard system” — without, e.g., the need for a separate system for uninsured.

So in the context of the situation in the US, it is commendable for innovative, well run big businesses (e.g., Amazon, Walmart, Optum) to “try their hand” on delivering primary care effectively and efficiently via telehealth. After all, how hard can it be?

Turns out — very hard.

The recent history of healthcare, especially one that relies heavily on virtual care delivery, is now littered with failed attempts.

  • “The Clinic” was an attempt in 2019 by the Cleveland Clinic to team up with AmWell to — from what I could tell — make access to Cleveland Clinic care ubiquitous nationwide — seemingly never made it past its pretentious name selection.

  • JP Morgan, Berkshire Hathaway, and Amazon tried to lower the cost of care for their employee through a medical “Haven” they, too, failed.

  • Amazon Care emerged to much fanfare during Haven’s demise — only to be shut down, too, a few short years thereafter.

And now, just in the last few weeks, three other well known “innovative”, “economically-driven” telehealth services folded virtually(!) overnight: Optum Virtual Care, Walmart Health (which relied heavily on telehealth), and Walgreen’s Village MD.

Does this mean that Telehealth is Dead?

Now, one could conclude that this is an indication of telehealth not being a good solution for cost-effective and outcome-driven care and that telehealth was only Covid’s stop-gap measure. Many telehealth-naysayers will use this as a showcase for why telehealth does not work, how patients don’t want it, how there is no business model for telehealth, and how it simply is not good medicine. “If even Amazon and Walmart cannot figure it out, why do we think we have a chance?” the self-appointed pundits ponder.

But nothing could be farther from the truth.

The real reason that these ventures failed is not because of any flaws in the idea of “delivering care at a distance”. Nor is it due to the lack of talent — the ventures recruited illustrious names, industry titans, and brought smart minds together. I don’t even think that inefficient workflows (my favorite go-to pet peeve) were the culprit.

No, the reason why these ventures failed is because in our current environment it is freakingly difficult to make money in healthcare – virtual or not. Others can explain the economics better than I can, but suffice it to say that the margins are razor thin and the slightest problems, such as clinician recruitment, can turn a minimal profit into large losses.

It is not telehealth that failed here. It’s profit-driven primary care / behavioral health care that failed. Because in the current environment, there is very little money to be made – virtual or not.

As one hospital executive put it: “If my business model does not work, I cannot simply exit stage left and close up shop.”

Telehealth is Here to Stay

I repeat the words that, in a moment of poor judgment, I sang on the stage of the MATRC meeting 10 years ago (channel your inner Louis Armstrong and Ella Fitzgerald here:) “It’s very clear…telehealth is here to stay. Not for a year…but ever and a day.”

And over the past month, as I’ve attended and presented at three telehealth conferences (MATRC, NRTRC, and ATA), it is clear that many larger health systems have taken a path to “normalizing” integrated care — i.e., the integration of video visits and RPM into the standard care delivery.

The initial hype of telehealth use during the pandemic (when much of it was just sadly only telephonic) was followed by the predictable dip into the “trough of disillusionment”. For organizations that did not give up as easily and dedicated staff to the support of telehealth, they saw a much shallower dip and now a slow but steady increase in utilization.

As I’ve observed this year, with the normalization of telehealth and RPM, organizations higher up on the telehealth maturity spectrum are now building out their programs with focus on applications in various specialty care situations, such as pediatric care, inpatient monitoring, diabetes care, etc.

Because they have accepted that “telehealth is here to stay”.

Our Takeaways

From those recent news, here are the conclusions my colleague Kathy Letendre and I are drawing:

  • For-profit organizations who are not in the health care delivery business wanted to get into healthcare because they saw big revenue and profit opportunities.

  • The complexities of doing health care are not for the faint of heart (e.g., rules, regulations, reimbursement, large deductibles, revenue cycle with long period between delivery and cash in the door)

  • They tried to create a “new” way to offer a service to their members (Optum) and customers (Walmart, Walgreens)

  • With health care’s typical delivery margin of -2% to +3% (at most) they found primary health care not interesting enough to take on for for-profit entities.

  • Most Modern Healthcare Consumers value a relationship with their care provider, not transactional ad hoc sick care.

Overall, these developments actually create a very positive report card for traditional health care delivery organizations:

  • They understand and can deal with the complexities of healthcare delivery

  • They are grounded in their communities and understand their patients’ larger ecosystem.

  • They see healthcare as relationship-based not as transactional.

  • They increasingly realize that telehealth is best delivered in an integrated care (formerly known as “hybrid care”) model that can seamlessly alternate between in-person and at-a-distance care.

  • Telehealth is still mostly about trust and on an ongoing basis, patients don’t just want anyone but someone they know and that they can trust.

In the interim though, while big business disruptors will continue to find ways to attempt to make healthcare work, the good news is that the “patient poaching” will slow down for quite a bit. This will give your health system, health center, or clinic a chance to beef up every system, every workflow, and to be increasingly appealing to patients (and your clinicians), so that your clinic can be ready for another big business or even another Covid to disrupt your peaceful relationship with your patients.

Let me know if you’d like to chat about telehealth “build out” opportunities for your outpatients and your inpatients.

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Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.

Contact Christian by phone or text at 657-464-3648, via email, or video chat.