Teladoc and the future of Telehealth

Teladoc Charts the Future of Telehealth

December 14, 2021

Kenton Williston

Telehealth visit

Telehealth, virtual care, digital health—call it what you will, the future of healthcare is online. The pandemic radically accelerated the adoption of telehealth, but what’s next? How can technology help patients and practitioners focus on what’s most important—getting and staying well, both physically and mentally?

We speak with Dr. Yulun Wang, Distinguished Fellow at Teladoc Health, a leader in virtual care and digital health, about the untapped opportunities for telehealth, as well as its biggest challenges. He’ll walk through the medical workflow of the future, speculate about the role of AI in virtual care, and explain how Teladoc Health is working to bring healthcare to remote parts of the US and the world.

How did the pandemic affect the telehealth space?

COVID really advanced the adoption of telehealth. Prior to the pandemic, telehealth was growing at a nice 30% clip, but it was still only 2% or 3% of overall healthcare delivery. Then COVID hit, and everything was being done via telehealth because that was a safe way to get healthcare.

And then COVID peaked, and virtual care dropped to maybe 30% to 50% of healthcare delivery—which is still significantly above where it was prior to the pandemic. So COVID really propelled the growth of telehealth by orders of magnitude, but now we’re on a much more sustainable growth trajectory, where it is slowly being incorporated, systemically and appropriately, into all of healthcare delivery.

There are also many kinds of trends converging right now. One is the acceptance of virtual-care type of delivery. Another is the digitization of more and more healthcare capabilities—like showing the wait time in a waiting room—whether that waiting room is virtual or in person. And another thing is that healthcare is appreciating that it really needs to become very patient or consumer friendly—like other industries. People are coming in equipped with a tremendous amount of knowledge about what’s wrong with them, what they want to have taken care of, or even how to stay well. And the healthcare system has got to be able to adapt to that new kind of customer.

What do you think are some of the biggest challenges going forward?

When the pandemic hit, there was just a frenzy of adaptations to allow healthcare professionals to interact with patients and deliver care. And so some of the normal healthcare considerations were thrown aside—for example, technology that was HIPAA compliant and ensured patient safety. There are a number of things that need to be taken into account. What is the platform being used? Is it medical grade? Is it meant for healthcare? Does it have the right kind of encryption? Does it have the right patient protections in order to be used effectively for a healthcare application?

Another thing that was not taken into consideration at the beginning of the pandemic was putting in place an infrastructure of virtual care that was well integrated with in-person care and continuum of care. We’re pretty much past the frenetic part of the pandemic now, and we’re starting to think about how to incorporate virtual care into the overall healthcare-delivery system smartly and well.

Healthcare is often criticized for being very fragmented and very siloed. And that’s true, unfortunately. So we have an opportunity, with healthcare delivery going virtual and digital, to solve that problem. To have platforms that allow a patient or consumer to have their information ported easily across the entire healthcare system—as opposed to making the patient fill out another 20 pages of forms that they just filled out a week ago. These kinds of things weren’t taken into consideration during the rapid adoption that COVID drove, but they are now that people are thinking about virtual care for the long term.

What exactly is the Teladoc platform?

There are a few components to the Teladoc platform. In a broad stroke, we do virtual-care visits in a similar manner to an urgent care center. We have doctors that we pair up with patient members as they need to see a physician—as in an urgent care center, but virtually. And we can do the same thing with certain specialties—for example, mental health. We can connect members up with therapists or psychologists or psychiatrists—with the right level of care depending upon the situation.

We take care of patients with chronic diseases as well. The main ones are diabetes, hypertension, and obesity. We’re doing congestive heart failure now, and, I think, chronic kidney disease. We are also treating mental health as a chronic disease. If you can solve mental health problems early, it solves all kinds of physical health problems—like obesity perhaps leading to diabetes or hypertension. If you can get at the mental health cause at the root, it stops all these other bad things from happening from a physical health perspective.

And then, last but not least, our platform is also sold into health systems where they use it to deliver care using their own clinicians. Mayo Clinic and Cleveland Clinic, for example—a lot of these big systems are using the Teladoc platform.

So our platform comprises all of those pieces, and a member coming in through any of those use cases will be known to providers even as they traverse into other use cases, so that we can really get whole-person, or longitudinal, care.

How can healthcare organizations build on the momentum provided to virtual care by the pandemic?

Let’s take an example from the health-system side—perhaps a patient who’s got a bad hip. Without virtual care, that patient goes in to see a primary care doc; gets referred to an orthopedist; waits several weeks to get in to see the orthopedist; maybe has surgery scheduled; goes in to have a surgical procedure; maybe goes to one or two or three follow-up meetings in person. So, how might that change with virtual care?

Well, our patient might see a primary care doc virtually first. That virtual–primary care doc says, “Okay, the patient’s really got a bad hip.” The patient physically goes in to see the orthopedic physician, who manipulates the hip and appreciates that the hip needs to be replaced. But let’s say for a second that the patient’s overweight. So the orthopedist might put that patient on some kind of a digital app to help that patient reduce down to an acceptable weight for the surgery. So now the patient uses the digital app, and slowly but surely gets to the right weight.

The orthopedist and the primary care doctor are perhaps getting updates of what’s going on—not needing to see the patient in real life, or needing to use that time and energy, but just seeing how that patient’s coming along. Patient hits the desired weight. Patient goes in to have the surgery. And then, virtually perhaps, the primary care doc might make a visit. The orthopedist comes in after the patient goes home, and there might be a bunch of virtual follow-ups—there might be a digital app making sure the patient does the right exercises for physical therapy and recovery. That whole example shows how digital interactions, virtual interactions, and in-person interactions can be all integrated into a flow where each capability is used at the right time.

Another thing that is important to consider in thinking about these new technologies is that we’re doing it for the benefit of the providers as well—the healthcare professionals. You don’t have to look very far to see that burnout among healthcare professionals is at an all-time high. Every single healthcare professional I’ve ever talked to over several decades has always said that the best part of their job is taking care of the patients. And then that the worst part of their job is all the administrative overhead they need to go through in order to take care of those patients. If we can eliminate a lot of that administrative burden, we’ve done a lot to improve the quality of life and quality of work of our healthcare professionals, which then actually translates to improved quality of care for our members and patients.

How is Teladoc using telehealth to provide healthcare services to remote parts of the world?

In the US, roughly 25% of the population lives in rural locations, and in rural locations oftentimes there’s not even a doctor, let alone a specialist. Telehealth can get expertise into anywhere where there’s internet, which is pretty much everywhere in the world now. Taking that a step further, another thing that I’m involved in is a nonprofit called World Telehealth Initiative, an NGO to which Teladoc Health donates its technology.

The World Telehealth Initiative identifies under-resourced communities in the world, and finds volunteer physicians who want to help train the clinicians in those communities to improve their capacity to take care of themselves. After four years we’re in 22 different locations around the world, and it’s actually proving to be a very effective model. At first we wondered if it would be difficult to get volunteer physicians. Well, it turns out it’s not difficult at all. We actually have thousands of physicians who are asking to volunteer for these efforts. So telehealth could actually be a key part of the solution to global healthcare.

What has been the value of Teladoc’s partnership with Intel^®?

Our efforts with Intel^® have been fantastic. First of all, our telehealth cloud—which is how Teladoc services our health-system partners—is all powered by Intel chips. We have many servers around the world, and they are all running off of Intel processors in Intel software and boards.

We have also built a number of different telehealth-specific devices, such as a wall-mounted head that can look all around a patient’s room, and provide interactions with the patient. And this device is all Intel based as well. Intel has also helped us with the World Telehealth Initiative, providing a grant to help us bring healthcare to the less privileged in the world.

What is the future of telehealth? And what do you see as the role of AI in that future?

I believe that AI will be a big part of the future of telehealth. Just the concept of telehealth requires the digitization of the interaction between the clinician and the patient. And by virtue of the fact that it’s digitized, you can now run algorithms like AI on it to improve capability. For example, if you’re interacting with a person on a virtual screen, using AI you can automatically measure their heart and respiration rates through subtle changes of motion or color in the video image.

Another capability could be in the whole area of natural language processing, where you have an AI scribe that is able to listen to the entire interaction between the clinician and the patient, automatically generating a transcript and a note, and perhaps even billing for the encounter. That would completely take the burden off the clinician, which would be a huge benefit.

An analogy I often fall back on is the banking system. When I was younger, I went into the bank every time I had to withdraw or deposit money. Now you never do, basically. You only have to go in the bank to, say, sign loan documents. Healthcare is going to be the same way, where the health centers—whether they’re hospitals or clinics—they really become hubs of knowledge, and then they can deliver their expertise out into communities around the world. Occasionally people will have to come in to get an MRI or CT scan, or something like that. But they won’t have to always come in, in the way they do today.

It’s an exciting time. And I think we are at an inflection point, accelerated by COVID, and that acceleration is going to get us to a better place, quicker than we might have otherwise. It’s really amazing, the different kinds of use cases that people are coming up with and pursuing.