The Race to Zero

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“Merry Christmas” – that was the first SMS message ever sent, back in 1984. Twenty-one years later, trillions of text messages whip around wireless networks all over the world. SMS’s rise in popularity foreshadows telemedicine’s evolution from traditional video/phone-based encounters into asynchronous and technology-assisted virtual care. Along the way, the effective transactional virtual care costs will trend towards $0 – which is beautifully aligned with value-based care models that reward outcomes over encounters. This transition forward requires fresh thinking about who pays for virtual care. To spur this process along, I’ve mashed up non-healthcare models to see how we might unchain telemedicine from old-school PEPM + per visit fees.

Jon Pearce
CEO, Zipnosis


Bundled Virtual Care Plans:
Analog: Wireless data plan: Individual or Family.
Description: In this model, patients can purchase a large block of interactions for a fixed price. The effective transaction price is technically not $0, but, like text messages or data usage, it trends towards that over time. Pricing is based on anticipated utilization across broad swaths of medical risk.
example: An employer purchases a lipid management bundled payment plan. The bundled service includes 1-2 in person visits and unlimited virtual care encounters through the year.


Streaming Seasons of Care:
Analogs: Netflix, AppleTV, Hulu, Amazon
Description: Instead of buying the entire season of Top Gear BBC, patients buy a “Season of Care” for a disease or care pathway. Individuals can build their own care networks on the fly by choosing from a menu of Seasons of Care. They get unlimited access via virtual visits through the season, but the “content” or access channels are titrated out based on the appropriate care protocols. In this way the tools (e.g. video/phone/asynchronous) are free but patients pay for content pushed by providers.

Example: Jim, who was recently diagnosed with Type 2 Diabetes, purchases “Season 1 of Living with Diabetes” from Mayo Clinic. Each week he gets a new virtual care plan and access points across his devices. It might include scheduling a virtual visit to review his diet compliance and speak with a care coordinator about any open questions on his glucometer.


Hardware Unlocks Content:
Analogs: Television, radio
Description: With a proliferation of wearable technology, remote devices and other health-enabled hardware, it is possible to use these to cover basic transactional costs. When you buy a TV, it comes ready to watch a handful of channels. The free content/channels are akin to basic care visits. Knowing that a vast majority of new hardware users are also potential new patients, providing content becomes a marketing expense to bring those into a system.

Example: You walk into the Nike store and purchase the latest workout shirt with embedded sensors that monitor pulse, respiration and perspiration. The shirt comes with free virtual visits for simple conditions for as long as you own the shirt and regularly upload biometric data.

The advent of SMS was facilitated by powerful technology innovation. But it was adopting an “unchained” economic model that allowed it to proliferate. Like SMS, the tide of technology is pushing telemedicine towards lightweight, zero-cost virtual care transactions. Now it’s time to get unhinged in devising new economic models that allow virtual care to explode.



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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