The way Zocdoc CEO Oliver Kharraz, M.D., describes the explosion in telehealth demand that occurred in the days after the COVID-19 pandemic was declared, a few key players were best positioned to deliver.
Those brands that have been most successful, such as Teladoc, quickly took telehealth from a service that was hard to use to one that provided patients critical access to physician care during stay-at-home orders when the country really needed it, he told Fierce Healthcare in a recent interview. Patients could sign on to their computers and be connected with a doctor almost instantly.
But as telehealth moves into a new phase where it has become a source of ongoing patient care, Kharraz said platforms that enable care online have to evolve to—or rather, return to—prioritizing strong patient-physician relationships.
"Those really were never designed to support patient choice or patient continuity of online/offline care and so the ability to scale," he said. "I think taking this model that just instantly available to then scale it would be a mistake."
Of course, Zocdoc has skin in this game. In April, the online medical appointment booking company added telehealth appointments to its platform in response to the spike in demand for virtual care. It now has more than 10,000 providers signed up to offer telehealth across 100 different specialties, Kharraz said.
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Here's a look at our conversation about what he argues the future of telehealth should look like:
Fierce Healthcare: What have you seen happen in telehealth this year?
Oliver Kharraz: I think everyone agrees that telehealth is part of that future healthcare system. If you were to ask anyone in 2019 around this time if they thought it would be as prominent as it is this year, they would've laughed us out of the room. But clearly what's been powerful for companies like Teladoc and other companies that really deserve praise in how they stepped in when the pandemic hit. They took it from a point where essentially telehealth was hard to use and it was mostly there to support acute needs, like to identify rash or "I need a prescription." It was really much more like an online urgent care experience.
FH: Why do you believe teleheath needs to change from that model?
OK: If you think about what it really is: randomized triage care. The patients go online, they wait in a queue and they get connected to the first doctor who happens to be available. For a patient … they've got very little choice. You're on a conveyor belt. As a result, the patient-doctor relationship—which is really the building block of our healthcare system—really morphs into something that's more like the relationship to an Uber driver. In its best case, it's polite, but it's transactional and ephemeral. That may work for cabs. But it's important to remember that healthcare is not the gig economy and that patients aren't getting a ride to the airport. They are putting their health in someone's hands, and they ought to have a say in who that somebody is.
FH: So what should it look like?
OK: If you look at how the healthcare system has been organized, it's always been premised on this idea that we should have an ongoing relationship with a local care provider, and the reason for that is that you don't want the information to be lost through handoffs. I remember back in the day when I did my residency, the theory was that handoffs are so bad that you want to push the residents to their maximum so we only did 30-hour shifts to make sure that we had the most longitudinal perspective on the patient we could possibly have. And it's interesting if you think about the impacts on the care. There's always something you can't document … Are they always a little bit grumpy or are they having depression right now? What are their reflexes and other things that are really hard to quantify, but doctors get to know their patients and sort of build a real longitudinal perspective of what that patient is like and they can view change as it happens and know what's important to double-click on in terms of the current state of the patient.
That's something that we just cannot and should not lose sight of as we design America's telehealth infrastructure.
FH: How does this play out when it comes to patient demand for telehealth?
OK: Zocdoc is a marketplace for patients to come and pick the type of care they want. We don't provide care. We don't try to sell doctors software or anything like that. We are essentially operating under the thought that the patients are better stewards of their own healthcare than anyone else such as a random doctor generator. Because we are neutral to what kind of care the patient ultimately picks, you have the privileged position to observe patient choices when we offer them different options. What we have been able to see in a first test is that we gave patients the option to go through a Teladoc-type experience where they would go to a queue and they would be seen by the first doctor available. They wouldn't necessarily have a lot of choice but it would be pretty immediate. And the other option was that the patient could select the doctor but the telehealth appointment would happen at a scheduled time, or when the doctor was available. We presented these two options side by side to patients to really understand: "Where is the preference? What is the thing the market should offer more of?" That was not a close call at all. What we saw was nine out of 10 patients who booked telehealth preferred to schedule with a provider of their choosing. Nine out of 10 will take the scheduled telehealth where they will probably have to wait over getting into a queue which might promise more immediate care. That was our first learning and points to patients wanting that ongoing patient/doctor relationship.
FH: So patients would prefer to wait if they can choose to return to the same doctor?
OK: Yes. The second question from there was: "Is that alone sufficient?" So is the option to see a doctor in person an important element of that? We presented patients side by side with doctors they could schedule with and choose where some of these doctors were close by and around the corner and some of the doctors were far away or only available through telehealth. Here too, we saw a very clear verdict: Seven out of 10 chose the nearby doctor when booking virtual visits. They weren't sure if they'd need a follow-up visit but they still wanted to be with a doctor who was close by because I think patients instinctively know that, at some point, they'll either want or need to be in the same room with their doctor. They need their mouth to be looked in. They need their heart to be listened to. They need their oxygen to be palpated. There's just no app for that. Many of these things are like pizza. There's no tele-pizza because the core event is being in the same room. At least, that's the way I like pizza.
What is clear from the patient's perspective is they don't want to be forced to choose between teleheath and an ongoing relationship with a provider they trust. I think they're right. They shouldn't have to.
FH: So you're saying Zocdoc's competitors aren't tapping into consumers' top priorities?
OK: It's clearly not what they choose when you give them both options. And I am neutral as I say that. I don't employ any of the doctors, and if patients were choosing immediacy of access over the specific doctor, we'd be happy to serve that upon the marketplace, too. It's just not what we're observing.
FH: Why, then, is there so much energy around the models of the big telehealth companies like the Teladocs and Amwells of the world right now?
OK: I think what happened was, in March and April, when there was barely an alternative to Teladoc and Amwell, as they got some early momentum. That's completely understandable and I think people made the right choice at the time versus not going to the doctor at all. But as they think about how to evolve the telehealth, doubling down on what worked in March and April will be a losing proposition because it's not in line with what consumers prefer. There's a whole set of companies that are enabling providers to sort of see their patients in their offices.
FH: How should healthcare investors be thinking about this?
OK: There's a whole set of tech companies that are enabling providers to see their patients in their office … there are many types of software that allow them to do that and, of course, EHRs will offer them. We also offer a completely free product for the digital enablement of practices they can use for telehealth. I think that's probably where a lot of this is going. I think the actual digital on-ramp will probably be commoditized. It will be a free product in the future. So it's a little like open-source software. You can't really make money with the software. You have to have services around that in the practice that you hopefully would get paid for. That is, if you were thinking of this from the investor angle, what the future is or closer to it than trying to have a centralized national care delivery network that is something patients reject. It's always very hard for them to use something they don't want when there are alternatives available.