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1 6 F E B R U A R Y
2 0 2 1
RO B ERT M I T T ENDO RFF MD MBA
1 6 F E B R U A R Y
2 0 2 1
P A R T N E R A N D C O - H E A D , H E A L T H C A R E
N O R W E S T V E N T U R E P A R T N E R S
E M E R G E N C Y P H Y S I C I A N
I L E A D H E A LT H C A R E I N V E S T M E N T S I N C AT E G O R Y D E F I N I N G
C O M P A N I E S L E D B Y E X C E P T I O N A L L E A D E R S H I P T E A M S
R E L A T E D I N V E S T M E N T S ( M Y C O N F L I C T S ) :
O M A D A H E A L T H
T A L K S P A C E
Q V E N T U S
T I G E R C O N N E C T
H E A L T H C A T A L Y S T
V I S I T P A Y
C R O S S O V E R H E A L T H ( F M R )
THE FUTURE OF TELEMEDICINE AND PRIMARY CARE
THE MODALITY WILL REQUIRE CHANGES TO TRAINING, CARE PATHWAYS, CONDITION MANAGEMENT AND TECHNOLOGY
PATIENTS (CONSUMERS)
• PATIENTS GENERALLY TRUST TELEMEDICINE PHYSICIANS AS THEY DO THEIR CURRENT PCP
• PATIENTS EXPECT TO SEE INCREASES IN TELEMEDICINE VISITS WITH EXISTING AND NEW DOCTORS
• MANY PATIENTS MAY OPT TO SEE A “TELEMEDICINE FIRST” PRIMARY CARE PHYSICIAN
• PATIENTS EXPECT TELEMEDICINE TO BE LESS EXPENSIVE BUT DOCTORS EXPECT PARITY
• PATIENTS ARE CONCERNED ABOUT THE LACK OF PHYSICAL EXAM AND NEW DIAGNOSES
PHYSICIANS
• PHYSICIANS HAVE MOVED TO ~25% OR MORE VISITS VIA TELEMEDICINE, WHICH MAY REMAIN
• PHYSICIANS ARE CONCERNED WITH A “VIRTUAL FIRST” NEW PATIENT INTAKE
• PHYSICIANS EXPECT REIMBURSEMENT PARITY, BETTER TECH & EMR FLOW
• PHYSICIANS EXPECT MORE STRUCTURED “WITHIN” RESIDENCY TRAINING
• ALLIED HEALTH PROFESSIONALS (NP/PA) HAVE A KEY ROLE
R. Mittendorff et al. 2020
THE PANDEMIC DROVE DOCTOR VISIT VOLUME DOWN 10-30%
PEDIATRICS, PULMONOLOGY AND BEHAVIORAL HEALTH DROPPED RAPIDLY; AT THE SAME TIME, TELEMEDICINE ROSE RAPIDLY
Source: The Commonwealth Fund, Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on
Outpatient Visits: Practices Are Adapting to the New Normal, 2020.
THE PANDEMIC DROVE TELEMEDICINE VISITS; A NEW SET POINT IS LIKELY: 10%?
A NEW BASELINE BETWEEN IN PERSON AND TELEMEDICINE WILL TRANSFORM HOW CARE IS PERFORMED
Source: The Commonwealth Fund, Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on
Outpatient Visits: Practices Are Adapting to the New Normal, 2020.
TELEMEDICINE PUBLICATIONS ARE ACCELERATING AS A RESULT OF COVID-19
COVID-19 IS A PROVING GROUND FOR VIRTUAL CARE; 5 – 10 YEARS OF EXPERIENCE COMPRESSED INTO ONE
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020FC
Primary Care
Urgent Care
Endocrine
Dermatology
Rheumatology
Oncology
Allergy
Behavioral
Health
Publications
per
year
Mittendorff, et al. analysis of PubMed publications with specific terms related to telehealth and
telemedicine, 2020YTD.
COVID-19 IS THE CATALYST: RAPID INCORPORATION OF NEW CARE MODELS
Virtual Care
Connected Care
Summoned Care
CONSTRAINTS DRIVE INNOVATION TO OPTIMIZE TO NEW ENVIRONMENT: $20B -> $95B
Source: Teladoc, Livongo, and Dispatch Health documents, logos (top to bottom), 10K, S-1, other
public corporate documents, Piper Jaffray report ($20B -> $95B)
IPO Year 2020 2019 2015
Revenue at IPO
(annualized)
$298M $128M $66M
Gross Margin 45% 66% 68%
Footprint 80M lives
5.6M total visits
(2.9M visits through
6/2020)
36,000 employers
> 5,000 providers
679 clients
>164,000 members
11M members
300,000 visits
>1,600 employers
>1,100 providers
Market Cap $6.6B $13.8B $17.6B
TRANSFORMATIONS ARE DRIVEN BY KEY INPUTS AND TELEMEDICINE IS HERE
THERE IS A NEW ‘SET POINT’ BEING CREATED FOR TELEMEDICINE VISITS
Necessity is the Mother of Invention: Consumers Want it
The Tech is Available & Payment and Regulations Work
The Catalyzing Event Presented Itself: COVID-19
Trust in Physicians Is Required and Present
TELEMEDICINE IS LAPAROSCOPY FOR INTERNISTS: NEW TRAINING NEEDED
TELEMEDICINE IS A MODALITY REQUIRING NEW TECHNIQUES, ENHANCED CARE PATHWAYS, AND EVIDENCE OF UTILITY AND BENEFIT
1805
BOZZINI
Cystoscope
By
Candlelight
1901
KELLING
A Scope in
A Dog Belly
1929
KALK
The Father
Of the
Modern
Laparoscope
1971
LEVINSON
Lap
Tubal
Ligation
(1% of tot)
1981
SEMM
Lap
Append-
ectomy
THE TAKEOFF
1989-1992
BAN (DE)
1956-1961
…A 200 YEAR (OVERNIGHT) TRANSFORMATION…
SURVEY INCLUDED 2,015 INDIVIDUALS NATIONALLY; 52% HAVE INCOME BELOW $50K A YEAR
OUR SURVEY INCLUDED A BROAD VARIETY OF AGES WITH 25% ABOVE 60
25%
9% 10%
7% 8% 7%
9%
25%
25
to
30
31
to
35
36
to
40
41
to
45
46
to
50
51
to
55
56
to
60
Over
60
Age
n =2,015, “What is your age?”, Mittendorff et al. 2020.
52%
36%
11%
2%
<$50,000 $50,000 - $100,000 $100,001 - $200,000 >$200,000
SURVEY INCLUDED 2,015 INDIVIDUALS NATIONALLY; 52% HAVE INCOME BELOW $50K A YEAR
OUR SURVEY INCLUDED A BROAD VARIETY OF AGES WITH 25% ABOVE 60
25%
9% 10%
7% 8% 7%
9%
25%
25
to
30
31
to
35
36
to
40
41
to
45
46
to
50
51
to
55
56
to
60
Over
60
Age
n =2,015, “What is your age?”, Mittendorff et al. 2020.
52%
36%
11%
2%
<$50,000 $50,000 - $100,000 $100,001 - $200,000 >$200,000
MEDICARE PATIENTS ARE 28% OF THE SAMPLE
MOST OF CONSUMERS SURVEYED OBTAIN INSURANCE THROUGH THEIR EMPLOYER
35%
18%
27%
10%
8%
Employer
Medicaid
Medicare
Individual
Don't Have Insurance
Not Sure
Q6, n = 2,015, ‘Where do you obtain your health insurance?’, Mittendorff et al. 2020.
THE SAMPLE ALSO INCLUDES A SIGNIFICANT NUMBER [38%] OF CONSUMERS WITHOUT KNOWN COMMON CHRONIC CONDITIONS
OUR SAMPLE INCLUDES PATIENTS WITH TYPICAL CHRONIC CONDITIONS
Q7, n = 2,015, “What medical conditions (if any) do you have?”, Mittendorff et al. 2020.
38%
2%
3%
3%
3%
5%
5%
6%
6%
7%
7%
14%
20%
22%
24%
No diagnosed conditions (above)
Kidney Disease
Cancer
Musculoskeletal
Gynecologic Conditions
Auto-Immune Disease
Cardiac Disease
Others
Dermatologic Conditions
Gastrointestinal Conditions
Pulmonary Diseases
Diabetes
High Cholesterol
Hypertension
Mental Health
THE SAMPLE ALSO INCLUDES A SIGNIFICANT NUMBER [38%] OF CONSUMERS WITHOUT KNOWN COMMON CHRONIC CONDITIONS
OUR SAMPLE INCLUDES PATIENTS WITH TYPICAL CHRONIC CONDITIONS
Q7, n = 2,015, “What medical conditions (if any) do you have?”, Mittendorff et al. 2020.
38%
2%
3%
3%
3%
5%
5%
6%
6%
7%
7%
14%
20%
22%
24%
No diagnosed conditions (above)
Kidney Disease
Cancer
Musculoskeletal
Gynecologic Conditions
Auto-Immune Disease
Cardiac Disease
Others
Dermatologic Conditions
Gastrointestinal Conditions
Pulmonary Diseases
Diabetes
High Cholesterol
Hypertension
Mental Health
31%
36%
23%
8%
2%
None 1 - 2 3 - 5 6 - 10 10+
43%
21%
17% 19%
Yes for > 5 yrs Yes for 2-5 yrs Yes for < 2 yrs No, I don't have a
PCP
[TOP] n = 2,015, “Did you have a regular primary care physician prior to COVID-19 in February 2020? “, Mittendorff et al. 2020. [BOTTOM] n = 2,015,
“How many, if any, medications do you take on a daily basis (excluding vitamins and natural supplements)?”, Mittendorff et al. 2020.
THE CONSUMER SAMPLE INCLUDED 31% WHO DON’T TAKE DAILY MEDICATIONS, WHILE 69% TAKE A MEDICATION OR MORE PER DAY
43% OF OUR CONSUMERS HAVE A PCP FOR 5 YEARS AND 19% DON’T HAVE A PCP
31%
36%
23%
8%
2%
None 1 - 2 3 - 5 6 - 10 10+
43%
21%
17% 19%
Yes for > 5 yrs Yes for 2-5 yrs Yes for < 2 yrs No, I don't have a
PCP
[TOP] n = 2,015, “Did you have a regular primary care physician prior to COVID-19 in February 2020? “, Mittendorff et al. 2020. [BOTTOM] n = 2,015,
“How many, if any, medications do you take on a daily basis (excluding vitamins and natural supplements)?”, Mittendorff et al. 2020.
THE CONSUMER SAMPLE INCLUDED 31% WHO DON’T TAKE DAILY MEDICATIONS, WHILE 69% TAKE A MEDICATION OR MORE PER DAY
43% OF OUR CONSUMERS HAVE A PCP FOR 5 YEARS AND 19% DON’T HAVE A PCP
18% OF CONSUMERS SEE A DOCTOR MORE THAN 6 TIMES A YEAR
CONSUMERS TYPICALLY SEE A PHYSICIAN 1-3 TIMES EACH YEAR
13%
38%
31%
11%
7% None
1 or 2
3 - 5
6 - 10
More than 10
Q7, n = 2,015, “How many times did you and your dependents interact with a doctor in the last 12 months
(include all in person visits, telemedicine visits, hospitalizations, surgeries)?”, Mittendorff et al. 2020.
64% OF CONSUMERS WOULD BE COMFORTABLE USING TELEMEDICINE FOR URGENT CARE IF THEIR PCP IS UNAVAILABLE
CONSUMERS DEMONSTRATE SIGNIFICANT INTEREST IN URGENT TELEMEDICINE
n = 1,630 of 2,015, “For an urgent or emergent visit, where your regular PCP is unavailable would you be
comfortable using telemedicine with an unknown licensed physician?” Mittendorff et al. 2020.
73%
27%
Yes
No
24% OF CONSUMERS ARE COMFORTABLE REPLACING THEIR IN PERSON PCP WITH A TELEMEDICINE PHYSICIAN AND SERVICE
CONSUMERS SHOW INTEREST IN REPLACING THEIR PCP WITH TELEMEDICINE
24%
37%
38% Yes
Maybe
No
It depends
n = 1,630 of 2,015, “Would you be comfortable replacing your regular in person primary care physician with a telemedicine physician and service that
keeps a record of all of your medical documentation?”, Mittendorff et al. 2020.
CONSUMERS SHOW SUPPORT TO TRANSLATE A LARGE PERCENTAGE OF IN PERSON VISIT TO TELEMEDICINE VISITS
63% OF CONSUMERS BELIEVE THAT 1/4 OR MORE VISITS COULD BE TELEMED
37%
30%
21%
12%
Less 25% 26% - 50% 51% - 75% Over 75%
n = 385 of 2,015, “What percentage of your visits with your primary care physicians do you believe could be accomplished with
telemedicine ”, Mittendorff et al. 2020.
37%
63%
Less Than 25% of Visits
26-100% of Visits
CONVENIENCE, COST, EASIER LOGISTICS AND REDUCED TRAVEL TIME ARE ALL TOP ADVANTAGES
PATIENTS SEE SIGNIFICANT ADVANTAGES TO TELEMEDICINE
11%
1%
5%
6%
7%
9%
9%
12%
20%
20%
32%
34%
36%
36%
54%
No benefits to telemedicine
Other benefits
Better integrated care
Centralized data
Higher quality doctors or providers
More responsive provider
Ability to upload images or other documentation
Ability to communicate via text
Help to decide whether to see provider in person
Easier to get prescriptions
Faster appointment booking
Easier to manage with schedule
Reduced travel logistics
Possible lower cost
More convenient
n = 2,015, “What are the advantages of telemedicine for you?”, Mittendorff et al. 2020.
10% ATTESTED TO NO BENEFIT TO TELEMEDICINE
A SMALL PERCENTAGE OF PATIENTS SEE NO BENEFIT TO TELEMEDICINE
n = 2,015, “What are the advantages of telemedicine for you?”, Mittendorff et al. 2020.
11%
1%
5%
6%
7%
9%
9%
12%
20%
20%
32%
34%
36%
36%
54%
No benefits to telemedicine
Other benefits
Better integrated care
Centralized data
Higher quality doctors or providers
More responsive provider
Ability to upload images or other documentation
Ability to communicate via text
Help to decide whether to see provider in person
Easier to get prescriptions
Easier to manage with schedule
Faster appointment booking
Reduced travel logistics
Possible lower cost
More convenient
PATIENTS ALSO EXPRESS CONCERNS THAT COULD LEAD TO EROSION OF TRUST
TELEMEDICINE DISADVANTAGES CENTER AROUND LACK OF EXAM OR PROCEDURES
1%
7%
8%
9%
13%
18%
20%
24%
24%
38%
38%
42%
46%
Others
Not reimbursed
No disadvantages to telemedicine
Trust was impaired
Perception of lower quality providers
Technology didn't work well
Couldn't get the care that I need
No prior in person physician / patient relationship
Higher risk since doctor not physically present
No ability to collect labs at home
Fear of doctor missing something
Less comprehensive because no physical exam is possible
Doctor unable to do procedures (e.g. injections, vaccines, etc.)
n = 2,015, “What are disadvantages of telemedicine for you?”, Mittendorff et al. 2020.
TELEMEDICAL PRACTICE WILL NEED TO ADAPT TO CONCERNS AROUND QUALITY AND PERCEPTION OF TRUST
QUALITY AND TRUST WERE CONCERNS FOR A MINORITY OF THOSE SURVEYED
n = 2,015, “What are disadvantages of telemedicine for you?”, Mittendorff et al. 2020.
1%
7%
8%
9%
13%
18%
20%
24%
24%
38%
38%
42%
46%
Others
Not reimbursed
No disadvantages to telemedicine
Trust was impaired
Perception of lower quality providers
Technology didn't work well
Couldn't get the care that I need
No prior in person physician / patient relationship
Higher risk since doctor not physically present
No ability to collect labs at home
Fear of doctor missing something
Less comprehensive because no physical exam is possible
Doctor unable to do procedures (e.g. injections, vaccines, etc.)
DISEASE MONITORING, REFERRALS, PRESCRIPTION MODIFICATIONS AND ADDITIONS ARE ALL REASONABLE OUTCOMES
PATIENTS ARE COMFORTABLE WITH A NUMBER OF VISIT OUTCOMES
12%
24%
47%
49%
49%
51%
55%
None of the above
Diagnose a new condition
Refer to an imaging center, lab test, or
other diagnostic setting
Prescribe a new prescription
Modify an existing prescription
Refer to an in person provider or
specialist
Monitor an existing condition
n = 2,015, “Which of the following would you trust a new telemedicine provider to do?”, Mittendorff et al. 2020.
THE TELEMEDICAL MODALITY MAY HAVE LIMITATIONS WITH NEW PATIENTS OR PATIENTS WITH NEW CONDITIONS
SIGNIFICANT CONCERNS EXIST IN USING TELEMEDICINE FOR NOVEL DIAGNOSES
12%
24%
47%
49%
49%
51%
55%
None of the above
Diagnose a new condition
Refer to an imaging center, lab test, or
other diagnostic setting
Prescribe a new prescription
Modify an existing prescription
Refer to an in person provider or
specialist
Monitor an existing condition
n = 2,015, “Which of the following would you trust a new telemedicine provider to do?”, Mittendorff et al. 2020.
THERE WERE NO DIFFERENCES IN THE LEVEL OF TRUST CONSUMERS PLACED IN THEIR PCP AND HEALTH SYSTEM, AND TELEMEDICINE
TRUST IS AN IMPERATIVE: BUT CONSUMERS TRUST TELEMEDICINE LIKE THEIR PCP
1% 1%
2% 2%
8% 8%
16%
22%
16%
24%
1% 1% 0.9%
3%
10%
13%
22%
18%
11%
20%
1 - I have
little to no
trust in
them
2 3 4 5 6 7 8 9 10 - I have
a great deal
of trust in
them
Your PCP and Health
System
Telemedicine Providers
[Black] n = 2,015, “How much do you trust the doctors at your local hospital/health system/regular primary care physician?” [Gray] n = 655, “How would
you describe how much you trust the doctors through a telemedicine service offered by your employer or health plan?”, Mittendorff et al. 2020.
THEY EXPECT TO SEE THEIR CURRENT AND NEW DOCTORS MORE VIA THE MODALITY
MOST PATIENTS EXPECT TO SEE DOCTORS MORE VIA TELEMEDICINE VISITS
30
44%
23%
19%
28%
expect to see my
current doctors
more via
telemedicine visits
expect to see new
doctors via
telemedicine visits
expect to see all
doctors less in
person or via
telemedicine visits
do not plan to use
telemedicine at all
over the next 5
years
n = 2,015, “Which statements represent your potential use of telemedicine in the next 5 years?”, Mittendorff et al. 2020.
28% OF SURVEYED PATIENTS DON’T PLAN TO USE TELEMEDICINE AT ALL IN THE NEXT 5 YEARS
A LARGE GROUP OF PATIENTS, HOWEVER, DON’T EXPECT TELEMEDICINE TO RISE
31
44%
23%
19%
28%
expect to see my
current doctors
more via
telemedicine visits
expect to see new
doctors via
telemedicine visits
expect to see all
doctors less in
person or via
telemedicine visits
do not plan to use
telemedicine at all
over the next 5
years
n = 2,015, “Which statements represent your potential use of telemedicine in the next 5 years?”, Mittendorff et al. 2020.
NEARLY ALL WORK IN A PRIMARY CARE OR MULTISPECIALTY CLINIC BUT SOME ALSO ATTEND AT A HOSPITAL
THE PHYSICIAN SAMPLE IS DIVERSE IN GEOGRAPHY, PRACTICE SETTING AND TYPE
46%
47%
7%
Urban / City
Suburban
Rural
2%
2%
3%
6%
7%
14%
16%
18%
23%
23%
25%
Urgent care
Cash Only Practice
Concierge Practice or Executive…
Hospital (hospitalist) 0 - 250 beds
Accountable Care Organization
Primary care clinic with 11-50…
Hospital (hospitalist) 500+ beds
Hospital (hospitalist) 251-500 beds
Multispecialty clinic (IM/FM+ other…
Primary care clinic with 1-2…
Primary care clinic with 3-10…
Physician survey n=201, “Please choose the practice environment(s) that best describes where you currently practice (check all that apply):”, “What
type of community do you practice in currently?” Mittendorff et al. 2020.
COVID-19 PANDEMIC IS A STRONG CATALYST (WITH REIMBURSEMENT AND REGULATORY PATH) FOR SHIFT TO 10-20% TELEMEDICINE
A RAPID SHIFT TO A NEW SETPOINT FOR TELEMED: FROM 0% PRE TO 20% POST
76%
18%
1% 1% 0% 1% 1% 1%
3%
28%
21%
14%
11%
9% 8%
4%
8%
43%
23%
12%
8%
3% 2% 1%
None 10% (1/10th) 25% (1/4th) 33% (1/3rd) 50% (1/2) 66% (2/3rd) 75% (3/4th) 100% (all)
Pre Covid
COVID
Post COVID
Physician survey n=201, compilation of 3 questions: (1) Prior to COVID-19, (2) During COVID-19 Pandemic, (3) After COVID-19 ‘return to normal’: “What
percentage of appointments [did/do/will] you perform virtually or via telemedicine (estimate and choose closest percentage)?”, Mittendorff et al. 2020.
38% AGREED WITH: “I AM GENERALLY COMFORTABLE MANAGING PATIENTS WITH MOST OF THESE CONDITIONS VIRTUALLY”,
BUT A SIGNIFICANT MINORITY OF PHYSICIANS AREN’T COMFORTABLE TREATING VIRTUALLY A NUMBER OF THESE CONDITIONS
38% OF PHYSICIANS ARE GENERALLY COMFORTABLE TREATING MOST VIA TELEMED
Physician survey n=201, “What types of conditions and visits do you not feel comfortable managing with virtual visits or telemedicine in your
practice?”, Mittendorff et al. 2020.
3%
9%
9%
10%
10%
10%
11%
11%
12%
13%
14%
15%
16%
16%
17%
18%
20%
38%
Others
Autoimmune diseases (SLE, RA)
Impotence
I am generally comfortable managing patients with most…
Infertility
Pediatric (< 18 year old) patients
Hair Loss
Common chronic disease (diabetes, hypertension,…
Dermatologic conditions
Gastro Intestinal
Gynecologic
Urgent care
Infectious Disease
Cancer
COPD and Asthma
Annual physical examinations
Coronary Artery Disease and Congestive Heart Failure
I am generally comfortable managing virtually patients…
18% of physicians
Are NOT comfortable
Performing
Annual Physical Exams
Virtually
VERY FEW [1%] PHYSICIANS BELIEVE FELLOWSHIP TRAINING IS NEEEDED, WHILE SOME [35%] BELIEVE “IN PRACTICE” TRAINING WORKS
MOST [64%] OF PHYSICIANS BELIEVE TELEMED REQUIRES IN RESIDENCY TRAINING
Physician survey (n = 72 initial results), “Do you believe medical schools or medical residencies should incorporate specific modules or clinic time for the
teaching of how to practice medicine in a virtual care model?”, Mittendorff et al. 2020.
64%
35%
1%
YES, VIRTUAL CARE IS A NEW MODALITY
THAT REQUIRES IN-RESIDENCY TRAINING
NO, VIRTUAL CARE SKILLS CAN BE
ACQUIRED POST TRAINING (IN PRACTICE)
YES, VIRTUAL CARE REQUIRES FOCUSED
FELLOWSHIP TRAINING (AFTER
RESIDENCY)
THE FUTURE OF TELEMEDICINE AND PRIMARY CARE
THE MODALITY WILL REQUIRE CHANGES TO TRAINING, CARE PATHWAYS, CONDITION MANAGEMENT AND TECHNOLOGY
PATIENTS (CONSUMERS)
• PATIENTS GENERALLY TRUST TELEMEDICINE PHYSICIANS AS THEY DO THEIR CURRENT PCP
• PATIENTS EXPECT TO SEE INCREASES IN TELEMEDICINE VISITS WITH EXISTING AND NEW DOCTORS
• MANY PATIENTS MAY OPT TO SEE A “TELEMEDICINE FIRST” PRIMARY CARE PHYSICIAN
• PATIENTS EXPECT TELEMEDICINE TO BE LESS EXPENSIVE BUT DOCTORS EXPECT PARITY
• PATIENTS ARE CONCERNED ABOUT THE LACK OF PHYSICAL EXAM AND NEW DIAGNOSES
PHYSICIANS
• PHYSICIANS HAVE MOVED TO ~25% OR MORE VISITS VIA TELEMEDICINE, WHICH MAY REMAIN
• PHYSICIANS ARE CONCERNED WITH A “VIRTUAL FIRST” NEW PATIENT INTAKE
• PHYSICIANS EXPECT REIMBURSEMENT PARITY, BETTER TECH & EMR FLOW
• PHYSICIANS EXPECT MORE STRUCTURED “WITHIN” RESIDENCY TRAINING
• ALLIED HEALTH PROFESSIONALS (NP/PA) HAVE A KEY ROLE
R. Mittendorff et al. 2020
1 6 F E B R U A R Y
2 0 2 1
R O B E R T M I T T E N D O R F F M D M B A

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Telemedicine and the Transformation of Primary Care 2020/2021

  • 1. 1 6 F E B R U A R Y 2 0 2 1 RO B ERT M I T T ENDO RFF MD MBA
  • 2. 1 6 F E B R U A R Y 2 0 2 1 P A R T N E R A N D C O - H E A D , H E A L T H C A R E N O R W E S T V E N T U R E P A R T N E R S E M E R G E N C Y P H Y S I C I A N I L E A D H E A LT H C A R E I N V E S T M E N T S I N C AT E G O R Y D E F I N I N G C O M P A N I E S L E D B Y E X C E P T I O N A L L E A D E R S H I P T E A M S R E L A T E D I N V E S T M E N T S ( M Y C O N F L I C T S ) : O M A D A H E A L T H T A L K S P A C E Q V E N T U S T I G E R C O N N E C T H E A L T H C A T A L Y S T V I S I T P A Y C R O S S O V E R H E A L T H ( F M R )
  • 3.
  • 4. THE FUTURE OF TELEMEDICINE AND PRIMARY CARE THE MODALITY WILL REQUIRE CHANGES TO TRAINING, CARE PATHWAYS, CONDITION MANAGEMENT AND TECHNOLOGY PATIENTS (CONSUMERS) • PATIENTS GENERALLY TRUST TELEMEDICINE PHYSICIANS AS THEY DO THEIR CURRENT PCP • PATIENTS EXPECT TO SEE INCREASES IN TELEMEDICINE VISITS WITH EXISTING AND NEW DOCTORS • MANY PATIENTS MAY OPT TO SEE A “TELEMEDICINE FIRST” PRIMARY CARE PHYSICIAN • PATIENTS EXPECT TELEMEDICINE TO BE LESS EXPENSIVE BUT DOCTORS EXPECT PARITY • PATIENTS ARE CONCERNED ABOUT THE LACK OF PHYSICAL EXAM AND NEW DIAGNOSES PHYSICIANS • PHYSICIANS HAVE MOVED TO ~25% OR MORE VISITS VIA TELEMEDICINE, WHICH MAY REMAIN • PHYSICIANS ARE CONCERNED WITH A “VIRTUAL FIRST” NEW PATIENT INTAKE • PHYSICIANS EXPECT REIMBURSEMENT PARITY, BETTER TECH & EMR FLOW • PHYSICIANS EXPECT MORE STRUCTURED “WITHIN” RESIDENCY TRAINING • ALLIED HEALTH PROFESSIONALS (NP/PA) HAVE A KEY ROLE R. Mittendorff et al. 2020
  • 5. THE PANDEMIC DROVE DOCTOR VISIT VOLUME DOWN 10-30% PEDIATRICS, PULMONOLOGY AND BEHAVIORAL HEALTH DROPPED RAPIDLY; AT THE SAME TIME, TELEMEDICINE ROSE RAPIDLY Source: The Commonwealth Fund, Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Practices Are Adapting to the New Normal, 2020.
  • 6. THE PANDEMIC DROVE TELEMEDICINE VISITS; A NEW SET POINT IS LIKELY: 10%? A NEW BASELINE BETWEEN IN PERSON AND TELEMEDICINE WILL TRANSFORM HOW CARE IS PERFORMED Source: The Commonwealth Fund, Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Practices Are Adapting to the New Normal, 2020.
  • 7. TELEMEDICINE PUBLICATIONS ARE ACCELERATING AS A RESULT OF COVID-19 COVID-19 IS A PROVING GROUND FOR VIRTUAL CARE; 5 – 10 YEARS OF EXPERIENCE COMPRESSED INTO ONE 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020FC Primary Care Urgent Care Endocrine Dermatology Rheumatology Oncology Allergy Behavioral Health Publications per year Mittendorff, et al. analysis of PubMed publications with specific terms related to telehealth and telemedicine, 2020YTD.
  • 8. COVID-19 IS THE CATALYST: RAPID INCORPORATION OF NEW CARE MODELS Virtual Care Connected Care Summoned Care CONSTRAINTS DRIVE INNOVATION TO OPTIMIZE TO NEW ENVIRONMENT: $20B -> $95B Source: Teladoc, Livongo, and Dispatch Health documents, logos (top to bottom), 10K, S-1, other public corporate documents, Piper Jaffray report ($20B -> $95B) IPO Year 2020 2019 2015 Revenue at IPO (annualized) $298M $128M $66M Gross Margin 45% 66% 68% Footprint 80M lives 5.6M total visits (2.9M visits through 6/2020) 36,000 employers > 5,000 providers 679 clients >164,000 members 11M members 300,000 visits >1,600 employers >1,100 providers Market Cap $6.6B $13.8B $17.6B
  • 9. TRANSFORMATIONS ARE DRIVEN BY KEY INPUTS AND TELEMEDICINE IS HERE THERE IS A NEW ‘SET POINT’ BEING CREATED FOR TELEMEDICINE VISITS Necessity is the Mother of Invention: Consumers Want it The Tech is Available & Payment and Regulations Work The Catalyzing Event Presented Itself: COVID-19 Trust in Physicians Is Required and Present
  • 10. TELEMEDICINE IS LAPAROSCOPY FOR INTERNISTS: NEW TRAINING NEEDED TELEMEDICINE IS A MODALITY REQUIRING NEW TECHNIQUES, ENHANCED CARE PATHWAYS, AND EVIDENCE OF UTILITY AND BENEFIT 1805 BOZZINI Cystoscope By Candlelight 1901 KELLING A Scope in A Dog Belly 1929 KALK The Father Of the Modern Laparoscope 1971 LEVINSON Lap Tubal Ligation (1% of tot) 1981 SEMM Lap Append- ectomy THE TAKEOFF 1989-1992 BAN (DE) 1956-1961 …A 200 YEAR (OVERNIGHT) TRANSFORMATION…
  • 11.
  • 12. SURVEY INCLUDED 2,015 INDIVIDUALS NATIONALLY; 52% HAVE INCOME BELOW $50K A YEAR OUR SURVEY INCLUDED A BROAD VARIETY OF AGES WITH 25% ABOVE 60 25% 9% 10% 7% 8% 7% 9% 25% 25 to 30 31 to 35 36 to 40 41 to 45 46 to 50 51 to 55 56 to 60 Over 60 Age n =2,015, “What is your age?”, Mittendorff et al. 2020. 52% 36% 11% 2% <$50,000 $50,000 - $100,000 $100,001 - $200,000 >$200,000
  • 13. SURVEY INCLUDED 2,015 INDIVIDUALS NATIONALLY; 52% HAVE INCOME BELOW $50K A YEAR OUR SURVEY INCLUDED A BROAD VARIETY OF AGES WITH 25% ABOVE 60 25% 9% 10% 7% 8% 7% 9% 25% 25 to 30 31 to 35 36 to 40 41 to 45 46 to 50 51 to 55 56 to 60 Over 60 Age n =2,015, “What is your age?”, Mittendorff et al. 2020. 52% 36% 11% 2% <$50,000 $50,000 - $100,000 $100,001 - $200,000 >$200,000
  • 14. MEDICARE PATIENTS ARE 28% OF THE SAMPLE MOST OF CONSUMERS SURVEYED OBTAIN INSURANCE THROUGH THEIR EMPLOYER 35% 18% 27% 10% 8% Employer Medicaid Medicare Individual Don't Have Insurance Not Sure Q6, n = 2,015, ‘Where do you obtain your health insurance?’, Mittendorff et al. 2020.
  • 15. THE SAMPLE ALSO INCLUDES A SIGNIFICANT NUMBER [38%] OF CONSUMERS WITHOUT KNOWN COMMON CHRONIC CONDITIONS OUR SAMPLE INCLUDES PATIENTS WITH TYPICAL CHRONIC CONDITIONS Q7, n = 2,015, “What medical conditions (if any) do you have?”, Mittendorff et al. 2020. 38% 2% 3% 3% 3% 5% 5% 6% 6% 7% 7% 14% 20% 22% 24% No diagnosed conditions (above) Kidney Disease Cancer Musculoskeletal Gynecologic Conditions Auto-Immune Disease Cardiac Disease Others Dermatologic Conditions Gastrointestinal Conditions Pulmonary Diseases Diabetes High Cholesterol Hypertension Mental Health
  • 16. THE SAMPLE ALSO INCLUDES A SIGNIFICANT NUMBER [38%] OF CONSUMERS WITHOUT KNOWN COMMON CHRONIC CONDITIONS OUR SAMPLE INCLUDES PATIENTS WITH TYPICAL CHRONIC CONDITIONS Q7, n = 2,015, “What medical conditions (if any) do you have?”, Mittendorff et al. 2020. 38% 2% 3% 3% 3% 5% 5% 6% 6% 7% 7% 14% 20% 22% 24% No diagnosed conditions (above) Kidney Disease Cancer Musculoskeletal Gynecologic Conditions Auto-Immune Disease Cardiac Disease Others Dermatologic Conditions Gastrointestinal Conditions Pulmonary Diseases Diabetes High Cholesterol Hypertension Mental Health
  • 17. 31% 36% 23% 8% 2% None 1 - 2 3 - 5 6 - 10 10+ 43% 21% 17% 19% Yes for > 5 yrs Yes for 2-5 yrs Yes for < 2 yrs No, I don't have a PCP [TOP] n = 2,015, “Did you have a regular primary care physician prior to COVID-19 in February 2020? “, Mittendorff et al. 2020. [BOTTOM] n = 2,015, “How many, if any, medications do you take on a daily basis (excluding vitamins and natural supplements)?”, Mittendorff et al. 2020. THE CONSUMER SAMPLE INCLUDED 31% WHO DON’T TAKE DAILY MEDICATIONS, WHILE 69% TAKE A MEDICATION OR MORE PER DAY 43% OF OUR CONSUMERS HAVE A PCP FOR 5 YEARS AND 19% DON’T HAVE A PCP
  • 18. 31% 36% 23% 8% 2% None 1 - 2 3 - 5 6 - 10 10+ 43% 21% 17% 19% Yes for > 5 yrs Yes for 2-5 yrs Yes for < 2 yrs No, I don't have a PCP [TOP] n = 2,015, “Did you have a regular primary care physician prior to COVID-19 in February 2020? “, Mittendorff et al. 2020. [BOTTOM] n = 2,015, “How many, if any, medications do you take on a daily basis (excluding vitamins and natural supplements)?”, Mittendorff et al. 2020. THE CONSUMER SAMPLE INCLUDED 31% WHO DON’T TAKE DAILY MEDICATIONS, WHILE 69% TAKE A MEDICATION OR MORE PER DAY 43% OF OUR CONSUMERS HAVE A PCP FOR 5 YEARS AND 19% DON’T HAVE A PCP
  • 19. 18% OF CONSUMERS SEE A DOCTOR MORE THAN 6 TIMES A YEAR CONSUMERS TYPICALLY SEE A PHYSICIAN 1-3 TIMES EACH YEAR 13% 38% 31% 11% 7% None 1 or 2 3 - 5 6 - 10 More than 10 Q7, n = 2,015, “How many times did you and your dependents interact with a doctor in the last 12 months (include all in person visits, telemedicine visits, hospitalizations, surgeries)?”, Mittendorff et al. 2020.
  • 20. 64% OF CONSUMERS WOULD BE COMFORTABLE USING TELEMEDICINE FOR URGENT CARE IF THEIR PCP IS UNAVAILABLE CONSUMERS DEMONSTRATE SIGNIFICANT INTEREST IN URGENT TELEMEDICINE n = 1,630 of 2,015, “For an urgent or emergent visit, where your regular PCP is unavailable would you be comfortable using telemedicine with an unknown licensed physician?” Mittendorff et al. 2020. 73% 27% Yes No
  • 21. 24% OF CONSUMERS ARE COMFORTABLE REPLACING THEIR IN PERSON PCP WITH A TELEMEDICINE PHYSICIAN AND SERVICE CONSUMERS SHOW INTEREST IN REPLACING THEIR PCP WITH TELEMEDICINE 24% 37% 38% Yes Maybe No It depends n = 1,630 of 2,015, “Would you be comfortable replacing your regular in person primary care physician with a telemedicine physician and service that keeps a record of all of your medical documentation?”, Mittendorff et al. 2020.
  • 22. CONSUMERS SHOW SUPPORT TO TRANSLATE A LARGE PERCENTAGE OF IN PERSON VISIT TO TELEMEDICINE VISITS 63% OF CONSUMERS BELIEVE THAT 1/4 OR MORE VISITS COULD BE TELEMED 37% 30% 21% 12% Less 25% 26% - 50% 51% - 75% Over 75% n = 385 of 2,015, “What percentage of your visits with your primary care physicians do you believe could be accomplished with telemedicine ”, Mittendorff et al. 2020. 37% 63% Less Than 25% of Visits 26-100% of Visits
  • 23. CONVENIENCE, COST, EASIER LOGISTICS AND REDUCED TRAVEL TIME ARE ALL TOP ADVANTAGES PATIENTS SEE SIGNIFICANT ADVANTAGES TO TELEMEDICINE 11% 1% 5% 6% 7% 9% 9% 12% 20% 20% 32% 34% 36% 36% 54% No benefits to telemedicine Other benefits Better integrated care Centralized data Higher quality doctors or providers More responsive provider Ability to upload images or other documentation Ability to communicate via text Help to decide whether to see provider in person Easier to get prescriptions Faster appointment booking Easier to manage with schedule Reduced travel logistics Possible lower cost More convenient n = 2,015, “What are the advantages of telemedicine for you?”, Mittendorff et al. 2020.
  • 24. 10% ATTESTED TO NO BENEFIT TO TELEMEDICINE A SMALL PERCENTAGE OF PATIENTS SEE NO BENEFIT TO TELEMEDICINE n = 2,015, “What are the advantages of telemedicine for you?”, Mittendorff et al. 2020. 11% 1% 5% 6% 7% 9% 9% 12% 20% 20% 32% 34% 36% 36% 54% No benefits to telemedicine Other benefits Better integrated care Centralized data Higher quality doctors or providers More responsive provider Ability to upload images or other documentation Ability to communicate via text Help to decide whether to see provider in person Easier to get prescriptions Easier to manage with schedule Faster appointment booking Reduced travel logistics Possible lower cost More convenient
  • 25. PATIENTS ALSO EXPRESS CONCERNS THAT COULD LEAD TO EROSION OF TRUST TELEMEDICINE DISADVANTAGES CENTER AROUND LACK OF EXAM OR PROCEDURES 1% 7% 8% 9% 13% 18% 20% 24% 24% 38% 38% 42% 46% Others Not reimbursed No disadvantages to telemedicine Trust was impaired Perception of lower quality providers Technology didn't work well Couldn't get the care that I need No prior in person physician / patient relationship Higher risk since doctor not physically present No ability to collect labs at home Fear of doctor missing something Less comprehensive because no physical exam is possible Doctor unable to do procedures (e.g. injections, vaccines, etc.) n = 2,015, “What are disadvantages of telemedicine for you?”, Mittendorff et al. 2020.
  • 26. TELEMEDICAL PRACTICE WILL NEED TO ADAPT TO CONCERNS AROUND QUALITY AND PERCEPTION OF TRUST QUALITY AND TRUST WERE CONCERNS FOR A MINORITY OF THOSE SURVEYED n = 2,015, “What are disadvantages of telemedicine for you?”, Mittendorff et al. 2020. 1% 7% 8% 9% 13% 18% 20% 24% 24% 38% 38% 42% 46% Others Not reimbursed No disadvantages to telemedicine Trust was impaired Perception of lower quality providers Technology didn't work well Couldn't get the care that I need No prior in person physician / patient relationship Higher risk since doctor not physically present No ability to collect labs at home Fear of doctor missing something Less comprehensive because no physical exam is possible Doctor unable to do procedures (e.g. injections, vaccines, etc.)
  • 27. DISEASE MONITORING, REFERRALS, PRESCRIPTION MODIFICATIONS AND ADDITIONS ARE ALL REASONABLE OUTCOMES PATIENTS ARE COMFORTABLE WITH A NUMBER OF VISIT OUTCOMES 12% 24% 47% 49% 49% 51% 55% None of the above Diagnose a new condition Refer to an imaging center, lab test, or other diagnostic setting Prescribe a new prescription Modify an existing prescription Refer to an in person provider or specialist Monitor an existing condition n = 2,015, “Which of the following would you trust a new telemedicine provider to do?”, Mittendorff et al. 2020.
  • 28. THE TELEMEDICAL MODALITY MAY HAVE LIMITATIONS WITH NEW PATIENTS OR PATIENTS WITH NEW CONDITIONS SIGNIFICANT CONCERNS EXIST IN USING TELEMEDICINE FOR NOVEL DIAGNOSES 12% 24% 47% 49% 49% 51% 55% None of the above Diagnose a new condition Refer to an imaging center, lab test, or other diagnostic setting Prescribe a new prescription Modify an existing prescription Refer to an in person provider or specialist Monitor an existing condition n = 2,015, “Which of the following would you trust a new telemedicine provider to do?”, Mittendorff et al. 2020.
  • 29. THERE WERE NO DIFFERENCES IN THE LEVEL OF TRUST CONSUMERS PLACED IN THEIR PCP AND HEALTH SYSTEM, AND TELEMEDICINE TRUST IS AN IMPERATIVE: BUT CONSUMERS TRUST TELEMEDICINE LIKE THEIR PCP 1% 1% 2% 2% 8% 8% 16% 22% 16% 24% 1% 1% 0.9% 3% 10% 13% 22% 18% 11% 20% 1 - I have little to no trust in them 2 3 4 5 6 7 8 9 10 - I have a great deal of trust in them Your PCP and Health System Telemedicine Providers [Black] n = 2,015, “How much do you trust the doctors at your local hospital/health system/regular primary care physician?” [Gray] n = 655, “How would you describe how much you trust the doctors through a telemedicine service offered by your employer or health plan?”, Mittendorff et al. 2020.
  • 30. THEY EXPECT TO SEE THEIR CURRENT AND NEW DOCTORS MORE VIA THE MODALITY MOST PATIENTS EXPECT TO SEE DOCTORS MORE VIA TELEMEDICINE VISITS 30 44% 23% 19% 28% expect to see my current doctors more via telemedicine visits expect to see new doctors via telemedicine visits expect to see all doctors less in person or via telemedicine visits do not plan to use telemedicine at all over the next 5 years n = 2,015, “Which statements represent your potential use of telemedicine in the next 5 years?”, Mittendorff et al. 2020.
  • 31. 28% OF SURVEYED PATIENTS DON’T PLAN TO USE TELEMEDICINE AT ALL IN THE NEXT 5 YEARS A LARGE GROUP OF PATIENTS, HOWEVER, DON’T EXPECT TELEMEDICINE TO RISE 31 44% 23% 19% 28% expect to see my current doctors more via telemedicine visits expect to see new doctors via telemedicine visits expect to see all doctors less in person or via telemedicine visits do not plan to use telemedicine at all over the next 5 years n = 2,015, “Which statements represent your potential use of telemedicine in the next 5 years?”, Mittendorff et al. 2020.
  • 32.
  • 33. NEARLY ALL WORK IN A PRIMARY CARE OR MULTISPECIALTY CLINIC BUT SOME ALSO ATTEND AT A HOSPITAL THE PHYSICIAN SAMPLE IS DIVERSE IN GEOGRAPHY, PRACTICE SETTING AND TYPE 46% 47% 7% Urban / City Suburban Rural 2% 2% 3% 6% 7% 14% 16% 18% 23% 23% 25% Urgent care Cash Only Practice Concierge Practice or Executive… Hospital (hospitalist) 0 - 250 beds Accountable Care Organization Primary care clinic with 11-50… Hospital (hospitalist) 500+ beds Hospital (hospitalist) 251-500 beds Multispecialty clinic (IM/FM+ other… Primary care clinic with 1-2… Primary care clinic with 3-10… Physician survey n=201, “Please choose the practice environment(s) that best describes where you currently practice (check all that apply):”, “What type of community do you practice in currently?” Mittendorff et al. 2020.
  • 34. COVID-19 PANDEMIC IS A STRONG CATALYST (WITH REIMBURSEMENT AND REGULATORY PATH) FOR SHIFT TO 10-20% TELEMEDICINE A RAPID SHIFT TO A NEW SETPOINT FOR TELEMED: FROM 0% PRE TO 20% POST 76% 18% 1% 1% 0% 1% 1% 1% 3% 28% 21% 14% 11% 9% 8% 4% 8% 43% 23% 12% 8% 3% 2% 1% None 10% (1/10th) 25% (1/4th) 33% (1/3rd) 50% (1/2) 66% (2/3rd) 75% (3/4th) 100% (all) Pre Covid COVID Post COVID Physician survey n=201, compilation of 3 questions: (1) Prior to COVID-19, (2) During COVID-19 Pandemic, (3) After COVID-19 ‘return to normal’: “What percentage of appointments [did/do/will] you perform virtually or via telemedicine (estimate and choose closest percentage)?”, Mittendorff et al. 2020.
  • 35. 38% AGREED WITH: “I AM GENERALLY COMFORTABLE MANAGING PATIENTS WITH MOST OF THESE CONDITIONS VIRTUALLY”, BUT A SIGNIFICANT MINORITY OF PHYSICIANS AREN’T COMFORTABLE TREATING VIRTUALLY A NUMBER OF THESE CONDITIONS 38% OF PHYSICIANS ARE GENERALLY COMFORTABLE TREATING MOST VIA TELEMED Physician survey n=201, “What types of conditions and visits do you not feel comfortable managing with virtual visits or telemedicine in your practice?”, Mittendorff et al. 2020. 3% 9% 9% 10% 10% 10% 11% 11% 12% 13% 14% 15% 16% 16% 17% 18% 20% 38% Others Autoimmune diseases (SLE, RA) Impotence I am generally comfortable managing patients with most… Infertility Pediatric (< 18 year old) patients Hair Loss Common chronic disease (diabetes, hypertension,… Dermatologic conditions Gastro Intestinal Gynecologic Urgent care Infectious Disease Cancer COPD and Asthma Annual physical examinations Coronary Artery Disease and Congestive Heart Failure I am generally comfortable managing virtually patients… 18% of physicians Are NOT comfortable Performing Annual Physical Exams Virtually
  • 36. VERY FEW [1%] PHYSICIANS BELIEVE FELLOWSHIP TRAINING IS NEEEDED, WHILE SOME [35%] BELIEVE “IN PRACTICE” TRAINING WORKS MOST [64%] OF PHYSICIANS BELIEVE TELEMED REQUIRES IN RESIDENCY TRAINING Physician survey (n = 72 initial results), “Do you believe medical schools or medical residencies should incorporate specific modules or clinic time for the teaching of how to practice medicine in a virtual care model?”, Mittendorff et al. 2020. 64% 35% 1% YES, VIRTUAL CARE IS A NEW MODALITY THAT REQUIRES IN-RESIDENCY TRAINING NO, VIRTUAL CARE SKILLS CAN BE ACQUIRED POST TRAINING (IN PRACTICE) YES, VIRTUAL CARE REQUIRES FOCUSED FELLOWSHIP TRAINING (AFTER RESIDENCY)
  • 37. THE FUTURE OF TELEMEDICINE AND PRIMARY CARE THE MODALITY WILL REQUIRE CHANGES TO TRAINING, CARE PATHWAYS, CONDITION MANAGEMENT AND TECHNOLOGY PATIENTS (CONSUMERS) • PATIENTS GENERALLY TRUST TELEMEDICINE PHYSICIANS AS THEY DO THEIR CURRENT PCP • PATIENTS EXPECT TO SEE INCREASES IN TELEMEDICINE VISITS WITH EXISTING AND NEW DOCTORS • MANY PATIENTS MAY OPT TO SEE A “TELEMEDICINE FIRST” PRIMARY CARE PHYSICIAN • PATIENTS EXPECT TELEMEDICINE TO BE LESS EXPENSIVE BUT DOCTORS EXPECT PARITY • PATIENTS ARE CONCERNED ABOUT THE LACK OF PHYSICAL EXAM AND NEW DIAGNOSES PHYSICIANS • PHYSICIANS HAVE MOVED TO ~25% OR MORE VISITS VIA TELEMEDICINE, WHICH MAY REMAIN • PHYSICIANS ARE CONCERNED WITH A “VIRTUAL FIRST” NEW PATIENT INTAKE • PHYSICIANS EXPECT REIMBURSEMENT PARITY, BETTER TECH & EMR FLOW • PHYSICIANS EXPECT MORE STRUCTURED “WITHIN” RESIDENCY TRAINING • ALLIED HEALTH PROFESSIONALS (NP/PA) HAVE A KEY ROLE R. Mittendorff et al. 2020
  • 38. 1 6 F E B R U A R Y 2 0 2 1 R O B E R T M I T T E N D O R F F M D M B A