Why America's Love Affair With Telemedicine Is Fizzling Out

Amanda Loudin

June 15, 2022

When Josh Emdur, DO, announced in 2017 that he was leaving hospital practice to join a startup telemedicine venture, his colleagues were shocked.

Though telemedicine wasn't brand-new in the scope of care back then, it wasn't exactly the model patients sought as their first line of defense, either. But Emdur believed in the idea and viewed technology as the avenue for him to have more impact in the medical world — a way to provide access to care for those who otherwise might not have it.

SteadyMD, the venture he joined, was one of a few other big players in the telemedicine world in 2017, when telemedicine was greatly underutilized. Then came 2020 and COVID-19, and the switch flipped. Lockdowns kept many people at home and physical offices closed. For the first time, payers, clinicians, and consumers all became willing to try telemedicine.

Regulatory changes meant that Medicare and Medicaid would reimburse for the modern-day delivery of care, and seemingly overnight, telemedicine exploded. Emdur's former colleagues, no doubt, no longer questioned his career move.

"Many organizations were dabbling in telehealth pre-pandemic — they had maybe a few thousand visits per month, if that," says Adrienne Boissy, chief medical officer at Qualtrics. "Then we saw an explosion of usage to 70,000-100,000 visits per month in the spring of 2020."

Given the rapid onset of the pandemic, such a paradigm shift was not a surprise. But more than two years in, what's the state of telehealth today?

"We have seen a gradual decline and some stabilization," says Boissy, "with approximately 10% of visits being telemedicine. That said, certain specialties lend themselves to more popularity with patients, including mental health, routine primary care, dermatology, and endocrinology."

An American Medical Association (AMA) survey fielded in November and December of 2021 found that, at the time, 85% of physician respondents were using telehealth, and 60% of respondents agreed/strongly agreed that telehealth enabled them to provide high-quality care. Some 80% of patients surveyed said that they had better access to care since beginning to use telehealth. More than half (54.2%) of surveyed physicians responded that telehealth improved their work satisfaction.

Still, there's been both a shaking out of clinicians and a dip in demand for telehealth as people perceive a post-pandemic world. Teladoc Health, one of the nation's biggest telehealth providers, saw a big drop in share prices in 2022, after disappointing first-quarter results. In response, Teladoc CEO Jason Gorevic told analysts during an earnings call that "I think the market is in transition. It's in a period of transition now from historic point solutions to the future, which is really whole-person virtual care."

The SteadyMD model, where Emdur serves as chief medical officer, has evolved over the past 5 years as well, landing in a place of high demand. "We began as concierge medicine, seeing hundreds of patients a day," Emdur says. "But we moved into a space where we were bombarded with requests for our knowledge to power telehealth to many customers. We moved from the direct-to-consumer space to the business-to-business space and treating thousands of patients a day."

In designing its original business back in 2017, SteadyMD became adept at technology and honed its operating platform.

With these new skills, SteadyMD became a resource for healthcare organizations around the country. Today, it powers telehealth for myriad partners, including digital healthcare companies, labs, large employers, and pharmacies.

Even so, Emdur says the current demand is around 32% off the peak during early- and mid-pandemic time. "But we still see high demand for digital health, and we've worked with many medical students to teach them about it," he says.

The Digital Health Evolution

Emdur says that digital health — a term he prefers to telehealth — has followed the Gartner Hype Cycle, which provides a graphic representation for the maturity and adoption of technology and applications. These cycles progress through five key phases of a technology's life cycle: innovation trigger; peak of inflated expectations; trough of disillusionment; slope of enlightenment; and plateau of productivity. "COVID-19 served as the trigger for digital health," Emdur says. "People think telehealth was invented recently, or with the internet. But really it goes back to the 1870s and the invention of the telephone. COVID-19 was the trigger to innovate, however."

The peak period coincided with COVID-19 lockdowns, and since then, says Emdur, the model has entered the "trough of disillusionment" phase. "This is when we learned that not everything can be carried out remotely," he says.

Boissy agrees. "What is clear is that telehealth is not a silver-bullet solution and should not take the place of in-person care for all situations," she says. "For those physician respondents in the AMA survey who reported a decrease in telehealth use, they indicated doing a mix of in-person and virtual care now and going forward."

The same holds true for surveyed patients. "Some value the warmth of a touch and may want to be examined based on their symptoms or condition or believe that the in-person model works best for them," says Boissy. "Some patients also want reassurance that privacy is protected in a virtual platform."

But plenty of others report satisfaction with the digital experience. A 2021 survey featured in the Journal of Medical Internet Research revealed that the mean patient satisfaction score was 4.4 out of 5 for those receiving virtual care. Over 90% reported that their virtual visit made it easy to receive the care they needed.

There's no question that digital health now has a permanent place in the practice of medicine. Consumers are accustomed to the convenience that technology can provide in every aspect of their lives — think Grubhub, Uber, Amazon, and the like — and this now carries over to medicine. But there are gaps that remain to successfully bring telemedicine up to speed.

"The biggest barrier today is that regulations are making it harder, if not impossible, to access virtual care across state lines," says Boissy. "Unfortunately, this disincentivizes clinicians from using telemedicine. The digital divide — including accessing the Internet and lack of comfort with technology — is also a barrier to virtual care for patients. We are seeing multiple organizations and counties working to resolve this, however."

Emdur envisions a future that is largely made up of hybrid in-person and digital care. "Legacy healthcare systems will have to embrace innovative delivery models if they want to stay competitive," he says, "You have to give patients options and easy access to a multi-modal front door. If they want to schedule a live appointment, great. If they want video, that should be fine too."

Boissy agrees. "By enabling clinicians to see patients virtually at home in a setting in which the patient feels more comfortable, most clinicians would agree that telehealth allows them to provide more comprehensive quality care," she says. "Increasing access to care, especially for those with limited mobility and access to transportation, is a big driver for telemedicine."

She adds that this applies to her own practice. "As a neurologist caring for patients with multiple sclerosis, I believe that telemedicine is the most empathic thing I can do for my patients," says Boissy, "saving them time and money and keeping them safe."

There's another layer to telemedicine: The growing clinician shortage. "It's predicted that in 12 years we will have a huge shortage in primary care physicians," says Emdur. "I see digital health as a toolset to bridge those gaps."

Boissy co-signs on this thinking and adds in that digital health can enhance a clinician's experience, as well. "With staffing crises and violence against caregivers, focusing on their experience is a must," she says. "You might not think of telemedicine when it comes to the employee or staff experience. However, clinicians report that their lives have been enriched by telemedicine because of the flexibility it gives them and the more comprehensive view of the patient.

"I know when I see patients virtually, I get a look at their house, see rugs they worry about tripping on, meet their extended family — it feels like a special window into their lives I would never have otherwise."

As the digital healthcare model moves forward, organizations like SteadyMD are continuing to gear up. "We're building an army of licensed doctors to provide digital health services that scale and help with the doctor shortage," says Emdur. "We want to be an asset to the current healthcare system as well."

Digital health will continue to evolve, and only time will tell how it will eventually shake out. But most doctors and patients view it as a positive. "The future is about more deeply personalizing the experiences of patients to learn not only their preferences for visits and communication, but to honor them," says Boissy. "Key to delivering on this level of engagement is to understand what platforms work best in a given situation, and how those values may change pending circumstances."

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