Health insurance company Cigna is launching a new video-based primary care service that will reach over 12 million people. The company is partnering with MDLive, which already provides telehealth services to several hospitals including Humana and some locations of Blue Cross Blue Shield. However, this is the first time it has waded into primary care.
Due to fears that a whole generation of doctors will soon be retiring, reducing the supply of available doctors and therefore appointments, there is an increasing push from the medical community to conduct as many medical visits as possible online or at home. As it is, doctors feel overextended in their day-to-day practice, and burnout is recognized as a pervasive problem in the industry. Unless in-person presence is absolutely necessary, virtual care has the promise of making individual appointments more efficient, freeing up doctors’ time.
It is also a lot more convenient for patients. According to an 2019 Accenture survey, 29% of respondents said they’ve used virtual care, up from 21% two years ago. Cigna has been working with MDLive and its platform of 1,300 physicians for the past five years on 24-7 online urgent care services. The insurer has now added MDLive’s therapy and behavioral services to its client benefits and will roll out primary care in April. The hope is that by putting services online, Cigna will be able to get members who historically have not gone the doctor to finally go.
“There’s a whole portion of our population not seeking any care, and we need to find convenient and affordable ways for those patients to be accessing care,” says Julie McCarter, head of product solutions at Cigna.
The deal between Cigna and MDLive comes at a time when virtual care may finally be hitting the mainstream. “It took us nine years—through May of 2018—to do one million visits,” says MD Live CEO Rich Berner. “We did 900,000 just last year.”
Over the past 20 years, platforms like Teladoc, Amwell, Doctor on Demand, and Plushcare have tried to push more patients online. At the end of last year, there was a tipping point. In September, Amazon launched a virtual clinic for employees. A month later, the Cleveland Clinic partnered with telehealth company Amwell to launch a diverse new healthcare venture called The Clinic that would take patient appointments over the web while also connecting and training doctors online. Cleveland Clinic’s CEO expects half of the company’s outpatient services to be conducted online by 2025. That same month, Walmart announced a partnership with Doctor On Demand, giving employees in Colorado, Wisconsin, and Minnesota expanded access to online doctor’s appointments for preventive, immediate, and ongoing healthcare.
“In 2019, telehealth startups completed an all-time high of 231 deals, pulling in close to $3 billion in funding,” says Marissa Schleuter, an intelligence analyst at CB Insights. “Corporate interest continued to rise as well, with ‘telehealth,’ ‘telemedicine,’ or ‘virtual care’ being mentioned over 60 times during the most recent earnings cycle.”
MDLive will give patients the option of choosing their primary care doctor and staying with them, as opposed to being introduced to a new doctor every visit. Before patients meet with their online doctor, they will first have to schedule an appointment with a lab to undergo a blood screening test, so the results will be in the hands of the doctor on the day of the appointment. Before video-chatting with the doctor, patients will also do an interview with an artificially intelligent chatbot (all patient data lives on MDLive’s HIPAA compliant platform and is shared with healthcare providers as well). Doctors, which are all board-certified, then use this interview, the lab results, and physical cues to diagnose patients, write prescriptions, or make further recommendations for screenings or specialty care, says Berner. MDLive can also tap into Apple’s Health Kit for more patient information. However, unless patients have access to a blood pressure cuff, scale, or some form of heart rate detection, for example, the doctor won’t have those measurements.
When you look at the quality of this, you have to not measure it against what would have happened in the office.”
Lyle Berkowitz, MDLive
While virtual care presents an opportunity to reimagine annual visits, at least this iteration seems to be removing some important steps. Physical exams are a crucial if underestimated part of practicing medicine. In 2015, researchers from Stanford University, Tufts, and University of California San Francisco asked 5,000 doctors to recount instances where they had made a medical error. “The cause of the oversights in the 208 responses was most often a failure to perform the physical examination at all—in 63% of the cases. Other times, errors were caused by misinterpreting or overlooking physical signs,” said Dr. John Ioannidis, a physician and researcher at Stanford University, in an interview about the physical examinations.
“When you look at the quality of this, you have to not measure it against what would have happened in the office,” says Lyle Berkowitz, chief medical officer at MDLive. “You have to measure what would have happened if this was not available. The likelihood that the patient would not get any kind of care screening at all.” The purpose of virtual care is not to eliminate in-person visits; it’s to give more people access to regular care with the expectation that doing so will reduce the potential that they’ll end up in an emergency room down the road.
Berkowitz also suggests that integrating telehealth into a doctor’s day-to-day may make more efficient use of their time and allow for more thorough in-person physical examinations. Regardless, he is confident that the ability to take vital signs over video will become more widely available soon.
MDLive’s primary care service will launch with other insurers later this year.
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