The Telemedicine Journey: If you don’t know where you’re going, you’re bound to get there.
Fourteen years ago, I was just starting out in the telemedicine industry, and people in remote areas without access to healthcare couldn’t get help. Our projects had clearly defined direct incremental clinical value. Even if the business case did not make sense versus the cost of the technology, there was a definite need between providers and outlying rural areas. In those cases, telemedicine grants funded most of those opportunities.
Today, digital health and telemedicine has been technically accepted, but up until March 2020, there wasn’t a compelling event to make that happen and there is still a lot of confusion on when and why to launch telemedicine programs. A significant symptom I call “paralysis by analysis” prevents the purchase of technology because of fear that it could be outdated in a year or worse, not used. We no longer have that problem. We know that telemedicine is here to stay.
In our years consulting healthcare organizations there are 5 overarching reasons to establish a telemedicine program:
- Access to Care- Expansion of Services
- Access to Market- Patient Retention/Acquisition
- Cost Savings/Avoidance
- Risk Aversion – litigation & penalties
- Revenue Enhancement/Generation
Any of these 5 reasons, when incorporated into a telemedicine program, demonstrate the underlying principle that positive medical outcomes can be achieved outside of the four walls of a hospital. Good programs consider at least two of the reasons above, and great programs have more across multiple service lines (i.e., risk aversion for readmission penalties for high acuity patients and cost avoidance of unnecessary pediatric ambulance transports).
Telemedicine is a small industry where people tend to know each other and share stories about experiences. Fueled by venture-capital speculation, there are dozens of new entrants into the digital health marketplace each year creating more confusion. Prior to COVID, each suffered the same issues as those who were already established in the market. The only “pure play” publicly traded telemedicine company prior to the COVID public health emergency stated in their 2018 annual report that all telemedicine platforms likely share the same challenges and risks. Here are 10 examples picked off the annual report of the aforementioned company and nearly everyone of these risks have been mitigated in the post-COVID world of telemedicine:
1) Our business could be adversely affected by ongoing legal problems to our business model or by new state actions restricting our ability to provide the full range of our services in individual states.
2) Evolving government regulations may require increased costs or adversely affect our results of operations.
3) We conduct business in a heavily regulated industry, and if we fail to comply with these laws and government regulations, we could incur penalties or be required to make significant changes to our operations or experience adverse publicity, which could have a material adverse effect on our business, financial condition, and results of operations.
4) We have a history of cumulative losses, which we expect to continue, and we may never achieve or sustain profitability
5) The impact of recent healthcare reform legislation and other changes in the healthcare industry and in healthcare spending on us is currently unknown, but may adversely affect our business, financial condition and results of operations
6) A significant portion of our revenue comes from a limited number of Clients, the loss of which would have a material adverse effect on our business, financial condition and results of operations.
7) We could incur substantial costs as a result of any claim of infringement of another party’s intellectual property rights.
8) Our sales and implementation cycle can be long and unpredictable and requires considerable time and expense, which may cause our results of operations to fluctuate.
9) We operate in a competitive industry, and if we are not able to compete effectively, our business, financial condition and results of operations will be harmed.
10) The telehealth market is immature and volatile, and if it does not develop if it develops more slowly than we expect, if it encounters negative publicity or if our solution does not drive Member engagement, the growth of our business will be harmed.
To be clear, I am not picking on this particular organization, especially when their own identified risks are much different than they were just 2 years ago. As a publicly traded company, they have to disclose the same risks inherent to the vast majority of vendors in the market. However, there are more established players that carry an additional business and technology transformation burden and incur more cost and potentially more debt because they entered the market before the “cloud revolution” and still have to make that adjustment to become a cloud-delivered platform versus an on-premise solution.
On the provider side, there is also a risk. There is a tongue-in-cheek saying among my colleagues that speak to a mentality of, “I’m gonna get me some telemedicine,” referring to tales of companies rushing to get their telemedicine program up and running without proper planning. This has never been so evident than during the COVID public health emergency. Now that the dust has (mostly) settled, we can all hopefully take a deep breath and make decisions based on the needs of our respective businesses and not have these things dictated to us (i.e. COVID-19).
Organizations that are getting bids and making purchases without clear direction at the outset are going to fall victim to a pre-COVID mindset. The old saying that failing to plan is planning to fail is still in play today. To execute on a failed plan is more dangerous than “paralysis by analysis” because once a program fails to produce the outcomes (clinical and financial), it’s harder to justify getting back in the game at a later date.
Going to bid before defining your goals strategy or letting a vendor guide your vision based on their technology puts the cart before the horse. The goals of vendors and providers don’t always align which means it’s not in the best interest of healthcare organization to rely solely on vendor recommendations. They offer good advice, but usually, it’s forced by the supply side and not genuinely based on what the customer needs. The good news is that there is, however, an approach which alleviates both the “paralysis by analysis” method as well as the “rush to failure” method.
Starting with the problem, the goal, and then working backwards is always prudent. When it comes to telemedicine, a good place to start is by reviewing your regional Community Health Improvement Plan or Community Needs Assessment, where you’ll find the pain points and requirements for managing the health of your local population. Use a data analysis/business intelligence vendor with data from separate repositories, to find the right demographic within your patient base to serve first. Once you identify the community you want to help, it will point you in the direction using the five reasons listed above to develop a telemedicine program. At this point you can leverage the benefits of a telemedicine readiness assessment for your organization. The resulting SWOT analysis tells you what is essential to launching a successful telemedicine program and will put you on the right track. It finds your internal champions as well as those who are not as enthusiastic about telemedicine. Doing this will give you a picture of where you are, where you want to go, and how to get there.