Monday, February 17, 2014

I'll Take My Care To Go

I have to admit that when fast food restaurants first got into drive-throughs, I didn’t really see the point.  Well, I missed that one: they now do 60-70% of their business via the drive-through, changing the architecture, menu, and consumer expectations of the fast food industry along the way.  Aside from pharmacies, I haven’t seen drive-throughs impact health care yet, but one doesn’t have to be much of a seer to recognize that that the need to actually visit providers’ offices for health care is quickly being whittled away.

Let’s start with kiosks, which are increasingly providing quick alternatives for some services that used to require consumers to visit their doctor.  For example, in the news recently was a deal higi did with Rite Aid, which will put higi’s kiosks in some 4,000 Rite-Aid stores.  higi already has kiosks in Publix and Whole Foods.  Their approach features kiosks that allow consumers to measure and track their vitals, while gamifying that mundane process.  They combine all the measures into a single “higiscore” that consumers can easily track, and also offer some community features.

higi is not alone in the kiosk business.  There’s SoloHealth, which claims 40m annual user engagements, driven in large part due to its deals with Walmart/Sam’s Club and Safeway, as well as some deals with health insurers, such as Wellpoint (Blue Cross and Blue Shield of Georgia and Anthem Blue Cross in California) and HCSC.  Indeed, Wellpoint led a $12m investment round for them in 2012.   eHealth and even HHS also like SoloHealth’s ability to target consumers while they are thinking about their health.       

Not unlike higi, SoloHealth offers quick self-service screening options, but the deals with insurers have them offering information on health plan options as well, a move that is not without critics due to the perceived privacy concerns.  

HealthSpot goes the other screening kiosks one better by also offering video visits with board-certified physicians.  They’ve been doing deals with provider organizations, including University Hospitals Rainbow Babies & Childrens Hospital (Cleveland), MetroHealth (Cleveland), Nationwide Childrens Hospital (Columbus), and Miami Childrens.  HealthSpot also recently teamed up with telepharmacy – there’s another wrinkle! – vendor MedAvail Technologies to create an all-in-one Redbox-type system. 

Other kiosk providers include StayHealthy, Computerized Screening Inc., Honeywell. 

Of course, non-office visit alternatives are broader than kiosks, especially “virtual visits” offered via phone or computer.  Parks Associates recently found over 25% of American households have used some kind of virtual care, and predict that will grow to 65% by 2018.  They also see a big market for online health and fitness tracking, as does the Consumer Electronics Association, among other forecasts.

Examples of virtual visit vendors include TeleDoc, American Well, and MDLive.  TeleDoc has been offering a telephone-based physician consult service for years, and now also offers a video consult service.  They even recently partnered with HealthSpot, adding to TeleDoc’s reach and deepening the HealthSpot physician network. 

American Well started with email physician consults, added video consults, and recently went beyond its traditional payor partners to offer a direct-to-consumer option at $49/visit.  American Well notes that its services are available via web, kiosk, and mobile – and, in fact, says that 60% of its video visits are from mobile devices. 

MDLive is the most recent newcomer of the bunch, but has a wide range of tele-services and some serious backers, including Sutter Health and John Sculley.  

Some patients (and more physicians) may be skeptical of the quality of services that can be done via a video consult, but that may be changing.  For example, a recent study in JAMA Dermatology found that the video consults produced essentially the same results as in-person visits when it came to triaging.

Kiosks themselves may end up being a niche offering along the continuum of points-of-care, as the video consults are already available on computers and mobile devices and as more and more biometric measures can be done via remote monitoring and apps – why drive to a kiosk when you get do the same things at home or on your phone?  After all, health related apps are booming, and include screening and diagnostic tools.  The stethoscope app, for example, has been around for several years and has proved popular with both consumers and – surprisingly -- physicians.  That’s just one example, but this future is happening, as evidenced by Apple’s expected interest. 

So we’ve got sophisticated bio-metric screenings at your convenience in a wide number of retail settings and, increasingly, via mobile devices, plus we’ve got physicians available literally in the palm of your hand.  That’s not all.  IBM’s Watson is teaming up with “social health management” vendor Welltok to help answer consumers’ health and wellness questions without the assistance of a physician – or any live person.  IBM is so excited about the potential that they’re actually part of an investment round for Welltok. 

Wellpoint is already using Watson on a number of fronts, including providing advice to cancer physicians and to help their pre-approval process.  We may be a long way from the holographic medical program that the TV series Star Trek Voyager had in The Doctor, but I don’t think we’ll have to wait until the 2370’s to see such applications either.  Most likely we’ll start with artificial intelligence programs assisting physicians in decision support, as computers are much better at remembering and searching vast databases than humans are.  

All these new options for receiving care and medical advice remind me again about how much behind the curve traditional health insurance and health providers are.  MobiHealthNews recently did an analysis of hospital apps, and found a lot of doctor and facility locators, but not so many trying to reinvent how/where they deliver care.

I’ve written before about how health plans need to radically reshape themselves, giving an example of them becoming more “provider brokers” for patients than network managers.  The trend of “virtual care” provides another example of a potential alternative to traditional insurance. 

As I noted in an earlier post, AHQR recently reminded us that the 50% of consumers only account for 2.8% of all spending, while the top 10% account for 66%.  I.e., a few people need lots of hands-on, intensive care, and some people may need such care occasionally, but most care for most people does not need have a physician physically present (and may not need a physician at all).  This care could be delivered through retail clinics, kiosks, and computer/mobile-based options. 

Instead of continuing to fight the good fight to increase insurance reimbursement, maybe we should be thinking about developing new products that offer consumers a prepaid package of such virtual services, carving them away from the insurance market.  Or the industry could go the new American Well consumer approach and simply offer virtual visits on a per-use basis, like most other consumer purchases.  In either case, I suspect many consumers – and providers -- would be willing to trade the convenience of the virtual options for the hassles of dealing with insurance coverage. 

Consumers might give up continuity of provider, but that doesn’t necessarily mean giving up continuity of care, such as through use of patient-centered EHRs.

One of the earliest posts I wrote, several years ago and on another platform, warned that “free” preventive care might not be as good an idea as its supporters made out (and this was before the more recent questions about, say, screenings for prostate cancer or mammograms).  One of the many things I don’t like about ACA is how it locks “essential benefits” into a more expansive and more expensive health insurance product, when what we really should be doing is finding more consumer-friendly and less expensive options for care and for paying for that care.  These various virtual care options provide the potential for such an approach.

Consumers should have the option to receive care at the time and place that best suits their condition, preferences and convenience, and that we should not be allowing reimbursement decisions to limit those choices.  It should always be about what is best for the consumer – not the provider or the health plan.


  1. Thought provoking perspective on the ubiquitous health journey.. With banking and with travel etc. we have effectively torn down the walls between modalities of service across brick and mortar and virtual environments.. We still in healthcare have to embrace the multiple touch points as equally significant and relevant.
    However we must educate consumers before we let them choose the place they want their care. Misconceptions of getting quality care at the ER should be addressed through health literacy

  2. Interesting article on a "virtual" trend I failed to cover -- virtual currency (see