Bob Kocher is a physician, a partner at venture capital firm Venrock, and a senior fellow at the USC Schaeffer Center. He was recently chosen by California Governor Gavin Newsom to serve on the state’s new public-private coronavirus testing task force, which seeks to significantly expand testing capacity across the state. Previously, Kocher served as a special assistant to President Obama and is credited with helping to shape the Affordable Care Act.
When the state of California enlisted my help working on our state’s coronavirus response, my goal was to address the enormous initial gap in testing. We’re ramping up testing to identify where the virus is spreading, how to contain it, and, ultimately, determine when it’s safe to go back to work. We have made a lot of progress and need to make sure that we can accurately and rapidly diagnose new infections, track the rate of viral spreading, and contain outbreaks.
While the risk of COVID-19 is greater for older and sicker patients, there have been hundreds of younger and healthier people dying from the disease. People of all ages are nervous—rightfully so—about going to hospitals and clinics during this time. Healthcare organizations are advising people to stay home unless they require urgent medical attention and are recommending virtual treatment options instead. Probably, many are forgoing useful treatments out of fear too.
Medicare, knowing that all of its beneficiaries, by definition, are high risk, changed the rules and announced that telemedicine could replace in-person visits to reduce the spread of coronavirus. This created a huge opportunity for telemedicine companies to serve a large and brand-new market. Under this new waiver, Medicare now pays for telemedicine at the same rate as in-person visits. Previously, Medicare had strict requirements for telehealth, requiring that patients live in a rural area and travel to a local medical facility to conduct a virtual visit, and generally not allowing patients to receive telehealth services in their home. Additionally, private insurance companies such as Aetna and Blue Cross Blue Shield are waiving copays for telemedicine for many members until at least June.
COVID-19 is causing millions of people to try telemedicine for the first time.
I think that demand for telemedicine will continue to grow rapidly. Sadly, we will be dealing with high risk from COVID-19 until a vaccine is developed or enough people are infected to establish herd immunity in our population. This will cause people to continue to rely on telemedicine whenever possible. Habits that we form now will grow into preferences and default behaviors, and patients won’t want to return to a pre-COVID-19, less-convenient form of in-person healthcare.
Seeing is understanding
Doctors, too, will prefer telemedicine because it enables them to spend more time doing what they like—caring for patients. With virtual visits, doctors can check in with sicker patients more often and can learn more about them by seeing their living environments through video. For instance, do they have access to safe housing? Do they have pets that may exacerbate or help their medical condition? Do they have the food they need? Do they have evidence of the social support needed to help care for them? All of these factors are important and hard to assess in an in-person office visit.
It’s also easier to provide more thorough and comprehensive care through telemedicine. With in-person visits, it’s incredibly difficult to get a primary care provider and a specialist in the exam room at the same time, but virtual visits can make group care possible. It is better for patients to have their doctors coordinate care, and far easier to do it together with the patients in real time. Today, a lot of time and information is lost between visits from primary care doctors to specialists. We still depend on faxes after visits for a great deal of the coordination.
Providers can also use technology to tailor and improve care—such as issuing surveys about symptoms, engaging in text-based conversations with patients and caregivers, and even conducting group educational visits with patients with similar conditions to create peer support.
Insurance companies will find that this approach lowers the total cost of care since it will avoid ER visits and allow patients to access care earlier while complications may be able to be averted. Doctors will find that telemedicine is more profitable, since it eliminates a substantial amount of the overhead required to run a traditional medical office.
This shift to virtual care has been on the horizon for some time, but COVID-19 has ushered in this new wave of telemedicine with increased urgency. This will lead to a large number of new startups focused on how to deliver care in previously untapped markets. Specialty medicine will also go virtual, particularly specialties such as cardiology, where high blood pressure and other heart conditions can be monitored through connected devices with more precision than quarterly office-based blood pressure checks and EKGs. Pulmonary medicine can also be virtualized improve the treatment of asthma through connected peak flow meters and emphysema with connected oxygen monitors. Diabetes management is the furthest along with companies like Livongo, Virta (one of Venrock’s investments), and Omada already caring for thousands of patients. Behavioral healthcare also has a huge opportunity to grow, particularly for the Medicare population, which hasn’t traditionally had access.
I’m confident that we’ll develop a vaccine and effective treatments for COVID-19. But even after the the pandemic is under control, it is going to have a lasting impact on all of our lives. One silver lining is that virtual care will become a much integral part of healthcare for all us, and this will lead to better care and more accessible care.