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The doctor is "out"—but he can still see you.
Pharmacy giant CVS Health on Wednesday announced it will work with three leading telehealth companies to expand patients' access to doctors, who will be able to provide consultations remotely via the Internet or over the phone.
Those companies, American Well, Teladoc and Doctor On Demand, will begin receiving referred CVS customers, as well as referring their own customers to 150 CVS walk-in clinics, in six states by the fourth quarter, according to the pharmacy chain.
The deals aim to expand upon a successful pilot program that CVS recently ended in a handful of its 1,000 MinuteClinics. They also underscore the company's continued push to position itself as a resource for consumers seeking broader health-care services, and not just medications.
In addition, they highlight how telehealth services are becoming more commonly used by patients—and embraced by insurers, employers and health-care systems—as a potential way to provide quick care at lower cost.
Advocates say they're able to deliver basic care for less by reducing the number of physical office visits required, instead relying on a patient's computer, tablet, smartphone or landline to act as the virtual "office."
Part of CVS' decision to enter telehealth stems from an expectation that there will be an increase in patient demand for health care in coming years, due to several factors. These include the expansion of insurance coverage through the Affordable Care Act, an aging population, the "epidemic" of chronic disease and "the primary physician shortage."
"I think obviously we're at the beginning here," said Dr. Andrew Sussman, executive vice president and associate chief medical officer for CVS Health, and president of its MinuteClinic division.
But, "we're certainly eager to increase access," he said. "We actually think [telehealth] is going to be important in the health system in general."
"I think this is just another piece of the puzzle. It's trying to help with access that leverages technology, and provides care that is high in quality and low in cost," Sussman said.
CVS operates 7,800 retail drug stores nationwide, of which 1,000 have walk-in clinics. The company also acts as a pharmacy benefits manager for 70 million plan members.
Its previous foray into telehealth, which ended in June, was an 18-month pilot program in 12 MinuteClinics in California and Texas. About 14,000 customers ended up receiving online consultations from an off-site clinician.
Out of 1,700 patients who were surveyed, 95 percent were highly satisfied with the quality of care they received, the ease of using the technology, and the timeliness and convenience of the care, according to CVS.
"In addition, one-third of patients indicated they preferred a telehealth visit to a visit with a clinician in the same room," the company said.
Sussman said CVS will soon announce which states will offer the telehealth services for each of the companies participating in the deals announced Wednesday.
The program will have three main components.
Existing CVS customers who use CVS Health's online site will get access directly to the telehealth companies, where they can receive an online consultation with a doctor.
Also, "There would be times where one of those telehealth patients needs something actually done that requires physical contact," such as obtaining a throat culture or examining inside their ear, Sussman said. In those cases, patients would be referred by the telehealth companies to a CVS MinuteClinic.
The third opportunity would allow a nurse practitioner in a CVS clinic to consult with a physician via the telehealth services, Sussman said.
Adam Jackson, CEO and co-founder of Doctor On Demand, called the arrangement "a pretty effective two-way referral system" which will help his company expand its business.
Jackson also said that "the fact that CVS has vetted Doctor on Demand's patient app experience and clinical quality standards enough to refer its valued patients to us is very validating, not only to our business, but to the burgeoning telehealth sector as a whole. "
"When a respected brand like CVS, which is synonymous with quality, enters a sector, it can only be a good thing for that sector," he said.
Dr. Roy Schoenberg, chief executive of American Well, said the deal with CVS Health comes at "an inflection point in this technology," which effectively puts a doctor in a patient's home via an online app.
"It's an acknowledgement of a booming reality," said Schoenberg, who noted that American Well saw 1,100 percent growth in patient visits last year, and that 2015 "seems to be significantly more bullish." American Well has doubled its revenue in the past two years, according to the company.
"Increasingly, Americans understand that there are simpler ways to interact with the health-care system," he said. "Telehealth is going to play an enormous part in the health-care system."
Jason Gorevic, CEO of Teladoc, said the deal represents an opportunity to expand the company's business into the "direct-to-consumer" market, after having been embraced by health plan clients and employers.
"It's a distribution channel for us to get to consumers directly," Gorevic said. "Of course, CVS has a tremendous platform to do that."
"We see this as the beginning of a much larger opportunity to work with CVS to bring telehealth to the market, in multiple facets," he said.
The American Medical Association in June tabled a discussion of proposed ethical guidelines for telemedicine, after a delegate said a proposal could conflict with the Texas Medical Board's policy of requiring an initial face-to-face visit with a physician, or an initial visit using a telecommunications device if the patient is "in a health-care setting with another provider physically present," ModernHealthcare.com reported at the time.
The Texas Medical Board, which Teladoc has filed a lawsuit against, says it is concerned that the lack of close interaction between a patient and a provider can lead to inadequate care.
"No one would think if they showed up at their doctor's office they would go back to a room, have the doctor stand on one side of the door, they would stand on the other, they would tell the doctor their symptoms and the doctor would slip a prescription out from under the door. No one would think that was good care," Mari Robinson, executive director of the board, told NPR Radio in a report on the dispute. "That is exactly the same as doing it over the telephone or over some system where a physician can't get objective diagnostic information."