In the midst of crisis, the U.S. health system is dramatically changing.
Doctors have been told by the federal government that they can have a FaceTime or Skype call with seniors enrolled in Medicare. Hospitals are setting up chatbots, symptom checkers and telemedicine tools virtually overnight to triage patients so the healthy ones can stay home. Some providers have transitioned almost entirely to virtual consults, and hospitals are offering training sessions for those who aren't yet using telemedicine in their practice.
For many of them, including the UC San Francisco cardiologist Ethan Weiss, the experience has been a pleasant surprise.
Telemedicine was "waaaaaaaaay better than I thought," he told CNBC.
Weiss, who previously saw the vast majority of his patients in person, said he could see himself introducing more telemedicine into his practice going forward. It would make a big difference, he said, if regulators approved more tools for clinicians to conduct remote examinations. That would mean many of his less complicated cases could be seen virtually, which could free him up to spend time with his most vulnerable patients.
Health-tech experts say that a new front door for medicine has emerged in the midst of the coronavirus pandemic. Instead of booking an appointment with a doctor, patients now have multiple options at their disposal whether it's to get advice via a chatbot or to message a nurse. And providers are are increasingly finding they're getting paid regardless of the method of communication.
For Silicon Valley, it's a welcome change.
Countless technology entrepreneurs have tried to move medicine to embrace digital and consumer tools for years. But many of them say they have faced immense resistance from the health care industry. The status quo is highly lucrative for many stakeholders. The big fear is that technology companies like Google and Amazon, along with a slew of venture-backed start-ups, will come in and upend their businesses, while targeting their healthiest and most profitable patients.
Some of the concerns about technology companies are very legitimate, and include fears around protecting patient privacy or the potential liability for doctors. We still have some important questions to work through, such as whether a chatbot company is responsible for giving bad advice to a patient. And some of the approaches from the start-up world aren't designed to make the lives of physicians easier. They inundate doctors with endless streams of data, or flout regulations in the quest for growth.
But entrepreneurs generally say the current system needs to adapt to the modern age. They note that even simple changes that benefit the average American, like getting medical record companies to share a patient's chart between hospitals or allowing pharmacists to talk to their patients about more affordable medication options, have taken years to remedy. And consumers are increasingly footing the bill for medical services, with the rise of high deductible plans, so they're expecting a better experience.
"It was too hard to satisfy all the stakeholders, payers, patients (and) doctors," said Jordan Michaels, recalling his own experience running a start-up called Ringadoc. His company, which developed software for doctors and patients to communicate virtually, sold to a medical record provider in 2014.
According to Michaels, one of the biggest challenges to innovating in health care was that stakeholders weren't exactly rushing to step up and do things differently. In theory, they all wanted to embrace ideas like "consumerism," "patient engagement," and "price transparency," but no one wanted to go first. One particular challenge for companies like Ringadoc involved getting a health plan to agree to reimburse for a new technology, so that doctors would get adequately paid.
Michaels, who is now a vice president at the consumer-focused medication company GoodRx, was left wondering: "Who was going to be the one to give in and do something they didn't want to do?"
Another big problem for technology companies was to get consumers aware of these new options. It's hard to inspire people to think deeply about their health care options when they're not sick. Even the largest companies like Google and Microsoft have struggled to scale tools that make it easier for people to aggregate their medical information. Google Health shut down in 2014 due to lack of traction, and Microsoft HealthVault ended its service last year.
So companies building digital medicine tools never really had their moment in the sun, where people were widely introduced to the new options.
Neal Khosla, who runs a virtual medicine startup called Curai, said that the day has come where digital health is showing its usefulness to patients and the medical community. Public health authorities are advising patients to see their doctors remotely if they suspect they have symptoms of COVID-19, or need medical help for many other reasons. It reduces the chance of people getting infected by the virus if they can stay home.
Khosla said that these changes could become permanent if companies in the space do their jobs right in this critical period.
"Right now I think most health systems are scaling telehealth and a bunch of operations without regards for their bottom line because they have to," he said.
"But what's going to happen when the emergency ends and they go back?" Khosla said. "At the end of the day, I think some of the law changes will make it tenable to stick with telehealth, and the competitive pressures from patients will help."