Virtual Nation: Telemedicine’s Breakout Moment

As we collectively struggle through the fear and isolation of a global pandemic, Americans are turning to online video communication services in droves for everything from routine work meetings to virtual “sing alongs”¹ and video happy hours² to lift spirits and preserve community. Students across the country are attending class via the internet. And organizations have moved quickly to bring planned in-person conferences³ online (including our own Summer 2020 DiabetesMine D-Data ExChange).

What I am also witnessing is a new reliance on “telehealth,” to allow routine medical care to continue in the face of this public health crisis. It’s encouraging to see government extend support and loosen regulations⁴ for telehealth, recognizing that virtual visits are no longer just a “stretch” option for the most disenfranchised patients, but rather a lifeline for all.

The leaders in virtual diabetes care—Livongo, One Drop, MySugr, Cecelia Health, Steady Health, and Virta Health—all responded to my query confirming that they have seen an uptick in subscribers. Most are also offering discounts to patients during these difficult first months of COVID-19 impact. And even many local physicians are gratefully jumping on board. For example, one “old school” endocrinologist near me had begun phone consults in response to coronavirus, but soon switched to video for a fuller experience.

He treats mostly older patients, and says: “Seeing their faces is good. Most of what I do doesn’t require physical proximity. . . I’m now very confident I can at least get my diabetes patients through the next 3 months using telemedicine. . . In a lot of ways, patient satisfaction is greater.”

I personally was an early client of San Francisco-based Steady Health that offers virtual care based on continuous glucose monitor (CGM) use. Ironically, shortly before COVID-19 hit, I was considering dropping the service based on the $50/month charge. But now, I am more appreciative than ever to have a “diabetes coach in my pocket”—that is, their smartphone app that connects me directly to an endo and diabetes care and education specialist. They keep tabs on my glucose trends and make proactive suggestions, and I can message them 24/7 for anything from Rx refills to adjusting my basal rates. Thank God I’m not dependent on physically driving to a clinic!

If I diligently track my food intake and exercise alongside my CGM data for a week or two, the Steady team compiles a visual report with meaningful insights into what’s driving my glucose levels. They caught things like long-term effects of exercise, or insulin timing issues, that I was completely unaware of. Honestly, this intense coaching is the best diabetes care I’ve ever had in my 17 years with this illness.

As these advantages become ever more evident, I believe the shift to virtual care is here to stay. For the skeptics who say telehealth won’t change anything, consider:

• The major barrier holding telemedicine back has not been technology or people, but reimbursement. Now with forced reimbursement and mounting evidence of efficacy, it will be hard to go back.

• Time efficiency and convenience, reducing stress and frustration.

• Green effect: decrease in travel and pollution.

• Huge advantages reaching underserved populations—many with no car, or no means to pay for childcare (note that hospitals near a bus line⁵ fare better).

• Care via smartphones further extends reach (data says up to 91% of patients have a smartphone⁶).

• Opportunity for new types of group visits—with big potential but previously held back by logistical and billing issues.

• The COVID-19 crisis is providing healthcare providers valuable experience about what works well in virtual visits (down to setting and lighting).

As my good endo friend Dr. Richard Jackson says: “Schlepping in to see your doctor and waiting around if you’re not retired is a pain. And it’s not that great if you are retired.”

Jackson, former director of medical affairs at Joslin Diabetes Center, adds that a huge number of in-person appointments are really unnecessary—more a chance for clinic reimbursement than anything else. “Like when you ‘need’ to see your doctor to get a refill for your CGM supplies. What is the real purpose of the appointment?” He adds: “For patients in a stable phase, virtual provides more flexibility. Doctors could touch them more lightly."

Of course, to make all this possible, we need to move from a pay-per-visit healthcare business model to something more holistic. “Our system is still so awkward,” Jackson says. Recent CMS policy changes are promising. And eyes are being opened to the longstanding benefits of virtual healthcare.

I predict that we will soon drop the “virtual” and simply refer to these online visits as “healthcare”—just as what was once futuristically called “e-commerce” is now simply “commerce,” conducted from anywhere, with powerful results.