Teladoc Announces Q3 Earnings & Primary Care Plans

Teladoc recently announced its financial results for the third quarter of 2021, providing investors with an update on the company’s earnings, as well as giving insight into the future direction of its Primary360 virtual-first primary care offering.

  • Financial highlights included year-over-year revenue growth of 81% to $522m, driven by strength in its BetterHealth mental health unit, and a 37% increase in total visits as a result of steady adoption for Teladoc’s direct-to-consumer offerings.
  • Teladoc revealed on its investor call that it plans to begin taking on financial risk with its Primary360 solution in the future. The company is aiming to generate savings with its virtual-first program and will take on risk where it can have the most impact.
  • CEO Jason Gorevic said that the rollout of risk taking for Primary360 would develop in tiers, “from first clinical measures, to then risk corridors to, ultimately, full capitation.”
  • Primary360 was only recently made available to payors nationwide, but Teladoc stated that it is beginning talks with hospitals about white-labeling the service for them to use as their own digital front door.

Primary360 Strategy

Since Primary360 integrates a wide range of Teladoc products, the service generates significantly higher revenue per member than the company’s general medical and mental health solutions. 

Most health plans lack the network and provider base required to develop a nationwide virtual primary care solution in-house, but as telehealth demand rises and pressures them to begin offering the service, many are turning to options like Primary360 to meet the need.

If Teladoc can successfully meet this demand while taking on risk, it will be able to capture a larger share of any savings it generates, further improving the economics of the service.

DHW Q&A: Micro-Fulfillment & Telehealth With NowRx

With Carry Breese
NowRx, CEO and Co-Founder

At a time when consumers are wary of traveling to crowded pharmacies to pick up their medications, NowRx is taking a new approach to solving medication nonadherence: same-day prescription delivery.

In this Digital Health Wire Q&A we sat down with NowRx CEO Carry Breese to discuss the company’s micro-fulfillment strategy for prescription delivery, recent moves into telehealth, and why equity crowdfunding could be the right fundraising path for many companies.

Can you tell us about NowRx and the company’s overall strategy?

We originally began as a direct-to-consumer pharmacy offering same-day delivery on prescription medication, but as we’ve evolved we’ve begun to look at ourselves more as a digital health platform. We still provide same-day pharmacy delivery, but we also couple that with a broad telehealth platform and virtual services.

The whole key with NowRx is to be a full replacement for traditional pharmacies. To do this, we use a micro-fulfillment strategy, which involves dispensing out of our own brick-and-mortar pharmacies, which are staffed with pharmacists, technicians, and local drivers. The proprietary tech inside our micro-fulfillment centers makes them extremely efficient and keeps costs down.

The philosophy of our company is to use technology to try and fix the bottlenecks in healthcare that produce bad patient experiences.

Earlier this year NowRx moved into telehealth, what was the motivation behind that transition?

The way we built the delivery pharmacy component is probably the best way to illustrate that answer. We’ve always looked at successful approaches to the healthcare industry as needing to integrate as many components as possible to provide a full experience.

Some companies have tried to do delivery pharmacy, but they were mainly just doing delivery logistics, acting as couriers between pharmacies and patients. We felt that model doesn’t give you enough control over what’s going on inside the pharmacy, and can lead to constraints with anything from physician communication to inventory management.

To solve this problem in the best way possible, you need to own the dispensing, have your own software systems, and directly address these constraints.

The entrance into telehealth was an extension of this thinking. Oftentimes it’s not only hard to get a prescription delivered, but also to get an appointment with a physician to write the prescription in the first place. Removing those barriers is key to our mission of providing great healthcare experiences, which is what made telehealth a natural extension for us.

How has the pandemic impacted remote care and your business?

There’s been a few distinct shifts during the pandemic. In the beginning, there was definitely a surge in demand for our services, and at the same time we had to institute all kinds of new safety controls: social distancing in the pharmacies, hygiene for the cars, contactless delivery. This was a huge operational strain, but since then it’s smoothed out quite a bit.

Although there was a significant boost in awareness for new ways to get medication, as well as an increase in demand, doctors began seeing patients less frequently. Patients pulled back on routine checkups and preventative visits, so overall, the pharmacy business saw a bit of a drop off in volume.

We expect that to alleviate as the pandemic wanes, and it’s also likely that we’ll see a strong rebound for new prescriptions driven by the backlog of doctor visits that have been postponed over the past couple of years.

Why did NowRx take a non-traditional approach to crowdfunding its $72 million Series C through SeedInvest and what are the plans for the funding?

Following the heightened demand over the past couple of years, we began looking to broaden our reach without sacrificing quality of service. As NowRx expands into new territories, we first launch a micro-fulfillment location, which requires a large up-front investment. The funding helps cushion that.

We were an early adopter of equity crowdfunding, and this will be our third round through SeedInvest. It works well for NowRx because people can easily grasp the concept. Delivery pharmacy makes a lot of sense to a lot of people.

Crowdfunding allows us to continue focusing on the customer experience while retaining more control over the direction of the company, as opposed to feeling pressure from a VC to grow at all costs. On top of that, it builds brand awareness. The retail investors become engaged ambassadors, even in territories where we don’t currently operate, and they help advocate for NowRx and our mission.

How does NowRx view the competitive landscape and how does it plan to differentiate moving forward?

New entrants like Amazon, especially following the acquisition of PillPack, are cutting the delivery times for medication from around one week down to approximately two days. Our belief is that it’s essential to perfect same-day service. That’s what patients have grown accustomed to in pharmacy. That’s why there’s a pharmacy on every street corner.

Patients have been trained to leave the doctor’s office with a prescription order that they go and get filled later that same day. That’s where our offering is differentiated. The micro-fulfillment strategy allows us to provide highly responsive care, and even one hour delivery, if needed for things like pain medication and antibiotics that are time sensitive.

Consumers are pulling the market towards that same-day delivery end state. That’s why having proprietary software and quick-fill systems to eliminate causes of delay is such a differentiator for the customer experience.

How can remote care be improved and how does NowRx fit into this picture?

The key to success is focusing on improving care and health outcomes above all else. One of the things that people generally don’t think about when they hear “delivery pharmacy” is how it helps to solve the problem of people not taking their medications.

Medication nonadherence is a huge strain on the health system, and it has many different causes. A majority of the time, it’s due to one of three reasons. The first is time and inconvenience. The second is lack of transportation. The third is simply “forgetting” to pick up a prescription. NowRx addresses all three of these directly.

There are countless unnecessary hospitalizations and avoidable issues due to medication nonadherence, so that’s one of the biggest problems we’re trying to solve. There’s so much inefficiency in the healthcare system, and we’re excited about using new technology and delivery models to address it.

Best Buy Acquires Remote Care Company Current Health

Best Buy acquired care-at-home company Current Health, supporting the electronics retailer’s ongoing push into the healthcare market.

Although Best Buy is well-established as a consumer electronics store, the company has begun turning to new areas such as home fitness and healthcare to fuel growth beyond its core technology business.

  • Current Health is a care-at-home platform that combines remote patient monitoring (RPM) and patient engagement tools into a single solution aimed at addressing the infrastructure gaps that obstruct providers from delivering care in the home.
  • Best Buy is best known as an electronics retailer with over 1k stores and 100k employees throughout the US and Canada. As televisions grow more affordable and people begin holding onto their smartphones longer, Best Buy is leaning into new services to drive revenue growth. 
  • The acquisition allows Best Buy to leverage its expertise in consumer-friendly technology and supply chain logistics to streamline care delivery, building on past investments in senior care (GreatCall) and RPM (Critical Signal Technologies).

Industry Impact

At-home healthcare has seen a post-pandemic surge in adoption, allowing patients to receive treatment where they’re most comfortable while simultaneously reducing costs. This trend has accelerated the reliance on the technology that Best Buy offers, but also gives the company a new way to take advantage of its large physical reach.

Best Buy’s existing services like Geek Squad and In-Home Advisors send trained employees into customer homes to provide personalized technology solutions while gaining the hard earned trust of consumers. By expanding this trust to Current Health patients, Best Buy can deliver a high-touch customer experience at a scale difficult to achieve for most pure healthcare competitors.

Carbon Health Acquires RPM Company Alertive Healthcare

Carbon Health is extending its home-based care capabilities with the acquisition of remote patient monitoring (RPM) company Alertive Healthcare. 

The move highlights Carbon Health’s focus on having a greater impact outside of its physical clinics at a time when an increasing number of providers are adopting hybrid care models.

  • Alertive Healthcare offers a range of RPM tools and hardware for proactively managing patients across a variety of specialties (primary care, cardiology, neurology, nephrology). Alertive’s platform records patient data and sends alerts to providers to decrease the treatment time for chronic conditions.
  • Carbon Health provides an “omnichannel care” platform designed to meet patients where they are by delivering care through multiple avenues (in-person clinics, home-based care, and virtually with the Carbon Health app).
  • The acquisition allows Carbon Health to integrate Alertive Healthcare’s tools and services into its existing care delivery model. Carbon Health will provide Alertive’s connected devices and monitoring sensors to patients so that they can share vitals with providers. 

Industry Impact

Carbon Health is investing in hardware as a key pillar of its omnichannel care model. The company operates over 90 brick-and-mortar primary care clinics across 14 states, but has been expanding into new channels to meet its goal of becoming “the largest primary care provider in the US” with over 1.5k clinics by 2025. The Alertive Healthcare acquisition arrives shortly after Carbon Health bought remote glucose monitoring company Steady Health in June, which marked its first venture into home-based care.

Unlocking Value With Digital Patient Monitoring

New research from Deloitte and Harvard CBE highlights the value of digital patient monitoring, which provides benefits not only to patients, but also to healthcare systems, hospitals, and governments.

Digital health monitoring covers a wide class of technologies that enable patient follow-ups outside of conventional care settings, including remote care platforms, mHealth apps, and wearable devices.

A whitepaper of the findings released through MSD Connect details the value as it relates to each stakeholder group:

Patients

  • Increased level of health information exchange and patient engagement
  • Improved medication compliance and disease management
  • Improved health outcomes, safety, and quality of care

Healthcare Systems

  • Optimization of HCPs workflow due to reduced no-shows and administrative burden
  • Improved informed decision-making strengthened by longitudinal patient data
  • More personalized care delivery based on real-world data and evidence

Hospitals

  • Reduced hospital (re)admissions, follow-up visits, and length of stay
  • Improved efficiency leading to increased hospital capacity and reduced costs
  • Diminished risk of employee burn-out

Governments

  • Increased value of healthcare services offered through better budgeting
  • Improved population health by better allocation of health resources
  • Improved accessibility and equity of care

The Takeaway

The thread connecting the benefits across all stakeholder groups is clear: better data leads to better outcomes. Digital patient monitoring gives all parties a clearer view of individual healthcare journeys, which in turn leads to more efficient systems built on top of this data and improved health for the entire population.

The Proof is in the Patients, Trinity Health RPM

A recent article from HealthcareITNews explored the benefits of remote patient monitoring programs (RPM) by highlighting the success of Trinity Health’s recently deployed system.

In 2017, Trinity Health was feeling the weight of its scale, with a 16% readmission rate for its high-risk Medicare population across 94 hospitals in 24 states. The health system was beginning its transition to a value-based care model and seeking to improve patient outcomes and reduce costs by lowering its readmission rate to single digits.

To accomplish this, Trinity Health created a plan to avoid preventable hospitalizations through a dual-approach RPM program:

  • Home Care Connect – For skilled home care patients that require persistent attention, Home Care Connect utilized Vivify Health’s connected care platform to offer chronic-condition pathways and a home care kit that addresses diagnosis-specific needs. Patients were provided an LTE-equipped tablet and monitoring devices including a pulse oximeter and blood pressure cuff.
  • Virtual Care Center – Patients who did not meet skilled home care eligibility were given access to Trinity Health’s Virtual Care Center, which connects patients to remote care services through an online portal.

Results

Following the RPM program’s month-long pilot with 55 patients, only a single patient was readmitted to the hospital, giving Trinity Health the confidence to expand the program nationally. Over the next year, readmissions dropped from 16% to 6%, leading to not only lower costs, but also to an increase in CMS incentives.

Trinity Health attributes the success of its RPM program to its user-friendly interface and a strong educational component, driven by the tablet’s ability to provide voice instructions and answer condition-specific questions.

For the Home Care Connect program, the proof is in the patients, with compliance and satisfaction numbers remaining high at 85% and 96%, respectively.

Remote Care Investment is Climbing

According to a Current Health survey of 250 health system decision makers, 81% expect their organizations to increase investment in remote care technology over the next year.

While home care was once a nice-to-have option for forward thinking providers, it is now a necessity for those looking to effectively care for high risk patients amid the ongoing pandemic.

Many health systems have already begun to adopt new remote care technologies, with 89% of respondents expanding its use over the past year, but the study suggests that care-at-home programs have more room to grow.

  • Investment Areas: Respondents indicated that they plan to increase investments in three main categories: home-based chronic care (64%), hospital at home (60%), and transitional care (58%). When asked about the key benefits of remote care in these areas, answers included reduced hospital admissions (69%), and improved patient (63%) and provider (62%) satisfaction.
  • Barriers to Success: According to those surveyed, the key barriers to remote care’s success are patient and provider engagement, workflow integrations, and operational concerns. Additionally, over 50% of respondents reported patient adoption and adherence as a challenge they’ve faced with care-at-home.

The Takeaway

As healthcare organizations transition from small remote care pilots to enterprise-wide strategies, new investments are addressing the long-term challenges of scaling to care for more patients with limited clinical staff. The technologies that are likely to find the most success are those that keep sight of patient engagement barriers without adding complicated workflows for providers.

Mayo Clinic Finds Success With Remote Patient Monitoring

Mayo Clinic recently published a new study of its remote patient monitoring (RPM) program for ambulatory care of COVID-19 patients (n = 7,074), aimed at reducing acute care utilization and hospital admissions.

The program included two care-delivery models based on patient risk, enabling RPM-registered nurses to respond to technology-generated alerts and deliver standardized care for clinical assessments and patient management.

Low-Intensity Care Model (n = 2,314)

  • Patient had no risk factors for severe illness and low symptom burden
  • Mayo provided thermometer and pulse oximeter
  • Patient reported symptoms twice daily
  • 1:50 nurse to patient ratio

High-Intensity Care Model (n = 4,760)

  • Patient had 1+ risk factors for severe illness and moderate-to-high symptom burden
  • Mayo provided LTE-enabled tablet, thermometer, pulse oximeter, blood pressure monitor
  • Patient reported symptoms twice daily
  • 1:30 nurse to patient ratio

Results

Among all patients, ED visit and hospitalization rates within 30 days of enrollment were 11.4% (low-intensity) and 9.4% (high intensity), with a 30 day mortality rate of 0.4%. The RPM engagement rate was above-average at 78.9%, supporting recent changes to the CMS physician fee schedule to expand reimbursement for RPM services to patients with acute conditions.

The Takeaway

The study suggests that RPM for management of COVID-19 is associated with “excellent clinical outcomes,” especially among patients at risk for severe illness. 

Given that Mayo Clinic’s RPM program was part of a retrospective cohort study, it remains unknown how the results compare with “usual care,” but a matched case-control study is planned to evaluate the program.

Less Hospitals, More Homes

Current Health, who raised a $43m Series B in April to expand it’s remote care management platform, has now done just that. 

Newly announced partnerships with Workpath (a Ro company) and ScriptDrop enable Current Health’s service to begin offering both in-home blood draws as well as medication delivery.

  • Workpath – Current Health’s clinical dashboard now allows physicians to determine what blood tests are needed for remote patients before using Workpath’s integrated tool to dispatch a certified phlebotomist. 
  • ScriptDrop – Physicians can now access ScriptDrop’s on-demand and same-day prescription delivery tool within Current Health’s platform, a feature that could improve patient adherence to needed medications.
  • Benefits – The fully-integrated remote care platform greatly simplifies physician workflows when ordering in-home tests or medications, with the added benefit of further reducing the need for patients to visit a lab or pharmacy.

The Takeaway

Current Health’s latest partnerships are centered around improving access for patients and finding efficiencies for physicians. The company is aiming to build a world where doctors can develop a diagnosis and provide a treatment without ever having a face-to-face interaction with a patient, and this latest expansion gets them at least two steps closer to reaching that goal.

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