Whether you’re trying to leave on vacation or you’re in the middle of prepping for Thanksgiving dinner, we often get sick at inconvenient times. Getting to the doctor’s office only adds to the stress. Many people are turning to telehealth for a quick and affordable option you can access from the comfort your couch.
Telehealth is all about getting health care on your own terms: anywhere, anytime, anyway. On this episode of Cambia’s HealthChangers podcast, we talk all things telehealth and why you should give it a try. We’re joined by two guests: Jolie Rhodes, a busy mother of two who recently tried (and loved) telehealth, and Brodie Dychinco, Cambia’s General Manager of Convenient Care.
Jeremy Solly (JS): Welcome to the HealthChangers podcast, presented by Cambia Health Solutions, where we share real stories of health care transformation from those experiencing it and those helping to make health care more personalized. I'm your host, Jeremy. Today on the podcast we're going to talk about telehealth. Illness doesn't wait around to hit us when it's convenient, in fact more often than not we get sick when it's the least convenient, in the middle of the night, right before a big meeting, the first week of school, or if you're like me last week, as you're leaving for vacation.
"Finally when they said head on down, we're ready for you, we sat there for another almost two hours. I ended up missing a whole entire day of work."
When we get sick and are looking for quick answers, it's likely we'll go to urgent care or even the emergency room. That was true for Jolie. She's a busy mother of two. For many years she used urgent care because it was cheaper than the ER and the staff would send her a text message when they had an opening. That saved her time waiting around. But on one occasion, when her older son had a minor skin issue, she got text after text from urgent care saying “It'll be another hour.”
Jolie Rhodes (JR): And finally when they said head on down, we're ready for you, we sat there for another almost two hours. I ended up missing a whole entire day of work. I couldn't do anything or go anywhere because I was waiting for that call back. And in the end it cost be $232 to have them give him a cream for whatever it was that he had going on at the time on his skin. So I was like, “This is so frustrating.”
"I was able to continue on getting ready for Thanksgiving and [my son] was able to stay comfortable on the couch."
JS: When the next illness came around in Jolie's household it was just before Thanksgiving. Her younger son had a cough and an earache. She remembered that her insurance company offered a telehealth open and she decided to give it a try.
JR: We get online, I create an account—it was super easy to do that. They called me back within an hour and they had a pediatrician on the phone that I was able to talk to. And then they talked to Derrick, my son, and asked him some questions and then they got back on the phone with me.
And in the end we had decided, the pediatrician and I, that at this particular time, that the best course of action was to keep an eye on him. And if he did start to run a fever, or his symptoms got worse, then I could take the next step and that only cost me like $38. I felt good, Derrick felt better because he understood it wasn’t an ear infection, and there wasn’t any medication he was going to have to take.
I mean, all told, from time I sat down in front of the computer and started the registration process, to the time that I hung up the telephone with the pediatrician, it was like two hours tops. It didn’t take any amount of time. I was able to continue on getting ready for Thanksgiving and Derrick was able to stay comfortable on the couch with a blanket, and we were all able to just move on.
"You rarely ever hear examples about how getting health care services is easy and convenient."
Brodie Dychinco (BD): Thank you, it's great to be here.
JS: Tell us a little bit about your role at Cambia and what convenient care delivery is.
BD: My primary responsibility is to lead the product strategy on making available easier options for people to get a diagnosis and a treatment. When you usually ask people for examples of convenient experiences that they have, you rarely ever hear examples about how getting health care services is easy and convenient. That's a challenge that is really intriguing to me and it's definitely one of my major interests. So really trying to make health care understandable and easy for the consumer, and in this case it's really about getting that diagnosis and that treatment anytime of the day, pretty much anywhere where you are.
"It's the concept of being able to stay in your pajamas, stay at home, not make a situation worse and just have health care come to me."
JS: Why are you so passionate about telehealth and convenient care options?
BD: I think because it's such an easy concept to grasp about how difficult things are when it comes to getting health care, and just like Jolie, I actually have two young kids myself. And trying to pack up the entire family to go get health care is something that I could totally relate to, where the risks of actually bringing my healthy kid with me to a place where there are a lot of other sick kids is really not that interesting to me as well.
So the concept of being able to stay in your pajamas, stay at home, not make a situation worse and just have health care come to me rather than me go to health care is such a basic thought, and it's so common in other industries that I just want to bring that same level of ease and convenience to health care, and that's why I'm interested in it.
JS: Do you think Jolie and her story is common for people that use these new convenient care options?
BD: Yeah, in our research and just in general readings that I've done, parents of kids really, often times, are the ones that come out and say “Hey, this is great.” What was interesting for me to see actually wasn't just parents of kids where the kids were still living at home with them, but even for kids that are out of town like in college. I actually hear a lot of examples about how parents are worried that their kids are sick, they're not in the same place with them, the parents don't really know what doctors are in that town.
Having a telehealth option or an ability to have this virtual visit with a doctor where you don't need to be in the same location proves to be quite a valuable solution in those cases and many technologies actually even enable three way calls, that they actually could share that visit and be on that as well. The example of a parent with kids is a very common example.
"Historically, telehealth has been something that a doctor would setup on behalf of the patient...it's been only recently where a person could actually initiate that visit."
JS: Let's take a step back. There's this whole grouping of convenient care delivery options and one of the ones we hear about a lot right now is telehealth. Can you define it for us? What is telehealth and take us through what are telehealth solutions?
BD: Telehealth does belong to this broader family of conveniences. If you really think about a convenient option, it really is about getting health care on your terms, where health care is coming to you as opposed to you having to go to the health care itself. That could take the form of video chats, it could take the form of phone calls, for many it may be the form of texting a doctor back and forth. And others it actually may be the doctor coming to your home.
So there's this broader category of conveniences that are available. Telehealth is one very specific form of convenience, and that is the ability to use interactive technologies where you have a real time conversation with a doctor to get that diagnosis and treatment, either through phone or through video chat. It is an example of one type of convenience, but it's the most common type and it's actually been around for quite some time. But it's been only recently that it's been used actually where the consumer or the person, him or herself, could actually initiate that visit.
Historically, telehealth has been something that a doctor would setup on behalf of the patient, for example the doctor may be in a case where the case is starting to get a little bit more complex since they need a specialist, but the specialist is not available or close by. So generally the doctor's been setting up these appointments for a patient to talk to another specialist.
But more recently it's evolved to the point where consumers, or people, the general public, could actually initiate a visit for things where they otherwise would have gone to the urgent care or emergency room. Or in Jolie's case have to wait hours on end for that type of visit.
"Think about all the people that live in areas where there are actually maybe only one primary care physician and very few specialists."
JS: Interesting. It seems to me like there's a really interesting opportunity for ... I think about those cases where they were for a specialist, and you hear about those all the time where, oh man I had to fly to Cleveland or I had to fly to New York and see this specialist about this case that I have. And the opportunity for telehealth seems really large in terms of possibly a lot of cost savings, but then also a lot more people getting the treatment that they need, right? Those are just a few that I'm seeing in that one case. What are the biggest benefits that you see to telehealth?
BD: Well you really hit the nail on the head on the clinical value of it. There are many benefits, so let's go through several of them. From the clinical perspective, you brought up the example of being able to get access to doctors that you otherwise wouldn't have access to. Think about all the people that live in areas where there are actually maybe only one primary care physician and very few specialists. This technology and these capabilities are actually opening up a really large, convenient world where you can access really top notch doctors from wherever you are and it doesn't matter where you live, it's actually opening up that level of capability and access to those doctors.
The amount of travel time, in some cases you have to stay at a hotel, those are costs that go beyond just the cost of the medical care, so the value of convenience has some clinical value and being able to open up the choices that people have.
"They can take really high resolution images of people's ear, to actually see whether there's an infection there. They can look down the throat, they can look at lung function."
The technologies are really advancing in this space as well, the way that I like to think about these devices are, they're extending the hands and the eyes of the doctor into that home, or wherever the person is that's trying to seek that care.
They can take really high resolution images of people's ear, to actually see whether there's an infection there. They can look down the throat, they can look at lung function, all these types of data points that doctors need in order to make good diagnosis, these types of devices are making that all very possible. And when we look at it from an economic standpoint there are definitely benefits there as well.
These benefits are price and also the cost, as I mentioned, associated with having to travel. Even if you didn't have to stay at a hotel, sometimes you have to pay for parking, whether it's bus fare or taxi, Uber, whatever that may be there are travel costs associated with that as well. But the visits themselves are commonly the same price or cheaper than actually going in, in some cases.
"Four out of every five visits is actually replacing an action that they previously would have done...visits to the emergency room...visits to urgent care."
JS: You have implemented convenient care. Are you seeing some of these outcomes already through your implementation?
BD: Based on our research and what we've seen out there, we're taking a very conservative view on this, but we're seeing that roughly one out of every five telehealth visits is a person that otherwise would have stayed home. We are seeing that there are people that are accessing the health care system that previously would have just done nothing.
That means that four out of every five visits is actually replacing an action that they previously would have done. So what are those actions that they were doing? There are visits to the emergency room that commonly cost over $1000 per visit. There are visits to urgent care that easily run over $100, or you heard here it was over even $200 in some cases. And then there's the doctor's office visit, which generally runs over $100 as well.
The average consumer saves around $120 per visit that they are seeing, and that if their employer is offering the insurance coverage and they're offering them the plan, that the employer is saving over $200 per visit. That's a pretty rare win-win where everyone is saving.
"Where telehealth is succeeding right now are the more routine types of visits that people can understand. And there isn't a lot of fear associated with what is happening."
JS: So everyone's saving and it sounds like people are getting more access to care that they probably need, right? You're introducing more of it as visits that maybe wouldn't have happened before. One thing I'm curious about is, so telehealth is ... It's an old concept, but it seems to be somewhat new in its current form because now we have more digital technologies and tools to be able to implement it.
And I'm kind of curious—in its current form, is it right for everybody? What are the cases where I should, maybe I have telehealth through my insurer, my employer, when are the times that I should be thinking that I should use it? Or are there other times that I don't use it? I'm kind of curious, what's the sweet spot for telehealth in its current form?
BD: It's a great question and there are many layers on how you could address that question. The first layer that I would take in answering the question is that where telehealth is succeeding right now are the more routine types of visits that people can understand. And there isn't a lot of fear associated with what is happening. Generally people know when they have allergies, people can look in the mirror and say, "Yeah my eye's pink. I must have some sort of infection." "My ears hurts every time I pull it."
"What else is open at two o'clock in the morning, for example, when you're really worried?"
You kind of already have a sense, and so where we're seeing most of the traction for these types of visits that people are initiating on their own tends to be things that generally would have replaced and urgent care visit or an emergency room visit where you know you really don't need to go to the emergency room, but you just don't really have any other options. I mean, what else is open at two o'clock in the morning, for example, when you're really worried?
And most of the time, just relating it back to the story of the parents and kids, most of the time the visit really is for peace of mind rather than actual clinical care. Because yeah, I could hang on until eight o'clock that next morning, but I really want to take care of this now, just so that everyone can go to bed with peace of mind. So this really adds those types of options.
JS: Is the service 24/7 mostly for the instances that you've seen applied now?
BD: There are many entities that offer telehealth. In some cases your local doctor may belong to a clinic where they, themselves offer telehealth as an option. So you should definitely ask your own doctor whether they have that. But definitely the national vendors out there that health plans work with or employers work with, or even direct to consumer types of offerings, they're always 24/7 as well.
"One way to attract more doctors is to give them options where they actually could work from home. They have that work life balance."
JS: Brodie, these are some great benefits to consumers. What are some of the benefits that doctors can get by offering telehealth solutions?
BD: There are a couple examples that I could think of. One of them is related to just happier patients. There is some value in doctors having happier patients, they follow instructions better, they are more likely to follow up and follow through. And the second example I can think of are the follow up rates of care. So let's say someone had a surgery or someone had a pretty serious issue that they got treated, sometimes it's hard to get that person back into the office to have that 10 minutes conversation about how that medication is doing or how are the wounds healing for the surgery? So there's sometimes a no-show rate. So to actually provide a more convenient option for people to get that follow up care will actually help in the clinical outcomes.
And the last one is kind of an interesting one as well, which is that you may have heard about a shortage of primary care physicians and things like that in the industry. Well one way to attract more doctors is to give them options where they actually could work from home. They have that work life balance, there are some people that actually are trained as physicians that aren't in the field for whatever reason that is, and sometimes being able to offer more ways to do health care and treat patients is a way to do that.
"The general public is quite aware of the technology, but they don't really connect that technology to something that is accessible to them."
JS: I'm hearing so many benefits, right? Like there's the convenience of access to the care, the quality of care sounds like it's very high as you pointed out. The coordination of care is also a huge benefit and it's starting to lower costs. So why isn't this the norm? Are there hurdles in place? And what are those hurdles that this isn't what all of us are doing in terms of getting access to care?
BD: The bottom line answer is there's a big awareness challenge. There are many instances, I can actually think of a story where we actually setup a booth at a golf tournament just to ask the general public as to whether they aware of telehealth and those types of options. And generally speaking, most people said, "Yeah I've heard of the technology." The technology is not way out there that no one would have actually conceived that it's possible that you could have a video chat with a doctor or a phone call, people have had phone calls with their doctors all the time for just general quick questions.
But for actual treatment, the general public is quite aware of the technology, but they don't really connect that technology to something that is accessible to them, especially as something that is covered.
"If you think about the next layer, or the next level of where this is going—there are developments in the lactation consulting space. There are developments in behavioral health."
JS: Sounds like they're waiting around for the Star Trek tricorder to show up and scan their body. But really a lot of them may have the power already in their iPhones, right?
BD: Exactly, exactly. But in other cases there is the aspect of getting comfortable with a new experience. So that's why I was saying that where it's really taking hold are those more routine care types of examples.
But there are—if you think about the next layer, or the next level of where this is going—there are developments in the lactation consulting space. Even having a wife and two kids just seeing the frustration of having a baby latch during the breastfeeding. There has been some interest and so there have been some solutions that have been offering for 24/7 lactation consulting.
There are developments in behavioral health. If you really think about people who are struggling with depression or stress, there actually is a motivation factor to actually physically get out of your home and go see a doctor. And being able to actually access behavioral health providers from the comforts of your home actually encourages more people to seek that type of care.
"A pretty prevalent practical issue that people generally don't really think about is the access to high quality broadband service and internet."
JS: So Brodie, are there any other hurdles to helping telehealth become more mainstream?
BD: In some ways I think that there are so many ways to get care conveniently now that for a doctor or a doctor's office or a clinic, much of the challenge is determining “Which types of options am I going to offer my own patients?” So if you think about the choices that doctors need to make, there's some hurdles associated with determining if I'm going to invest in offering more ways to access me, I have to solve for how I’m going to staff that.
And then there's actually a pretty prevalent practical issue that people generally don't really think about, and it's about the access to high quality broadband service and internet. Many of these technologies are really data hungry—there is a certain level internet that is required to have a video chat with someone. Though if not video, yes they have their phone, but sometimes people want to see their doctor eye to eye, even though it may not be face to face. But they still want to see their doctor.
So internet access isn't equally available to everybody, there are certain areas of the country that may still be on dial up modems. So there are some challenges associated with that. All in all, there is a type of convenience that is available to you that everyone can access.
JS: I guess it would be hard to show that picture of your ear or your eye if it's just buffering all the time, right?
BD: Yeah, yeah.
"I encourage you to give it a shot and save some time, save some money and enjoy not having to leave your home."
JS: Well thank you Brodie, this has been really enlightening to learn more about how telehealth works and its opportunities. Is there a take away that you'd like listeners to think about, like a call to action or what they can go do today to either try telehealth or help advance it in the industry?
BD: It's really about the awareness issue, and I think the call to action here is to try it yourself, to tell others about it as well. One of the great things, as I mentioned, is that the conveniences are generally the same cost or less in many cases. There aren't many industries that I can think of where convenience is actually cheaper. In the case of movie tickets, things like that, you generally expect to pay a surcharge for not having to wait in line. But when it comes to getting health care, there actually are many options that are less cost in that case.
I encourage everyone to check with their health insurance plan as to what options they have for telehealth. A lot more people have coverage than they think, so it definitely will be worth your time to check to see what your options are. And I encourage you to give it a shot and save some time, save some money and enjoy not having to leave your home.
JS: Thanks again to Brodie, GM of Convenient Care Delivery at Cambia Health Solutions, for sharing the benefits, challenges and opportunities of telehealth. Thanks for listening to this episode, you can find more information on all of our episodes on CambiaHealth.com. Please subscribe to HealthChangers on iTunes or Stitcher and leave a review.