As primary care has become more scarce, telehealth has become more mainstream.
“We’re the pressure release valve” for primary care, according to Jason Gorevic, president and chief executive officer of Dallas-based Teladoc. His company is the oldest and largest U.S. telehealth company.
Teladoc offers physician visits either by telephone or online, depending upon the state. The service allows people to reach a U.S. board-certified doctor or a licensed pediatrician from home. The company estimates the average doctor call-back time is 16 minutes, according to Gorevic. Its physicians use electronic medical records and prescribe electronically. The service is available at all times and costs $38 or less per consultation. Teladoc emphasizes that it supplements—not replaces—the family physician.
Although the company does not disclose specific revenue figures, the company almost doubled its annual revenue in 2012 and plans to do so again in 2013. It expects to do 125,000 consultations this year.
Because healthcare is regulated primarily at the state level, Teladoc has to operate flexibly based on local laws. It operates in 49 states and plans to re-enter Oklahoma, which would be the 50th. Texas is one of only a handful of states that does not allow physicians and patients to interact by Internet.
However, Gorevic said, state regulators are “moving toward a recognition that (telehealth) is a necessary solution to some of the cost and access problems in healthcare. Demand from employers and health plans has been very significant. There is finally recognition that it’s very difficult to improve the cost of care without tackling access to care.”
Teladoc has worked with insurers such as Aetna, Blue Shield of California and Highmark Inc. The company is participating in a pilot program with Aetna for its 800,000 members in Texas and Florida, where the service is a covered benefit. Teladoc and the insurer promote telehealth as an alternative to the hospital emergency department (ED) and for after-hours care. Although Gorevic declined to disclose specifics of the pilot’s results, he said both partners are pleased so far.
According to a survey by consultant Mercer, about 15 percent of large employers used some form of telemedicine in 2011, and another 39 percent are considering it.
Teladoc uses three primary kinds of physicians: those who are semi-retired or taking time off from active practice; ED physicians who provide services when they are not at the hospital, and actively practicing physicians who treat Teladoc patients between their office appointments.
Gorevic said the company has a waiting list of physicians who want to participate. Physicians generally keep about 90 percent of the visit fees and do not spend time doing paperwork because patients pay them at the time of the visit by credit card. He said physician satisfaction scores exceed 90 percent.
Gorevic said the company does not allow patients to request a specific Teladoc physician because the company does not want them to view the service as a substitute for live care.
“We support the medical home and the need for a family physician. We are a supplement to the primary-care system when you can’t get there,” he said.
Teladoc is used as an on-call service for physician practices. In its only direct-to-consumer effort, it charges patients $30 a year for individuals and $50 a year for families as an on-call service for patients of Continuum Health Partners physicians in New York.
Gorevic sees alternative media as growing parts of the company’s business. He estimates about 5 percent of physician-patient encounters use videochat, which he said will grow as people become more comfortable with the technology. Teladoc recently formed a partnership with HealthSpot, a company that provides medical diagnostic technology in a walk-in kiosk called the HealthSpot Station.
Teladoc last month was named one of the top 10 most innovative companies in health care by Fast Company magazine.
Gorevic said the company’s service is a simple concept, but “very operationally and clinically complex. It is difficult to execute well. I think they recognized us for doing that,” he said.
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected].
