President and Chief Innovation Officer
December 8, 2020
COVID-19 Has Changed the Face of Telehealth
By Hans Kaspersetz and Irvin Carlin, Principle, Firefly Marketing LLC
How Can Healthcare Marketers Respond to This Major Shift Online?
When the US went into sudden lockdown at the end of March 2020, clinics and healthcare centers were compelled to move their services online — and quickly. The role of telehealth changed almost overnight — from an innovation hampered by uncertainty related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other unknowns to a life-saving necessity. Telehealth had become the solution to delivering essential healthcare while protecting patients and staff from COVID-19.
Within weeks, healthcare providers were conducting 50 to 175 times as many telehealth visits as they were before the pandemic.1 Payors extended policies to cover telehealth appointments. Regulators were already easing restrictions and allowing physicians to prescribe drugs even without in-person doctor-patient interaction, unconsciously laying the groundwork for what was to come during the lockdown.2 According to the US Department of Health & Human Services, only 0.1% of Medicare Fee-for-Service (FFS) visits in February 2020 were via telehealth. Once the COVID-19 public health emergency began in March, with stay-at-home orders and warnings on the risk for severe illness increasing with age, in-person primary care visits plummeted. By April, 43.5% of Medicare primary care “visits” were provided via telehealth.3
According to Arteric’s analysis of data from Google, 64% of providers are saying that they are now more comfortable with using telehealth systems. Telehealth is increasingly becoming part of the new normal, bearing enormous responsibility and offering enormous potential. In this post, we look at how telehealth is affecting patients, healthcare professionals, and pharma brands: the impact and the opportunities. How has the industry stepped up to the plate? What are the future trends in healthcare, and what is happening across the telehealth landscape? Going forward, what can healthcare marketers do to meet the developing needs of patients and healthcare professionals?
Barriers to telehealth
The telehealth landscape is vast and growing fast. It encompasses virtual healthcare (the broad definition for remote healthcare services delivered by live video, audio, and instant messaging platforms) and telemedicine (remote clinical care from doctor to patient, including consultation and diagnosis).4 Despite its scope, capability, and potential, telehealth has encountered its fair share of barriers.
Back in mid-2019, before the pandemic hit and changed everything, there was a striking disconnect between the expressed willingness to use telehealth and the actual adoption of it. In a survey carried out by American Well, 67% of those in the 45 to 54 age-group were aware of telehealth and willing to use it, but only 6% had adopted it.5 The concept of telehealth appealed to more than half of the people in all age categories, yet it was being used by relatively few people.
So, what were the barriers? Regulatory red tape limiting flexibility, patient concerns about cost or insurance coverage, healthcare providers’ lack of awareness on how to integrate it; these were all contributors to the low adoption rate. But crucially, there was a question of trust. How can people trust an online doctor-patient relationship at a time when data hacking and cybercrime loom large? And what about quality? Can you trust telehealth services to deliver high-quality care via an online connection?
Prior to COVID-19, many consumers were dubious. In a survey of 2,000 Americans carried out by Sykes at the very start of the US lockdown, the perception of telehealth was problematic. When asked what would deter them from making a telehealth appointment in the future, 41.35% of respondents said they were not convinced they could be properly diagnosed via telehealth; 36.40% said they would just prefer to meet with someone in-person.6 Perceptions like these undermined the entire point of telehealth — to deliver healthcare remotely.
Sudden shift online
When news of the lockdown hit, healthcare providers were under pressure to perform a digital roll-out that would normally take months of planning. Arteric saw the speed of this shift first-hand in our work with an outpatient recovery center for people with substance use disorders (SUDs), which we will call The Network. The Network moved their services online in only 24 hours.
Switching to telemedicine is not as simple as setting up your patients on Zoom for Healthcare. All communications now had to make it clear to patients that The Network was still there for them — 24/7. During this process, The Network was battling multiple challenges simultaneously. Facing falling demand and a complete change in their delivery paradigm, The Network saw a 50% drop in the search volume for their services. Tactics that had been productive suddenly stopped working between February and March 2020. Arteric supported The Network by overhauling their PR strategy, rewriting their website content and paid media to highlight their new digital services. Through our online monitoring, we noticed a sudden rush of The Network’s competitors toward remote services, so optimizing The Network’s channel remains a continuous task.
This changing landscape has made it a challenge for slower-moving pharma and medical-device brands to evolve their messaging and media strategies. In contrast, smaller and more nimble operators have shifted very quickly. For a switch to telemedicine to be successful, there must be a radical shift in marketing, lead generation, intake and evaluation practices, and finally healthcare delivery and follow-up. Healthcare delivery has an end-to-end customer experience continuum that must be tuned specifically for telehealth, to ensure the best outcomes.
HIPAA video conferencing
For The Network and many other clinics, secure video conferencing has enabled staff to speak face-to-face with isolated patients during an anxious time, when a cut-off from human connection could trigger a relapse. Through the power of Zoom for Healthcare, The Network has created a virtual version of their clinics, to replicate a safe place where patients can continue their treatment. Their physicians can effectively evaluate new patients, provide care, and remotely order prescriptions to be sent to a patient’s local pharmacy.
Many of us are using video conferencing platforms to connect socially and for work. But are these platforms robust enough from a security perspective to protect the confidential nature of a health appointment? Can healthcare providers just fire up platforms like Skype and FaceTime to deliver telehealth services?
Not quite. Platforms’ handling of protected health information (PHI) must be HIPAA-compliant to meet the security standards that safeguard patient confidentiality. Zoom for Healthcare is a HIPAA-compliant video-conferencing platform, which is why services like The Network can use it to conduct their online rehab programs.
In terms of other platforms, Skype itself is not HIPAA compliant, but Skype for Business is — only if the healthcare provider purchases the Enterprise E3 or E5 package and has a Business Associate Agreement (BAA) in place.7 The BAA ensures that the platform used by the provider is HIPAA compliant and also protects the provider from liability if a data breach caused by the vendor occurs. Meanwhile, Apple refuses to sign BAAs with providers, which therefore rules out FaceTime for HIPAA accreditation and use in a telehealth context.8
The Centers for Medicare & Medicaid Services (CMS) are temporarily reimbursing telehealth care at the same rate as physical visits to healthcare centers.9 Before COVID-19, CMS telehealth requirements were extensive. Medicare could pay for telehealth only in limited circumstances: when a patient lived in a designated rural area and travelled to a local medical facility to receive the service. This has all changed in 2020. The CMS issued a waiver that allows Medicare patients to “use telecommunication technology for office, hospital visits, and other services that generally occur in-person.”10
Private insurers have broadened their coverage, too. United Healthcare has “expanded access to telehealth to help you stay in your home and reduce exposure to the virus,”11 Aetna advises its members to use Teladoc®, which offers e-clinic and video visits covered by most Aetna Commercial plans. The insurance company now reassures its members that they are now covered for telehealth options such as routine care; urgent medical care; behavioral health; physical, speech, and occupational therapies; and teledentistry.12
During a live virtual event, Seema Verma, MPH, administrator of the CMS, said that these extended measures should continue after the coronavirus pandemic. She strongly believes that telemedicine has significantly improved access to care. Verma said that the administration would support the efforts to allow the practice of telemedicine across state lines. Rethinking the current licensing laws that limit patients from accessing care outside of their state has “the potential to provide better services and reduce some of those shortages, especially in some of the highly specialized fields.”13
Whether the CMS waiver to equalize payment for telehealth and in-patient care goes beyond a temporary measure is something the government still needs to evaluate. While reimbursement parity between telehealth and in-person appointments has been a huge incentive for providers, it reduces telehealth’s cost-effectiveness. With in-person visits at twice the price of a virtual consultation, equalizing payment undermines telehealth’s cost-saving benefits and the need for pricing transparency.14
Searching for answers
The new demand for telehealth is reflected in the surge of Google searches and YouTube views of telehealth-related content. What’s interesting is that people are changing their search terms. The top “telehealth”-related terms on Google have shifted from generic information to the specifics of use. Broad searches like what is telehealth have been narrowed to medicare telehealth. This change suggests that the search intent has shifted from general curiosity about telehealth to an active attempt to find out if their insurance covers it.
For marketers, this search volume for telehealth-related content reinforces the role of organic search in making it easier to connect patients with the care they are trying to find. It highlights an opportunity for targeted pay-per-click advertisements to reach those searching for a telehealth service that could help them.
Views of telehealth-related video content on YouTube have risen by a staggering 996% since mid-March, with 3,000 hours of video content viewed per day. Some of the most viewed videos have included Telehealth Appointments Now Available, GMHBA Health Insurance and Telehealth, Patient Assurance/Telehealth Video. Viewers are researching what telehealth options are available and if they are covered by their insurance. Payors are creating videos that explain their extended telehealth coverage. Healthcare professionals are using YouTube to raise awareness of their new telehealth services.
Healthcare marketers can respond by producing informative, engaging, educational, and awareness-building videos that deliver the answers to patients and healthcare professionals.
Proving its worth
COVID-19 has been the ultimate proof of concept for the remote delivery of healthcare nationwide and even globally. Since the onset of the pandemic in mid-March 2020, an estimated 28.1% of visits to healthcare professionals have been conducted via telehealth.15 This is a substantial uptick when compared to the low levels of 2019.
How are patients and healthcare providers finding the experience? Feedback is positive. Bob Kocher, MD, is a physician and partner at venture capital firm Venrock, which invests in Doctors on Demand, a telemedicine service provider. According to Dr. Kocher, patients using telemedicine for the first time consider it valuable, and doctors now have access to a deeper level of insight9:
“With virtual visits, doctors can check in with sicker patients more often and can learn more about them by seeing their living environments through video. For instance, do they have access to safe housing? Do they have pets that may exacerbate or help their medical condition? Do they have the food they need?”9 — Bob Kocher, MD
According to a report by McKinsey, healthcare providers are conducting 50 to 175 times as many telehealth visits as they were conducting before the COVID-19 pandemic. The perception of telehealth has improved as 57% of providers now view telehealth more favorably than they did before the pandemic. In addition, confidence levels are up, with 64% of providers saying that they are now more comfortable with using telehealth systems.1
Patients’ willingness to consider telehealth was high in 2019, even though few were actually making use of it. That willingness increased with the arrival of the coronavirus pandemic. In late March 2020, Sage Growth Partners (SGP) and Black Book Market Research reported that 59% of respondents in a survey said they would be more likely to use telehealth services than before the pandemic, and 33% would even switch to a provider that was accessible via telehealth.16 In May 2020, McKinsey reported that 76% of consumers were interested in using telehealth going forward.1
Recent telehealth trends
Across the telehealth landscape, we are seeing two major trends right now: direct-to-consumer services and strategic collaborations between pharmacies, tech companies, and payors.
The telemedicine software company RxDefine is drawing on its expertise in technology to improve the healthcare user-experience for patients, healthcare providers, and healthcare brands. The full-stack solution is designed to support pharmaceutical companies’ direct-to-consumer marketing (DTC). The customizable platform costs $10k to $15k per month. It works by connecting patients who are visiting pharmaceutical landing pages to licensed telemedicine providers. The aim is to improve convenience, minimize cost, and enhance the patient experience.
However, the RxDefine platform has not been without controversy. Earlier this year, the online prescription site dermatology.com, which was backed by Bausch and powered by RxDefine technology, was pulled soon after launch when a dermatologist exposed an incorrect and potentially dangerous recommendation for the wrong drug, without diagnosis or follow-up questions.17
Healthcare brands can avoid this risk by partnering with an agency that has strong experience in DTC platforms and by investing adequately in planning and risk mitigation prior to implementation. Arteric is currently working on multiple launches of drugs whose marketers are considering DTC telehealth options at launch to increase access to the product. Over the past two years, we have supported Arbor Pharmaceuticals in their offering of a cash DTC telehealth option; this included their digital marketing strategy and pay-per-click targeting.
DTC platforms are disrupting the market by democratizing access to medications. They provide a channel for healthcare marketers to create branded or unbranded campaigns and the technology to offer asynchronous physician consults. This is an option for those who want to go directly to the consumer, either by cutting out the payor with a cash-pay program or increasing access by reducing the friction of having to go to a doctor’s office.
Organizations such as Roman, Hims/Hers, Torch Rx, and Lemonaid Health focus on therapies for common, but somewhat stigmatized conditions, where telemedicine’s benefit of privacy is meaningful. While their insurance coverage is limited, consultation fees are low, with frequent promotional offers.
Strategic partnerships between pharmacies, payors, and technology companies are forming. For example, Anthem, the second largest health insurer in the United States, has partnered with Samsung and telehealth provider American Well to expand access to remote healthcare.18 Members of Anthem’s health plan with a Samsung Galaxy smartphone and the Samsung Health app can video chat with a board-certified healthcare provider about non-emergency medical needs, receive diagnosis and prescriptions, 24 hours a day, 7 days a week. This functionality is powered by American Well’s technology, LiveHealth Online. The app also integrates other health and wellness tracking, such as activity, nutrition, and sleep. Thus, consumers can access all elements of their healthcare from their smartphone.
Another service that integrates all aspects of health is the VIVUS® Health Platform. Among other features, VIVUS offers a remote patient-monitoring tool that integrates a wide range of Bluetooth®-enabled devices, such as the Apple HealthKit™ and the Apple Watch®, digital weight scales, blood pressure cuffs, and spirometers. Physicians can access the collated data from all these devices on the VIVUS® Health Platform for a detailed and holistic view of a patient’s health.19
Pharmaceutical brands are partnering with online prescription platforms. Migraine drug Ubrelvy™ (ubrogepant) has created a branded site on UpScript, which offers migraineurs an online consultation with a physician, for a $45 fee, to discuss whether Ubrelvy™ is an appropriate course of treatment. If the prescription is right for the patient, the patient proceeds to the checkout and enters their local pharmacy and insurance information. This enables UpScript to contact the pharmacy and find out if the prescription is covered by the patient’s plan.
Telehealth in the future
Telehealth will grow more important post-COVID. Patients researching healthcare will find an increasing number of convenient, low-cost, private, and immediate solutions to their needs — bypassing primary care physicians in certain cases. Awareness of telehealth is converting to usage, and this usage is turning into patient trust. This trust is creating a snowball effect as patients share experiences by word of mouth. As a result, more and more healthcare providers are adopting telehealth services to meet patient demand, and access will increase further still.
Consumers have come to expect outstanding web experiences from online retailers, such as Amazon, which has relentlessly improved its services and capabilities both before and during the pandemic. As a result, consumers are raising their expectations of all online transactions, including those with healthcare professionals, pharmaceutical companies, and payors.
Patients and healthcare professionals are increasingly demanding easy-to-use and readily accessible digital services and resources. They expect pharmaceutical companies to provide high-quality, scientific, patient-appropriate, non-promotional content. Savvy pharmaceutical organizations are rising to the occasion and filling the need.20
This is a critical time for healthcare marketers to do everything they can to learn from the pandemic experience and investigate opportunities to engage healthcare providers, patients, and caregivers. Healthcare marketers should be exploring ways to leverage the telehealth channel as part of a multichannel branded and unbranded communications program.
But while telehealth is an important channel for healthcare marketers, a bigger priority is a great customer experience. This is the touchstone of success for every transformational brand. Telehealth is only a conduit in a multichannel campaign strategy. If the brand cannot engage with the audience, the channel is wasted. “Is telemedicine going to be a big part of oncology launches? Probably not,” said veteran pharma marketer Meghan Rivera. “You won’t get prescribed a chemotherapy over a PC.”21 However, telehealth will work for many other medical conditions, so the brands that treat those conditions will need to align their strategy and content with audience conversations in order to dominate the competition in every tactical aspect of a digital non-personal promotion strategy.
As an example, Phexxi (lactic acid, citric acid, and potassium bitartrate), a vaginal contraceptive gel aimed at women seeking a non-hormonal form of birth control, created and branded the “Phexxi Concierge Experience”, which allows women to contact a prescriber, access copay and prior authorization support, connect with a pharmacy that delivers, and sign up for refill reminders. By creating this end-to-end online experience, they made it extraordinarily easy for women to take action.21
At Arteric, our approach begins with understanding what is missing for customers — what are their perceptions, needs, and aspirations? By focusing first on customer value, we stand apart from competitors who saturate with brand-centric information. This allows us to identify opportunities to improve something for customers or offer a capability that they did not have before. Because at the end of the day, telehealth will be meaningful only if it creates value for patients and providers.
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- Telehealth: A quarter-trillion-dollar post-COVID-19 reality? McKinsey & Co website. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality. Published May 29, 2020. Accessed October 30, 2020.
- Coronavirus briefing: hocus pocus, face mask focus, fright vs. Fauci, science trumps superstition. MM+M website. https://www.mmm-online.com/home/channel/coronavirus-briefing-hocus-pocus-face-mask-focus-fright-vs-fauci-science-trumps-superstition. Published October 28, 2020. Accessed October 30, 2020.
- HHS issues new report highlighting dramatic trends in Medicare beneficiary telehealth utilization amid COVID-19 [press release]. Washington, DC: Department of Health and Human Services. https://www.hhs.gov/about/news/2020/07/28/hhs-issues-new-report-highlighting-dramatic-trends-in-medicare-beneficiary-telehealth-utilization-amid-covid-19.html. July 20, 2020. Accessed October 30, 2020.
- Telemedicine vs. virtual care: defining the difference. InTouch Health website. https://intouchhealth.com/finding-the-right-term-for-modern-digital-healthcare/. Accessed October 30, 2020.
- Telehealth index: 2019 consumer survey. American Well website. https://static.americanwell.com/app/uploads/2019/07/American-Well-Telehealth-Index-2019-Consumer-Survey-eBook2.pdf. Accessed October 30, 2020.
- Americans’ perceptions of telehealth in the era of COVID-19: Sykes report. Sykes website. https://www.sykes.com/reports/2020-telehealth-survey/. Accessed October 30, 2020.
- Is Skype HIPAA compliant? Compliance Group website. https://compliancy-group.com/is-skype-hipaa-compliant. Published March 21, 2020. Accessed October 30, 2020.
- FaceTime HIPAA privacy concerns. Telebehavioral Health Institute website. https://telehealth.org/blog/facetime-hipaa. Published February 1, 2019. Accessed October 30, 2020.
- Kocher B. COVID-19 is normalizing telehealth, and that’s a good thing. Fast Company website. https://www.fastcompany.com/90490988/covid-19-is-normalizing-telehealth-and-thats-a-good-thing. Published April 16, 2020. Accessed October 30, 2020.
- Centers for Medicare & Medicaid Services. Medicare telemedicine health care provider fact sheet. Centers for Medicare & Medicaid Services website. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Published March 27, 2020. Accessed October 30, 2020.
- Talk to a doctor from home using telehealth services. United Healthcare website. https://www.uhc.com/health-and-wellness/health-topics/covid-19/telehealth-options. Accessed October 30, 2020.
- COVID-19 FAQs. Aetna website. https://www.aetna.com/individuals-families/member-rights-resources/need-to-know-coronavirus.html. Accessed October 30, 2020.
- Ross C. ‘I can’t imagine going back’: Medicare leader calls for expanded telehealth access after Covid-19. Stat website. https://www.statnews.com/2020/06/09/seema-verma-telehealth-access-covid19/. Published June 9, 2020. Accessed October 30, 2020.
- John Locke Foundation. The case against telemedicine parity laws. John Locke Foundation website. https://www.johnlocke.org/research/telemedicine. Published January 15, 2018. Accessed October 30, 2020.
- Walsh M. COVID-19’s impact on pharma marketing. Crossix website. https://crossix.com/covid-19s-impact-on-pharma-marketing/. Published April 17, 2020. Accessed October 30, 2020.
- Survey quoted in Harpaz J. 5 reasons why telehealth is here to stay (COVID-19 and beyond). Forbes website. https://www.forbes.com/sites/joeharpaz/2020/05/04/5-reasons-why-telehealth-here-to-stay-covid19/#446a318253fb. Published May 4, 2020. Accessed October 30, 2020.
- Court E. Bausch yanked online prescribing after dermatologist backlash. Bloomberg website. https://www.bloomberg.com/news/articles/2020-03-11/bausch-yanked-online-prescribing-after-dermatologist-backlash. Published March 11, 2020. Accessed October 30, 2020.
- Japsen B. Anthem in telehealth deal with Samsung and American Well. Forbes website. https://www.forbes.com/sites/brucejapsen/2018/07/23/anthem-in-telehealth-deal-with-samsung-and-american-well/#20b62b885f86. Published July 23, 2020. Accessed October 30, 2020.
- Bourgealt G. VIVUS finding support after launch of its remote health platform. Seeking Alpha website. https://seekingalpha.com/article/4337126-vivus-finding-support-after-launch-of-remote-health-platform. Published April 12, 2020. Accessed October 30, 2020.
- The pharmaceutical industry needs a customer-centric digital transformation. Harvard Business Review website. https://hbr.org/sponsored/2020/09/the-pharmaceutical-industry-needs-a-customer-centric-digital-transformation. Published September 28, 2020. Accessed October 30, 2020.
- Iskowitz M. The ‘COVID-proof’ drug launch? Why telemedicine could become a staple for more pharma brands. MM+M website. https://www.mmm-online.com/home/channel/the-covid-proof-drug-launch-why-telemedicine-could-become-a-staple-for-more-pharma-brands/. Published October 29, 2020. Accessed October 30, 2020.