MSNVA: Telemedicine Built by Doctors, for Doctors

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In Virginia, a medical society chooses a different path towards telemedicine, one which places a uniquely high priority on the value of the physician. But can their bootstrapped experiment in non-profit telemedicine survive in a crowded marketplace? 

When Claudia Tellez moved from the north side of Chicago to the north side of Virginia to become the executive director of the Medical Society of Northern Virginia (MSNVA), she had no idea where the job would take her. The move to Virginia was driven in part by the desire to be nearer to family as her own family grew, but she was also seizing an opportunity to impact healthcare access for low income families by managing the MSNVA’s charitable foundation. What Tellez didn’t know nearly eight years ago was that this position would lead her to help start a trailblazing digital health program, DoctorsTelemed, the first telemedicine platform architected by a medical society as a service for its members.

When Tellez started her job with MSNVA, she recalls, it felt more like a social organization than anything else. She sat down with her board to look at how healthcare was changing and together they crafted a 10-year roadmap aimed at making the MSNVA a more proactive, service-oriented organization. Had they a crystal ball, that roadmap would have included the creation of remote care pathways and telemedicine solutions, but that would have to come later.

The turning point happened a couple years ago when Tellez and her team began to be asked to review telemedicine contracts. Members of the MSNVA were slowly beginning to consider signing on with major telemedicine companies, such as Teladoc, American Well and MDLive. When Tellez dove into the fine print of those contracts, she was shocked at what she found.
“For us, it was appalling to see how much of the profit the big telemedicine providers were taking,” says Tellez. “We realized that a lot of the business models currently on the market are either based on taking income from the physician or are predicated on insurance reimbursement. Which we all know has been diminishing over time. We couldn’t’ turn a blind eye to this and just say that this is the way things are. There had to be another solution.”

So began a months-long search for a telemedicine platform that could be harnessed by MSNVA for the benefit of its members. What they found was CloudVisit, a telemedicine software company located in picturesque town of Beacon, New York. CloudVisit founder Daniel Gilbert, the son of a physician, appealed to Tellez and her team for his personal grasp of the modern medical practice.

“He really understands the challenges that independent practitioners face now days,” says Tellez.

Together, MSNVA and CloudVisit decided to build DoctorsTelemed, an in so doing laid down the gauntlet for medical societies everywhere.

Here’s how it works. DoctorsTelemed is a non-profit direct-to-consumer telemedicine service built for MSNVA members – who number about 1600 – and community physicians. The only telemedicine platform designed specifically by and for a medical society, DoctorsTelemed allows providers to join the platform and then offer DoctorsTelemed as a “service of convenience” to their patients.

Using the platform is similar to many other direct-to-consumer telemedicine experiences. Patients create an account, fill out a medical history questionnaire and then find a doctor. Patients have control over which provider they want to access by scheduling a consult specifically with a physician of their choice. And if your clinician isn’t a part of the program, DoctorsTelemed encourages you to ask them to join, rather than simply using another physician online.

Once they’ve found a doctor, patients go through a payment portal. DoctorsTelemed doesn’t charge a registration fee for patients, relying instead on a credit-based fee structure for revenue. Patients can purchase credits (1 credit = $55) in advance or at the time a consult is requested. Most consults cost 1 credit, but can be more depending on the nature of the consult and the specialty requested.

All consults are stored safely for later access, and doctors can gain appropriate access to the medical record. In order to measure quality, patients are sent satisfaction surveys to fill out following each consultation. The results are analyzed for trends at least four times per year.
So far, you could be forgiven for confusing this product with others on the market. The real differentiator comes on the backside of the visit – in reimbursement. DoctorsTelemed gives 95% of the income generated on the platform back to the physicians, and they’re currently charging no sign-on fee.

When asked if a 5% administrative fee was going to be sufficient and sustainable, Tellez was adamant.

“It’s totally sustainable. You can run the numbers. It’s no secret. If you do 10 visits times 10 doctors, at $55, there’s substantial income to be had,” says Tellez. “Since we don’t have shareholders, we don’t have to pay out dividends. Anything that is made is going to be reinvested in improving the product.”

The question remains whether this experiment will work in practice. DoctorsTelemed soft launched in January 2016 and then officially rolled out the program in late May. In that time they’ve garnered only 15 patient subscribers and hosted 25 live sessions. According to Tellez, the goal for participation is 100 physicians by the end of 2016, with each conducting an average of four consults per week. If they hit their goal, those 1600 patient encounters will bring in approximately $4400 per month in administrative fees. Whether they can hit these targets, and whether these numbers can sustain operations, only time can tell.

“We have a timeline,” says Tellez. “We have two years of this. We’re going to give it our best shot.”

One the biggest challenges that Tellez has faced came as a surprise: marketing. The initial plan for spreading the message focused on word of mouth – each board member was responsible for educating their peers. But Tellez quickly found that there was a startling lack of understanding among providers of telemedicine in general, and DoctorsTelemed in particular.
“When I say, like Facetime, their faces light up,” says Tellez. “Then they ask if they can use Facetime, which the answer is no.” Because of this general lack of understanding, Tellez is monitoring the organizations marketing messages closely.

“We’re finding out that that has to be a very tight partnership between the providers and us. It’s not enough for them to just sign up. We need to be proactive, pushing the solution to their patients. If this were a capital venture, they would have been ready with all of those tools and resources, but we are learning as we go. We need to help our physicians market the service. They can’t do it on their own.”

What is that marketing message? It comes down to one word: “Convenience.”
“We’ve tried several sound bites, but we’ve learned that people love the word convenience. You really have to convey the idea of convenience to people. Let’s think about the mom tied up at home with one sick child and one in the hand. When will she have time to get to the doctor? You have to spell that out for the patient. That’s a challenge we hadn’t anticipated, but it’s been a wonderful learning experience.”

Currently DoctorsTelemed is putting energy behind two marketing campaigns, including a bus shelter campaign and participation in community events.

When asked why it was advantageous for a telemedicine company to be run by a medical association, Tellez said it came down to one main concept: Trust.

“Patients trust their physicians,” says Tellez. “Physicians need to have a vehicle to maintain that trust. The differentiating factor for DoctorsTelemed is that, since we are regionally focused, if a patient wants to see their doctor in person, they can. If you sign up for Teladoc or American Well, you never know where the provider will be. You might get a doctor from a different state or region. On a related note, continuity of care is also a big deal. When our doctors sign up, they can make use of community labs and local hospitals. That’s a big differentiator. It’s not just a one-off consult.”

While sign-ups have been slow, and the team is small, MSNVA has a unique leg up as a non-profit – access to grant funding. DoctorsTelemed received a shot in the arm from a recent grant for charity care, designed to help them extend telemedicine services to patients with the greatest financial needs in Northern Virginia.  “Those little victories are really energizing our members.”

The question remains as to whether this pathway for telemedicine adoption is superior to the more market-driven, for-profit offerings in the industry. And, by extension, is the MSNVA’s lead one that other medical societies should follow? When asked this directly, Tellez responding that starting a telemedicine company wasn’t for everyone, but that most medical societies did need a change in perspective.

“I think medical societies need to change the way they’re doing business,” says Tellez. “I think they cannot be social in nature anymore. They cannot spend more than 60% of their focus on policy, because policy is in flux, and I don’t know how much impact doctors have on policy, because of the AMA’s grip in that area. If medical societies want to survive, they need to be more invested in delivering a real service. It doesn’t have to be the same model that we have, but it has to include very strong information to educate physicians to take the right path for them. How do you maximize your time as a provider? If organized medicine isn’t carrying that message I think they’re doing a disservice to their members. Sure, technology is intimidating, but they need to dive a little deeper beneath the surface and get with the program.”

ABOUT THE AUTHOR

Logan has created, edited and designed healthcare publications since 2005. After redesigning and managing Emergency Physicians Monthly, he founded Emergency Physicians International in 2010, and then launched Telemedicine Magazine in 2015 where he served as writer/editor until 2018. Logan is the co-founder of The mHealth Toolbox, a project that brings practicing physicians into the conversation about innovative medical technology. Logan also served as the Director of Communications for The IFEM Foundation, the leading non-profit supporting global emergency care development.

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