The recent spike in global telemedicine usage can leave no doubt as to the effect that Covid-19 has had on market demand. According to FAIR Health, a data solutions provider in the US, telemedicine claim lines for private insurance increased 4,347 per cent year-over-year in March 2020. Also in the US, Forrester analysts estimated that coronavirus-related virtual health visits could top 900 million this year. Dr Luke James, Medical Director of Bupa Global, revealed to ITIJ that the company had seen a 180-per-cent increase in the number of its customers registering for and using its Global Virtual Care service, particularly within the UAE and UK.
Cigna International told ITIJ that downloads of its telehealth app rose 130 per cent and logins increased 134 per cent between February and March 2020, while telehealth customer usage increased 514 per cent globally during the same period. And Ireland-based Abi Global Health’s CEO Kim-Fredrik Schneider told ITIJ that in terms of assistance companies, insurers and healthcare providers, his company has seen an enormous acceleration in demand for its medical micro-consultation service, Abi, in the last few months.
The truth is, telemedicine usage has been advancing on a steep trajectory for the last few years, and looks set to continue that way going forward (see boxout). With the uptake of wearable health devices and the continued expansion of and investment in the IoHT, telemedicine has long been the most logical step forward. But with all its promise, it hadn’t quite yet made it to mainstream status. Thanks to the severe conditions brought about by Covid-19, that all looks set to change.
Only time will tell, but there is every indication that some of the changes we’re seeing in telehealth will remain with us long after this pandemic
“Before the pandemic, telemedicine was a suitable service,” Director of Operations for US-based NFG Bettina Gammelgaard told ITIJ. “Now it is an absolute necessity.” She explained that social distancing practices along with stay-at-home orders have made physician office visits near impossible due to safety – a point that Canada-based Robin Ingle, Chairman and CEO of Novus Health, Travel Navigator and international travel and health insurance company MSH – Ingle International, also made: “Many of the healthcare facilities globally did not want asymptomatic patients or patients with manageable health issues to attend the emergency rooms of hospitals since many were either preparing for an influx of seriously ill Covid-19 patients or had an influx of Covid-19 patients and ICU rooms that were at their maximum,” he explained. But as both Gammelgaard and Ingle pointed out, healthcare needs still exist for clients, patients and employees; and ‘the safest, most efficient way to interact with a provider is using telehealth’, said Gammelgaard.
Alleviating strain on healthcare systems
A report published by Siemens Financial Services (SFS) in November 2019 revealed that respondents from around the world – specialist management consultants, academic commentators, national health departments, medical associations and acute care organisations/groups – judged telemedicine to hold the highest potential for rapid positive impact on pressurised healthcare infrastructures and operations. For hospitals, as demonstrated by SFS’ report, telemedicine enables patients to consult a doctor remotely, helping to counter the skills shortage faced by many healthcare systems across the globe – indeed, the World Health Organization (WHO) has reported that the world will be short of 12.9 million healthcare workers by 2035.
Telemedicine also helps overcome the issue of an unevenly dispersed healthcare workforce. As Patrick Graham, CEO, Asia Pacific and Head of Strategy, Analytics and Innovation, International Markets, Cigna International, told ITIJ: “The most obvious benefit of telehealth is having access to a doctor, from home, by phone or video. This means that people do not have to travel to clinics or make an appointment, which can take days or weeks depending on the healthcare systems in their market.” In countries around the world, particularly in Asia, the Middle East and Africa, the provision of quality healthcare is usually weighted away from rural areas. In the world we currently find ourselves in, where hospitals are offlimits to all but the most vulnerable and everyone else is encouraged to stay home, access to medical professionals is equally difficult, if not more so.
“Navigating complex healthcare systems in a new country can be challenging at the best of times,” Bupa Global’s Dr James highlighted, “and the pandemic has meant that the way healthcare is delivered around the world has transformed. Virtual GP services are a lifeline for many of our customers living or working overseas during lockdown, offering a quick and simple way to speak to a doctor in their chosen language from the safety and comfort of home.”
While the insurance industry has arguably taken some years to grapple with the new normal of techempowered consumers, the good news is that the innovation cavalry has arrived just in time
What’s more, Gammelgaard cites that 83 per cent of conditions can be solved through telemedicine consultations instead of scheduled doctors’ visits. And she also reasoned that for a telemedicine consult, the only two required parties are the physician and the patient, “whereas an onsite patient consultation necessitates an infrastructure, which includes buildings, typically requires office personnel, test equipment, nurses, and various other expense items, which is a more costly interaction.”
The mental health epidemic
Gammelgaard also explained that according to vendor data from the WHO, telemedicine reduces the need for urgent healthcare visits by 45 per cent, as simple conditions can be treated easily and more complex ones can be detected and solved early on. Certainly, the importance of preventative healthcare practices should not be underestimated at this crucial point in time.
As Ingle points out, Covid-19 is not the only crisis currently facing the healthcare industry – the current pandemic has brought with it an epidemic of increased anxiety and mental health problems. Ingle reveals that an increased number of telemedicine users are reaching out for mental health support at this time. “Many cases are linked to anxiety and stress related to Covid-19, ranging from fear of the unknown, to managing the daily care of their young children while working, to grief over loved ones who are ill, to dealing with the financial hits they have taken due to the pandemic.”
What’s more, Bupa Global’s Dr James revealed that, in the UK, there is growing evidence that fewer people are coming forward with signs of symptoms that could be cancer. “Which is worrying because we know early diagnosis is key to improving survival rates,” he added. The good news is that telemedicine provides the perfect platform to manage such issues, and as Dr James notes, it is a platform that offers a breadth of timely physical and mental healthcare services, which is encouraging more people to try remote care at this time.
The benefits of telemedicine are undeniable – by extending patient care outside of the clinical setting, telemedicine reduces unnecessary hospital visits and creates greater flexibility for both healthcare providers and patients.
The missing link
But if telemedicine is such a logical solution with such obvious benefits, why has it taken a global pandemic for the healthcare industry to start rolling out telemedicine solutions on a mass scale?
“In many respects, providers have been the missing link in the evolution of telemedicine,” Schneider of Abi Global Health told ITIJ. “This is because providers have long understood that traditional telemedicine improves the patient experience but does not reduce costs. But, in the current situation, they have no choice.” Ingle echoes this point. “We are finding that more and more providers have no choice but to provide virtual physician or nurse practitioner services and this has forced them to change their perspective on hospital care (home care versus inpatient stay),” he said. “Having a member inpatient for IV antibiotics used to be a fight with most hospitals to get them to discharge our members for home care and visiting nurses. Now, due to the pandemic, with the need to keep hospital beds free, the choice for discharge and home care is number one.”
In the current pandemic, telemedicine services have been reimbursed by the state, and governments and media outlets are driving the promotion of these services, encouraging more patients and providers to take them up, Ingle notes.
Now the genie’s out of the bottle. Consumers will expect and demand telemedicine into the future
Putting the ball in the patient’s court
But it’s not just providers that have had to change their practices as a result of Covid-19. Michele Elmore, Head of Business Development – International Healthcare at UK-based insurance and assistance provider Collinson, asserts that digital consumer behaviours are fundamentally driving insurers to rethink their propositions, and that the recent boom in telemedicine usage has played a large part in encouraging an industry shift from having customers who simply pay or claim, to having customers who engage with their products.
“What was barely acceptable a few years ago is unforgivable today,” Oisin Lunny, UX Business Professor at Barcelona Technology School, told ITIJ, commenting on the familiar scenario of a customer being forced to join a call centre queue to speak to their service provider. “Spurred by our transition to a UX-obsessed planet of phono-sapiens, consumers have zero tolerance for a bad customer experience. While the insurance industry has arguably taken some years to grapple with the new normal of tech-empowered consumers, the good news is that the innovation cavalry has arrived just in time.”
Schneider drives this point home. “A lot of digital health services have been designed from the perspective of providers or payers, not patients, up until now,” he said. “Insurers and assistance companies understand that their customers look to them for support in times of crisis. And the current pandemic is no different.”
Innovation for innovation’s sake?
Following this train of thought, Ingle reasons that the needs-must approach to telemedicine in these Covid-19 times has helped break down the barriers for change. Those who were hesitant to use telemedicine (which Ingle notes includes payers, providers and patients) have been forced to use it, and will now likely see the benefits of it, even becoming proponents of it. In fact, Cigna International’s Graham reveals that his company is now seeing younger generations bypassing traditional, in-person relationships with primary care providers and seeking out telehealth services instead. “As a result, the younger generation is encouraging other family members who may not be as tech-savvy to try out telehealth services for themselves,” he said.
Contemplating the impact this will have going forward, however, Schneider said: “Now the genie’s out of the bottle. Consumers will expect and demand telemedicine into the future.” He reasons that as the necessity abates, ROI will be ‘the name of the game’ when it comes to telemedicine. In the past, he explains, the true cost of video telemedicine has been obscured by very low rates of utilisation, and the more this platform is used, the more people will realise that it doesn’t significantly reduce healthcare costs, but may actually increase them. “Innovation for its own sake won’t be enough anymore,” he proclaimed. “Payers (public and private) will expect results. And synchronous models – whether chat, telephone or video – don’t significantly reduce physician time per consultation and, therefore, don’t significantly reduce healthcare costs.”
AI and machine learning under the hood is the icing on the cake, ensuring a frictionless user experience “ that gets better every time
Adapting to the needs of the future market
Schneider continues to muse upon the situation: “If video telemedicine is now reimbursed by the state and it becomes a normal part of every provider’s patient care toolkit, then are insurance companies still adding value by offering the same thing? How will private payers innovate to stay ahead?” Lunny and Schneider both proffer an answer to this: hybrid models and microconsultations. Reasoning that video calls are not for everyone and can be as timeconsuming and archaic as in-person visits, Lunny explains that a text-based consultation (a form of ‘micro-consultation’) with a real doctor strikes the perfect balance. These asynchronous micro-consultations, Lunny continues to explain, are enabling consumers to interact with healthcare providers wherever they are, at their own pace, on their own terms, and in a nonintrusive fashion.
“AI and machine learning under the hood is the icing on the cake, ensuring a frictionless user experience that gets better every time,” he said. “Textbased micro-consultations are a genuine life-saver, both for consumers who feel more at home so utilise the platform more, and for insurance companies who can see the storm clouds of disruption forming.” Schneider also details that the privacy of these telemedicine apps makes patients more comfortable asking more sensitive questions – and this translates into more accurate information for healthcare professionals to process, which translates to more detailed claim information for insurers.
Echoing the points made by Lunny and Schneider, Ingle insists that the move toward telemedicine will likely spur on innovation for improved and more efficient care, including a hybrid of virtual and in-person consults. And while he reasons that this may cause increased financial pressures on the system, as well as administrative pressures associated with needing to review more holistic data gained over time, the positive impacts of telemedicine surely outweigh these costs. Preventative care options presented by telemedicine could eventually drive down healthcare costs. He even takes it a step further: “Telemedicine could be applied in other settings like emergency departments, with triaging or initial treatment being conducted virtually before further escalation,” he said. “Also, for specialist appointments that usually take a long time to materialise (especially in countries like Canada), the patient could be seen by their family doctor (or a local general practitioner) in person, with the specialist being present virtually – where the GP could provide any necessary physical examination and work alongside the specialist to treat the patient together.”
On the other hand, Ingle also notes that telemedicine has its limits and its risks: “Virtual walk-in clinics, if there’s no continuity of care,” he reasoned, “are not the optimal way to fix the lack of quality healthcare. “Chronic disease management is also a growing challenge,” he acknowledged. “We would need to be strategic about the use of telemedicine to help improve health outcomes overall and with improving chronic disease management.” Still, Cigna International’s Graham certainly believes that patients with chronic conditions are likely to reap some of the best long-term benefits from telehealth services, as they can access a single provider for improved continuity of care.
Spurred by our transition to a UX-obsessed planet of phono-sapiens, consumers have zero tolerance for a bad customer experience
Only time will tell
Looking forward, Graham asserts that we should expect the demand for telemedicine to continue. “One thing is certain,” he said, “the outbreak has brought physical and mental wellbeing to the front of mind for people globally. As more people are taking charge of their physical and mental wellbeing, we expect to see a continuing demand for telehealth services.”
Bupa Global’s Dr James also reasons that there is a growing acceptance by healthcare professionals and patients that remotely delivered healthcare can offer real benefits, and satisfaction rates are high. He, like Graham, believes that the benefits of telehealth will extend beyond the current crisis. “There are also solid health, wellbeing and environmental benefits to having digital consultations in situations when a face-to-face visit isn’t necessary,” he said. “Only time will tell, but there is every indication that some of the changes we’re seeing in telehealth will remain with us long after this pandemic.”
Overall, it certainly seems that telemedicine has provided the perfect solution to the Covid-19 crisis. And the integral role that remote access to medical care has played amidst the outbreak of the virus cannot be underappreciated – especially as mental health issues begin to rise as a result of the pandemic. Still, the crucial lesson thrown out by Covid-19 is that widespread rollout of technological solutions such as telemedicine – while innovative and timely, and despite having been in operation for some time by many healthcare providers – have been, by and large, a reactionary response to the Covid-19 crisis.
What a highly successful healthcare infrastructure requires is preventative methods that allow it to avoid such large-scale catastrophes in the first place. While tech has certainly allowed medical providers to enhance their services, meeting the social distancing demands of Covid-19, the fact remains that healthcare infrastructures were still, in many ways, facing insufficiencies long before Covid-19 came about. And if non-Covid conditions have not been properly monitored during this time (although it’s worth noting that monitoring of non-coronavirus patients is beginning to recommence), then healthcare systems will likely face further strain as we emerge into a post-Covid scenario.
Telemedicine, as part of a larger health ecosystem consisting of microconsultations and wearables, was the direction the healthcare industry seemed to be moving towards even before Covid-19. Now it seems to have a bit more incentive to get there faster. ■