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Healthcare/Pharmaceutical Market: The Future of Healthcare Has Arrived — and It’s D-to-C

1 Jun, 2017 By: Bridget McCrea Response

Doctors, psychiatrists, pharmaceutical firms, and others are jumping into the mobile-enabled, direct-to-consumer healthcare space.

When Brittany Sherwood consults with patients, she doesn’t invite them to her office for a 30-minute block of “face time” nor does she meet with them in person to perform evaluations. Instead, this psychiatric nurse practitioner — who works “somewhere between a psychiatrist and a psychologist” — utilizes telemedicine — mobile and secure online video chat — to see, evaluate, and treat patients.

Sherwood, who owns Mental Calm: Personal Private Psychiatry in Miami, says she developed her mobile/online direct-to-consumer (D-to-C) care delivery model after realizing that not many people have the time (or patience) to trek back and forth to a healthcare provider’s office in the middle of the day, and then spend time there waiting to be seen and — eventually — evaluated and treated.

“I see and treat patients in my private practice all virtually, via videoconferencing,” says Sherwood, who utilizes HIPAA-compliant software and “a lot of instant messaging,” when working with her patients. All of her intake packets and consent forms are signed electronically. And while she admits that there’s still a place for traditional doctor’s office visits, Sherwood says the mental health arena is “particularly well suited” for remote visits. “In most cases, we don’t have to do physical exams,” she adds.

The virtual model also provides an extra layer of security for Sherwood, who can work confidently with patients knowing that those consultations won’t ever lead to potentially dangerous or threatening situations. And, she can offer appointments later in the evening and on weekends because she doesn’t have to commute to work. Sherwood, who previously worked with a psychiatrist who had multiple physical locations, says that experience pushed her to build out a D-to-C telemedicine service delivery model.

Of course, there are some downsides to the arrangement. In Florida, for example, there’s not currently a mandate for insurance companies to cover these “virtual” psychiatric appointments. “The fact that patients have to pay cash out of pocket is obviously the largest limitation,” says Sherwood. (A bill recently passed through the state’s legislature that could reverse this rule sometime in the next few years, she notes.)

In assessing the growing trend of evaluating patients and delivering care online or via mobile applications, Sherwood says it’s hard to ignore the convenience and time savings associated with not spending 90 minutes or so traveling to an office, waiting for the provider, and then being seen. “I can see patients while they’re on their lunch breaks at work,” says Sherwood. “They don’t even have to lose work hours to go to their appointments.”

Addressing the Confusion

To say that the average American is confused about the state of healthcare and everything that goes along with it would be a major understatement. Combine this confusion with millennials’ — and, the following generation of digital natives’ — comfort with technology, and you get the perfect recipe for a more direct, intentional delivery of healthcare.

Right now, most of the activity in this area revolves around telemedicine, or the remote delivery of healthcare services and clinical information using telecommunications technology. This includes a wide array of clinical services using Internet, wireless, satellite, and telephone media.

“Younger patients grew up with technology and are much more comfortable seeing a provider on the phone, or using their mobile phones to connect,” Sherwood points out. “For them, it’s a lot easier to communicate via text than it is to pick up the phone or drop everything for a doctor’s visit.”

Writing in Telemedicine: What the Future Holds, Penn Medicine CIO John Donohue adds, “Delivering healthcare to remote locations is hardly a new concept. Technology advances in both healthcare and telecommunications have resulted in significant strides and evolving ways to deliver care. It’s clear that effectively harnessing the full breadth and depth of telemedicine’s capabilities, in fact, can impact healthcare for millions of people, especially those in more remote communities and regions.”

Big Pharma Goes Mobile

Large pharmaceutical companies have jumped into the D-to-C game in an effort to improve patient care and streamline processes. This year, for example, Pfizer Inc. will roll out a new version of its BeLive mobile app, which helps patients track chronic pain.

Diabetes and fibromyalgia patients using the app wear a wristband that communicates with a mobile app on iPhone or Android devices, CIO Journal reports. They log their pain levels on a scale of zero to 10 at intervals during the day and can record other details, such as anxiety levels and sleep quality. They can print or share charts to discuss with their clinicians, who can fine-tune the mix of medication and therapy.

And at the pharmacy level, a prescription price comparison app called OneRx is helping patients figure out what their co-pays are before they arrive at the pharmacy counter to pick up their medication. Launched by Truveris, the app is meant to empower patients and help them make more informed decisions, understand what their benefits cover, and find out if lower-cost options exist. The app was built in collaboration with pharmacists in order to ensure that it would create a better, more streamlined pharmacy experience, according to Pharmacy Times.

In describing the evolution of mobile apps in the healthcare and life sciences space, Daniel Piekarz, vice president of business development for DataArt in New York, says the movement took root when people started realizing that the vast majority of interactions are now happening via mobile phones. “At that point, we saw a big rush to get out and starting going mobile and building apps,” says Piekarz, who estimates that about 100,000 medical-related mobile apps were introduced in the 2012-13 timeframe.

None of those apps were reviewed by the Food and Drug Administration (FDA), Piekarz recalls, and there were questions about their legitimacy, and whether or not they actually provided good medical advice. “At the time, downloading a medical related app was kind of ‘Wild, Wild West’ — take your health into your own hands,” says Piekarz. The atmosphere has improved during the past two years, he adds, with regulatory agencies taking the time to review and approve some (but still not all) of the apps.

“Things are definitely improving,” says Piekarz, who notes that consumer acceptance — and use — of the apps has increased in recent years. Within the pharmaceutical space, specifically, he says companies have “started to have some success” in getting patients onboard with the idea. When Johnson & Johnson released an app that parents could use to track their infants’ sleep patterns, for example, more than 100,000 people downloaded it.

“It’s one thing to put out an app, but getting people to download it and actually use it is a different story,” says Piekarz, who sees texting as a good potential direct contact method for healthcare providers and pharmaceutical firms, but notes that there are HIPAA requirements and other regulatory issues to figure out before that can become a “mainstream” D-to-C tool.

“The more channels that can be opened up between pharma and its customers, or doctors and their patients,” says Piekarz, “the better that communication will be and the more interaction the industry can have directly with the customer.”

Getting Into the Mobile Groove

A quick Google search reveals dozens of different players making their way into the D-to-C medicine space. In Sweden, for example, Apotek Hjärtat recently launched a virtual reality (VR) app on the Oculus Rift store. The app, called “Happy Place,” uses an “immersive virtual world” to distract patients from pain.

“Apotek Hjärtat want to be at the forefront when it comes to offering products and services that can help people feel better,” Annika Svedberg, head pharmacist at Apotek Hjärtat, said in a company press release. “Combining pain relief and VR-technology in an app and making it available to the public feels very exciting.”

The app is not designed to replace pharmaceutical painkillers, but to distract people from temporary pain such as “vaccinations, tattoos, menstrual, or muscle aches,” building on research that shows distraction can help with pain.

In New York, telemedicine services provider Sherpaa began offering text-based telemedicine to individual patients for $40 per month. Customers can use Sherpaa’s app, the web, or a phone to communicate with doctors that work exclusively for Sherpaa, 24-7. Through these direct platforms, users can get in touch with doctors who can answer questions about a medical issue and send a prescription to a local pharmacy when appropriate.

“We just did the math, baked in some profitability, and we launched with this initial price,” Jay Parkinson, founder and CEO, told MobiHealthNews. “We’re going to learn a lot based on traffic and interest but that’s a number we’re comfortable with and I think it makes sense. It’s unlimited care; we’re not billing your insurance on top of it. This is $40 a month. The way I like to think of it is, if we prevent a $5,000 ER visit, that’s 10 years worth of Sherpaa.”

Some companies are going a bit deeper with their mobile apps by providing remote monitoring capabilities. ImpediMed, for example, recently introduced a D-to-C body fluid monitoring device known as SOZOmed. According to MobiHealthNews, the device tracks body composition, fluid status, and hydration in a variety of settings.

“This is for athletes, coaches and individuals to look at their weight, body composition, and hydration levels,” said CEO Rick Carreon. “It’s a very interactive, intuitive system that shows trends over time.” (ImpediMed is currently seeking FDA clearance for the device.)

Helping Doctors Enjoy their Careers

Along with helping patients navigate the confusing healthcare environment while ensuring that their individual needs are met, D-to-C care also empowers doctors to actually enjoy their professions for a change.

“No doctor spends eight-to-10 years studying medicine to say, ‘Oh, I’m so excited to work with administration and electronic health records,’” says Clinton Phillips, CEO and founder at Medici in Austin, Texas. His company’s secure messaging app meets HIPAA requirements for patient privacy, and lets users invite family physicians, pediatricians, dermatologists, dentists, veterinarians, and other medical providers to communicate with them via its app on a “price-per-interaction” basis.

“We saw the opportunity to help connect the doctor and the patient in a seamless experience that was safe and secure, and where the doctor got paid,” says Phillips, who sees texting as a foundation not only for the Medici app, but also for the future of the doctor-patient relationship. “Doctors love texts because it’s less intrusive and it forces people to be a little more concise. If you try to FaceTime with your doctor while he’s at dinner, he’s never going to answer. But if you start with a text that is compliant in our app, the chance of the doctor answering you goes up considerably.”

“Everyone is panicked about healthcare right now,” says Phillips, “and mostly because there’s no clear direction. There’s a lot of confusion and complexity around how to build the model (i.e., single-payer, multi-payer, or consumer-run) and run it.”

On the bright side, Phillips says putting the power of healthcare into the consumer’s hands — literally, right to his or her mobile device — not only helps to quell some of the panic, but it also makes communication easier while lowering the costs associated with doctor care.

Of course, introducing new D-to-C models into an age-old industry that runs on very traditional philosophies and values isn’t going to be easy. “Direct marketing to pharmaceutical firms is very tricky,” Phillips explains. “Marketers are generally far more advanced than patients in their ability to create needs and draw attention to certain drugs and medication, while doctors are very wary. Too many patients are coming in with demands to ‘Give me X,’ when the doctor is saying, ‘Why don’t you tell me what the problem is, and then I’ll provide the direction?’”

Going forward, Phillips predicts an uptick in the amount of consumer-driven, D-to-C healthcare being delivered worldwide, noting that countries like South Africa (where Phillips was raised) are actually “well ahead of the U.S. in terms of insurers empowering some fantastic D-to-C models.” As Sherwood pointed out earlier in this article, what’s still missing is the reimbursement piece — or, how non-traditional healthcare delivery methods make money in an industry where so much revolves around insurance coverage?

“We’re still at a point where you go into a doctor’s office and offer to pay cash, and no one can actually tell you how much it’s going to cost,” Phillips notes. “I took my daughter recently, and two weeks later I got a $496 bill for a 12-minute visit with the doctor. When I inquired about it, the office said they weren’t sure what to charge because everything goes through insurance.”

Looking ahead, Sherwood envisions a time when more doctors and providers use D-to-C methods of staying in touch with patients and nurturing those relationships, instead of only “seeing” those patients when someone is sick or in need of urgent care.

“I’d like to see primary care providers offer direct options of connecting over the weekend or in the evenings,” says Sherwood. “If you have a urinary tract infection (UTI) and it’s Saturday evening, where are you supposed to go? It would be a lot easier to be able to reach out to your primary physician — who already knows your medical history — to get a prescription instead of going to an urgent care center or emergency room.” ■


About the Author: Bridget McCrea

Bridget McCrea

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