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Inside Piedmont Health's Telemedicine Strategy

 |  By Philip Betbeze  
   January 08, 2016

A new service that immediately links physicians and patients by video puts the focus on what the customer wants, not on what's easiest for the health system, says its chief consumer officer.

Piedmont Healthcare is looking to solve its access problem and build long-term loyalty by possibly cannibalizing some of its primary care business.

Piedmont On Call, launched in December, is a bit of a test. But even though the telemedicine service allows consumers to bypass the system's traditional primary care practices in favor of on-demand video care delivered by non-Piedmont physicians on smartphones or tablets, the Atlanta-based health system's chief consumer officer is already convinced it will serve the system as a whole quite well.

"The number one issue or problem with patients is access and convenience," says Matt Gove, Piedmont's chief consumer officer. "It's also the thing we have the hardest time delivering."

Designed to help consumers get quicker treatment for a variety of urgent, yet low-acuity healthcare needs, Piedmont On Call provides board-certified physicians for consultation from 8 a.m. to 8 p.m. for $100 per virtual visit. It's the result of conversations started with potential partners more than two years ago, he says.

Two questions come immediately to mind. First, will consumers use it? Second, will it steal volume from Piedmont's 150 primary care docs and 50 specialists over 50 locations in the Atlanta area?

Gove predicts the answers to those questions are an unqualified yes and not much. Yet he says they are not exactly the right questions over the long term for Piedmont as an organization.

"We already own the healthcare trust of the community, and we've earned that trust over 110 years. What we've not been doing is adapting our system to the way customers want to use us," he says. "That's what On Call is about."

And he says, while volume may be affected to some degree, the service is an "obvious and easy" way for Piedmont to put a tool into customers hands that will help them solve some of their healthcare needs that in-person visits can't adequately meet. At least, not as the consumer targeted for the service sees it.

"I don't expect this to have any substantive effect on primary care volume or ER volume, but there's a growing segment of the population that want to be able to use this because they're schedule's busy and we don't have anything for these people."

Gove says the new product stems from a broader change he and his team are trying to engineer within Piedmont, and that is a focus on what the customer wants, not on what's easiest for clinicians or the health system.

Video interactions with physicians, which Piedmont says happen within 120 seconds of a request, are not covered by insurance and Piedmont is careful to stress that they're not meant to replace regular visits with a primary care physician.

But Gove is not worried too much about cribbing from regular PCP visits because he says the people seeking each type of service don't overlap much. "This customer is part of a generation where everything's on demand," he says.

Matt Gove

The application consumers use to access a physician was developed by Atlanta-based Alii Healthcare, which partners with Piedmont to offer the service. The physicians who work with the app are local emergency physicians contracted by Alii, and trained to triage and diagnose quickly. Gove says Piedmont leadership is still discussing internally how its employed physicians might integrate with the service at a later date.

"Customers get their cues from other parts of the world," says Gove. "They can have this kind of experience with other service providers, and wonder why they can't have it with us. We have a multipronged approach to fixing our access problem, but this is a big part of it."

In four years at the health system, Gove says he's had to train other senior leaders to expect more from the marketing folks. One way to do that is with the Piedmont On-Call initiative, "where we can put consumer-focused, revenue-generating experience to work," he says.

"At many healthcare organizations, it's like stepping into a time capsule where everyone believes brand advertising is the height of marketing, where plans aren't built around achieving strategic goals for the business, and where [patient] experience is the domain of clinicians."

That can lead to marketing initiatives that have very little to do with what the customer actually wants or expects from the organization as a whole, he argues. On the contrary, this initiative will help Piedmont attract customers it's not getting now, and will help effectively deal with the health system's number one existential threat, according to Gove: Low-acuity retail medicine.

"When you're inside a system it's hard to believe that. I talk to bright and accomplished physicians who lead institutes of care and help them understand that what they are doing is super important, but it isn't as meaningful if we can't bring patients into the system—if we lose the top of the funnel," says Gove.

In that sense, he sees the recent push by drugstore operators CVS Health and Walgreens to enter primary care through quick-care clinics as his top competitive targets. This battleground is hugely important because he envisions a day where a CVS Health could use its muscle with patients to steer referrals for more complex procedures or care, such as in cardiology.

By using telemedicine as a tool to capture the patients at the "top of the funnel," Piedmont helps ensure it will get an early jump on those possible future referrals—without needing the drugstores' help.

As for competitive pricing, Gove says that the retail model of offering primary care services for less than $100 is ultimately unsustainable. "Services that provide a visit with a licensed physician for less than $100 are doing it at a loss. Most of the ones you see doing that are the venture-backed apps."

Piedmont's model is still cheaper than urgent care, and most patients are using HSA dollars, (60% of potential consumers have a plan with at least a $1,000 deductible) he says, which count toward the deductible for most insurance. Ultimately, Gove says he wants to use tools like Piedmont On Call to give customers what they need to make the right decisions for themselves, but meeting that need also positions Piedmont Healthcare well competitively.

"This not only helps us succeed now in world between fee-for-service and value," he says, "but also will put us in better position to manage these patients' care long-term."

Philip Betbeze is the senior leadership editor at HealthLeaders.

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