TELEHEALTH INDEX 2015 CONSUMER SURVEY

TELEHEALTH INDEX: 2015 CONSUMER SURVEY

Overview
Telehealth is a hot topic – for technology players, healthcare delivery systems, employers
and health plans. But how do consumers feel about the idea of seeing a doctor remotely
via video? Are there some conditions consumers are willing to use video visits for, but not
others? What concerns or objections do consumers have?
To answer these questions, American Well partnered with Harris Poll to run a nationally
projectable online survey to get consumer perspectives about perceptions and desires
surrounding telehealth services. Our survey was fielded in December, 2014 and gathered
responses from a total of 2,019 consumers ‐ a nationally representative sample. This eBook
reports on what we found and what it means for healthcare delivery.
INTEREST IN TELEHEALTH
PEAKS IN
AGES 18-44
Most consumers would have a video visit with a doctor.
We define ‘telehealth’ as a remote video consultation between a doctor and a patient.
When surveyed, an impressive 64% of consumers reported willingness to have a video visit
with a doctor. Their reasons were very relatable. Common reactions were:
“It would be much more convenient,”
“The wait times would be shorter,”
“If I don't have to drive, it would be wonderful!”
Of all the reasons consumers provided, convenience was listed 61% of the time. Others
mentioned saving time and money, avoiding germs lurking in hospitals and clinics, and the
joy of being able to stay in their homes when not feeling their best. On the flip side, 36%
of consumers said they were not willing to have a video visit. Some found the concept
new and unfamiliar, and others didn’t understand how it would work. Top questions for
consumers include:
Interest in telehealth spans all
ages, but peaks in ages 18-44.
This demographic is most likely
to be juggling busy careers and
scheduling demands, often with
children at home.
How would the doctor examine the patient?
How can you know if there’s a real doctor on the other side?
Emerging technologies naturally elicit doubts and questions, and we found these types of
objections natural, and addressable.
Willingness to have a video visit
36%
64%
Willing
Not Willing
1

Consumers think of the ER first, but video visits rank second.
When sick, many people won’t or can’t go to the doctor – especially in the middle of
the night. For those who do seek care, there aren’t many options for those who get
sick or injured at odd hours. Options for care are dictated by physician schedules and
local emergency care options, which are often inconvenient, expensive, and can require
lengthy waits. We were curious: what would consumers prefer to do if they or a loved one
was sick with a high fever and needed medical attention in the middle of the night, if they
had video visits as an option? Turns out, most people still think of ER first, but video visits
came in solidly second and ranked higher than 24-hour nurse lines.
What options consumers would select for middle-of-the-night care
21%
44%
17%
9% 4%
5%
Video Visits
24 Hour Nurse Line
Online Symptom Checker
Ambulance
Other
ER
Perhaps not surprisingly, parents with children under the age of 18 at home found this
to be especially true, as seen in the graph below. Those with children under age 18
selected a preference for video visits 30% of the time, above the population average of
21%, and well above those without children.
Consumer
Responses
When it comes to
refilling prescriptions,
an online video visit
would be incredibly
useful.
I am partially
disabled and have
difficulty getting into
and out of the family
car which makes
doctors visits a
painful experience.
Consumers who would select video visits for middle-of-the-night care
30%
25%
20%
15%
30%
If it's a simple
problem like a sinus
infection … it seems
more efficient to do
an online visit.
10%
5%
18%
0%
No Children in HH
Children in HH
2

Consumers would rather see a doctor via video to get common prescriptions.
At least 70% of consumers reported that they'd rather have an online video visit to obtain a prescription than travel to their doctor's office.
This makes sense. The average wait time to get a doctor’s appointment is 20 days in the U.S., and doctors are often not willing to take
phone calls as they can’t get reimbursed for the time they spend answering them. 1,2 It’s also increasingly expensive to see the doctor;
patients report that they are avoiding it altogether because of rising insurance co-pays and deductibles.
Prescription Refills
60%
Birth Control (18-34 yo women)
Antibiotics Rx
42%
41%
Blood pressure Rx
30%
Asthma or Allergy Rx
27%
To be clear, this is interest in live video visits with a physician to obtain common, appropriate medications at the discretion of the physician
- not an interest in online "pills mills". Top medications that consumers would want to get online instead of in-person are:
Prescription refills. Consumers often dislike going into the doctor’s office for regular medication refills, and they can’t always wait
for an opening in their doctor’s schedule. One consumer responded, “When it comes to refilling prescriptions, an online video visit
would be incredibly useful.” Video visits present a winning option for both patients and providers, as the patient can get what they
need, and the doctor can get paid.
Birth control: A surprising number of consumers were interested in birth control via online video visits: 42% of women aged
18-34 expressed interest, and that number increases to 44% for students. In the U.S., 62% of reproductive age women are
currently using some for contraceptive method, making the opportunity to provide online contraceptive services enormous. 3
Antibiotics. People often get sick at inconvenient times. Bacterial infections don’t plan around doctors’ available hours, and often
the only alternative is the ER. One consumer responded, “If it's a simple problem like a sinus infection … it seems more efficient to
do an online visit.”
Prescriptions for chronic conditions. When considering the incidence of chronic disease in America, the responses regarding
chronic disease medications were impressive. One consumer responded, “I am partially disabled and have difficulty getting into
and out of the family car which makes doctors visits a painful experience.” If just a portion of long-term care, including medication
management, could be conducted online, the quality of life for many would be improved.
1 2014 Survey of Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates, Merritt Hawkins
2 The Doctor Won’t Take Your Call, The Wall Street Journal, July 2013
3 National Health Statistics Report, Number 60, The Center for Disease Control October 2012
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Consumers perceive HD video as better
quality care than phone or email.
Today, anyone can go on the internet and seek a diagnosis. There
are options available such as question and answer chat boards, email
services, and phone-based call-back services. At the most robust
level, there are visits that engage both audio and video streams.
What model do consumers percieve as highest quality for health
care needs?
When it comes to accuracy, patients believe that video is the most
effective method to get a diagnosis. This is most pronounced for
smartphone owners, where 69% of them believe high-definition video
is the best way to see a physician.
What consumers believe results in best remote diagnosis:
7%
30%
63%
A recent patient recalled the benefits of video-based telehealth
appointments for post-surgical follow up:
“The video part of the appointment played a big role for me. I could
see the doctor’s face clearly on the screen, and it felt normal speaking
to him over video because I’m so used to doing it with friends and
family. When [the doctor] asked to see the scar and observe movement
in my toes, all I had to do was lift my foot up to my laptop camera.” 4
And physicians agree: “The first thing I do when I treat a patient is
I look at their face,” said Dr. Peter Antall, President and Medical
HD Video Telephone Email
Director of the Online Care Group, which provides telehealth services.
“A person’s facial expressions and body language give me an
understanding for their overall well-being that could be missed over
the phone. Beyond that, video gives me an opportunity to see skin
rashes or tonsils – important signs when making a diagnosis.
With the HD-quality video, I can assess the patient closely and
provide a diagnosis that will produce the best possible outcome.”
Importantly, this aligns with the guidelines set by the Federation
of State Medical Boards “Model Policy for the Appropriate Use
of Telemedicine Technologies in the Practice of Medicine,” which
endorses the use of audio and video as a best practice when
Amwell's consumer app lets patients select their doctor
4 American Well Patient Testimonial, 2014
5 Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine, Federation of State Medical
Boards, April 2014
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Consumers want to select their doctor, not be
randomly assigned.
In some instances it’s not reasonable to expect the option for choice; for
instance, when you visit the emergency room. But when given the option,
would consumers prefer to make the choice themselves?
The answer is overwhelmingly, “yes”: 88% of people wish to select their
physician. That number climbs as high as 94% for retired individuals, who
may be making choices about their medical care for more serious conditions.
Those that have high incomes seem to also value choice: 92% of those with
household income of $100k+ want to select their doctor.
The ability to know what doctor you’re connecting with - to have
information about what medical school they attended, to know their specialties,
and to ensure they are U.S. board certified - relates to consumer questions
about online doctors that we uncovered earlier in our survey.
If patients can review the doctor’s credentials, see their picture, and verify
their board certification - they’ll likely be more satisfied with the service.
When it comes to a new doctor, what would you prefer?
Randomly
Assigned
12%
Select
Doctor
88%
Consumers want online visits to be affordable.
Many consumers responded that they were willing to see a doctor online if the cost was right. When surveyed, most believed that
telehealth visits should cost less than an in-person visit. Fortunately, online video visits are typically priced at or below typical in-patient
copays. 6 Increasing access to care without breaking the bank is one of the core tenants of telehealth services.
How much should online visits cost compared to an in-person visit? 7
Cost of care
22%
11%
62%
$750
5%
$140
$95
$49
Less
More About the same Not Sure
Emergency
Room
Urgent
Care
PCP
Telehealth
6 Milliman (2011) actuarial analysis and American Well client data
7 American Well Consumer data, 2014
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Online video visits are changing doctor-patient
relationships.
We wanted to know: How does the availability of telehealth impact doctorpatient
relationships? To start with, we asked about the longevity of
consumers’ primary care relationships. We found that 76% of people have
a physician relationship of 2 years standing or more – and that the remaining
34% either had a new primary care doctor or no such relationship.
Surprisingly, 7% of consumers said they were actually willing to switch
doctors to get online video visits. While this number may sound low, it is
already high enough to be a cause of serious concern for most practices.
Doctor-patient relationships of 2-4 years standing are most at risk
for online switching – even more than new relationships. Some of this is
related to demographics – younger adults value online video visits more –
but it may also reflect a core sense on the consumer’s part that they are
not entirely satisfied with how long it takes to get in to see a doctor. Least
at risk are relationships of 10 years standing or more.
How long have consumers had a PCP? (years)
27%
14%
19%
20%
20%
34%
have had a primary
care relationship for
2 years or less.
A closer look at the demographics shows that as many as 11% of young
adults aged 18-34 would switch doctors to get video access. This may
mean that younger consumers are less loyal to their physicians, but it also
correlates with the age groups who are most willing to have a video visit in
the first place. While the number of people who would switch doctors for
video visits is still low, if younger healthcare consumers are the most likely to
switch to a doctor that offers video visits, this may indicate a wave of change
to come. Doctor's who incorporate video visits into their practice may be
better positioned in the long term.
Don't have one

Market Impact
While there is still much we don’t know about the future of telehealth, we believe we have uncovered information that is valuable to many
players in the marketplace, including healthcare delivery systems, large employers, and health plans.
Health systems can retain existing patients and acquire new patients.
Healthcare organizations already find telemedicine services valuable for cost savings as financial incentives under ACA shift from a feefor-service
model to one that makes payments based on patient outcomes. Eighty-four percent of health care executives surveyed in
2014 reported that telemedicine services were important to their organizations, and 90% reported they are developing or implementing
at least one telemedicine solution. But most of these solutions are equipment-intensive and not designed for acute urgent care services.
Now that 64% of consumers want to have a video visit for general services such as prescription refills and after-hours care, it’s important
to consider how telehealth services can enable healthcare delivery systems to compete with retail and urgent care models to reach new
patients and keep existing ones. Telehealth also allows health systems to surround patients – especially at-risk patients and those with
comorbid conditions – with needed primary and specialty care. This will keep patients healthier, prevent readmissions, and retain more of
their capitated payments.
Employers can recognize cost savings.
For employers who bear the risk of employees’ healthcare consumption, offering their employees a lower-cost, more convenient alternative
to emergency department and urgent care visits is of high value. Towers Watson projects that as much as $6 billion will be saved through
the adoption of telehealth, and 71% percent of employers are expected to offer telehealth services by 2017. 8 There is also the important
issue of productivity as consumers express interest in telehealth as a time-saving measure, employees can get back to work faster.
Hourly employees especially benefit from telehealth services as missing work often results in a smaller paycheck, and can leave employers
short-staffed.
Health plans can retain large accounts, win new consumers and save costs.
As employers increasingly adopt telehealth, they look to health plans to cover these services. Health plans must cover telehealth in order
to stay competitive, retain large accounts and win in the new era of healthcare exchanges. Telehealth also enables health plans to directly
realize cost savings by offering telehealth to fully-insured members.
8 Current Telemedicine Technology Could Mean Big Savings, Towers Watson, August 2014
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Telehealth resources.
As your organization considers telehealth, American Well can assist the decision-making process with resources and support. American
Well has helped health systems, employers, government agencies, and health plans through adoption and implementation of telehealth
services for a range of clinical and business applications. Below is a list of content to inform you along the way.
Additional eBooks
Why ACO are Hot for Telehealth eBook
Delivery System Best Practices eBook
Employer Best Practices eBook
Articles and Literature
Frost & Sullivan Telehealth Services Award, 2014
Federation of State Medical Boards Telehealth Policy
Article: Becker’s Health IT & CIO Review, "Best of Both Worlds"
Article: Medscape, "Virtual Visits Benefit Physicians as Well as Patients"
Blog Posts and Hot Topics
Five Surprising Specialties Using Telemedicine
Top 10 Stats You Need To Know About Telehealth
Telehealth Myths De-Bunked
Author:
Mary Modahl, Senior Vice President
American Well, January 2015
Methodology: This survey was conducted online within the United States by Harris Poll on behalf of American Well Corporation
from December 1-3, 2014 among 2,019 adults ages 18 and older.
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www.AmericanWell.com