Why Telehealth is Not Enough

Local Care Teams FTW

The Covid-19 pandemic opened the floodgates to telehealth services. A need arose when we had to isolate from one another but doctors still needed a way to see their patients. I was in my third year of medical school at the time and my entire primary care rotation was done over Zoom. I never met my attending in person and spent hours on Zoom calls talking with patients about issues from depression and anxiety to diabetes medications to monitoring their blood pressure at home. It was a new experience for everyone, patients and healthcare providers alike.

Telehealth definitely has its advantages. It enables easier access to healthcare, especially for patients in rural areas or with limited mobility and was incredibly useful during the pandemic for doctors and patients to stay in touch. Another benefit was normalizing telehealth as a reimbursable healthcare intervention. Reimbursement rates for video visits increased, allowing more people to be seen and physician practices to be compensated for this work.

With this new trend and funding, health tech companies seized the opportunity. Telehealth-first companies became a venture funding focus in 2020 and continued through 2021. Even as telehealth utilization rates fell with more in-person doctor visits, numerous companies emerged. Telehealth has become integral to patient care scalability, and software is a natural fit for achieving broad access to care. Many companies also built services outside the traditional insurance market, creating membership models for accessing care. This benefits patients who want to have quick access to a physician and health tech companies who want to have recurring revenue and scale quickly.

However, it doesn’t always work for more complex patients from lower socioeconomic backgrounds.

Enter Local Care Teams

Though health tech companies can partner with insurance companies and navigate Medicare and Medicaid, complex patients require more than just telehealth. Companies offering field teams or care teams on the ground are well-positioned to serve these patients.

Don’t get me wrong - this is a challenging business and one that many companies don’t want to get involved with. Building locally deployed care teams demands substantial infrastructure, coordination, and mostly a deep understanding of the local environment. It takes a combination of physicians, nurses, care managers, and patient advocates to build tight relationships with patients facing complex medical, social, and financial issues.

As we all know, most of healthcare doesn’t happen at an office visit but in between office visits. For complex patients, on-the-ground care teams provide continuity, preventing deterioration that can lead to an ER visit or hospitalization. Field teams are the glue that hold together a patient’s care, offering ongoing monitoring, assistance with medication adherence, home visits, and personalized care plans.

How Do You Build This?

If you work in tech, I know what you’re thinking — hOw DoEs ThIs ScAlE?! Let’s discuss.

There are a number of ways that we can see models like this scale (though there may be nuances that have to be developed in each individual geography). If you’re working with complex patients, you can’t really afford to run a volume based business - i.e. you’re goal may not be hypergrowth of your user base. Risk based contracts are ideal here, aligning incentives. Strategies include partnering with payers to get a panel of patients and providing care directly or collaborating with provider practices for care coordination. In my opinion, field teams generally excel with direct care, though hiring clinicians is time-consuming and expensive. By emphasizing outcome metrics over volume metrics, profitability becomes possible in this model. As a physician, I can see the high costs of complex patients and what it takes to care for the, but I also see great potential for improved management with proper tools and systems. Currently prevalent in primary care, these models will inevitably extend to specialties, addressing conditions like dialysis, heart failure, COPD, and pulmonary hypertension.

The other option is to combine a volume-based telehealth business with a panel of complex patients requiring direct, in-person care, as seen with companies like Galileo. There’s more to the math of operating this kind of business, but a simple way to think about it is a steady stream of recurring revenue through the telehealth only piece of the model that can help fund the complex care portion of the business (in addition to risk based contracts with payers). The only other thing to consider here is having a network of specialists that you can work closely with from a clinical, operational, and data-sharing standpoint since complex patients will inevitably need specialist services.

Some Parting Thoughts

The normalization and spread of telehealth as a mechanism to provide healthcare has forever changed the industry. It’s great to see companies eager to innovate and expand healthcare access. However, it’s easy to get stuck in a world where we think telehealth is all we need, forgetting that much of medicine is local and in-person, especially for the most complex patients.

Serving these patients requires extra time and nuance but it’s definitely possible, even in the current model of our healthcare system. Establishing local care teams is an important way to support these patients, tailoring care to their environment. It demands significant infrastructure and coordination upfront but yields results for populations in greatest need and has the potential to significantly impact healthcare costs.