Teladoc and Doctor on Demand CEOs share their vision for telehealth

BOSTON—Telehealth is indelibly changing healthcare delivery in the U.S., and it’s just beginning. Two telehealth businesses, Teladoc and Doctor on Demand, shared how they are upending traditional healthcare models to open up access to quality care at the Digital Healthcare Innovation Summit on Nov. 4.

Teladoc, “the oldest telehealth company in the country,” has seen “phenomenal growth”—almost tripling in three years, said Jason Gorevic, the company’s CEO. The day before, Teladoc facilitated 1,200 telemedicine visits and consumers waited an average of 11 minutes to be linked with its network of physicians. The company is expecting to do half-a-million telemedicine visits this year.

“If you are wondering if [telehealth] is real, the data has arrived and there is a massive wave building and we’re at the beginning of that wave,” Gorevic said. While in the past he had to explain telehealth, now it is becoming mainstream and the largest employers and health systems are contacting him to implement his business, he said.

Doctor on Demand is another company beginning to make waves. It’s a direct-to-consumer service with its own fleet of physicians. “Everything else in life is on demand, so why wouldn’t care be?” said Adam Jackson, its CEO and co-founder. This service offers direct face-to-face contact with physicians.

“Consumers are ready for this in healthcare,” he said. Doctor on Demand gained some popularity from the daytime show Dr. Phil, which is an active promoter of the service and has demonstrated how to use the technology on the show. Once consumers begin using the service, they are hooked and share their experience with family and friends, he said.

To gain both physician and consumer buy-in, quality is paramount, said Gorevic. “For us, quality is at the top of the food chain.” Teladoc physicians are credentialed every three years, with NCQA-certified provider credentialing standards. “We work a lot with health plans which audit credentialing of the network.”

Teladoc also works to prevent over-prescribing of antibiotics. “We make sure prescribing is appropriate so we are not perceived as a pill mill,” he said. The Rand Corporation conducted an independent study of a California payer of 370,000 visits and found no evidence of a pattern of misdiagnoses. “It turns out, it’s not only more efficient, but everything points to it being more effective than in-person care for the same type of thing.”

Also, the company reviews at least 10 percent of its charts to ensure they are meeting quality standards. “We aren’t afraid to remove physicians for quality lapses,” he said.

At Doctor on Demand, Jackson said they work closely with boards and all physicians undergo training. The company can monitor in real time the efficiency and prescribing habits of its team of virtual docs. “We’re very open with sharing data with self-insured employers or payers.”

Allan Khoury, MC, PhD, a telehealth pioneer who currently works as a senior health management consultant at Towers Watson, said the arrival of telehealth is similar to the rise of urgent care in the 1970s and convenient care in the 1990s. Concerns about quality of care were widespread, but over time consumers grew confident in the new practices. “Now questions around telehealth are the same.”

However, he noted that the rise of value-based care, as well as high deductive plans, are advancing telehealth. “Change is occurring for economic reasons.”

An improved regulatory environment is pushing telehealth forward as well. Both the Federation of State Medical Boards and the American Medical Association have issued guidelines for telemedicine as a way of standardizing it, he said.

But Gorevic said his company works cautiously when telehealth is rejected by local medical groups. For example, it completely ceased operations in Idaho, but now is working with the state legislature to override a local medical board that is working against the service.

Both Teladoc and Doctor on Demand cited significant savings. Jackson said the ROI ranges from $7-$15 saved for every $1 spent. “We don’t charge employers a per month fee. We are hinged on utilization as much as they are,” he added.

Gorevic said he is currently working with actuaries to ascertain savings. While it is yet to be validated, he said there could be a $600 to $700 in savings per patient.

Khoury also cited savings, noting his research that found that 15 percent of emergency room visits could be potentially divertible to telemedicine.

“If 7 percent of employers use the service, you have an ROI of 1. This is incredibly low risk. You’ll save money, it will be effective and 20 to 30 percent of employees will love you for having it available,” he said.

Khoury also predicted that if all employers took advantage of telehealth, it would yield $6 billion in savings per year.