Telehealth 2018: Vendor Assessment and Market Outlook

Interest in telehealth technology is rising among healthcare’s key stakeholders - the provider organizations that deliver care, the insurers and employers that pay for care, and the patients that receive care. Most momentum to date has focused on low-acuity direct-to-consumer (DTC) services and high-acuity inpatient services. While these two markets have clear differences in use case, execution, and value proposition, they are similar in one key way: They emphasize single episodes of care and rarely account for what happens to patients when they are not being cared for directly or virtually.

This report examines a third, largely untapped market: telehealth beyond the hospital, when patients are not being cared for directly but are otherwise participating in their care, whether through passive monitoring or active engagement with their care team.

In this report, the analyst identifies the challenges and opportunities associated with engaging with patients between in-person care episodes using various telehealth technologies. We describe the market segments that are best positioned to support telehealth beyond the hospital and forecast the extent to which new or emerging market sub-segments may disrupt incumbents over the next 10 years. We profile leading vendors and assess the maturity of their core functionality. Finally, we offer recommendations for healthcare providers, as well as vendors looking to invest in telehealth to extend care, now and in the future.

Market Dynamic

The American Telemedicine Association, which now uses the terms telemedicine and telehealth interchangeably, offers the following definition for telehealth:

• Telehealth is the remote delivery of healthcare services and clinical information using telecommunications technology. This includes a wide array of clinical services using internet, wireless, satellite, and telephone media.
• Further, there are three main types of telehealth services: Asynchronous telehealth (also known as store-and-forward) transmits data to medical professionals for later use. This type uses data collected from wearable devices, passive sensors, or other peripherals to help inform clinicians’ decisions during diagnosis and treatment.
• Synchronous telehealth (also known as real-time) enables clinicians and their patients to communicate remotely using desktop or mobile video, kiosk, telephone, or emerging modality such as a chat-bot or voice assistant. This type of telehealth most closely resembles an in-person appointment.
• Remote patient monitoring (RPM) telehealth tracks patients’ data from their home or a third-party care facility. Data can be collected from wearable devices, passive sensors, or other peripherals. Since RPM telehealth typically services high-acuity or chronic patients, data is collected and monitored by medical professionals more frequently than it is for asynchronous telehealth.

Based on our research and discussions with providers and vendors, the analyst takes these accepted definitions of telehealth one step further for reasons described below. We have defined telehealth beyond the hospital as follows:

• Telehealth beyond the hospital is the delivery of services and information outside of an inpatient setting, with the goal of supporting ongoing care in the form of follow-up visits, guided condition or disease management, RPM, or care coordination.
• Telehealth primarily benefits four key stakeholders: Patients, employers, payers, and providers. Some groups differ in their primary motivation for paying for or using telehealth. Traditionally, providers use telehealth to complement high-acuity care across an enterprise HCO - in the ICU or specialty care such as stroke treatment, cardiology, or radiology. Meanwhile, patients, payers, and employers typically view telehealth as a low-cost and convenient way to receive low-acuity care.
• Increasingly, each key stakeholder, and the vendors that serve them, seeks to use telehealth beyond the hospital - to, in effect, continue a hands-off but still connected form of care after discharge. In this way, the use of telehealth has begun to shift from one-off care episodes to ongoing care support that can take place inside a patient's home or in an urgent care, retail, employer, or outpatient setting. This use case will offer the greatest growth potential in the telehealth market for the next decade. Nevertheless, smart home technology from vendors like Alphabet, Amazon, and Apple, could make this emerging market increasingly vulnerable to disruption.
• Taken together, these care sites and technology solutions position the healthcare industry to expand the number of front-line access points - referred to as “front doors to care” - that are available to patients. These access points are poised to disrupt traditional models of care delivery, and providers that are unable to effectively support the front door to care risk losing business by the early 2020s. We provide the following definition for the front door to care:
• The front door to care refers to the access point a patient uses to interact with healthcare services. Traditional access points such as the primary care physician office and emergency department are increasingly being disrupted by new healthcare business models (such as retail health, urgent care, direct primary care) as well as new technology solution (such as telehealth apps, chat-bots, and smart speakers).

Market Outlook

In this report, we profile 12 vendors that provide some degree of telehealth beyond the hospital. (See Table 1.) We divide vendors among three primary market segments: DTC, acute care, and RPM within the patient-centered medical home (PCMH). We also discuss technology types that are poised to disrupt these market segments; these include the “smart home” powered by voice-enabled virtual assistants, the telehealth kiosk, and digital therapeutic solutions that support clinical care across various settings. All told, this report identifies more than 90 vendors that support telehealth beyond the hospital in some way.

We have chosen not to rank or compare individual vendors but, rather, evaluate the telehealth market as a whole. To do so, we looked at the maturity of functionality in six key areas:

• Patient identification
• Patient intake and outreach
• Variety of supported use cases
• Care coordination support
• Peripheral device management and support
• Ongoing patient assessment

Based on the products we reviewed, functionality that maximizes utilization and revenue-generating opportunities in support of fee-for-service (FFS) business models is more mature than functionality that prioritizes ongoing and/or complex interactions in support of value-based care (VBC) models. That said, vendors should prepare to support VBC as payers continue to transition away from FFS and look to telehealth as a way to provide low-cost access to convenient care with the potential to improve both clinical and financial outcomes.

Key Takeaways

To succeed in the telehealth market, vendors will need to be ready to do the following:

• Adapt to the smart home. Over the next decade, sensors, smart speakers, and voice-activated virtual assistants will transform how people initiate interactions with healthcare stakeholders.
• Evolve to support VBC. Telehealth must increasingly support use cases that align with providers’ evolving VBC needs, not just their financial imperatives to add patients and increase revenue.
• Consider overlooked care venues. Long-term post-acute care sites (LTPACs), skilled nursing facilities (SNFs), and nursing homes are open to telehealth as a way to curb costs and improve outcomes without adding clinical staff.
• Expect fierce competition. Telehealth vendors will compete with each other - and with urgent care, retail clinics, kiosks, and hospitals that all want to become the new front door to care.
• Focus on platforms. Enterprise stakeholders are losing interest in point solutions, especially as they seek to implement telehealth across business lines and cohort populations.
• Anticipate large-scale changes. Telehealth adoption forces stakeholders (especially providers) into new workflows - not just clinical but operational, and also across service lines. This will change the way that organizations do business.