The world’s transition from in-person to telehealth may be one of a generation’s quickest and most complete technological revolutions. Less than a decade ago, seeing your doctor through a screen or on the phone was unheard of. You scheduled your appointment, showed up in the waiting room, and filled out your paperwork like everyone else. But now, that’s all changed—and it started in North Texas.
Teladoc Health is one of the nation’s largest telehealth providers, with 12,000 clients that provide access to 85 million members. The company was founded in North Texas in the early 2000s as the nation’s first telemedicine company, and its 5,000 employees have now hosted more than 50 million visits.
Teladoc’s Chief Quality Officer Jason Tibbels joined Teladoc in 2015—before telehealth exploded during the pandemic—but he already could see how the concept would change healthcare. “This was the one paradigm shift we get in a career,” he says.
The Decatur family physician jumped into telehealth with both feet and has worked on everything from government affairs and policy work, to commercial strategy. He now manages Teladoc’s quality program. He is the co-founder and president of The Institute of Patient Safety and Quality of Virtual Care, the first Patient Safety Organization dedicated to quality improvement in the virtual setting. He spoke with D CEO Healthcare about telehealth’s journey and what is next for the industry.
D CEO Healthcare: What do you remember about your introduction to the concept of telehealth?
Tibbels: “In 2015, which in this space was forever ago, telehealth was largely about point solutions. It was very niche with specific use cases. There were questions at the time about if this was even legal. One big change from 2015 is that it was very condition-based. Now, we are talking about treating people across multiple dimensions, thinking about whole-person care, and treating people through a primary care service, as well as including things like nutrition and mental health. At that time, it was in-person versus virtual care, and that distinction is gone. We’re talking about hybrid care, not virtual care as the exclusion of in-person care, but integration with the healthcare ecosystem. The organizations that are winning now and are going to win are those that are pushing into that hybrid environment.”
D CEO Healthcare: What changes have you seen among the patient population since 2015?
Tibbels: “Even in 2015, people underestimated consumer capability in the digital realm. People are pretty savvy, even older populations who are used to FaceTiming their grandchildren. It’s not a big leap to move to video visits with their clinicians. Consumer expectations around the level of care they get through a new delivery method have changed. Think about the first time you used Uber and what your expectations were. I remember thinking, ‘What is this? Someone’s going pick me up and drive me somewhere in their own car?’ That feels like you’re taking some risks, but now, this is part of your life. You expect high-level service, you expect high quality, and you expect it to be better than what you were used to. Consumer expectation has changed, and they expect virtual care to be incredibly high quality as good, if not better than what they’ve been used to. My role in the organization is to ensure that the care we deliver is as good—or better in some cases—than what they’re used to in traditional delivery sites.”
D CEO Healthcare: You co-founded the first patient safety organization (PSO) dedicated to virtual care. What’s the function of a patient safety organization for Teladoc Health, and how does it improve care?
Tibbels: “Patients Safety Organizations were created as part of the federal Patient Safety and Quality Improvement Act by Congress in 2005. PSOs are certified by AHRQ, the Agency for Healthcare Research and Quality, a federal agency that oversees legal and regulatory environments where quality and safety activities can occur in a way that has very strong protections. They foster an environment where healthcare providers can voluntarily report and analyze safety issues and promote shared learning from adverse events and other incidents. You can imagine that if a provider feels like reporting an error is going to result in a cascade of disciplinary actions, there’s reluctance. The organizations are meant to create a safe space to report, analyze, and, most importantly, learn and share back and improve on safety and other quality-related events. Teladoc’s PSO was established in 2019, before most digital health companies were even conceived, much less existed, and Teladoc was making a real investment in quality and patient safety. We created the first and, to my knowledge, continue to be the only PSO dedicated to quality improvement in virtual space.”
D CEO Healthcare: What’s one thing misunderstood about virtual care?
Tibbels: “People still carry this one-or-the-other mental model: It’s virtual, or it’s in-person. Virtual first does not mean virtual only. A great healthcare system should have all the tools at its disposal. An orthopedic surgeon can’t do your surgery remotely today, but in our lifetime, that can change. But to do the follow-up on a virtual tool makes a lot of sense. People talk about it like it’s binary, when the discussion should be around all of the above. That’s why we have invested so heavily in this hybrid model, particularly around primary care. When in-person care is needed, it is our job to get people to the right place, whether that’s connecting to a high-quality in-person specialist or screenings or mammograms or colonoscopies and things that necessitate an in-person setting. We’re talking about healthcare and what’s the right tool for the job.”
D CEO Healthcare: What do you see for the future of virtual care in terms of payers and parity with other appointments?
Tibbels: “Clinicians, providers, physicians, etc. should be appropriately reimbursed for the work that they do regardless of where, how, and when they’re providing the service. If brick-and-mortar-based providers are providing virtual care, it is a reasonable expectation for reimbursement to be equal to the same work they’re doing in person. At the same time, entities like Teladoc or providers that are exclusively providing virtual services, and are adding value, and pulling costs out of the system, and making things more affordable should have the ability not to be forced to take the same payment. If I’m not carrying all the overhead of an in-person clinic, and we want to contract in a way that can share that savings with another stakeholder, we should also be able to do that.”
D CEO Healthcare: How do you think telehealth will change in the future?
Tibbels: “Anyone who tries to prognosticate in this space 10 years out is being disingenuous. Innovation is moving so fast. Thinking back to eight years ago, I cannot believe the progress, so I’m going to shorten the window. The biggest thing is already happening: We’re moving from the siloed use cases that are very condition-based to integrating hybrid care in a seamless and unique way. Also, things like generative AI are moving so rapidly that it’s going to impact healthcare in general and certainly in the virtual and digital space. I cannot help but think about where this is going on the clinical side and supporting clinical decision support.”
D CEO Healthcare: How do you see telehealth impacting brick-and-mortar healthcare facilities in terms of size and function?
Tibbels: “The answer is probably very specific to a given in-person facility and what they’re trying to accomplish. I’ve seen people setting up dedicated spaces for telehealth; we have devices that we put in hospitals that can move from room to room, which are basically robots that go into a room and facilitate virtual encounters. You see healthcare facilities trying to enable provider-to-provider consultations to cities with specialists they may not have in a rural setting.”
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