Telemedicine: Winning Over Skeptical Docs

The chief physician officer of a five-hospital system explains how she allayed the concerns of skeptical physicians after the organization partnered with a virtual physician service provider.

MultiCare Health System, the Tacoma, Washington–based nonprofit with five hospitals, numerous outpatient clinics, and more than 10,000 employees, is not new to offering its patients access to virtual care. It has well-developed telemedicine initiatives in genetic counseling, obstetrics, stroke, and ICU.

Instead of leveraging its experience to expand into virtual visits for patients needing a primary care doctor, however, MultiCare executives have decided to outsource the task.

Despite its technological expertise (MultiCare hospitals and ambulatory clinics recently won Stage 7 HIMSS awards), the system is partnering with San Francisco-based Doctor on Demand, a virtual physician service provider that gives patients access to a doctor via smartphone, tablet, or computer.

The service is meant for patients with common ailments such as colds, sore throats, eye infections, rashes, and the like; it is not intended for patients with chronic conditions or cancer. The cost is just $40 per virtual visit and the virtual physicians can prescribe most medications.

The Reality of Virtual Care

"The reason [for partnering] is speed to market," says Claire Spain-Remy, MD, chief physician officer at MultiCare. "It takes a while to build the physician population. They have experience, and we know patients want it."

The drive to satisfy consumer demand for virtual physician visits is accelerating at a quick pace. In addition to MultiCare's move, UnitedHealthcare recently announced that it will cover telemedicine visits for most of its members by next year.

Telemedicine Gets a Lift from UnitedHealthcare

As the nation's largest commercial health insurer, UnitedHealthcare often sets the tone for coverage decisions by other health plans. That means hospitals, health systems, and physician practices that are absent in this space now will need to start considering the implications of offering in-person visits only.

Spain-Remy says MultiCare was "constantly" thinking about expanding its telemedicine services into its primary care settings, and the initial discussions were about doing it themselves. Ultimately, she says, a partnership accomplished MultiCare's main aim of rapidly giving its patients greater access to primary care services.

"To build something out, you have to develop technology, you have to make sure you can grow clinical staff, and manage it, as well," she says. "If you have a willing partner who can do that, [you can] get to market in a short period."

Physicians are Skeptics
Selling MultiCare's physicians on the idea that their patients would be getting care from someone other than them was greeted with uncertainty. Spain-Remy says she expected a natural amount of skepticism because "it always happens with new technology."

So to get physicians on board, she made sure that MultiCare's standard of care protocols would be followed. For example, MultiCare physicians do not want patients with viral colds treated with antibiotics because that's not the care pathway MultiCare follows. "We made sure that they [Doctor on Demand] complied with our standards to avoid the patient shopping around," says Spain-Remy.

MultiCare's contract with Doctor on Demand is for three years. The health system will measure the company's effectiveness by looking at how many patients were referred elsewhere, the amount of time before a patient is seen, overall satisfaction, and quality outcomes. Interestingly, Spain-Remy says MultiCare will not measure the virtual care visits against its telemedicine program metrics.

"We are measuring them against what we think is important for patient access," she says. "We are looking at number of patients served and monitoring the quality of care."

Fad or Future?
The promise of telemedicine raises many questions, though a big one—coverage by insurers—has been answered with UnitedHealthcare's decision. The remaining unknowns center on coordination of care and patient demand. Will virtual visits replace the doc-in-the box option made popular by retail drugstores? Is it a passing fad that, once the novelty has worn off, will send patients back to physicians' waiting rooms?

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Whatever the prevailing opinion is in doctors' offices now, healthcare systems are ready to invest in telemedicine. In the 2015 HealthLeaders Media Industry Survey, 56% of respondents said they believe telemedicine is a strategy to reach future financial targets and said that such an initiative requires a major investment.

For the patients with very limited access to care, such as the 115,826 Texans who live in counties with no doctors, virtual visits may be not only a solution to the shortage, but the solution.