Disclaimer: This White paper is intended as a summary of the current issues that should be considered when selecting and implementing a Direct to Consumer solution. It is based on personal experience of the writers and current published literature. For a more in-depth understanding, we suggest the reader see the Helpful Links included in the Bibliography and conduct a search of current literature
The purpose of this study is to inform potential Direct to Consumer Telemedicine (DTC) buyers. The objective is to provide a useful background on DTC, the solution options, and a sample listing of current Direct to Consumer Telemedicine companies, including the options available, approaches, and business plans/profiles. We have included critical issues and considerations. In addition, TTAC has completed a video performance comparison that simulates actual performance typical to challenging rural environments. We hope this provides a solid platform for assessment and decision making.
Direct to Consumer (DTC) Telemedicine is the provision of healthcare consultations directly to a consumer. The consultation can take place over video, voice or text-based communications. The consultation is generally initiated by the consumer but can be initiated by a provider. The consultation can be scheduled or unscheduled (on-demand). DTC falls into two general categories: #1. A direct video, audio or text conversion with a provider and #2. A consultation executed and/or assisted by a ChatBot.
DTC offers convenience and a fixed price. Any consumer can ask for healthcare consultation and advice anytime from anywhere without having to travel to a care provider, wait in line and expose themselves to infections. Also, because the price of a DTC consult is known up front, the consumer knows the total cost in advance.
DTC telemedicine consults are generally used as an alternative option for Primary Care, Urgent Care, and low acuity Emergency Room visits.
Examples:
DTC service promises online “on-demand” access to a provider. Typical examples might include an employee with a cough, a parent with a feverish child, or a college student or traveler away from home. The consumer is offered the convenience of immediate service. The consumer can stay at home and workers could stay at work. When a person wants a provider consultant, they simply access a web site or an APP on a smart device, log in, create an account with their basic complaint and history and see a provider.
Panels of providers are available to take a call. Every provider is licensed in the state where the patient is. Assignment of a provider is similar to the UBER or Lyft model. A provider posts his/her availability, specialty and other demographics. The consumer can select one of the providers that are available or be assigned a provider based on need. Patients are held in a short cue until the provider gets online. The provider conducts a structured diagnostic interview with the patient face to face. The provider either makes a diagnosis and recommends treatment. If a prescription is needed, the provider writes and transmits a prescription to a pharmacy local to the consumer/patient. If the case is too complicated for the online visit, the provider gives instructions/referral for a higher level of care. The provider documents the encounter in an EMR Electronic Medical Record (EMR).
In a number of DTC services, ChatBots automate the structured interview and usually use AI to provide a differential diagnosis. The differential diagnosis is then given to a provider. The provider is connected to the consumer over video and the provider completes the interview, chooses the diagnosis and recommends treatment. They can write a prescription if needed. The ChatBot encounter and results are documented in the EMR. A few AI ChatBots are designed to give the differential diagnosis with treatment instructions directly to the patient.
DTC calls can also be used for follow-up appointments for previous face to face consults or video consults. These are scheduled and can be made with the same provider as the initial visit or another informed provider. Applications typically include follow-up for chronic disease, chronic pain or to check status of the patient on a care plan.
Author disclaimer: The lead author has no financial or management interest in any of the companies listed.