Telemedicine's Expanding Options
These days, those encounters include video over wireless carriers' networks. "We're able to have a high-definition videoconference consult with the doctor without having the very highest-speed network available without having to be connected into a landline," Marek says.
Online consultation cannot and does not replace many in-office visits, Marek notes. American Well physicians perform necessary triage to advise those who should seek in-person medical help.
"The intent has never been to take services away from the doctors or compete with them," Marek says. "This is not a disruptive strategy. Rather, this is a strategy to better serve consumers, and also it has the potential to allow doctors to be more effective and efficient with their services, especially if you can imagine the emergency room doc who may have some downtime could also log on and serve members and patients, and so that is being explored as well."
At Mount Sinai Health System, a relatively new but fast-growing service called Teladoc became part of the organization's rapid response to Hurricane Sandy in 2012.
"We launched it right after Sandy had hit, and it was a direct-to-consumer service," says Adam Henick, senior vice president of network development for Mount Sinai Health System and Mount Sinai Beth Israel, a 1,083-bed hospital with $1.1 billion in annual revenues, which became part of Mount Sinai Health System last year.
Under the program, New Yorkers who were willing to attest to their residency could access a physician via telephone or video chat for $38.
"Teladoc's model historically has been to either contract with an insurer to provide the service to their beneficiaries, or to contract with an employer to provide the service to their employees," he says. "They had not done a direct-to-consumer offering, and we wanted to try that, and so we launched it."
Despite "great media coverage," however, customer turnout for the service was disappointing. "After about three months, we started doing focus groups to figure out what we were doing wrong, and it turned out that the model was you paid an annual registration fee of $30, and that enabled you to get visits at $38 a visit," Henick says.
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