A visit to a physician’s office is rife with inconveniences. Patients need to take time away from work, travel, park and wait. Yes, the wait is consistently rated as the top inconvenience in the hierarchy of patient experience gaps. Waiting is aggravated by patient concerns about being surrounded by sick people who could spread their illnesses. Then there is the issue of prescriptions and waiting again for pick up and refills. Waiting is just part of the patient experience coupled with a whole set of other secondary concerns. The frustration at wasted time in doctors’ offices while waiting for routine test results and prescription renewals for common health conditions will drive change in the patient care and communication model.
Convenience matters
As always convenience is a top need for patients who have little time to spare. A key question has been what is the premium a patient will pay to video chat with a physician on their phone at their desk? This question is driving a niche in the health technology sector where patients pay to connect with a licensed physician online. Skipping the trip to the physician’s office is attractive enough to dramatically change the way patients interact with their physicians- essentially a doctor in your pocket.
A survey by Arcus of 500 Canadians shows that 49 per cent of respondents would be willing to pay for more convenient access to family doctors. There are 180 million visits to the doctor every year in Canada. If half of these visits migrate online, that would translate into a market of 90 million virtual doctor visits. Forty per cent of those is 36 million visits.
Service models are evolving
One service started with a Q&A service with certified doctors with a payment for quick responses. Some products like Akira have had over 15,000 virtual consults and 12,000 registered users. Another service called Maple caters to about 6000 patients. EQ Virtual is a third service that is expanding in BC and Quebec. Another called Askthedoctor is one of the longest existing services. The gap to be addressed is access to a clinician at a faster pace. The shortage of family physicians which has resulted in a large volume of patient traffic to emergency centres will also be addressed. waiting for several hours for common health problems such as a sore throat or a prescription renewal is a significant gap.
The service model is relatively simple. A user creates an account and adds their credit card information in addition to symptoms and medical history with photos and other medical records. The user is connected with a clinician which could be a family physician, specialist or triage nurse to treat their symptoms.
Fee for service or subscriptions offer flexibility
A key barrier may be the cost of the mobile medicine service. Most services charge users $49 plus tax for an online consultation, via video chat or text, with a doctor who can write prescriptions, sick notes or make referrals. Or an annual membership for unlimited individual consultations ($120 per year) or a family package ($240).
Fees may vary by time of day. For example, a weekday virtual “visit” may cost $49 and an overnight call may cost $99 or a weekend appointment may cost $79 while memberships may range from $359 to $579 depending on the service.
A differential vs. government-funded alternatives, such as Ontario’s Tele-health may be that the service may go beyond limited acute care experience with Tele-health services, where for example, users are guaranteed a doctor whose experience corresponds to their needs instead of a generic clinician. Service providers say doctors have a 99-per-cent resolution rate.
Benefit to clinicians and employers
Virtual medicine has been in existence for over a decade in the United states. Kaiser Permanente, the country’s largest health-care provider in the US has 100 million patient-physician interactions per year of which 52 percent are virtual. The biggest barrier is that virtual interactions in Canada are not reimbursed. Insurers and private employers seem to be taking a lead in driving change with growing interest in offering virtual clinician interactions as an employee benefit or for health spending accounts. The benefits are significant as it saves users time and allows employers to be promote a more productive workplace. Another benefit is that it adds flexibility for physicians allowing them to extend their hours and also see more patients per day when the clinic may otherwise be closed.
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