Healthcare Disruption + Competition Part 1: The New Wild West

What comes to mind when you think about the Wild West? Clint Eastwood swaggering through swinging saloon doors? Stagecoach heists and train robberies? Whatever you learned about pioneer life playing The Oregon Trail in elementary school?

These are all intrinsically linked with the Wild West’s zeitgeist, but I see it a bit differently. Discarding the concept of manifest destiny, this was THE era of unbridled American opportunity. Homesteading pioneers, ranchers, and gold-rushers—the entrepreneurs of the mid-1800s—all flocked to the American West with dreams of making their fortunes. And many succeeded.

Virtual Care’s Wild West

Virtual care is the digital frontier. Smartphones are our stagecoaches. Cloud-based services are our picks and axes; reliable in their errand but indifferent to the outcome. Sleek apps and user interfaces are the 6-shooters brought into battle. True, no one is dying of dysentery (hopefully) on their virtual care journey. But, the gunfights at high noon are just as real (if not as bloody). The early prospectors must always watch their backs or have the smell of another, sexier app, be their last.   

Analogies aside, an article in the December issue of Health Affairs paints a wild-west landscape clearly – from innovation, to competition, to opportunity. It got me thinking about how this retailization of telemedicine is changing the face of healthcare—and how this disruptive shift in competition is likely to impact health systems.

Go West, Well, Everyone!

The other day, I read an article in Vox about how CrossFit is “amassing an army of doctors to disrupt healthcare.” Seriously. CrossFit. And that is just the latest in established players outside the healthcare space looking for ways to upend healthcare delivery. Amazon, Apple and Google have all thrown their hats into the healthcare ring.

Earlier this year, Amazon announced a healthcare focused partnership with JPMorgan and Berkshire Hathaway aimed at streamlining care for their self-insured populations. Apple increasingly offers health tracking functionality in their wearable and personal technology products and has been hiring doctors—as many as 50 over the past few years, according to CNBC. And Google’s parent company Alphabet recently moved to combine its DeepMind AI and healthcare businesses. Even social media platform Facebook made waves this spring with its foray into healthcare with its heavy handed, but certainly interesting exploration of how they could link social health determinants to actual patient health records.

These industry outsiders aren’t the only ones making waves in healthcare. Closer to home for health systems, retail clinics and pharmacies are working to grab a bigger piece of consumers’ healthcare spending. Retailers like CVS and Walgreens were early to jump on the retail clinic bandwagon, and are branching into other convenient care avenues, including telemedicine and virtual care.

For example, this summer, Walgreens launched a digital health service geared toward patients that connects them with direct-to-consumer telemedicine companies and a few regionally select provider organizations. And just the other day, I read an article in Becker’s about how they’re partnering with Verily – Alphabet’s life sciences subsidiary.  Likewise, CVS’ Minute Clinic now offers video visits through the CVS app – a service that connects exclusively with their telemedicine vendor, and Walmart launched a telemedicine initiative just this past October.

The Healthcare Disruption Gold Rush

These organizations are moving quickly to grab a piece of the action in healthcare for one specific reason: there is opportunity here. Healthcare in the U.S. is a $3 trillion (and growing) industry, and one that hasn’t yet reaped the benefits of the digital revolution. That means the race is still open to become the Amazon of healthcare – in fact, if you read the last section, you know Amazon is interested in becoming just that.

It may sound daunting, but it’s also exhilarating. The prairies of perverse economics are wide and hostile; the mountains of data silos foreboding. And technology giants, retail pharmacies, and non-traditional care delivery systems are all crowding the dusty trails of the true pioneers.  Next up, I’ll give you my two cents on how health systems can evolve to maintain their primacy – and win in the new Wild West.

The Importance of “Soft” Value in Virtual Care ROI

Measuring return on investment – whether that comes from realized cost savings, direct revenue or long-term revenue – is important when building a business case for virtual care. If you want to get into that, we’ve got plenty of material for you (here, here and here).

A lot of time is spent discussing hard numbers with customers, so it’s easy to lose track of the softer side of ROI – what’s known as “blue sky” or “soft” value. While more difficult to measure and quantify, the softer side of ROI is just as important for organizational success. Soft value includes things like market perception, brand reputation, employee engagement and customer (or patient, in this case) satisfaction.

Virtual Care and Soft Value

So, what does that have to do with virtual care? A lot. Virtual care is a key component in strategies that impact those less measurable, but still incredibly important, value drivers, including brand positioning, provider satisfaction, and patient satisfaction and experience.

Brand Position

When I’m speaking with customers, they often tell us that how their brand is perceived in the marketplace is of enormous importance to them. A well-publicized virtual care offering can help healthcare organizations position themselves as patient-friendly, convenience-focused, and technologically savvy. With a recent survey of patients finding that more than half of millennials would choose a provider who offers virtual care over one who does not, the brand impact of a virtual care solution can be the difference between patient acquisition and patient attrition.

Provider Satisfaction

In a world where provider burnout is front and center, finding ways to maximize provider satisfaction is critical. Providers remain skeptical about virtual care and adoption is slow—just 18% of physicians are interested in adding virtual visits to their practice, according to a recent Deloitte survey. However, patients are increasingly interested in virtual visits, with 57% indicating interest in online doctor visits, according to the same survey. Finding virtual tools to facilitate patient care that don’t add to providers’ workloads is critical. Virtual care, specifically store-and-forward or asynchronous modes of care, can lighten providers’ workloads while still enabling them to care for more patients. At Zipnosis, we’ve seen customers with provider satisfaction rates as high as 100% (top 3 box on a scale of 1-10).

“Zipnosis allows me to provide excellent treatment for patients with low-acuity health issues that can safely be managed without an in-person provider visit.”

-Virtual Care Provider

Patient Satisfaction and Experience

Spoiler Alert: In our soon-to-be-released On-Demand Virtual Care Survey Report, our team found that patient satisfaction was the most selected success metric across all respondents. Moreover, looking at the virtual care program goals, patient experience and satisfaction were the most selected reasons for launching a virtual care service. By launching virtual care health systems are demonstrating commitment to making healthcare work for their patients, instead of making patients work to get healthcare. This is vital in enhancing patients’ experience with the health system and their overall satisfaction.

Maximizing Value from Virtual Care

One of the things we tell customers is that their virtual care service is only as good as the marketing behind it. Realizing the benefits of soft value – as with hard ROI – means spreading the word about virtual care, with the greatest success coming to health systems that combine seasonal marketing campaigns with providers recommending the service to their patients in-clinic.

After all, it’s impossible for patients to experience the convenience and satisfaction of a virtual encounter if they don’t know it’s available. Your health system’s brand won’t be known as an innovative leader in care delivery if the marketplace isn’t aware of the innovative services on offer. And, your physicians, NPs and PAs won’t find satisfaction with a platform that their patients aren’t using.

Soft value is a real, if less tangible, benefit of launching virtual care. Health systems that want to build their brand, enhance patient experience, and support provide satisfaction would be wise to consider adding virtual care or leveraging their existing service to meet their goals.

5 Best Practices for Assembling a Virtual Care Steering Committee

Increasingly, health systems working to assemble high-functioning steering committees to guide their virtual care strategy and service, but overall the industry is lagging behind in creating the cross-functional teams needed to drive virtual care success. Part of what is holding health systems back may be the challenges surrounding identifying and assembling a virtual care steering committee. Great news: here are a few simple steps you can take to make sure your steering committee is set up for success.

1. Get Representation from All Key Stakeholder Groups

Virtual care is optimally part of a larger digital health and patient experience strategy, and bringing together key stakeholders across the organization is key to ensuring the right voices are heard. At a minimum, this means representation from any effected care specialties, clinical leadership, IT/technology, strategic leadership, and a liaison from the day-to-day operations team.

Virtual Care Steering Committee Structure

2. Identify and Invite Your Champions

In every organization there are people who are excited about new initiatives. Seek out your virtual care champions for your steering committee. The people who see the possibility and potential of virtual care are fit guardians for your virtual care service and strategy. They’re also the people who will go to bat for virtual care, and be willing to spend the time necessary to make sure your organization gets it right.

3. Have Clear Goals and Responsibilities

Clarity is the key to your steering committee’s success. Do you want your steering committee laser focused on strategy or do you want the members to hold responsibility for operations? Do you want them to make decisions or provide recommendations? Will the committee set goals for your virtual care program or merely be responsible for achieving them?

To help make sure that your organization and committee members know what’s expected, create a committee charter that outlines the precise level and limits of authority, areas of responsibility, and committee objectives. Then, review the charter on a regular basis – annually works well – to make sure it still aligns with what your organization needs.

4. Include Decision-Making Power

A committee that can’t take action isn’t going to do your health system or your virtual care service much good. Within the defined goals and responsibilities, make sure that there are members empowered to take action and affect changes. Virtual care is an investment, and a steering committee needs to have the authority to allocate budget to achieve your health system’s virtual care goals.

5. Avoid Groupthink

This ties back to best practice #2, but make sure you have different voices on your steering committee. A group working closely together needs to include diverse opinions and ways of thinking to avoid the dreaded groupthink. While champions are valuable, so are voices of doubt – even dissent. When assembling your virtual care steering committee, make sure to include at least one person who will pressure-test ideas and ask the tough questions necessary to ensure your program’s success.

Medical University of South Carolina Helped Patients with Free Virtual Visits During Hurricane Florence

Medical University of South Carolina logo

At Zipnosis, we talk a lot about clinical efficiency, quality, and reducing unnecessary visits to the ER for simple conditions. And these are all valuable outcomes of launching a virtual care platform. What is incredibly meaningful, however, is hearing how our customers deploy virtual care to help people in communities where there are particularly challenging situations. This is exemplified by one of our newer customers, Medical University of South Carolina (MUSC). When hurricane Florence was recessed out in the Atlantic, MUSC made the swift decision to offer South Carolina residents free virtual visits during the storm.

Free online visits in the aftermath of natural disasters aren’t a new thing – for big companies. Many of the major consumer-facing telemedicine service providers have offered free visits following some of the big hurricanes that left people stranded and unable to reach their doctors. But I believe MUSC’s fast actions signal a new phase in how virtual care can be used for disaster relief.

During the storm, patients who needed assistance with common conditions had access to care from their trusted, local providers. And providers could easily care for patients with common conditions in a fraction of the time, leaving them free to care for more complex or urgent cases face to face. MUSC even used their newly-deployed phone service to help current patients receive medication refills. And, because the virtual care platform is integrated with the EMR, patients’ records remain complete.

During the course of the storm, approximately 80% of MUSC’s more than 150 virtual visit patients throughout South Carolina used promo codes to receive free online care. These patients had health concerns ranging from upper respiratory infections and bronchitis, to bladder infections, to asthma inhaler refills.

According to Dr. Ed O’Bryan, Chief Medical Officer, Business Health at MUSC, “Conditions like bladder infections or bronchitis don’t wait because there’s a hurricane. Patients who weren’t able to come in due to flooding – or even evacuation to other parts of South Carolina – could get treatment easily.”

This deployment of MUSC’s virtual care platform highlights why many of us at Zipnosis come to work everyday. As our CMO, Dr. Lisa Ide says, “We are about more care for more people.” I’m proud to support and work with an organization like MUSC that is so clearly dedicated to supporting their community.

Healthcare’s STD Infection Crisis – How Virtual Care Can Help

Last week, the Centers for Disease Control and Prevention announced that rates of chlamydia, gonorrhea and syphilis in the U.S. climbed for the fifth year in a row. The newly released data prompted a call for federal intervention at the 2018 STD Prevention Conference. This begs the question, how did we get here? And more importantly, what can we do about it?

STD Infection by the Numbers

In 2015, the American Sexual Health Association noted that rates of chlamydia, gonorrhea and syphilis reached a record high. And they’ve kept growing from there.

Preliminary CDC data from 2017 shows a 31% growth rate in diagnoses of these three common STDs since 2013. Individually, diagnosed cases of gonorrhea increased 67% and syphilis 76%. Chlamydia didn’t see quite the same rate of increase, but it remains the most common of these conditions with more than 1.7 million diagnosed cases in 2017.

Candy Hadsall, RN, MA, a prevention nurse specialist with the Minnesota Department of Health was at the conference and noted that the data wasn’t particularly surprising. “The CDC’s announcement that STD infection rates climbed again in 2017 just confirmed what we’re seeing in the field,” she said.

These numbers present a concerning – and initially, more than a little baffling – trend. After all, each of these infections is curable with appropriate antibiotic intervention, and the long-term effects of going untreated can be serious. So, why are infection rates continuing to grow?

The Root of the Problem

The factors influencing the increase in infections are complex and varied. A 2007 study in Sexually Transmitted Infections found an abundance of socio-demographic influences on infection rates, including race, income, gender, state of residence, age and history of incarceration. It also notes that attitudes toward sexual behavior and STD testing are prime factors in the diseases’ spread.

In the CDC’s recent announcement, Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention noted, “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

At its core, the STD infection crisis is driven by this combination of attitudinal, demographic, economic and healthcare infrastructure influences.

Virtual Care’s Role in Fighting STD Infection

One of the best ways to stem the tide of STD infection is by reducing access barriers to testing and treatment, and here is where virtual care shows its value. The ways that virtual care can help patients overcome common barriers to care like geography, time and cost is well-documented. When it comes to sensitive issues like sexually transmitted diseases, virtual care can help mitigate emotional barriers, as well.

In an interview with MedCity News, Geri Lynn Baumblatt (then of Emmi Solutions from Wolters Kluwer Health) noted that patients tend to “engage in impression management” when seeing their doctor. What that means is, they try to paint themselves in the best possible light – consciously or unconsciously – in an attempt to avoid judgement and shame. While Baumblatt was speaking specifically about addiction concerns, this concept translates to sexual behavior. A solution that doesn’t require a face-to-face discussion can often produce more honest answers about sexual behavior and STD risk.

Hadsall concurs that the feeling of anonymity could help patients overcome the shame and stigma associated with STD infection. She also notes that adequate resources are a challenge in STD screening. “It’s just not possible to effectively screen everyone who should be screened,” she said. “Even at very high infectivity rates of 10-15%, that’s still 85-90 out of 100 people who are screened and test negative. With an online screening option, we could do a lot more and potentially make a real dent in STD infections.”

A Virtual Solution

Image: Stop STD Infection

Understanding the value of lowering barriers to STD testing and treatment, we developed evidence based protocols to support health systems as they work to manage steeply climbing STD rates for their patient populations. Our expedited partner therapy protocol enables patients whose partner has been diagnosed with chlamydia to get treatment. As the most commonly diagnosed STD across the country, and the one that is most frequently asymptomatic, this facilitates quick, discreet care for patients – without even requiring a test. By lowering barriers to receiving care for known chlamydia exposure, health systems can help reduce the continued spread of chlamydia.

We also recently created an evidence-based virtual care STD testing protocol that gathers risk assessment data and enables patients to access lab tests for chlamydia, gonorrhea and syphilis. This protocol leverages lab integration workflows to capture patient information and seamlessly route them to a lab location for testing. Our aim is to help health systems use the asynchronous patient interview to overcome the embarrassment patients feel talking about STDs, potentially increasing the likelihood of individuals to seek testing.

The continued rise of STD infections is a complex issue, impacted by everything from socio-cultural norms to poverty rates and education to healthcare access. It may feel overwhelming, but looking at individual pieces can still make a sizable impact. There are many factors virtual care can’t impact. What we can do is help take the strain off of the systems currently unable to manage this growing health crisis and lowering barriers to STD testing and treatment.

The Flip Side of ROI: Virtual Care and Cost Containment

The other day, I saw the Advisory Board released new research indicating that healthcare executives’ primary priority is cost containment, even over revenue growth. This focus shouldn’t surprise anyone remotely familiar with U.S. healthcare. Increasingly, health systems are being asked to do more with less – more patients, less staff; more innovation, less budget.

Working closely with our customers, I see first-hand the budgetary constraints and financial scrutiny that are an everyday part of operations. That’s why our team has worked hard to provide health systems with a clear understanding of the financial implications of an on-demand virtual care service, starting with revenue.

Why Revenue Still Matters

The Advisory Board’s study didn’t say healthcare executives were uninterested in revenue, just that often takes a back seat to cost containment. When it comes to effectively managing the bottom line, a two-pronged approach addressing both revenue and cost containment is vital.

As mission-driven organizations, non-profit health systems need to think about revenue. Grants and donations can only cover so much of a health system’s operating budget. In order to effectively provide services for their communities, health systems need to have additional sources of revenue.

A quick Google search yields numerous articles, seminars, webinars and other resources for health systems looking to maximize payer contracts. With the growing trend toward value-based care, effective contracting is critical to healthcare organizations bringing in revenue. Many of our customers use their virtual care services to support and enhance local payer contracts.

Virtual Care’s Revenue Impact

Traditionally, virtual care has been viewed as a patient satisfier (and sometimes market requirement) first and revenue generator second. The trouble is that revenue is seen primarily as visit fees, which often can’t cover the cost of care delivery much less software licensing. In reality, virtual care’s ability to generate revenue and return on investment for health systems lies in its utility as a patient acquisition channel. I won’t go into the nuts and bolts today, because it’s been done extensively in previous blog posts (here and here), as well as in case studies (here and here).

Cost Containment with Virtual Care

Cost containment is the flip side of the ROI coin

While revenue is important, health system executives are right to make cost containment a priority. Last year, expense growth outpaced revenue growth by 1.2%. And, just as health systems can’t achieve their missions without revenue, they can’t effectively operate in a deficit.

I really view cost containment and revenue growth as two sides of the same coin. And, while Zipnosis has been vocally focused on revenue, we have also been focused on the flip side. So, how does virtual care support health systems’ cost control initiatives? Two ways:

Expense Reduction for Risk-Based Populations

Health systems are also big employers, and employee compensation is one of the biggest expenses they face. To help control compensation costs, health systems are often self-insured. This creates a somewhat ironic situation where healthcare costs are actually a major health system expense.

Virtual care offers health systems a low-cost access point for convenient care delivery. When focused on risk-based populations like self-insured employees, this can translate to a major cost savings. A recent study by Humana found video visit costs paid out at approximately ⅓ the cost of in-person care while producing comparable follow-up rates and lower incidence of antibiotic prescriptions.

Looking at data from across the country, we calculate the mean cost of in-person care at $320 per visit (note: we’ve seen this as high as $500-$600). Conversely, our customers see the cost of delivering care via the virtual care platform at approximately $5. That’s an average per-visit savings of $315. On an individual visit level that may not look like much, but imagine the savings possible across an entire self-insured population. Even with activation between 5% and 10%, significant cost savings is possiTake the 2018 On-Demand Virtual Care Benchmark Surveyble – enough to cover software costs and free up budget to support important programs.

Enhancing Clinical Efficiency

I alluded to this somewhat in the previous section. Virtual care, in particular asynchronous modalities, can produce significant clinical efficiencies. On average, providers spend 15 minutes per in-person visit and are saddled with the administrative overhead of documentation later in their day, often after hours. With Zipnosis’s asynchronous modality, the visit time is a fraction of an in-person visit and there is no documentation.   

That efficiency is part of why virtual care can be an effective low-cost access point, but it also can help drive significant cost savings, since health system providers are able to grow their patient panels while avoiding the costs of adding staff, outsourcing, or the health system adding brick-and-mortar locations.

3 Reasons to Benchmark Your On-Demand Virtual Care Program

Virtual Care ROIHealthcare in the U.S. is a rapidly-shifting, highly demanding industry. From the shift toward value-based care to the quadruple aim to the dense regulatory landscape, health systems are repeatedly faced with thorny issues and complex challenges. Healthcare organizations deploying virtual care meet similar objectives and obstacles, but are doing so without the body of data and benchmarks available for other care delivery channels.

There’s a fair amount of industry research looking at telemedicine or virtual care, but it is primarily patient-focused. While a few look at providers or organizations, those are often focused on satisfaction. Organizations like KLAS, for example, do a great job of rating how companies like us are doing to support health systems. When it comes to actual deployment, modes of care, conditions treated, and other important data, we just don’t have a lot. And that’s a shame because benchmarking is critical to making informed, data-driven decisions.

To help address the lack of industry standard virtual care program success measures and usable data, we launched the 2018 On-Demand Virtual Care Benchmark survey. This study is intended to explore the challenges and opportunities of on-demand virtual care, while gathering valuable data to help health systems and other healthcare organizations measure their virtual care programs against aggregate peer-group data.

Why would health systems want to benchmark their virtual care programs? The benefits of benchmarking are numerous, but we’ve boiled it down to the top three:

Reason 1: Understand the Current State

In his 2001 book Good to Great, business coach, teacher and writer Jim Collins notes that “brutal honesty”is one of the key characteristics of “great” companies. He goes deep into the reasons for this, but the crux of his argument is, you can’t make good decisions without a healthy dose of reality.

Benchmarking can help your health system achieve that level of brutal honesty by generating a clear picture of how your program measures up against industry standards. This gives you insight into things like:

    • Gaps, strengths and opportunities 


    • How your program compares to peers


    • Whether you are effectively measuring success


    • Current competitive position


  • Effectiveness of your current strategy

Reason 2: Be Strategic in Planning and Growth

Visibility is an important part of planning. Objective, independent data about the industry, the current state of your program and how the two align gives you the information and confidence to make sound strategic decisions.

Those gaps? You can develop a roadmap to close them. Strengths? Build a strategy to leverage them. Opportunities? Craft a plan to go after them. Benchmarking also gives you the opportunity to clearly define (or redefine) goals and objectives, develop a standardized process for reporting and effectively monitor performance.

Planning with clear, real-world data is even more beneficial for organizations looking to launch virtual care. You’ll be able to see where gaps and opportunities exist, and set yourself and your on-demand virtual care program up for success from day one.

Reason 3: Performance Improvement

Far and away, the biggest benefit to benchmarking is the ability to improve performance, and gain strategic advantages. Virtual care has proven to be a useful patient acquisition channel, but with more healthcare organizations (and non-traditional competitors like consumer-facing telemedicine companies) offering this service, understanding the market is key to success.

The action plan you can develop from benchmarking takes into account the independent, objective and brutally honest view of the current state, the strategic planning and optimization that comes from it, and prepares your organization to take on the market with a high-performing, patient-satisfying virtual care service.

Lend Your Voice: Virtual Care Benchmarking

Benchmarking doesn’t happen in a vacuum. If you’re reading this as a healthcare organization and haven’t taken the 2018 On-Demand Virtual Care Benchmark survey, please consider doing so. Not only will you get an early summary of the results – you’ll be adding to the body of data available and helping to create clear standards for virtual care programs throughout the country.

Benchmark survey

How to Grow Market Share with Virtual Care

This past week, I was at the American Telemedicine Association’s annual conference, and one of the things I heard over and over was the growing need for health systems and providers to offer virtual care. But health systems are often in a difficult position when it comes to technology investments like virtual care. They need, not only to prove it aligns with their mission and organizational objectives, but that it makes financial sense.

Healthcare organizations are increasingly being asked to do more with less—to think as businesses with an aim to expand and grow revenues. In fact, non-profit health systems are often caught between their business needs, the aims of their missions, and of course, delivering high quality care to diverse patient populations. The great news is that virtual care can help bridge that gap, supporting health systems in expanding access to care, both by increasing convenience and lowering costs while aiding in expansion and growth.

The Business Case for Virtual Care

When I say that building a business case is less clear that doesn’t mean it is difficult, more that, because the technology is relatively new and evolving, health systems sometimes find it challenging to pin down how they want virtual care to impact their business. While expanding access and enhancing patient experience are mission-driven goals, they also can create impacts on the bottom line. Other facets of virtual care, like increased clinical efficiency can bring a positive impact to the bottom line, particularly for populations where the health system owns a portion of their risk (e.g., self-insured employees or other owned health plans). But the real winner in building a business case has to do with gaining market share.

Virtual Care Meets Market Share

We recently published a study with MultiCare Health System in Washington that demonstrated the patient acquisition potential of offering a virtual care service to the marketplace. Through the study, we found that 34% of virtual care users who had not received care from MultiCare in the 24 months preceding their virtual visit sought in-person care in the 12 months after their virtual care experience – more than 3 times that of a control group.

So, how do you set patient acquisition goals relative to your market? Start by figuring out how much of the market you currently have—your market share.

What’s Your Market Share?Grabbing a piece of the market share pie

To calculate market share, try this for a nice-round-numbers approach. You, or someone at your organization, probably have a relatively good handle on how many patients you treat per year, on average. Divide that by your approximate market size, which you can find this with a quick Google search.

Setting Market Share Goals

The 34% patient conversion rate MultiCare achieved is tied to the closely circumscribed study cohort, imagine what that could look like relative to a major metropolitan market. For example, imagine you have 12% of a market of 3 million – that’s a nice size patient panel of 360,000. But, what could increasing your market share just 1% do? Before you pull out your calculators, I’ll tell you that it would add 26,400 patients to your health system—or 1% of your market potential.

Market Potential

market potential equation

Once you know your current market share, set attainable goals. Start with an aim of increasing your market share .25%. Using our hypothetical scenario above, that translates to 6,600 new patients.

Working with the 34% conversion rate, how many virtual visits would you need to achieve that .25% increase? Once again, I’ll do the math for you. You would need just over 19,000 new patients to come through your virtual care service to gain your 6,600 new patients and .25% market share increase.

That may sound like a lot, but there are budget sensitive strategies to increase growth and virtual visit volume that can help you achieve your market share and patient acquisition goals.

Accelerating Growth

From my perspective, one of the most interesting findings of our study with MultiCare is not the patient conversion rate but the market opportunity. The independent analytics firm who compiled and analyzed the study data found that understanding the demographics of patients who were likely to use virtual care meant that targeting just 20% of the market would yield 82% of the people most likely to use virtual care. That means highly focused, targeted marketing efforts could significantly increase virtual care utilization.

It’s exciting to hear from various health system customers about how they are leveraging virtual care to reach new patients and broaden access to care. Several of our health system partners are unlocking market potential by contracting with local health plans and employers to offer virtual care to their members and employees. Combined with targeted marketing, this approach can help accelerate your health system growth and put you well on your way to achieving your objectives.

Under the Hood: Developing and Maintaining Clinical Content for Virtual Care

One of the big compliments we receive from customers is around the strength of our proprietary clinical content that forms the foundation of our virtual care platform. This means a lot to our team. As individuals and as an organization, we maintain a rigorous focus on clinical quality, and that comes through in our algorithms and clinical protocols.

What you don’t necessarily get to see is the amount of work and expertise that goes into developing, maintaining and improving our clinical content. We have a full team of clinicians and informatics specialists devoted exclusively to creating and maintaining our protocols and clinical content – and their contribution to the Zipnosis platform is worth talking about.

Starting off with Clinical Content Development

When we launched the Zipnosis platform, we knew that the only way the technology would work is if it was backed by unassailable clinical content. Remember, this was 2008, and nothing like the Zipnosis platform had been available before. Store-and-forward virtual care was still considered the providence of provider-to-provider care, specifically in imaging for radiology, dermatology, pathology, etc. It definitely wasn’t considered a means for collecting patient-generated symptom and health history information for diagnosis and treatment of common, low-acuity conditions.

Our original clinical content was something truly brand new in the outpatient healthcare space. We started with an enormous quantity of clinical guidelines for in-person care and painstakingly translated them into a few targeted protocols for virtual care.

From those humble beginnings, we expanded our protocol library to support diagnosing and treating more than 90 conditions. Each one required not only research into the standard of care, but a reframing of what care delivery for that particular patient complaint means without lowering the standard.

Clinical Content: Care and Feeding

Considering the extensive amount of work that goes into developing clinical protocols, you may be surprised to learn that protocol maintenance and improvement is where our clinical content team truly shines. The truth is, once a protocol is built, that’s not the end of the work it requires. Like a pet, clinical content supporting virtual care requires constant care and feeding.

At Zipnosis we have a rigorous maintenance process that includes annual content reviews, during which our content team delves into the latest research to ensure that our protocols meet the standard of care and can offer the same or greater guideline adherence as in-person care.

We also closely monitor alerts and updates from the CDC, departments of health, and the FDA to ensure that the treatment recommendations are in line with the latest guidelines. These alerts don’t always align with our protocol review schedule, so we also update protocols on an ad hoc basis when guidelines change.

Clinical Content Beyond the Standard of Care

Our clinical content is the foundation on which the entire Zipnosis platform rests. That means its importance to the quality of care providers deliver through Zipnosis is critical, but it also means that clinical content has a major impact on patient experience.

We dig into how protocols are utilized by patients and consult with our customers to identify opportunities for enhancing our content. This is a more intensive process than our annual clinical reviews, looking at how patients experience the content.

    • Is the language clear, conversational and understandable?
    • Are we effectively conveying empathy?
    • How many questions do patients have to answer at maximum and minimum? Can we reduce the number of questions?
    • Where are patients being referred out of the online system and into our customers’ brick-and-mortar clinics?
  • Do the patient education information and questions match health literacy targets?

A full protocol enhancement project takes 10 weeks, and involves the clinical content team as well as people throughout Zipnosis – and even our customers. We perform a deep dive into how patients are interacting with the content, and make modifications – sometimes minor tweaks, sometimes major overhauls – to ensure patients are having a positive experience. And, through it all, we maintain that laser focus on the standard of care.

What’s Next for Zipnosis Content

As we expand the platform into new areas like surgical care and behavioral health, our clinical team just keeps blazing new trails. And, with our Clinical Quality Advisory Council’s assistance and input, our team is even better able to monitor and report on adherence to clinical guidelines. Keep your eyes peeled – there’s always more on the horizon.

Marketing Your Virtual Care Service – Digital Access Needs Digital Marketing

Question: What do car sales, tax preparation, and virtual care have in common? The answer – they all see greater success with a digital marketing strategy. These days, even durable goods and in-person services are finding that digital marketing is providing the greatest returns. And online services are even more likely to see value from employing digital strategies in their promotional efforts.

Why Market at All?

Before I launch into how to use digital marketing for virtual care, I want to touch on why you need to put energy – and even budget – behind marketing your virtual care service. Just having a service isn’t enough. Unlike digital care like telestroke or eICU, on-demand, urgent care-focused virtual care requires patient adoption to be successful. And patients can’t adopt a service if they don’t know about it. If you want to see success with your virtual care service, marketing is a must.

Digital Marketing for a Digital Service

In a digital world, not all marketing is created equal. In large part, life happens online. We get our news, entertainment and even a portion of our personal interactions online; many of us spend a good portion of our day at a computer, checking social media or doing some online shopping in our downtime. We use the internet to make appointments, book travel, and (of course) watch cat videos. With all this time spent online, it’s no wonder that digital marketing efforts are increasingly vital to all segments – healthcare included. With that in mind, here are the top digital channels to look at when building your virtual care marketing plan.


In digital marketing, we frequently joke that the best place to hide a body is on the second page of Google search results. And there’s some truth in that. The top 5 results in Google searches have a combined click-through rate (the percent of people who see the result and click to open the page) of 65.15%. Expanded to the top ten results, and the combined click-through rate is 99.88%.

To effectively capture patients who could benefit from your virtual care service, using keywords in your landing page and content along with paid search can help you drive traffic to your virtual care site. Paid search, in particular, is useful, since it can put your page in one of the top spots or just to the right of the top search results. You don’t need a huge budget – pick a few key search terms, add in some demographic information and set the amount you’re willing to spend each day – Google AdWords helps with the rest.


Yes, email. 61% of people prefer email promotions to other forms of small business communication – including direct mail, mobile apps, and other promotional channels. What’s more, a focused, structured email campaign offers patients an easy way to access your virtual care service – through hyperlinks embedded throughout your email. No other digital platform lets you target and capture engagement reporting to your known population of subscribers quite like email marketing.

Social Media

Social channels offer different avenues to connect with patients and potential patients. Having a separate, but linked business page for your virtual care service can give patients a place to ask questions and get information about your offering. Likewise, using your primary Facebook or Twitter business account to share news and information about virtual care can help get those who are already engaged with your organization on board with your virtual care service.

Social media also provides an opportunity to purchase ads – often hyper-focused – to promote your service. Gaining understanding of the patients who are most likely to use your virtual care service can help you effectively target social media ads, giving you the best return for your digital marketing investment.


Last, but definitely not least, is your organization’s website. If it’s been a while since your organization last reviewed or updated its website, now is a great time to do so. This is your most important marketing asset – both for your health system and your virtual care service. I won’t go into overall web best practices in this post, but using your website to effectively promote your virtual care service requires three things:

    1. Make virtual care accessible in several ways – include it in your topline navigation, link to it from your primary care or urgent care page, and promote it in a banner ad. The more ways for people to find the service, the more likely it is they will use it.


    1. Make it easy to find – remember how the top search results have the greatest click-through rates? It’s because they are the first things you see. Put information about your virtual care service “above the fold” on your website – it should be easily findable without scrolling or a lot of clicks.


  1. Banner ads and video – “advertising” your virtual care service on your website may seem awkward, but an eye-catching graphic is likely to drive more traffic to your service than a mountain of text. Likewise, videos are promotional gold – 85% of internet users engage with video content, and an embedded video on your website can do a lot to help drive virtual care interest and utilization.

Traditional Marketing’s Role

When marketing virtual care, a digital strategy is critical, but that doesn’t mean there isn’t a role for more traditional marketing. Waiting room advertising, print ads, direct mail, and other more traditional elements help support your digital messaging and increase engagement. While not always the most important part of your marketing plan, these traditional avenues should not be ignored.

Trend Watch: Virtual Care as an Employee Benefit

There’s a new trend in employee benefits: offering a virtual care service. And, employers are embracing these additional health benefits. A study by the National Business Group on Health found that 96% of employers plan to make virtual care services available in states where the regulatory environment allows it by the end of 2018. Which raises the question, what is fueling this employer adoption and how can the healthcare industry address this rising demand and help drive success in virtual care benefit programs?

Employer Gains from Virtual Care

Employers have numerous and varied reasons for leaping on the virtual care bandwagon, but they all come down to seeing the advantages virtual care brings their organization. Typically these fall into two categories: cost savings and employee satisfaction.

Cost Savings with Virtual Care

This is the most tangible value employers get from offering virtual care as an employee benefit. According to a Willis Towers Watson survey, employers expect to see healthcare costs increase 5.5% in 2018. And collectively, employers spend more than $650 billion on health benefits. Virtual care offers employers – and their employees – a lower cost access point that meets the need for convenience typically addressed by high-cost urgent care centers or emergency rooms.

On average, an in-person visit costs approximately $175. This is based on average cost of care at various in-person locations – from primary care clinics up to the emergency department – and the average spread of utilization among them. Shifting even a small percentage of these in-person visits to a virtual access point can produce significant cost savings over time. For example, in a population of 5,000 employees and dependents, driving just 3% of anticipated visits to a virtual access point could produce savings of more than $65,000 per year.*

These are relatively rough calculations, but if you want to see how shifting care from a high- to low-cost access point can produce cost savings, we have an interactive calculator that can help.

Virtual Care and Talent Strategy

Increasingly, employers are faced with managing competitive talent markets. In the fight to acquire and retain the best talent, offering a benefits package that meets or exceeds the market standard is critical to an effective talent strategy. Remember, 96% of employers expect to offer a virtual care employee benefit by the end of 2018. Companies that want to attract and retain the best people, will almost certainly need to include virtual care in their benefits package to stay competitive.

Virtual care can produce other, “softer” wins for businesses, as well. Workplaces with a virtual care benefit may see reduced absenteeism and a corresponding increase in productivity, as employees don’t need to take time away from work to visit the doctor. Further, including virtual care in a benefits package signals that the company understands employee needs and is committed to their wellbeing, which can help increase employee satisfaction.

What it Means for Health Systems

Like other employers, health systems are also increasingly embracing virtual care. But unlike employers, they are adopting it as a care delivery channel. As a result, when health systems offer their own virtual care service as an employee benefit, they stand to gain even more than employers in other industries.

For starters, when launching a new virtual care service, health system employees make a phenomenal pilot population. They represent a clear, distinct population with a vested interest in organizational success, as well as being readily available to collect feedback on how the program is working. Piloting virtual care with employees can also help produce a rapid return in investment through the cost savings outlined above.

If you’re looking to launch to a broader population, one of the of the top drivers of virtual care utilization is provider recommendation. By launching virtual care internally as an employee benefit, health systems can increase provider acceptance and buy-in. When clinical providers and other patient-facing employees use the virtual care service as a patient, they can see first-hand the convenience it offers and the safety and quality of care delivered. Satisfied with their virtual care experience, these employees will be more inclined to recommend it to their patients, further driving utilization and return on investment.

How to Produce an Employee Benefit Win

With all these advantages untapped, what can organizations do to drive success with their virtual care employee benefit? Three things:

    1. Contract locally – One of the big challenges in healthcare is care fragmentation. Oftentimes, employers can unknowingly add to this by encouraging employees to use a contracted telemedicine service provider – taking care out of the standard care continuum and fragmenting their medical records. Health systems and employers can combat this by partnering to offer virtual care staffed with local providers. By contracting with local health systems, employers and patients get the value of a virtual care benefit without adding to healthcare fragmentation. Health systems win too, by adding a new avenue to acquire patients and improving virtual care utilization. 
    1. Find the right price – For employees to truly benefit, and employers to see utilization that will drive cost savings, the service needs to be priced appropriately. When working with an employee population that has both traditional and HSA health plans, this can be tricky. According to the Society for Human Resource Management, understanding HSA eligibility is a key barrier to an effective virtual care employee offering. Under current regulations, employees on an HSA plan cannot receive virtual care for free. At Zipnosis, we recommend either a nominal fee of $5-$10, which still presents significant cost savings to employees, but doesn’t run afoul of HSA plan regulations.
  1. Spread the word – The biggest mistake employers and health systems make once they have a benefit offering in place is to “set it and forget it.” Organizations should use multiple channels to keep the virtual care offering front of mind for employees. These can include benefit materials, a benefit portal, intranet site, employee newsletters, HR emails, and company or department meetings, among others.

*Assumes an average of 2.5 visits per member per year

What Does Access Really Mean?

Working closely with our customers, I hear over and over that patient access is a key strategy and reason for launching virtual care. Taking a cue from our health system customers, we talk a lot about virtual care’s ability to expand and facilitate access to care. But what does that really mean? Who benefits from the expanded access that virtual care provides?

Meet Kate

One of the things I find really refreshing about working at Zipnosis is that we don’t stop at thinking about what our health system customers need. What I mean here is we’re also thinking about tMiddle Aged Telemedicine Patientheir patients. Who is using their virtual care platform? Why are they using it? What can we do to improve the experience for them?

We actually have well-realized personas covering several known users. The flagship persona is someone we call “Kate.” Kate is in her mid-30s, married with two kids who she chauffeurs  around in a late-model SUV. Kate works full-time and has insurance through her employer. She’s also the persona who drives our standard product demo – if you’ve ever seen the Zipnosis platform in action, it’s probably through the lens of Kate.

Recently, I began to think about Kate because access for her means something different than it does for a lot of the population. It’s really about convenience more than need. Kate could take time away from work, she could drive to see her primary care doctor for care, it’s just inconvenient to do so. But what it we took away Kate’s SUV, her employer-sponsored insurance, even her full-time job?

Meet Katie

Katie looks a lot like Kate on the outside. She’s also in her mid-30s with two kids, but instead of Kate’s SUV, Katie relies on public transportation. Instead of Kate’s employer-sponsored insurance, Katie has a high-deductible health plan that means she pays for most healthcare costs out-of-pocket. Instead of Kate’s full-time job, Katie works two part-time jobs and doesn’t have paid time off. What does healthcare access mean to Katie?

To answer that question, I gave myself an exercise: Put myself in Katie’s shoes and understand the decisions she needs to make when looking at where—and whether—to seek care for a common condition like a UTI. Here’s what I learned:

In-Person Care Options

I looked at 4 in-person care delivery options: A primary care clinic, an urgent care center, a retail clinic, and the emergency room.

Work Schedules

Working two part-time jobs without PTO, Katie needs to find time to go to the doctor. That may mean determining if she can afford to take time off of work, coordinating shift coverage with co-workers, or finding an option that’s open when she’s free. That means the hours of operation and when an appointment would be available are major factors in decision making.

Primary care: 8 am – 6 pm; appointment availability “tomorrow”

Urgent care: 7 am – 7 pm most weekdays

Retail clinic (average): Weekdays, 9 am – 7:30 pm; weekends, 9 am – 4 pm*

Emergency room: 24 hours daily

*Lunch hours: Practitioners take a daily, required lunch break each day. Please note that lunch time are approximate and may vary.


Part of managing schedules is figuring out the impact of public transportation. Katie needs to factor in schedules and routes. Then, she needs to determine how much time she’ll need to spend in transit. Using my house as a starting point, I determined that transportation would take anywhere between 15 and 45 minutes each way, most of which required walking about ½ mile in addition to the bus.

Child care

If Katie needs to seek care outside of her typical working hours or when the kids are not in school, she needs to consider what to do with her children. Does she haul them along to the doctor’s office? Does she get a last-minute babysitter – and is that practical from a financial standpoint?


Finally, with her high-deductible health plan transitioning the full cost of care to Katie, how much will she have to pay out-of-pocket for each of her options? The data shows costs varying widely for services, but the following are pulled from a Blue Cross Blue Shield (MA) fact sheet on typical costs for common services and Consumer Reports:

  • Primary care: $130 – $180
  • Urgent Care: $120
  • Retail Clinic: $55 – $75
  • Emergency Room: $400 – $700

Access with Virtual Care

Imagine the impact a virtual care offering could have on Katie. Access to a virtual care service effectively eliminates the need to balance her competing priorities.

Work Schedules – With virtual visits available via any internet-connected device, Katie doesn’t have to worry about missing work.

Transportation – Katie can access virtual care anywhere, so transportation ceases to be a concern.

Child care – Katie can complete a virtual visit while her kids do their homework at the kitchen table, or while they’re playing at the park.

Cost – Unlike the more costly in-person options, most of our health system customers charge between $20 and $40 for a virtual visit, making it far and away the most affordable option.

With virtual care, Katie can quickly, easily, and affordably receive care for her UTI – without the stress and worry. Virtual care may well be working to bring convenience to the Kates of the world – and that’s no small thing – but our greater impact is in the benefit we bring to the Katies.

Virtual Care and the EMR: The High Cost of Free

Do you remember the healthcare world pre-EMR? Healthcare organizations from large IDNs to individual practices were swamped by stacks of paper. There were rooms filled with files, cabinets bursting with the medical histories of every patient that sought care at a given clinic.

Pre-EMR medical files

Then came computers and along with them, electronic medical record systems (aka, the EMR). And everything changed. Digitized patient records didn’t take up any space. Health systems, physician groups, and clinics were freed from the morass of paper they’d been buried in for years. And over time, the EMR evolved to be more than just a digital record storage solution. From patient portals to revenue cycle support and scheduling, EMR vendors expanded their offerings to support a wide variety of health system needs.

It’s no wonder then, that when health systems begin looking at a virtual care solution, the telemedicine module/functionality in their EMRs is often the first place they look. Many EMRs automatically include this online care delivery with the software. In fact, the main argument in favor of health systems using their EMR’s virtual care solution is that they’re already paying for the technology, so adding virtual care would essentially be free. But is it really?

Imagine this: Your health system is moving forward with launching virtual care. After reviewing your options, your team decided to build within your EMR. Like most health systems, you want to maximize your EMR investment – plus the promise of “free” virtual care technology is too good to pass up. Then you get started…

What Does “Free” Cost?


Turning on the telemedicine module in your EMR to offer virtual care is much more complicated than just flipping a switch. You will need to dedicate time and personnel to creating your virtual care service: developing the user experience and interface, creating and mapping the appropriate fields in your EMR, and ensuring the necessary integrations with scheduling, billing, etc. are in place and working properly. This means either diverting resources from other projects, adding to your technology team’s workload, or hiring – on contract or full-time.

The Cost:

  • Simply adding development to your technology team’s workload is the most cost-effective option, but it does cost the organization. Pushing off other projects incurs costs, and adding to the workload can stress employees causing an increase in absenteeism and even turnover.
  • Contracting with a certified consultant can run to hundreds per hour, and you may still need to dedicate person-hours toward development.
  • Hiring – whether contract or full-time – incurs costs in recruitment, training, and compensation.

Clinical Content

The technology side is just the first cost hurdle. Your virtual care service also needs high-quality clinical content, including patient-facing questions, algorithms, and clinical decision support – none of which is included in the EMR’s technology. Same as the technology, you have three choices for creating your clinical content: dedicate internal resources, purchase the clinical content, or hire a clinical informatics specialist – either on contract or full-time.

The Cost:

  • Even if you have a clinician with a background in informatics, finding internal resources means diverting clinical expertise away from patients. The cost of inexperience in this area could be even higher, with poorly-constructed algorithms producing the potential for quality concerns.
  • Purchasing content will, of course, incur the cost of the content, but it may also require additional time and energy from your technology and clinical team to customize it to your unique needs.
  • Hiring, again, means recruitment, training, and compensation costs.

Ongoing Investments

Building internally through your EMR means an ongoing resource commitment. You will need to regularly allocate resources for:

  • Technical support
  • Managing software updates
  • Clinical content management and updates
  • Service and technology enhancements (e.g., additional conditions, specialties, and services)

Opportunity Cost

Right now, health systems across the country – and likely in your market – are launching virtual care. According to a recent KaufmanHall study, 56% of health systems stated that developing virtual access points is a high priority, and 23% have a virtual care solution in place today. On top of which, telemedicine companies are growing their service capabilities and becoming more like complete online health systems than one-off urgent care centers. While you’re finding an EMR vendor-certified consultant, hiring IT and clinical staff to support virtual care, and actually building out all the individual, customized components of your service, these competitors are already marketing to and perhaps serving your patients.

Protecting patient relationships and retaining patients isn’t the only consideration. On the flip side, with virtual care proven to add patients to health systems, the time spent in building virtual care internally means the potential for losing new revenue. A recent white paper by Kurt Waltenbaugh, CEO of Carrot Health (and yours truly) found that approximately 25% of new patients from virtual care went on to have in-person care appointments within a health system. With the average annual revenue per new patient close to $3,000, this can add up to significant lost opportunity.

Finally, building your virtual care service within your EMR makes it much more difficult to change EMR vendors. You may not want to consider it right now, but if something occurs that causes you to change EMRs and you’ve built your virtual care, you lose your virtual care service, and all the time and money invested in building it.

Adding it all up

Back to our imaginary scenario: You’ve gone through your technology build, and you begin adding up all the costs associated with creating your virtual care service. All told, your free virtual care technology ended up taking more than a year and costing several hundred thousand dollars to build. During that time, your two biggest competitors launched online care services, and now have contracts with the major health plans and employers in your area. What’s more, your urgent care centers and clinics have seen a decrease in patients, as those services siphon visits away from your health system.

Having spent the past decade supporting health systems, I understand the temptation of the word “free.” Healthcare organizations are consistently asked to do more with fewer resources, and budgets are under heightened scrutiny. But look closely at any option billed as “free” – it may end up costing you more in the long run.

Highlights from the Zipnosis Customer Summit

Last week marked our 3rd annual Zipnosis Customer Summit. More than 20 representatives from 11 

Zipnosis Customer Summit

health systems joined us in Minneapolis to network, learn, and celebrate the accomplishments from the past year. This was my first Customer Summit, and I was thrilled by the spirit of partnership and excitement our customers brought to the event.

Over the course of the day, we covered a wide range of topics, all geared towards helping our customers optimize virtual care within their organizations. Presentations covered the evolution of Zipnosis as a company, customer successes, and a look into the future. So, with that in mind, here are a few of my favorite moments from the Customer Summit:

Peer Insights Win the Day

We were fortunate to have three customers join us as presenters. As Vice President of Customer Success and Operations, my goal is in my job title – success for each and every one of our customers. It’s gratifying for me to hear about the positive results customers are achieving. But more than that, the Customer Summit gave everyone in attendance an opportunity to learn from the experience of their peers.

Zipnosis Customer Summit presenter Andy Whitney of Bryan Telemedicine

Andy Whitney of Bryan Telemedicine presents on the impact of protocol enhancements

Zipnosis Customer Summit Presenter William Brazeau of Ascension Wisconsin

William Brazeau of Ascension Wisconsin shares his experience piloting our updated user interface

Molly Menton of Summa Health provides insights into their successful internal launch

Understanding Healthcare Today

We were lucky to have Brian Kalis from Accenture Consulting join us for a terrific keynote on the changing nature of healthcare. His insights on healthcare consumerism, shifts in the competitive landscape, and technology adoption were eye-opening.

Brian Kalis, Managing Director of Digital Health at Accenture Consulting, presents on the changes occurring in the healthcare industry

What Tomorrow Holds

In addition to presentations about what is happening right now with Zipnosis and the healthcare landscape, customers were treated to a preview of upcoming products as a part of the Zipnosis product roadmap session. I, of course, can’t share this top-secret information but we have some big things coming soon.

Lisa Ide, Medical Director, and Sue Irby, Product Manager, demo soon-to-be-released functionality

Sharing our vision for the Zipnosis platform

Networking at its Finest

The Customer Summit was packed with insights and information, and I felt fortunate to be able to to connect with so many of our customer attendees. We heard immediately how valuable it was for our customers to connect and network with one another. All in all, it was a fantastic event! My goal (and strong belief) is that having face-to-face time accelerates our customer’s understanding of their Zipnosis platform capabilities as well as opportunities they may not have thought of before. I hope to see many more health system leaders at next year’s summit.

A Baker’s Dozen: 13 Considerations for Selecting a Virtual Care Partner

As the healthcare industry evolves, health systems are increasingly using online care delivery to help meet the changing needs of healthcare consumers. But choosing a virtual care partner can be challenging. How do you know you’re making the right choice for your health system?

While there’s no silver bullet, our experience partnering with health systems has uncovered 13 areas every health system should look at when selecting a virtual care partner. Check out our virtual care baker’s dozen:

Internal Factors

1.  Who Are Your Stakeholders?

It’s easy to identify key executives who need to be involved in selection of a virtual care solution and partner, but making the right choice involves more than just top levels. Understanding the impact virtual care has on stakeholders throughout the organization can help you choose the solution that best aligns with your health system’s needs. This is particularly important for those who will be expected to interact with the virtual care solution on a day-to-day basis. Involving front-line stakeholders – particularly clinicians – early in the process can help foster buy-in, create a smoother transition when it comes time to launch, and ultimately support program success.

2.  Your Health System’s Goals

Before you can effectively evaluate potential partners, it’s vital to understand why you are launching virtual care and how this initiative intersects with larger organizational objectives.

Measuring Success in Virtual Care

    • Are you looking to expand patient access?


    • Do you have capacity concerns?


    • Are you seeking ways to manage a challenging competitive environment?


    • Are you looking for new revenue channels?


    • Is saving on your employee health insurance costs a focus?


  • Do you want to support your brand and be viewed as a technology leader?

The answers to these questions will help form your virtual care strategy, which should be at the center of your partner selection process.

3.  Internal Processes

It’s also important to fully understand internal processes and clinical workflows. A best practice is to perform an evaluation of current processes looking at elements like patient experience, clinician workflow, billing and claims, etc. prior to selecting a virtual care partner. This can be a good time to revise processes and workflows that are no longer working well for your health system. Whether you choose to make process improvements or not, a comprehensive grasp of current processes will help you select a virtual care partner and solution that complements – rather than hinders – clinical operations.

4.  Virtual Care Program Requirements

Your virtual care strategy and understanding of processes and workflows will provide a guide to building out your list of requirements. Health systems often start out with a long wish-list and idealized version of how the virtual care program will run. Prior to beginning your search for a virtual care partner, it’s important to evaluate and prioritize program requirements and understand where and if you’re willing to compromise. For example, you may have to balance factors like staffing levels and budgets with choice of modality, or organizational objectives with regulatory constraints. Get your team on board with a list of must-haves, nice-to-haves, and things to avoid at all costs.

Company Information

5.  Leadership & Team

Virtual care is most often a “software-as-a-service” (or SaaS) solution, meaning that you’re purchasing the right to use the software, but the result you get is more service-based. That means the people you’ll be working with matter. During the evaluation process, try to interact with both company leadership and people directly responsible for day-to-day operations. Most importantly, be sure to get to know the person or team that will be supporting your account – they will be critical to your success.

6.  Financial & Organizational Stability

With the proliferation of virtual care and telemedicine companies flooding the market, it’s important to make sure your virtual care partner is experienced and stable. Ask potential partners about:

    • Current and anticipated funding – Make sure your potential partner has a solid financial foundation


    • Industry tenure – While length of time providing services shouldn’t be the number one determining factor, make sure you’re not choosing an untested, untried solution


    • Board membership – This ties in with company leadership, but a stable, well-functioning board is indicative of a stable, well-functioning company


  • Company growth – Look for an organization that demonstrates steady growth, but not one that is growing so quickly they may not be able to effectively serve current clients

7.  Business Model

Understanding a potential partner’s business model is an important part of the selection process. Many companies serving health systems also have a direct-to-consumer offering, which may or may not present a conflict of interest or otherwise impact the success of your partnership. When evaluating partners, ask yourself:

    • Do they market and sell telemedicine or virtual care services directly to patients, health plans, and employer groups?


    • How deep do their services go in serving patients directly? Might patients who use the service go directly to them for other care down the line?


  • And, most importantly, does their business model present a conflict for your organization?

Solution and Relationship

8.  Technology & Product Roadmap

Finding the right technology for your health system and your patients is a critical part of selecting a virtual care provider. You need to understand the differences between different modalities – phone, video, and store-and-forward. Each has a place and a use, so the technology solution you choose needs to align with your goals and strategy. You also want to look at how different solutions work within your current technology ecosystem – you don’t want to sign a contract only to find that the virtual care software is incompatible with your EMR, billing, and scheduling tools.

When choosing a partner, it’s also important to take a long view. Telemedicine and virtual care today looks different than it did 10 years ago, and as technology and the healthcare industry evolves, your virtual care solution needs to evolve with it.

9.  Service & Support

When purchasing a software solution or a service, it’s vital to understand what type of service and support is included in your purchase. Determine what services are important to you and make sure you have a full understanding of what each solution brings to the table.

Services to look for:

    • Implementation plan and support


    • Initial and ongoing training for administrators and clinicians


    • Reporting availability and metrics tracked


    • Technical support for all users – providers, administrators, and patients


    • Account management services and relationship support


    • Branding and white-labeling


  • Ongoing product roadmap and service scaling

10.  Clinical Quality

Evaluating the clinical quality of potential virtual care solutions is a critical element of partner selection. Clinicians need to be comfortable with the quality of care provided, patients need to feel they are receiving the best possible care, and regulators need to see that the standard of care is upheld across care delivery channels. Potential partners should be willing to:

    • Share quality reporting data – guideline adherence, antibiotic stewardship, etc.


    • Provide information on clinical protocol development


    • Demonstrate the features and functionality that ensure quality care


  • Outline the steps they are taking to support clinical quality across all customers

11.  Clinician & Patient Experience

As you’re evaluating solutions, consider how your patients and your staff will interact with the virtual care software. If you’re outsourcing clinical functions, where will the intersections be and who will need to manage them? If you’re staffing internally, understand how this will look, and how it will impact your clinical operations. More importantly, how will it impact your clinicians? A positive clinician experience can make or break a virtual care service.

Patient experience is equally important. Developing a fundamental understanding of who your patients are and what their lives look like is critical to selecting a virtual care partner and solution that will work for them. Things to look for include:

    • Ease of use


    • Accessible language


    • Process transparency


  • Expectation management

12.  Partnership Approach

Virtual care is a critical, strategic initiative, and to realize the greatest benefit you need more than just a vendor – you need a true partner. As you evaluate technologies, services, and solutions, keep your eyes peeled for clues indicating which companies are truly committed to your success.Virtual Care Partnership

    • Ask for stories about how potential partners have helped their customers overcome specific challenges, or ways they’ve met an unexpected customer need.


    • Look at how their technology and service structure is set up – is it geared around bringing value to health systems and their patients?


  • What opportunities are available for customers to network, learn, and grow?

13.  Results

This may be obvious, but your potential virtual care partners should be willing and able to provide information on the results their customers are seeing. These need to be transparent, understandable, and provable. Check out case studies, webinars, and independent research (if any are available) to see what type of results health systems are seeing with each potential partner. While formal reference checks can be useful, also ask around to your health system peers. Virtual care providers will most likely only give you access to satisfied customers, which is why reading the buzz in the industry is just as important asreference calls.


How to Prevent Your Emergency Department from Becoming an Urgent Care

The Challenge:

Across the country, emergency departments (EDs) are experiencing, well, an emergency – specifically, overuse. Patients – for a variety of reasons – are treating emergency rooms like urgent care facilities. A report from the New England Healthcare Institute estimates that this overuse of EDs is responsible for $38 billion in wasteful spending each year. Additionally, a literature review published in the American Journal of Managed Care found that on average 37% of ED visits were judged to be non-urgent. The CDC’s numbers match up, finding that of the 130 million ED visits in 2013, only 8 percent could be classified as “immediate” or “emergent”.

Little girl in the emergency department with a broken arm

Patients treating the emergency room as an urgent care can cause problems for hospitals and health systems. ED use can cause fragmentation, and even with an efficient EHR, can make effective care coordination challenging. What’s more, an ED being used as an urgent care for non-emergencies may increase wait times for all. Using “broken bone” as an example, ProPublica’s ER Wait Watcher shows an average wait time of between 38 and 72 minutes.

Another major concern for health systems related to ED overuse is uncompensated care. Patients treating the ED like an urgent care my receive a rude awakening when they find that their visit cost is only partially covered by insurance or is exponentially higher than a PCP or true urgent care visit. According to an article in the Annals of Emergency Medicine, only 50 percent of ED charges are reimbursed – including reimbursements through Medicare, Medicaid, and private insurance.

With the mean cost of care delivered in the ED over $2,000 per visit (approximately 300% the cost of primary care) according to research published in the Journal of Medical Internet Research, that adds up quickly – for both health systems and patients. A study in the American Journal of Medicine found that medical debt is a contributing or primary factor in more than 40% of personal bankruptcies. This creates a financial strain on health systems, and has the potential to result in ED closures, which in turn compromises access for patients experiencing a true emergency.

Why Patients Choose the ED – Access, Access, Access

There is no doubt that many patients go to the emergency department due to a bona fide emergency. But an article in the Journal of Emergency Nursing found that the reasons for going to the emergency department for non-emergency care were centered around access and inappropriate referrals. Specifically, patients visited the emergency room because they were unable to obtain a PCP appointment, were told by staff (not physicians) to go to the emergency room, or felt that it would take less of their time.

A review in the American Journal of Managed Care found similar reasoning around convenience, access, and cost. But the inability to access quality care elsewhere was the foremost reason for patients visiting the ED for non-urgent conditions. This is a particular challenge for uninsured and underinsured individuals and families, as well as those classified as having a low income, and why the top strategy for reducing ED overuse is broadening access to primary care services, according to the Centers for Medicare and Medicaid Services.

Ultimately, many patients go to the ED because they think it is easier than the alternatives. Younger patients, in particular, view the emergency department as a reasonable alternative to a primary care clinic for receiving care. This is part of the larger trend of consumerism in healthcare, in which patient choice is driving change in how and when care is delivered.

So, What’s the Answer?

Unfortunately, there’s no magic bullet to the challenges of supporting efficient use of an emergency department. The good news is there are things health systems can do to help reduce overuse. And one of those things is launching a virtual care service line and driving patients to the online access point in lieu of the ED.

For patients who are unable to obtain a PCP visit, virtual care offers an alternative access point. Available 24/7, unlike primary care clinics or even urgent care facilities, virtual care gives patients unprecedented access to care. Patients who can’t afford to or are otherwise unable to take time away from work to seek care during normal office hours can use the virtual care service to get the care they need. And, when using a virtual care platform that incorporates  evidence-based algorithms and best practice-driven protocols patients are only directed to the urgent care or emergency department visits when clinically appropriate.

Improve Patient Access with Zipnosis Virtual CareWhat’s more, patients seeking convenience in addressing non-urgent needs will likely find virtual care more appealing than the emergency department. They no longer have to leave their home, drive to the hospital, and sit in the waiting room. And virtual visits take a fraction of the time a primary care visit or even a trip to the emergency room would take.

The low cost of virtual care can also help steer patients away from the ED. Patients who don’t have insurance, are underinsured, or are taking on a larger portion of risk with a high-deductible health plan may struggle to pay for emergency care, leaving health systems with higher rates of uncompensated care. Patients who cannot cover a several-hundred dollar (or higher) emergency visit (see the shocking ED price tag example above), may be better able to pay the $30 or $40 for a virtual visit, about the cost of a typical copay.

Most importantly, with a virtual care service, health systems are expanding access to care. That means common conditions can be treated quickly before complications develop and the danger to the patient increases. This can be the difference between a simple urinary tract infection and a kidney infection or an upper respiratory infection and pneumonia. That means, getting patients treatment early could help reduce ED visits and improve patient outcomes.

Follow the Data to the Real Virtual Care ROI

I am a firm believer in the power of data – not surprising considering my role as CEO of a data analytics company. In my experience, successful business decisions don’t happen by accident; they’re a direct result of careful evaluation of a large amount of information.

Recently, my company, Carrot Health, had the opportunity to work with a large health system to explore their virtual care service. Historically, the impact virtual care service lines and technology have on a health system hasn’t been very clear and there’s been a lot of debate about virtual care’s return and long-term financial sustainability. So, when a client came to us wanting help in evaluating their virtual care service, we were intrigued by the opportunity. What we found was surprising.

Virtual Care ROI – The Data Has Spoken

Beyond insight into who was using the service, we stumbled onto data that showed the behaviors of patients following a virtual visit – and then, the downstream impact on the bottom line. But first, let me share our methodology.

Looking at all virtual care users over a 12-month period, we narrowed down our pool to those who met the following criteria:

  • Men and women over 18 years old
  • Had not received care from the health system within the 24 months prior to their virtual encounter
  • Could be matched to a patient record in the health system’s EMR

Ultimately, we ended with a cohort 974 virtual care users. Of that cohort, 24.8 percent, or 242 virtual care users, had converted to in-person care within 12 months of their virtual encounter. By tracking the services these patients received through EMR data, we found that on average, these new patients had 3 in-person visits and generated $2,972 in revenue. That translates to more than $708,000 in incremental annualized revenue.

Virtual Care Revenue Potential

At first glance, $708,000 may not seem like a significant number. But looking purely at the conversion percentage and average revenue per patient, this impact potential for virtual care becomes much greater.

Remember, we took a very conservative approach in the creation of our data set. Let’s say that we’re looking at 10,000 virtual care users, 30% of whom are not current health system patients. At the 24.8 percent conversion rate and $2,927 average annualized revenue, that translates to approximately $2.2 million in incremental revenue.

Driving Conversions with Data

So, how does a health system get 3,000 new patients to use their virtual care service so they can see those kinds of revenue returns? The answer is, of course, data. Understanding consumer behavior using social, behavioral, and clinical variables enables health systems using virtual care to acquire patients to more effectively target marketing efforts at demographic segments most likely to use virtual care.

Health systems today are at a crossroads: Today’s data-rich environment gives health systems an unprecedented opportunity to make informed decisions that produce successful results. The organizations that take advantage of the information and technologies available are those that will be best positioned to thrive now and in the future.

About the Author

Carrot Health CEO, Kurt Waltenbaugh

Kurt Waltenbaugh, Founder and CEO, Carrot Health

Kurt has built successful analytic solutions, products, and companies in the healthcare, retail, manufacturing, education/credentialing, and fundraising industries. His previous companies were sold to Oracle and Pearson Education. Most recently, Kurt was responsible for product strategy at Optum, Inc. (United Health), building data analytic businesses for the provider, payer, and employer markets.

Avoid the Avoidable: 5 Common Virtual Care Mistakes and How not to Make Them

You may have heard the latest news coming out of Texas – A major piece of telemedicine legislation has just been signed into law that will change the game for health systems looking to deploy virtual care. This bill abolishes the requirement that patient-physician relationships be established with an in-person visit before telemedicine or virtual care can be used. For health systems, that means they can now offer virtual care to the broader marketplace, rather than just to current patients. With virtual care proven to add patients to health systems, this presents an opportunity to employ virtual care as part of a patient acquisition strategy. Game-changing.

In Texas (and elsewhere), health systems new to telemedicine and virtual care are now looking at launching their own services to support patient acquisition. But without a foundation in virtual care, health systems moving quickly to take advantage of the new environment may be making decisions that have potential long-term implications for their organizations and patients. More good news for Texas health systems: By avoiding these 5 common virtual care mistakes, success is within reach.

1. Lack of organizational support

Often, health systems will decide there’s a need for virtual care, and begin with the best of intentions, delegating a department or individual to work on finding and implementing a solution. But without a clear plan, regular communication, and stakeholder engagement, the virtual care project does not get the proper attention and true buy-in needed to create a successful, long-standing virtual care offering.

The Fix

Think of virtual care as a large, strategic technology investment – something that can support organization-wide objectives and strategies while adding value to your patients’ experience and your providers’ work. Make sure you have a clear plan around launching, and assemble a steering committee of leaders throughout the organization to guide the implementation and growth of your virtual care service.

After launch, maintain a communication plan to help keep virtual care front-of-mind throughout the organization. From clinical operations through marketing, your team should understand why virtual care is an important part of your strategy and how they can help make it a success.

2. Unclear reporting structure

Traditionally, telemedicine and virtual care service lines have been subject to a surprising lack of oversight. Health systems that don’t set up a clear reporting structure or determine which metrics to track will never be sure whether their virtual care service is meeting its objectives, and won’t have the insight needed to improve or grow the service.

Virtual care mistake: Unclear reporting structure

The Fix

This is an easy mistake to avoid – just make developing a cadence of accountability part of the implementation process. Understand what data your partner can capture and report on and what data you have access to. Decide on a reporting schedule—and identify who will be responsible for assembling and who will be responsible for reviewing reports.

If you need help identifying metrics or developing a reporting structure, our eBook, Measuring Success in Virtual Care, has the information you need to get off on the right foot.

3. Lack of marketing support

“If you build it, they will come” only works in baseball fantasy movies. But some health systems think that just having the service is enough. The truth is that patients won’t use your virtual care service if they don’t know it exists. And, in the digital age, marketing techniques need to be updated to match your audience.

The Fix

It’s not enough to buy billboard space. When launching a virtual care service, you need a multi-channel, long-term marketing plan to drive virtual care adoption. This may include elements like a press release and local media strategy, prominent website placement, social media strategy, direct mail, email marketing, and in-clinic marketing. Likewise, an initial introductory push will only do so much for the service. If you want to see long-term success with virtual care, create a continuous cadence of communication, including seasonal marketing pushes around things like cold and flu or seasonal allergies.

Internal communications are also key. Providing training and information to nurse line and front desk staff to help them direct patients to the virtual care service can do a great deal toward driving adoption. Additionally, getting physicians, physician assistants, and nursing staff on board with talking about and recommending virtual care can make a tremendous difference in virtual care adoption.

4. Not understanding big-picture value

People are people, and people get locked into old ways of thinking. This is particularly true when looking at payment and revenue. Health system finance departments sometimes view the return on a virtual care investment by subtracting revenue from cost – but that’s not how virtual care adds value. The true value of virtual care lies in downstream revenues and cost savings as evident in a recent study.

The Fix

Virtual care’s organizational impact can appear in any combination of the following:

    • Increased patient acquisition
    • Reduced patient leakage
  • Lower cost of delivering care – or cost shift

If you want more information about the potential revenue impacts of virtual care on your health system, our revenue calculators can give you a starting point:

ROI Calculator

Cost Shift Calculator

ROI Calculator

Patient Acquisition Calculator

ROI Calculator

Patient Leakage Calculator

5. Choosing the wrong partner

Not all telemedicine and virtual care companies are created equal – the technologies, business models, support, and product roadmaps can vary widely. For example, many telemedicine companies have a direct-to-consumer model, meaning that they have the potential to create a relationship with your patients that could lead to those patients circumventing your system altogether in the future.

Many health systems rush their decision due to pressure from increasing competition or fail to perform their due diligence in the belief that telemedicine and virtual care companies are all the same. Often, healthcare organizations will find that their partner isn’t providing what they need six months to a year into a multi-year contract. Concerns can be as simple as workflow alerts, to low utilization, to lack of flexibility and scalability in the technology. And then they’re stuck. Fortunately, with planning and care, it’s possible to select the partner best suited to your health system’s needs.

The Fix

First, talk to your stakeholders – understand patient and provider needs so you can choose the partner that is best suited to meet those needs. Don’t assume. Next, take a look at your organizational strategy and understand how virtual care fits into your overarching goals. Finally, develop your criteria for selecting a virtual care partner, including technology, support, staffing, and integration, to name a few.

Virtual care mistake: Choosing the wrong partnerThe partner you choose should offer technologies that meet your patients’ needs, while fitting seamlessly into their lives. They should also offer solutions that fit into provider workflows to maximize clinical efficiency and support a positive provider experience. Your virtual care partner should also be able to demonstrate support for providing the highest levels of care quality that your patients expect from your health system. Finally, find a partner that will be just that – a partner. Find a company that will work alongside you to help create a successful virtual care service line – from launch through growth, scaling, and innovating.

Get Set for Virtual Care Success

Virtual care holds the potential to bring health systems a lot of value. Keep your eyes peeled, put in some effort in planning on the front end, and avoid these five virtual care mistakes, and you’ll be in a great position to win – whether you’re a Texas health system taking advantage of the new regulatory environment or just ready to take the next step in launching an online care delivery service.

Financial Sustainability: How to Add Revenue to Your Health System with a Virtual Care Service

Recently, KPMG released a survey that found the number one barrier to health systems launching virtual care is lack of financial sustainability. Simply put, health systems aren’t seeing how virtual care produces returns. And in an environment where budgets are tight and expenditures are closely monitored, justifying the investment in virtual care technology can be challenging.

There’s just one problem with this barrier—it’s not real. The perception that virtual care doesn’t produce a sustainable financial return is rooted in the old “telemedicine” mode of thinking. In reality, health systems are seeing the financial benefits of offering a virtual care service today. This isn’t just a pipe dream – it’s backed by data.

Finding Financial Sustainability

I’ve had virtual care financial returns on the brain lately, trying to figure out how health systems are missing the ROI virtual care produces – and I think I’ve hit on an answer. The reason such a large misunderstanding around the true value of virtual care persists within the healthcare community is the focus on transactional revenue and outsourced telemedicine networks. I touched on this a recent blog post. Measuring returns by looking exclusively at transactions is an outdated way of viewing virtual care’s impact. It’s consistent with the fee-for-service mentality most health systems are rapidly leaving behind – not with modern, value-based reimbursement and digital care delivery.

Unlike traditional telemedicine, the financial return from virtual care goes beyond the individual transaction, appearing as downstream revenue impacts. This is evident in areas like diminished patient leakage, reduced cost of care delivery, and most importantly, patient acquisition.

The Real Virtual Care Value

Recent research from healthcare analytics company Carrot Health demonstrates exactly how virtual care is increasing the revenues for one Zipnosis health system client. Carrot Health followed a cohort of 974 virtual care users who had not received in-person care in the 24 months prior to their virtual encounter – matching the health system’s definition of a new patient.

In a new white paper, Carrot Health revealed that this large, integrated health system saw 25% of new virtual care users convert to health system patients by using additional, in-person services within 12 months of their online encounter. With an average annualized per-patient revenue of close to $3,000, these conversions translated to more than $700,000 in additional revenue over the study period.

In a recent article I wrote for Becker’s Hospital Review, I noted that this is just the tip of the iceberg. Applied over a longer period, or for a larger population, the revenues increase exponentially. For example, a population of 2,000 new virtual care users at the same conversion rate would produce revenues of $1.5 million. How’s that for financial sustainability?

And, the Market Says…

Have you wondered about the venture money funneled into virtual care and telemedicine software companies over the past few years? The data suggesting patient preference for online care, while interesting and valuable, isn’t enough to sway investors. It’s the ability to see the potential financial impacts virtual care can have on health systems that gets venture firms excited.

When asked about the reasons for investing in Zipnosis, Matt Hermann of Ascension Ventures noted, “In today’s environment, compelling ROI data like Carrot Health has compiled about Zipnosis’ virtual care offering will help health systems parse through the innovation noise and have confidence in making critical business decisions. We think every health system should be deploying multi-modal virtual care solutions like Zipnosis for both short term and long term success.”

And long-term success is really the name of the game. Virtual care is transitioning from being an interesting but unimportant feature to a vital care delivery channel. Health systems are using virtual care to find financial sustainability by adding patients and revenue today. And as this transition builds steam, the returns health systems will see are only going to grow.

So, How Does Virtual Care Fit into Your Digital Health Strategy?

No one will be shocked to hear that technology is driving the future of care delivery or that staying  current with healthcare technology is increasingly vital to organizational success. But you may be surprised at the role virtual care can play in your digital health strategy.

The Digital Health Ecosystem

Being successful in this brave, new, technology-fueled world means building a digital health ecosystem. Like an ecosystem in the natural world, all components should come together to create a seamless whole. Your digital ecosystem needs to support the overall goals of your healthcare organization, including enhanced patient access, continuity of care through EMR integration, simplifying billing and claims processes, easy patient visit scheduling, and superior patient experience through portal integration.

Having a clear digital health strategy that outlines the technologies you will employ and how they will work in concert to support the continuum of care is critical. It’s easy for health systems to become so focused the individual technology solutions, they can’t see the (digital) forest for the (virtual) trees. Without that strategy, they may not realize there’s a virtual care-shaped hole in their digital health ecosystem.

Virtual Care: The Missing Puzzle Piece

It seems myopic from today’s perspective, but virtual care was traditionally viewed as a siloed point on the care continuum. In the digital age, virtual care is a delivery channel that supports a large breadth of services – from low-acuity conditions to more complex services such as chronic care management, and from primary to specialty care.

Even better, virtual care complements other elements of the digital health ecosystem, making it stronger and more unified. Paired with ePrescribing, virtual care fosters convenient, complete treatment of a variety conditions. It can be used alongside traditional telemedicine video visits to reach more of your patient base. And, virtual care gets both patients and providers comfortable with online care, making it easier to accept digital health technology in higher-acuity situations.

Your Digital Health Strategy

Health systems need to keep pace with changing consumer needs and the shifting demands of the dynamic healthcare industry. According to research firm Gartner, 40% of primary care visits will be virtual by 2018. With direct-to-consumer telemedicine companies vying for patients and growing numbers of health systems launching virtual care solutions to meet growing patient demand, virtual care is a vital piece to your health system’s success and your overall digital health strategy. Are you ready?

Walk Before You Run: Driving Success with a Scalable Virtual Healthcare Business Model

When it’s time to pull the trigger on a new technology investment, particularly one with the potential to revolutionize care delivery in your health system, it’s tempting to shoot for the moon and include all the shiny bells and whistles. Like many large-scale improvements where change management is present, that is not always the best strategy. When developing a virtual healthcare business model, health system leaders need to balance the desire to employ the latest growth strategies with a systematic approach. A phased approach facilitates effective change management and the necessary checkpoints to support success.

Virtual Care Scalable Business Model


Change Starts from Within

Health systems frequently start their foray into virtual care by offering the service  internally to their employees. This strategy helps build acceptance and understanding of virtual care. It also helps get employees excited and become more knowledgeable about the service. Once your employees experience virtual care as a patient, they feel more comfortable recommending it to patients later on.

In addition to gaining buy-in from key employees, launching internally provides time to monitor the service and make any needed adjustments to the workflow. This means that when you are ready to expand to a broader population, your service is dialed in and working on all cylinders – for both patients and providers.

Grow With Confidence

After the initial phase, it’s time to grow your virtual care service by expanding your patient population. This may include current patients and/or the broader marketplace, depending on your acquisition and retention strategies as well as your regulatory environment.

This phase is the time to begin scaling your service beyond current patient population targets. Use your organizational strategy and virtual care goals to create a comprehensive growth roadmap.

Your plan may include adding employer and health plan contracts, integrating virtual care technology with internal systems, adding access points, or expanding the number and types of conditions that can be treated.

Whatever your scaling and integration plan includes, a methodical, step-by-step approach will serve you best. This supports analyzing the impact of each new addition and gives you the flexibility to make adjustments and optimize staffing to meet organizational goals.

Hit Your Stride

Being part of the virtual care revolution can be exciting – after all, you’re a pioneer on the forefront of innovative healthcare delivery. And, once you have a fully realized, mature virtual care service, innovation is the next step.

Virtual care is a rapidly evolving industry, and the sky’s the limit to its potential impact to your health system. Leading virtual care technology companies are beginning to expand into serving varied needs along the care continuum. For example, support for longitudinal care, such as chronic care management and post-operative care.

The growth and advance of technology is enabling ever-deeper systems integration, helping to eliminate silos and support greater connectivity throughout health systems. And expanding interoperability of your virtual care software is another way to be on the leading edge of healthcare information technology.

Moreover, by collaborating with your virtual care partner to offer the next generation of online care as a pilot site, beta tester or innovation partner, you give your clinicians and patients a voice in the future of care delivery.

Move at Your Own Pace – This Is Not a Sprint

Steady doesn’t necessarily mean slow. Following a phased plan for your virtual healthcare business model enables you to move as fast as makes sense for your health system. Healthcare leaders gain three main benefits from this strategic approach:

Change management: A systematic approach to launching, growing and optimizing your virtual care service can minimize the challenges that come with implementing a new service line. Effective change management relies on this type of phased approach. Being methodical and gathering information and feedback at every step will help set the stage for virtual care success.
Budget management: Launching a new service line means up-front investment – whether you’re going for traditional telemedicine access points like phone and video, or pushing into new frontiers with virtual care. Starting small, with a clear roadmap for scaling means more effective budget management, including the ability to strategically time capital investments.

Risk reduction: Innovation in healthcare is always a bit of a risk, but by starting small and scaling your virtual care service, you are mitigating the risk that comes with investing in something new. Starting small reduces risk by lowering up-front investment. And, using a documented plan to grow your service enables careful monitoring, which limits the likelihood of making an investment that doesn’t pay off.  

Find out how one leading health system successfully employed a measured approach to launching their virtual care service. Get the case study.

Where’s the Return? How to Find Virtual Care ROI for Health Systems

For early adopters of telemedicine, the excitement of new care delivery technology (e.g., video conferences) was enough to build a business case. These days, online care has gained acceptance by both patients and healthcare organizations – it’s no longer just early adopters being lured by something shiny and new. Health systems are being tasked with meeting patient demand for online care and justifying this investment by showing its impact on their organization.

Traditionally, determining the return on telemedicine investment hasn’t always been clear. As a newer way to deliver care, it’s taken some time to develop and validate ROI models and some telemedicine companies continue to struggle with proving ROI to health systems.

Virtual care, which includes traditional telemedicine tools in addition to its suite of transformative digital health solutions offers an alternative. Leading health systems are building out their digital healthcare programs with virtual care and seeing the organizational and financial benefits.

Beyond the Bottom Line

As with other strategic initiatives, virtual care’s return is not just financial. Patient perception in the marketplace and brand positioning are both impacted by launching a virtual care service line. Health systems that offer virtual care and communicate that offering effectively to the marketplace are more likely to be seen as a leader in patient access and technology. With 46% of consumers in a recent survey stating they would choose a health system that offers virtual care over one that doesn’t, this can have a big impact on position in the marketplace and your bottom line.

Virtual care and telemedicine can also play a big role in supporting long-term organizational strategy and building a foundation for the care delivery of tomorrow. The contribution of virtual care to achieving, say, improved patient access or greater operational efficiency goes well beyond any financial returns. Additionally, launching virtual care in support of long-term, strategic objectives can mean that the true financial impact takes time to materialize – think lifetime value.

How to Find Your Virtual Care ROI

Virtual care ROI has many lenses. The best return on investment approach is the one that fits your goals and organizational strategy. Effective goal setting, identifying the right KPIs to measure performance, and developing a reporting process and cadence are vital steps to understanding and measuring the success of your virtual care program.

Metrics like total visits, number of new patients, clinical guideline adherence, clinician work time and patient satisfaction combine to tell the story of a virtual care service. Is it helping bring new patients to the health system? Is it providing high quality medical care? Is it driving operational efficiencies? Do patients like it? These are some of the true measures of virtual care success.

Finding Financial ROI

Of course, there are the numbers…

Calculating the financial return on investment is more than just subtracting costs from revenues. If you want to see the impact virtual care could have on your bottom line, check out our interactive ROI calculators:

ROI through preventing patient leakage

ROI through cost shift in a value-based environment

And, download our latest eBook, Measuring Virtual Care Success: Your Complete Guide to ROI, for more information on quantifying the impact virtual care could have on your health system.

Forecasting the Future of Virtual Care in 2017: 5 Mystical Predictions

So long, 2016, we’ve officially begun a new orbit around the sun. It’s becoming a new year’s tradition for me to don my mystic robes, gaze deep into my son’s Magic 8 Ball and come up with predictions for the future of virtual care in the year ahead. (If the new year has you feeling nostalgic, check out my forecasts for 2015 and 2016.) So, let’s dive in.

1. Demonstrable ROI will be a requirement
Magic 8 Ball response: “Signs point to yes”

To date, the return health systems receive from their virtual care investments has been shadowy and not clearly understood. In fact, when I asked my Magic 8 Ball about the ROI of traditional telemedicine, it said, “Reply hazy try again.”

Some of this ambiguity is due to the relative newness of patient-to-provider virtual care. During the early stages of adoption, throwing things at the wall to see what sticks isn’t an unreasonable strategy. Alternatively, ROI has been a smoke and mirrors game with traditional telemedicine companies decreasing health system investment and inflating adoption hopes. But as virtual care becomes increasingly mainstream, clouding ROI in mystery or promoting unsustainable models will no longer be acceptable (tweet this).

In 2017, Health systems are going to expect a holistic, clear view of the return on their virtual care investment. That will include elements like how virtual care is helping to attract and retain patients and produce positive health outcomes.

2. Health systems will have higher expectations for care quality
Magic 8 Ball response: “Without a doubt”

2016 saw several high-profile telemedicine quality studies published, and traditional telemedicine did not come out looking great. Hospitals and health systems understand the need to increase access by offering online care, but are unwilling to launch services that could negatively impact their quality ratings. As a consequence, quality will become a much larger evaluation factor in areas including:

    • Clinical quality: Health systems will require hard data on clinical quality for care provided via digital channels. If not already in place, telemedicine and virtual care companies will need to find ways to collect and make this data available to their clients.
    • Interoperability: Electronic Medical Record (EMR) integration is no longer a “nice-to-have;” it’s a requirement for maintaining continuity of care and effectively tracking patients’ health data.
  • Data, reporting and analytics: Real-time data will be increasingly important, and health systems will require means of accessing and analyzing the performance of their virtual care service.

3. Driving internal adoption of virtual care will be a priority
Magic 8 Ball response: “Most likely”

Patient demand for virtual care continues to rise. My Magic 8 Ball says, “You may rely on it.” If that’s not enough for you, a recent survey by Rock Health found that 46% of consumers are active digital health adopters, up from 19% the previous year. The upshot is health systems will need their providers fully engaged and supportive of this mode of care delivery.

This year, health systems will focus on change management, provider engagement and making a cultural shift toward embracing virtual care and other digital health technologies (tweet this). Fortunately for health systems, online channels are gaining traction as a mode of care delivery. For example, a study by the Robert Graham Center found that 85% of physicians would consider using telehealth. This acceptance by physicians should make change management and the cultural shift toward embracing virtual access points much easier.

4. Policy support for digital health including virtual care will increase
Magic 8 Ball response: “Outlook good”

2016 saw a great deal of legislative movement in the area of digital health and virtual care. According to the Center for Connected Health Policy, more than 150 pieces of telemedicine-related legislation had been introduced in 44 states as of August. I anticipate a lot more movement on the legislative front for the coming year. It doesn’t hurt that a recent survey by the Federation of State Medical Boards identified “telemedicine” as “the most important medical regulatory topic to state medical boards.”

I also expect that, similar to recent legislation that passed in Wisconsin and Michigan, the policy we’ll see coming in 2017 will be friendly to digital health in general and virtual care in particular. Much of this policy will be driven, or at least influenced, by health systems seeking the best option to bring high quality, convenient care to their patient populations in a way that meets their business objectives.

5. Leading virtual care providers will expand to support more service lines
Magic 8 Ball response: “Signs point to yes”

Virtual care is increasingly venturing out of the acute urgent care space and into supporting a wider range of service lines. This means that virtual care providers will need to identify ways of meeting a wider array of health system needs, likely including forays into longitudinal care such as chronic condition management and/or post-operative care.

Health Systems Move Into the Driver’s Seat

Going through my list, you might have noticed a theme (beyond my surprisingly positive run with the Magic 8 Ball): Health systems are increasingly impacting the direction of this industry. Decision makers at leading health systems are getting more sophisticated about technology; have greater insight into patient and provider satisfaction, engagement, and expectations; and will require real value from their virtual care partner(s). And I, for one, am looking forward to it. “It is decidedly so.”

Want more information on virtual care? Check out our guide to best practices!

Value-Based Care: It’s Here and Virtual Care is Part of the Equation

We’ve all seen the news. Value-based care is coming, it’s inevitable, it’s here. But many health systems have yet to see major impacts from value-based reimbursement models such as accountable care organizations (ACOs), bundled payments, or patient-centered medical homes. Consequently, it’s easy to think that the hype around value-based care is just that: hype. We need to think again.

It’s not Hype

Value-based care really is coming, and soon health systems won’t be able to escape it. In early 2015, the Healthcare Transformation Task Force announced that 20 major health systems and insurers committed to moving 75% of contracts into value-based arrangements by 2020. The U.S. Department of Health and Human Services (HHS) expects that by the end of 2018 half of Medicare payments will go to alternative payment models, such as ACOs and healthcare organizations that accept bundled payments. And, a 2014 study by Avility revealed that more than 60% of providers expected value-based payment models to become dominant going forward.

What is Value-Based Care?

Traditionally, reimbursement has been volume-based. Under this model, providers are paid based on the number and type of visit. At its core, value-based healthcare encompasses a series of alternative payment models designed to support the triple aim of better patient access, lower healthcare costs and improved clinical quality. These models include accountable care organizations (ACO), patient-centered medical homes (PCMH), pay-for-performance and bundled payments. Under each of these payment models, health systems and providers are rewarded when they deliver quality care using fewer resources.

So, how can health systems who still operate in a volume rather than value-based reimbursement environment get ready for the shift? Look to virtual care.

The Impact of Virtual Care in a Value-Based Environment

Health systems looking toward the transition from volume to value-based care can benefit from launching a patient-provider virtual care solution. Virtual care can help health systems reduce costs by transitioning patients to a lower-cost access point, minimizing office visits, urgent care encounters and even trips to the emergency room. Health systems can also see the benefit of enhanced patient health outcomes, including stronger patient engagement and population health management.

Dr. Deborah Greer of John Muir Health discusses the online adaptive interview from the perspective of value-based care. 

Lowering Cost of Care

The online access point in a virtual care service offers health systems and patients a lower-cost diagnosis and treatment option. Using a “store-and-forward” solution like the Zipnosis online adaptive interview enables providers to diagnose and treat common acute conditions quickly and efficiently. Provider time per visit on the Zipnosis platform is typically around 2 minutes to diagnose and treat, compared with 15-20 minutes for an office visit.

Improving Patient Outcomes

Patient engagement isn’t just an industry buzzword. According to, people who are actively involved in their health and healthcare tend to have better outcomes. Offering a convenient, online access point can help increase engagement by making healthcare fit into patients’ lives. Additionally, patients may seek treatment through a virtual access point when they might otherwise decide against seeking care. That could be the difference between a routine UTI and a serious kidney infection.

Health systems and patients can also use virtual care as a population health tool. Online health assessments, for example, can help identify patients who are at risk for chronic conditions before those conditions become problematic. And, using an online access point for follow-up visits can help keep patients engaged in their care by making it quick and easy to provide their physicians with health information in between office visits.

Act Now to be Prepared for the Future

In the 2016 HIMSS Cost Accounting Survey only 3% of respondents indicated their health systems were highly prepared to to adopt value-based care reimbursement and leave behind volume-based, fee-for-service payment models. A full transition to value-based care may seem distant, but leading health systems are taking steps to prepare for the inevitable transition to value-based reimbursement.

Health systems who launch virtual care as a means for providing cost-effective care in a value-based environment will have the time to:

    • Work through change management and build clinician buy-in across their organization
    • Develop and implement a strategy that ties together online care delivery across departments and specialties
    • Monitor and enhance their virtual care service to ensure it meets the needs of both patients and the health system
    • Fully integrate virtual care with internal IT systems to promote a seamless patient and provider experience

Want more information on virtual care? Check out our guide to best practices!

Why Virtual Care Should be Part of Your Health System’s 2017 Growth Strategy

As 2016 comes to a close, health systems—like most businesses and non-profit organizations—are deep into planning their growth strategy for the new year. Faced with rising consumerism in patient populations, increasing competition from traditional and non-traditional healthcare companies, and the continued transition to value-based reimbursement, leading health systems are looking to virtual care as a means of supporting organizational growth strategies.

Aligning Virtual Care with Health System Growth Strategy

Any way you slice it, adding a virtual care service line is a strategic business decision. Your virtual care strategy should reflect your health system’s big-picture growth strategy. But how, precisely, do the two tie together?

The Virtual Care SWOT

Every health system is different, with unique cultures, competitive environments and goals. However, many health systems face similar challenges and opportunities. When it comes to health system strategic growth planning, virtual care can help make the most of strengths and capitalize on opportunities while shoring up weaknesses and mitigating external threats.

Leverage Strengths

With a virtual care platform in place, health systems can:

    • Offer patients online access to their clinicians by staffing the virtual care service internally
    • Increase patient engagement and satisfaction through convenient access and digital tools that fit into their lives
    • Maintain high levels of clinical quality and capture structured data to support quality initiatives

Capitalize on Opportunities

Launching a virtual care service line can help health systems:

    • Attract and retain new patients – particularly younger generations who have yet to settle into a primary care relationship
    • Build a foundation for continued innovation and partnership with a virtual care provider committed to keeping clients on the leading edge
    • Strengthen or develop new contract relationships with large employers, insurers and/or educational institutions to drive revenue

Address Weaknesses

Virtual care can help health systems work within internal constraints by:

    • Leveraging marginal capacity to treat more patients with current staff
    • Meeting patient demand for convenient care and improve access without adding physical locations
    • Offering virtual care at a free or reduced cost to employees and their dependents to reduce overall healthcare costs

Mitigate Threats

Offering virtual care supports health systems through:

    • Staying in step with – and/or offering a point of differentiation from – competitors’ online service offerings
    • Supporting patient retention by offering a convenient, online access point
    • Creating a lower-cost channel to provide care to patients in value-based reimbursement populations

For more information on how virtual care can support organizational growth strategies, check out our free Best Practices Guide to Virtual Care  – your handbook for successfully launching, operationalizing and growing a virtual care service.


It’s Not Too Late for Health Systems: Get Ahead of Cold & Flu with Virtual Care

Cold and flu season is just around the corner and as health systems across the country prepare to meet the challenge of full waiting rooms and sniffly noses, there’s one solution that can help: virtual care. Having a virtual care service in place during cold and flu season can help mitigate the sick visit surge and strain that many health systems face as fall turns to winter. 

Cold and Flu Season Puts Health Systems Under Pressure

Upper respiratory illnesses, in particular influenza-like illness (ILI), account for a major portion of annual visit volume in settings such as retail clinics, urgent cares and emergency rooms. Throughout the US, cold and flu visits account for 27.4% of all retail clinic visits, 9.7% of all primary care visits and 5% of all emergency department visits each year, according to research published on

According to a study published in Academic Emergency Medicine, the greatest number of urgent care visits occur during the winter, with the highest number of daily visits recorded from November through February. At Zipnosis we see this each year, with visit volume increasing during the fall and winter months (see Figure 1). Information from Google Trends, which aggregates web search data, follows a similar curve with more searches on cold and flu occurring during the winter (see Figure 2).

Cold and flu visits peak during the winter months

Figure 1: Zipnosis visit volume for cold and flu follows the general trajectory for urgent care and primary care clinics. 12-month visit data from the Zipnosis platform.

Cold and flu searches peak during the winter

Figure 2: 12-month data on Google Trends “cold and flu” searches

How Can Virtual Care Help ?

Implementing a virtual care solution can help health systems mitigate some of the challenges that come with cold and flu season.

Take the strain off of brick and mortar care locations

Regardless of how visit volume from cold and flu is distributed across your health system—urgent care, retail clinic, primary care or emergency department—it’s likely that locations are operating at or beyond maximum capacity during cold and flu season. Moving visits to a virtual care service takes some of the strain off your clinicians and support staff, and can free up visit slots for higher value, more complex conditions.

Virtual care has the potential to significantly reduce the burden of clinics during cold and flu season (Tweet this). For example, a large midwestern health system with a well-established virtual care service through Zipnosis saw nearly 6% of cold and flu visits shifted from in-person to virtual care, opening up appointment slots for more complex patient needs and relieving pressure on providers and staff.*

Keep your waiting rooms safe

Keeping patients healthy is important, and one element of this is minimizing exposure to illness. In a recent study, researchers from the University of Iowa noted that well-child visits for children younger than six years old increased the probability of a flu-like illness in these children or their families during the subsequent two weeks by 3.2 percentage points. This seemingly incremental risk translates to more than 700,000 preventable illnesses annually with a price tag of nearly $500 million. By moving office visits for highly contagious conditions like influenza to a virtual visit, risk of healthy patients becoming sick decreases (Tweet this).

Support patient retention and continuity of care

During the high volume times associated with cold and flu season—particularly when health systems are at capacity—it’s increasingly likely patients will seek care elsewhere. Whether they choose a retail clinic, competing urgent care or direct-to-consumer telemedicine service, visits outside your health system open the door to potential patient leakage. Moreover, seeking episodic care means that if patients return to their primary care provider, their record may not be reflective of the care they received elsewhere. Offering your own virtual care service can help capture these patients who might otherwise seek care elsewhere, while supporting continuity of care and maintaining accurate patient records.

There’s Still Time to Act

Many health systems are already beginning to see patients for cold and flu visits, but with peak influenza activity predicted for mid February to mid March 2017 according to the Epidemic Prediction Initiative, there is still time to launch and market a virtual care service. With Zipnosis’ 60-day guaranteed implementation, you can have your virtual care service up and running to handle cold and flu season – and help provide safer care for your patients.

*Assuming 9.7% of visits are for cold and flu (per the study referenced).

The String Theory of Telemedicine

Like a tangled ball of string, telemedicine can endlessly fascinate. It can improve care access – anyone from anywhere can see a physician. It can reduce care costs – how expensive can it be to Skype your doctor? It can be used to diagnose and treat your health problems – everything from your sinus infection to your Type I diabetes. It can even be used to talk doc-to-doc – care coordination solved. What can’t telemedicine do!?

The boundless enthusiasm reminds me of the great Monty Python skit about an advertiser brainstorming a marketing campaign to sell 122,000 miles of string in three-inch pieces. It’s waterproof! Rust proof! Low calorie! It can tie up very small parcels! It kills 99 percent of known household pests! It’s got a million uses!!!


The Quest for the Holy Grail

In reality, the implementation of a successful telemedicine strategy is a lot more tangled than that – think string theory in Quantum Physics not ball of string and cuddly kitten. What we perceive as promising answers to critical healthcare problems actually lead to other universes with new challenges to contemplate. It’s easy to get lost in the complexity, as practical applications with solid ROI remain elusive.

Telemedicine has been a tantalizing goal for about 60 years, ever since scientists in the space program first debated ways to diagnose and treat astronauts. Since then, not much has changed in the thinking behind the idea, so why the excitement now? Information technology, of course, is the new space program. Picture quality and bandwidth have advanced light years. We can FaceTime with Grandma whenever we want so why can’t we televisit with the family pediatrician? If Netflix can predict what we want to watch and how, why can’t a hospital help us avoid the ER when we know our child has strep?

Marketing claims made within the industry are propagating those easy parallels without being straightforward about the complexities or actual benefits. It’s got a million uses!!! Lacking a practical business model, video-only telemedicine services don’t come close to meeting the everyday needs of patients and the efficiency and financial challenges of clinicians and providers. Pushing video as a stand-alone solution is like selling three-inch pieces of string and promising the world.

What’s missing is a clear understanding of value.


And Now For Something Completely Different

Telemedicine, like any other healthcare service, is not a cure-all but a commodity. It has its uses but it’s a tool to be leveraged not an answer in and of itself.

Patients don’t care about access; they value convenience and ease. How convenient would it be to shop on Amazon by video conference?

Clinicians don’t want to spend time engaging patients on-screen the same way they do in person. They want quick, digitized interactions that focus on care and decrease hassle, data entry, and time wastage.

Provider organizations don’t want an IT strategy that drives up user numbers without bolstering revenue. They want channels to new customers, a more competitive value proposition for current patients and clinicians, and meaningful gains in cost reduction and workflow efficiency.

So why let video-only rule?

Adaptive online interviews allow patients to make health queries and enter information when it’s convenient for them, not for providers or clinicians – think in-between meetings or in the minivan, not in the waiting room.

Evidence-based algorithms can determine when it’s necessary for a patient to see a clinician in person, or when an e-scrip or video consultation are better options.

Text alerts and EMR messages can let busy clinicians know when a patient is ready for a video visit and give them all the patient information they need exactly when they need it.

Video, in other words, should just be one part of a larger platform of solutions that creates actual value for patients and clinicians while driving solid ROI for providers.

The next time yet another telemedicine startup describes its video solutions, ask about the whole ball of yarn, not just the three-inch piece.

You Say Access, I Say Convenience

The big argument for telemedicine is that it will improve access to care. But is access what consumers really want?

If providers think about telemedicine as just another channel for giving patients access to their services, they’re missing the bigger picture. When it comes to meeting consumer expectations, traditional health systems and physician clinics aren’t competing against other providers, they’re actually battling Amazon, StubHub, Netflix and every other service that customers already love and rely on.

Amazon just launched “Amazon Prime Now” in the Twin Cities where I live. Do I need day-or-night two-hour delivery for household items and groceries? Probably not, but the convenience blows my mind. I had a similar feeling when I discovered recently that I can use an app to feed my parking meter by our downtown Minneapolis office. Whether it’s the ability to binge-watch entire seasons of TV shows on Netflix or listen to almost any album ever recorded on Spotify, consumers are now primed for (nearly) instant gratification.

Healthcare still operates under a different set of expectations. Patients are viewed as a fixed population with few options for seeking care. Telemedicine and other virtual technologies theoretically expand those options. Coming from a traditional system in which access is tightly controlled, many providers I meet still see new technologies like telemedicine or virtual care either as a threat to their existing delivery model or a cumbersome add-on. I argue that they should view consumer-facing technology platforms as an opportunity to access patients in ways that those patients already expect in other areas of their lives and will increasingly demand from healthcare, too.

Here are three benefits healthcare providers can realize when they leverage a workable telemedicine strategy to do a better job providing patients with service they will value.

  1. Add new patients

If you ask people what telemedicine looks like, they describe a patient sitting in front of a computer screen talking to a doctor. When’s the last time you ordered anything on Amazon that way? Never. We do it by app when the need arises.

What would that sort of convenience look like in healthcare? It may be hokey but I picture a parent in his or her minivan initiating a doctor visit for the kids while waiting for them to finish some after-school activity.

Telemedicine strategies that force patients and doctors to meet through a screen are awkward interruptions of our lives. But if you can devise a system where patients can initiate a visit by app, and then direct them to a physical healthcare location, e-visit, or virtual diagnosis as needed, you’re helping them manage their care conveniently like they manage every other aspect of their lives.

In our data, we’ve observed that over 50 percent of patients who use this sort of approach are new to that particular health system or provider network. In other words, technologically savvy patients are migrating to convenient access points. And once they’re hooked on that ease, they tend to rely on that healthcare provider for the plurality of their care.

  1. Provide care in the right place at the right time

As value becomes a priority over volume, providers are being forced to develop strategies to steer patients away from higher cost locations like urgent care or primary care facilities. We’ve noticed that around 60 percent of patients who use virtual care services would have gone to urgent care or primary care facilities instead if they hadn’t had a virtual option.

Employers love virtual care because their employees can receive care when and where they need it without undue expense or disruption to their work lives. Patients love it because it puts an end to the age-old waiting room question, “Why am I here?” We’ve all experienced the frustration of sitting endlessly in a waiting room for a diagnosis or course of treatment when we already know exactly what we need.

And physicians appreciate the opportunity to have meaningful visits for challenging problems rather than cramming their day with patients who could be treated faster and easier elsewhere.

  1. Avoid “stealage”

The big retailers and pharmacy chains are making a major competitive push for the patients of traditional health systems and provider networks, and they have some big advantages on their side. They already understand customers well and are used to delivering compelling value. What’s more, nearly everyone in the country lives only a few miles from a Walgreens, CVS, or Walmart making it very convenient to shift toward those pharmacists and walk-in clinics.

Providers can combat those advantages if they move quickly. Patients still see health systems and traditional physician clinics as the best source for care. If you counter the convenience factor with a robust virtual care strategy rather than just building e-visits into an EMR, you can retain or recapture patients otherwise inclined to stray. Patients would still prefer to meet the totality of their needs in one system.

The future is fast upon us

Consumers and clinicians expect technology to make things easier and faster. Healthcare is lagging in providing people what they need and want when it comes to convenience, ease and value, not because the technology isn’t there but because managing change is hard. Yes, traditional processes and payment models are burdensome legacies to fight through but customers and clinicians are going to gravitate quickly to better options. You really have a limited time to figure out the right strategy to keep them happy and committed. Start by thinking like a consumer and find partnerships and services to build the capabilities you need.

2016 Telemedicine Predictions

Another banner year in virtual care/telemedicine.  Last year I ventured out with some predictions [read here]…you be the judge on my accuracy, but I think I could potentially play baseball for some minor league amateur softball team with my average.  If it was slow pitch.  Maybe.

So time to sharpen my dull pencil again and commit to some good laughs at 2017’s New Year’s party!

1. The Whole Virtual Care Kitchen includes Async:

Consumers and physicians have spoken clearly that video is not the preferred method for virtual interaction for simple conditions; this despite some massive legislative machinations from industry insiders to orient telemedicine legislation around video-based encounters.  As I have preached for years, this video fad is just that – it will pass as the economic value of asynchronous visits becomes mainstream.  Look for 2016 to be the year when asynchronous visits account for more than 25% of all virtual encounters across the country.

 2. #value is Telemedicine v2:

As the market matures around telemedicine and virtual care, so will the ability to calculate a true ROI around virtual care.  With so many companies grappling for consumers, providers and payers, having just another video solution with a clinical network won’t be enough.  Vendors who can’t demonstrate an ROI will be left in the dust.  The handful that can will find receptive buyers.  The hashtag for ATA this year won’t be #features but #value.

3. Prove it! Series A Investment will Wane:

The VC community will pull back for a bit on higher risk Series A investment in virtual care/telemedicine companies as they evaluate how the market begins to settle.  Start-ups that are in a proof of concept/beta phase will need to demonstrate true market adoption or transformative product differentiation to attract growth capital.

4. The Yellow Brick Road to Profitability:

Some telemedicine companies are touting adoption rates 3-5x actual utilization.  This will start to backfire on them as more transparency around adoption becomes available to the market.  Healthcare providers and payers will hone in (per #2) on facts/data in 2016 and orient investment/partnerships accordingly.  The halcyon days of hope will become a distant memory.  To this end, there is no wizard of Oz for driving consumer adoption – but there are viable business models that will weather this transition.  The companies investing in basic economics and product/market fit will survive or be acquired at a premium.

There you go.  Perhaps a little more vague than last year, but I sense the market truly maturing in 2016, especially on the health system side.  Of course, I’ll look forward to being surprised along the way.  Agree/disagree?  Love to hear your thoughts.  Here’s to a dynamic 2016!

Attracting Millennials Through Virtual Care

Today’s millennials are adept at all things mobile and look to technology as a starting point for most things in their digital lives. As healthcare systems work to build their future patient base, it is imperative to meet these digital natives where they are by offering clinical care options that are convenient as well as effective.

Virtual care is a perfect conduit for health care providers to build a relationship with millennials, however it can be difficult to instigate the initial relationship. The current medical regulatory environment often requires that patients establish a relationship with a provider via a bricks and mortar site before enabling them to offer virtual care options.

And while this may be seen as a hurdle, it is one that is easily scalable and well worth it. This demographic is keenly aware of the digital landscape and more often than not will choose a provider that will enable them to have the equivalent of a clinic in their pocket via a mobile device.

In addition, in marketing your virtual care offering to millennials and beyond, it is important to position it as a natural extension of your mission – versus an either-or alternative to the traditional clinic. Not only will this build your reputation as a provider that offers an array of options to its patients but it also further strengthens your identity in the community.

Given that more and more healthcare systems are transitioning from a fee-for-service to a fee-for-value proposition, millennials will not only appreciate the trend but embrace the options that are available to them.

The Future of Telemedicine Will Be Different Than You Think

Like jetpacks and flying cars, telemedicine has been part of our collective vision of the future for a long time. Has that future finally arrived?

I haven’t seen any cars flying by lately, but I did gaze heavenward in July when Teladoc achieved a dreamy billion dollar IPO. While that kind of market validation is reassuring for those of us working to transform healthcare delivery, I can’t help but wonder whether investors and the media are buying into a vision of the future that won’t quite match reality.

Why am I skeptical? Because when it comes to telemedicine – unlike flying cars and jetpacks – it’s not technology holding us back. The barriers are economic. Can telemedicine make it easier for patients to get treatment and also provide a sustainable economic benefit to providers?

Telemedicine’s Jobs-To-Be-Done

Telemedicine has been available since the early days of the space program. 60 years ago NASA could diagnose and treat astronauts on space flights via video consultation. Today, video is available on any smartphone or computer, people are starting to record their personal biometric data obsessively, and connectivity is ubiquitous, so it would seem that any remaining barriers to telemedicine have finally been eliminated. Then why are we not using video en masse for diagnosis and treatment?

The simple answer is that it’s still not convenient for patients or economical for providers.  Unfortunately, few of those heralding the next great advance in healthcare delivery take the time to really pencil out the ROI and the value add. We’re so infatuated with sexy video screens and the novelty of telemedicine, we gloss over the cold, hard facts.    

Where’s the Volume?

So let’s run the numbers.

The going price for a video consultation with a clinician runs about $40 to $50. From the consumer’s or payer’s perspective, this price is outstanding since emergency visits cost about $500 and a trip to urgent care runs about $250. Most of those visits are for minor ailments treatable by any primary care doctor or nurse practitioner. That’s why, if telemedicine was widely adopted, estimates of system-wide cost savings run as much as $25 billion.

Cost containment, however, does not a healthy market make. There’s a flip side to any exchange. Is it financially worthwhile for clinicians to perform primary care visits via video, and does the revenue model work for telemedicine businesses?

The short answer is no. Currently, most clinicians doing video visits handle about 100 to 500 a year, and the overall volume in the market is insufficient to keep clinicians working at their capacity, let alone earning the pay they would otherwise make through in-person consultations.

That reality is reflected in Teladoc’s IPO filing. A billion dollars in market capitalization notwithstanding, Teladoc’s expected revenues for the year are only around $74 million while costs are rising faster than revenue and the projected volume of customers will not make up the difference.

Although expectations around margins and profitability are generally different for emerging technology businesses, healthcare is in the throes of wrenching change to its business model. It’s unlikely that clinicians will embrace an approach that earns them even less money than they make now. It’s also hard to imagine outsourced telemedicine services like Teladoc, MDLive, American Well or Doctor-on-Demand driving growth that way, or investors continuing to back such ventures given the immense investments in marketing and infrastructure.

The Social Side of Telemedicine

Economics aside, there’s also an engagement factor to consider. Will consumers and clinicians find reasons to be drawn to telemedicine?

There’s no doubt that patients are more willing to engage with clinicians by video than they were a few years ago. Every busy parent I know likes the idea of avoiding the doctor for simple care. However, actually using video during the course of a normal hectic day is a barrier. Imagine trying to do a video call while juggling sick kids or sitting in your car. Now compare that to the ease with which you can order an Uber car or buy something on Amazon. In other industries, no thriving mobile service relies on video to conduct transactions.

And what about clinicians? Personally, I can’t imagine one 15 minute visit every four days or so providing enough activity to keep even an easy-going semi-retired healthcare professional content.

In my experience, physicians and nurse practitioners want to actively practice medicine and help patients. Their job satisfaction already wanes from struggling with crushing paperwork and cumbersome EMR data entry. Sitting in front of a row of video screens waiting for one or two visits a week would only exacerbate their dissatisfaction. Clinician satisfaction and engagement is key to any successful delivery model. Unhappy, under-paid clinicians are an anathema for change in healthcare.

The Search for a Better Answer

Instead of gazing heavenward, waiting for flying cars, let’s ground ourselves in solid economics and an understanding of what healthcare consumers and providers need to make telemedicine work.

In the next few blog posts, I want to show you how a new model for telemedicine, rooted in evidence-based care, is proving its ROI with health systems across the country. In the vision I’m going to lay out, patients get access to cost-effective, quality care in the right setting, providers are fully engaged within their workflow, and health systems get a boost to their bottom line and their market share. In the process, telemedicine starts to look a lot less like science fiction and more like another valuable convenience in our connected world.


Non-Traditional Competition for Health Systems

We all know that healthcare is local.  And the backbone of the U.S. healthcare system is local physicians and hospitals. Currently, health systems are under immense pressure from non-traditional competitors: retail pharmacy chains. Times have changed and this new insurgent threat is chasing the coveted digital patient

Large retail pharmacy chains are opening hundreds of new walk-in clinics and forming broad telemedicine partnerships with the ultimate goal of becoming traditional primary care providers. They’re following the trend of consumerization in healthcare and betting that patients want speed, convenience and easy-to-understand prices over a hospital-affiliated doctor to handle all of their medical issues. Often times, these competitors are targeting the younger, healthier patients that feed health system growth for years to come. This rapid growth of non-traditional competitors suggests hospital-based health systems have a growing market relevance challenge.  As a health system, what are the different strategies to respond to this competition? How can you move not just quickly but in the right direction to compete for and capture this new digital patient?

Patient Leakage vs Patient Stealage

Patient leakage has been top of mind for healthcare providers for years.  Even more so now that health systems are taking on risk for patient populations.  Patient leakage may occur because of convenience, change in health insurance plan or old referral patterns. That’s changing now.  “Stealage” is the new reality.  The partnership between large retail pharmacy chains and major outsourced telemedicine vendors means that patients now can choose to go completely outside the traditional care network.  This has potentially profound implications, not just for the business of healthcare providers, but for patient safety and care on a long-term basis.

Although retailers may have a lot of clinics, they do not have the infrastructure or ability to properly care for patients on a long-term basis. They are betting that health systems aren’t going to be able to move quick enough to provide the ready access and convenience to care that the new healthcare consumer is demanding…so instead of patients simply leaking out of a provider’s network, they are stolen.  The result is retailers capture all the easy value and control referrals and access points.  Provider networks are saddled with expensive, high-risk patients while negotiating with retailers for patient referrals. So how do health systems respond to this threat and prevent patient “stealage” from becoming a reality?

Strategies to Prevent Stealage

There are two key strategies that allow health systems to respond immediately with their own convenient access points while building sticky experiences for patients over the long-term:

  1. Rapidly enter your market with your own convenient access point
    Health systems need to respond immediately with a virtual care service that promotes their brand and clinical services. Retailers and outsourced telemedicine vendors are betting that health systems will move too slowly to react to this threat. By responding quickly, health systems can put the foundation in place for their convenient access points where they can begin to build stickier experiences over time.
  2. Appeal to digital consumers by extending your brand digitally
    Healthcare is still local and about trusted relationships. National retailers and outsourced telemedicine vendors are pursuing the digital consumer, but will have difficulty competing with health systems who are using the power of their local brands to build sticky relationships with digital consumers. This is a long-term strategy that will take years to play out. For it to succeed, health systems need to shift their marketing dollars from internal, traditional channels to external, digital channels.

So – two strategies to help health systems respond to the “stealage” threat. If systems can compete for convenience, they will win long-term because healthcare is still local and about trust. Neither strategies are all it takes, but both are great first steps in responding to non-traditional competitors.

2015 Predictions for Telemedicine