Virtual care infrastructure was designed to fill gaps in an ecosystem where most people see their provider face to face. Its primary function is to solve patients’ acute concerns – whether that is a known desire to fill a prescription or a question on whether or not to go to the ER.
As a supplement to in-person care, the industry has stayed relatively small, catering to startups that sought to bypass the traditional healthcare system altogether by selling directly to consumers or large enterprises looking to bring urgent care/ triaging services online.
I recently wrote a bit about how we think regulatory and reimbursement changes prompted by COVID will make virtual care the standard for chronic care management and home health services, rather than a back up plan.
Now that patients are comfortable and providers can get paid for telehealth, the biggest barriers to more creative virtual care platforms are technical.
Just as in the early days of e-commerce, virtual care startups are too often forced to build what they need for themselves or piece together point solutions that aren’t designed for them. It’s a requirement that keeps a lot of great ideas from coming to market.
On the flip side, full-stack telehealth platforms like AmWell support the entire patient journey, but are designed and priced for large health enterprises. Patients go through intake, eligibility/coverage assessment, enter their medical history and conduct a visit all through the AmWell Platform. Providers can take notes and e-prescribe. For major health systems, coverage of the full care continuum plus compatibility with existing workflows (including EHR integrations) is worth paying for, enabling easy provider adoption and reimbursement.
New virtual care platforms that establish and continue their relationships with users entirely online need all these functions and more.
We see three big opportunities to lower the barriers to innovation for virtual-first healthcare founders:
Shared services: Access to services that are currently reserved for established provider groups and health systems (recruiting, staffing, lab testing, billing, etc.). Truepill is the standout here. Starting with a pharmacy fulfillment network and now lab testing, startups of almost any scale can get prescription services up and running. Staffing, credentialing and billing continue to be owned functions for many digital health startups that I would love to see low-cost, modular solutions for.
Automation: Plug-ins to automate the administrative tasks along the care continuum, including intake, eligibility, documentation, billing, referrals, etc. There are plenty of excellent solutions for ecommerce businesses that can work here – products that automate authentication, messaging, user billing, and don’t necessarily need to be rebuilt. However, the information security and documentation burdens associated with handling patient data and billing insurance are great enough that an end to end platform, which also offers compatibility with hybrid (physical and virtual) practices’ EHR and practice management systems, would make sense here.
Interoperability: As an increasing share of services shift outside of the traditional system, there is risk of creating yet another disconnected data pool. One reason we invested in Particle Health is its unique approach to building a bidirectional data network. As healthcare becomes more decentralized, providers’ immediate access to health information is critical to ensure high quality care outside of the hospital. And new types of health data are increasingly valued by stakeholders across the ecosystem to advance personalized health services, therapeutics, risk products, and more.
With the CMS interoperability rules set to hit this Fall, we anticipate more opportunities for data products that create seamless access and usability of the vast array of health data that is coming online and unlocked (e.g., PHI, claims, provider directories, etc.).
If you’re working on making it easier to launch virtual-first healthcare businesses, we’d love to learn from you!