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August 8, 2018 Readers Write No Comments

A Smart Telehealth Strategy Creates Great Value While Meeting Myriad Needs
By Ray Costantini, MD

Ray Costantini, MD, MBA is co-founder and CEO of Bright.md of Portland, OR.


Friction is the enemy of efficiency, whether it’s an automotive engine clogged with grime or an athlete’s muscles slowed by lactic acid. Our healthcare system is stymied by high levels of friction throughout. Fortunately, for hospitals, doctors, and other healthcare providers seeking an edge in today’s highly competitive healthcare environment, a smart telehealth strategy presents an opportunity to slice through much of this friction and create great value in the process.

Telehealth is a broad category. At one end of the spectrum, it involves managing complex, high-risk conditions such as stroke through remote monitoring and consultation. At the other, it entails providing high quality, on-demand convenience care (or virtual care) for a range of acute, episodic, and non-emergent conditions in an effective, rapid, and cost-effective manner. There are many points across this spectrum to create and capture value for health systems and their patients. Telehealth services hold the promise of unlocking that value and now is an excellent time to think about integrating them into practice.

Several converging trends are contributing to this window of opportunity. One is the shortage of primary care physicians. Did you know that a patient in Boston typically has to wait up to 66 days to see a doctor through a traditional in-clinic visit? If you’re lucky, you’ll get sick in San Diego, where the elapsed time from scheduling to care is just seven days.

Another contributing trend is the consumerization of healthcare. Patients today are increasingly savvy. Empowered by technology, they expect on-demand access to care, and if they don’t get it or don’t like what they get, they’re all too ready to take their business elsewhere. This is one reason we’re seeing a proliferation of independent “retail care” locations, which by the way exacerbate the shortage of providers and add to the friction in the system.

What’s a provider to do to seize the telehealth opportunity? First, you’ll need to come up with a telehealth strategy. There’s no “one size fits all” approach here. For example, one system may be struggling with access issues, while another may face the challenge of serving a specific population group or demographic. The right solution with a tuned operational plan behind it can solve either of those issues. Start by taking an inventory of the pain points you want to solve. Also helpful: stop thinking in terms of return on investment or revenue created and instead begin thinking about the value created by your telehealth strategy and virtual care solutions. There are many different ways to create value, but you’ll have to decide on the right mix for your particular needs.

A smart telehealth strategy entails a comprehensive set of solutions, what I call a “ladder of care.” This could include options such as self-triage, nurse advice, and asynchronous virtual care for common ambulatory conditions. For higher-acuity issues, it could include video visits. In-person visits would be reserved for conditions where multiple comorbidities exist (diabetes and flu, for instance), or when a physical procedure is required (a minor procedure such as wart removal).

How does such an approach unlock value? First, it creates access and capacity in the system. Asynchronous virtual care visits can take less than two minutes of provider time and can be delivered from a smartphone with even a 3G connection from wherever the provider happens to be. One full-time equivalent of physician or Advanced Practice Clinician can deliver more than 20,000 of these virtual visits per year. Compare that with just 2,000 20-minute in-person or video visits for an in-clinic provider. This approach also attracts new patients and retains existing ones, which in turn drives downstream revenue and adds to your brand bank, building loyalty and positive word of mouth through innovation and patient-centered service delivery.

A ladder of care approach also ameliorates provider burnout by giving providers time to focus on higher-acuity patients (and generate associated reimbursement) in clinic and top-of-license practice. If the telehealth solution can automatically generate a chart-ready SOAP note, that dramatically cuts down on clerical work.

The value created pays dividends at the system, clinician, and patient levels of the healthcare ecosystem. At the system level, in a FFS (fee-for-service) world, a smart telehealth strategy can unlock downstream revenue through both patient acquisition and retention. In a capitated model, it helps keep the patient population healthy while preventing minor ailments from becoming major ones due to a lack of treatment or access.

A smart telehealth model can help cut your losses on primary care while also shifting fixed costs to variable costs. Instead of building or leasing and outfitting a two-clinician clinic, you would instead spend a fraction of that cost to provide a far more efficient usage basis. Integrating the staffing of your telehealth with existing retail or urgent care efforts would help fill the more than 30 percent of idle provider time that’s all too common in those settings. The list goes on.

For your patients, there are savings in time, money and more. Patients regain the hours it takes to schedule, wait for, and be evaluated by a physician, also avoiding lost wages, childcare costs if they have to visit the doctor, and so on. Telehealth patients report getting healthier sooner, recovering 1.5 days faster. For clinicians, a tele-visit can turn a 20-minute low-acuity visit into a higher-value visit with a patient who really needs it.

Meanwhile, the barriers to telehealth are quickly coming down. According to a 2016 Medscape study, both patients and physicians have improved their attitudes when it comes to embracing telehealth, with nearly two-thirds of patients surveyed expressing comfort in virtual care, diagnoses, and treatment plans. Add to that an increased availability of telehealth services from providers and a growing sense of patient trust versus privacy and security issues. With so many tech companies turning their focus to healthcare, many of the technology challenges associated with telehealth (bandwidth, availability, etc.) are a thing of the past.

Bottom line: this is no time for hospitals and doctors to retreat into traditional, friction-bound approaches to healthcare delivery. Your patients are already moving to a technology-enabled future of on-demand access to timely, convenient care. A smart, well thought out telehealth strategy is your ticket to join them and ride the next wave of patients and value-creation opportunities.

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