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While the word “telemedicine” was once considered a catch-all term for any type of healthcare service administered remotely, it’s become evident over the last decade that the word can be applied to the myriad virtual care services, tools and companies out there today. So in effort to get an idea of where the industry is heading in the next few years, a panel at the American Telemedicine Association’s conference in Orlando this week put three CEOs heading very different companies in the hot seat to get their take on the future.

“We can look around and see a lot of hype, so many amazing ideas and innovations, but when you push, you have to ask how many patients are actually treated through telemedicine. A lot of companies are still in their infancy,” moderator Dr. Ateev Mehrota, who is a professor of medicine at Harvard and a hospitalist at Beth Israel Deaconess Medical Center, said. “But online consultations are showing some real numbers, with a million or a million and a half visits conducted in 2016. But as great as that sounds, in the grand scheme of things, we have around 1 billion in-person visits per year. So how does telemedicine grow and catch up to that level?”

Scott Decker, CEO of telemedicine platform provider MDLive, said the main macro-level challenges affecting the telemedicine industry are the same as those in traditional healthcare, with cost barriers and a lack of primary care providers. From there, he says, telemedicine companies can rise up to expand the ideas people have around how to manage their wellness.

“We take this low-acuity business we started, but now we need to start thinking about how to push the envelope,” Decker said. “How comfortable can we make people? That comes from trying things and seeing if [users] are satisfied with new technologies like connected devices. I don’t think people get excited to go to the doctor or hospital, just like I don’t think people get very excited about going to the bank or the mall, but they will embrace new tools to do these things. I think we’re just at the cusp of saying telemedicine is proven, but I think now is the time we can be bullish and start to get aggressive about seeing what consumers might be interested in.”

For Hill Ferguson, CEO of app-based telemedicine provider and platform Doctor on Demand, his company is heavily focused on building their own brand and being seen as the main contact point for their services. Rather than just providing the technology, they want to be synonymous with quality healthcare and ongoing value.

“Our mission at Doctor on Demand is to take what is a transaction based consumer experience and evolve it into a relationship-based one that keeps building,” Ferguson said. “One of the things I do every morning, without fail, is go through all of our customer reviews. One of the themes emerging is, ‘That was great, I wish all doctors, etc.’ This is becoming more and more frequent, because people try, and they are like, ‘Hey, this actually works, it’s not just a doctor, but a good doctor, and how can I start engaging in my health more?’ So our vision for the next three to five years is you will be doing more and more visits.”

On the opposite end of the spectrum, American Well CEO Dr. Roy Schoenberg says while his company is certainly riding the wave of telemedicine growth, they don’t see themselves as the primary face of the service. Rather, American Well seeks to be a technology provider that allows for integration of new devices, virtual visit modalities and information systems.

“I do agree that branding needs to be in the front, because the brand is something that creates trust, legions, and becomes something that people come to expect more from. And I think that’s fine and healthcare should come with a brand, but I just think the brand shouldn’t be a software company. I think the brand of healthcare should be all healthcare entities,” he said. “As long as what you offer is incredibly new and different that has never been done by traditional healthcare entities, then I think it’s ok for us to do it under our brand. But really simply, in the world where every health plan is beginning to offer virtual healthcare services, I think the use of those healthcare services under a software company brand becomes gradually less important.”

That being said, Schoenberg does believe the industry itself will continue to grow, but perhaps not in the way some may foresee.

“I don’t think growth will be directed to telehealth products. I think the way growth is going to come, is the integration of telehealth services, which will more and more represent the usual suspects of healthcare,” he said.

As technologies get better and more widely adopted, Schoenberg thinks people will interact with them more and more not as standalone device or telemedicine technology brands, but through their familiar insurance providers, health systems or hospitals.

“Technology will retreat to the back as an enabler for Americans to interact with those institutions of healthcare,” he said.

Given the different perspectives on what’s to come, Mehrota asked the panel how all the different companies acting in the space go about developing their own business models.

For Decker, MDLive is embarking on plans and partnerships to allow for more data collection, analysis and sharing.

“I think we will see more integration, seamlessness, which will give us ability to do more data-driven models of delivery. Population health, right?” Decker said. “You are going to be able see massive amounts of data, you’ll be able to sort through it and use it, you will have healthcare-oriented data companies that help us do that. I think it’s a natural extension for telehealth companies, at least with our model. From a business model standpoint, I think that data moves us out of a transactional process to more of a value-building place.”

Ferguson said he would like to see better devices designed with the consumer in mind and smoother integration with existing workflows. As his company employs full-time physicians as well as part-time, he doesn’t like the idea of growing a large, disparate provider network so much as getting better tools that enable his own workforce to be more efficient. A big part of that would be integrating a remote version of services that need to be in-person, like lab tests.

“We’ve talked about the limitations of telemedicine, but we need to be realistic. Ask a different question: what is the resolution rate? Think about the fact that less than 10 percent of sore throats are strep throat. We don’t need to order enough for every kid, just 10 percent of them,” Ferguson said. “But we do need to build capabilities so when doctors feel that more testing is appropriate, we can get that done. “

Schoenberg pointed that many things will still need to be done in-person, and noted that telehealth cannot solve for all fragmentation problems.

“There are better ways of ensuring how that can happen, like with expanded physician networks, but I think the issue is actually much bigger. It’s not about dispatching, who’s coming in, who’s coming back. The biggest issue we have is that if a patient is seen by a clinician and any additional other procedure has to be done to establish a diagnosis. And forget telehealth, this is in all healthcare settings,” he said.

That being said, he thinks the growing sophistication of connected devices or at-home testing kits are definitely indicative of an evolving telemedicine industry that we can count on to keep moving forward.

“As technology improves, and more and more of these tests are valuable to the telehealth transaction, some of those tests become innovative enough and low cost enough to be able to do them in the home,” he said. “I think the devices coming in and everything, these are the reflection: all of these devices wouldn’t exist unless telehealth had grown in the last 10 years so that it made sense for a company to invent a telehealth-purpose device. The same thing is going to go for lab tests. You are going to see telehealth-purposed home kits for strep throat and UTI and a variety of diagnostic devices are going to surface, and that’s going to be driven because of the telehealth industry.”

As fun as FaceTime or other video calls can be, many people may choose to decline an incoming face-to-face chat for the simple reason of, well, not wanting to show their face. Understandably, when people are sick and are choosing to engage with their doctor virtually, they may not leap at the choice of a video visit.

“When we talk about telemedicine, a lot of people immediately think video. But when you look at modes preferred, most are not even willing to use video. In fact, half would choose a modality that specifically does not include it at all,” Dr. Kevin Smith, chief clinical officer at Zipnosis, said during a presentation at the American Telemedicine Association conference in Orlando.

And they aren’t eschewing the technology for complicated reasons, either, Smith said.

“In our company, we’ve done lots of testing with groups and done lots of polling, and many testers are mainly opting out of video for things like ‘what I’m wearing,’ or ‘what my hair looks like.’ Those are the top reasons.”

But providers and health systems need not put the brakes on bringing telemedicine into their practice for fear of alienating their patients, Smith said. Most patients are more than happy to use virtual visits, and, just like their aversion to the in-your-face approach of video, most even prefer it over a real human doctor.

“In our studies, we saw 70 percent of patients who would use telehealth over human contact,” Smith said. “That can be a bit sobering for physicians, but the fact is they are not nearly as loyal to our in-person relationship as we believe them to be.”

But it’s not personal. Cost savings and convenience are the main reason, even with older patients, whom many innovators may write off as tech-phobic, but are in fact the largest users of telehealth because, as Smith said, they are the people using the most healthcare services.

So when providers want to bring in telemedicine, Smith advised, it’s important for them to do their homework and make sure they are meeting patients with the technology they actually want to use. In Smith’s own research, he found patients vastly prefer email, phone calls and e-visits – a mix of online check-ins and patient-provided data and follow-up calls, emails or texts. Accordingly, satisfaction levels with the telemedicine modalities are on par with the patients’ initially stated preferences.

Once providers figure out what their patients want, then it’s onto how exactly how to intelligently bring telemedicine into their practice. Alex White, a consultant at KPMG, explained how telemedicine could be used to grow revenue and increase efficiency in ways that simply hiring more doctors can’t.
“We have to put telemedicine in broader context of growth strategy. When we are talking about delivering on a supply side of physicians, we can see how health systems may or many not be able to act on this demand,” White said in a presentation. “And it is clearly and definitely proven that we have to find out what consumers want before bringing in technology.”

To illustrate his point, White describe two hypothetical health systems. One hires more doctors to grapple with more patients than they could previously handle. The other brings in telemedicine to extend the reach of their existing physicians.

“You have one hospital CEO who says the way out of a problem is to grow, which will lead to economies of scale. Then you have another who wants to drive patient loyalty and physician productivity,” White said. “But the first one will most likely get is more patients, so the problem doesn’t change and you now have more costs associated with those extra physicians and the promotion of their extra services. Not only are you just as inefficient as ever, you are losing more money.”

Of course, there may be situations when health systems do have to hire more doctors, but at the same time, they should start thinking about operating models that could drive productivity, White said. That means taking polls, like Smith said, and figuring out what patients want and which modalities deliver the best engagement and outcomes.

“I don’t know why, but very few health systems are using CRM and they really should be. You need to be able to strip out noise and figure out ways to reframe telemedicine access programs in ways the CFO, CEO and COO will understand,” he said. “That means explain how you will grow, emphasize the lifetime value of retaining a patient, and not canonizing the in-patient visits.”

The American Telemedicine Association’s conference in Orlando, held earlier this week on April 24 and 25, hosted several partnership announcements, product launches and technology evolutions. Read on for MobiHealthNews’s roundup:

Stratus Video, which has made a name for itself with its video-based language interpretation services through everyday technology like tablets and smartphones, has been steadily expanding into telehealth technology. The company now currently works with 125 health systems over 1,600 hospitals, and are building on that further with a new partnership with Pennsylvania’s Geisinger Health System. While no program is in place yet, Geisinger plans to launch several different pilots over the next few months to leverage Stratus’s dual expertise. While Geisinger has many existing telehealth programs in place, they were searching for ways to seamlessly integrate more communication tools that could address language barriers.

“Over the last year, we’ve been looking at where our gaps were (and still are) within our organization, and originally we really started out thinking that new solutions would solely be inpatient, to bridge gaps of communication in the hospital only,” Janet F. Rushing, who is the systems director at Geisinger’s Center for Telehealth, told MobiHealthNews. “We knew patients were saying nurses and doctors are not spending enough time to explain, and we saw Stratus as a very viable solution because we needed something that allowed for high egagement and a simple one touch, one click solution.”

Stratus CEO Lee Horner pointed to the impact of language barriers on a patient’s health and well-being, which his company came to understand when they first began wading into healthcare.

“When we first looked at what was happening in the world of interpretation services, we saw people could get interpreters at the point of care, but getting specialists and physicians who could could communicate with them was a gap,” Horner told MobiHealthNews. “So we thought, how can we take on the healthcare side, add interpretation, drive the healthcare organization’s strategy of expanding telehealth, and leverage technology with staff? We know patient engagement is less than seven percent for people who are Limited English Proficient (LEP), but if we can integrate a model that has the interpration services in there, that engagement goes up to 50 or 60 percent.”

The agnostic model of Stratus’ offering was also an attractive selling point, and allows Geisinger to bring more people into the conversation at once.

“What’s important to us is that we don’t have to access another provider network to bring in both capabilities, we can work with the interpreter side and also have the telehealth platform that fits right into our workflow,” Rushing said. “The nurses at the bedside are familiar, the clinics and practice sites are already familiar, so patients will have that comfort level and an easy transition to adoption. And I know as an ICU from the interpreter side, patients are very trusting. They will do anything you ask of them, but most people don’t speak nursing, especially if it is not in their native language.”

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Royal Philips debuted its enterprise-level telemedicine software designed for use in intensive care units. Philips’ eCareManager, the company’s new FDA-cleared teleICU software, works to alleviate critical care team shortages by offering a platform connecting regular hospital staff with intensivists – physicians trained specifically for work in the ICU – and offering actionable insights to improve outcomes for patients with the most complex cases. More

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American Well announced two developments the company has taken to expand their footprint, both in regards to consumer accessibility as well as ease of use for providers and health systems using the platform. The company unveiled a new enterprise service called AW10, which contains over 100 new features specific to providers to make their experience with American Well’s platform simpler and more comprehensive. Also, the company finally unveiled details of their partnership with Samsung; a collaboration they shared limited information on just a couple of months ago at HIMSS 17. Now American Well’s platform is fully embedded into to Samsung’s newly revamped health app, Samsung Health, and can be accessed on many Samsung devices including the Galaxy S8 and S8+, which just came out last week. Under the “Experts” tab on Samsung Health, users can have on-demand video visits with any doctor who practices with American Well. More

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MAP Health Management announced its partnership with wearable maker Lief Therapeutics, which makes a patch that measures heart rate and breathing to track signs of stress. It syncs with a companion smartphone app to offer the wearer feedback and mindfulness exercises to calm their mind and self-regulate, ultimately teaching the wearer to monitor and positively control their behavior rather than succumb to knee-jerk responses common during moments of high anxiety. More

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Healthcare-focused video conferencing technology company Vidyo announced a partnership with patient engagement company Zillion. Using Vidyo’s API, Zillion will now feature face-to-face video communications as a component of their engagement platform. “Zillion’s partnership with Vidyo underscores our commitment to help make deep connections to users, whenever and wherever they want,” Bill Van Wyck, president and chief innovation officer at Zillion said in a statement. “Digital and on-demand health shouldn’t be less human, and we look forward to working with Vidyo to further enhance the patient experience.”

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Salus Telehealth announced the launch Quick Care, their on-demand mobile consultation platform that expands on their existing VideoMedicine offering. Users log into the VideoMedicine app, click the Quick Care banner, and are able to get a consultation from a US board-certified primary care provider within 30 minutes.

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Two connected care companies, eDevice and iHealth, teamed up to co-create a remote patient-monitoring platform called iHealth Next. The platform combines iHealth’s medical sensor and front-end application capabilities with eDevice’s medical hubs technology and mobile network services skills.

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Digital health company Medpod launched their self-named platform, which integrates proprietary communication software with real-time data collection from a variety of medical and laboratory devices.