August 10, 2014

With news that Richard Branson sees telemedicine as a decent investment opportunity, it raises the question of whether a dominant telemedicine model will emerge. That was one of the observations shared by Katerina Fialkovskaya, co-founder and managing partner at Boston-based OKM Capital.

She welcomed Branson’s entrance into the market last week and noted:

“The flow of investment into the space will certainly accelerate the process and help to figure out the winning model. Whoever is the winner, the benefits for the society, that mobile technology is to bring by disrupting the health care, are incomparable to the social network revolution.”

It’s too early to say which model will win, since familiarity with telemedicine will take some time before it works its way into the mainstream awareness. But here’s a sense of how some companies are approaching telemedicine models.


Web-based and mobile companies like Doctor on Demand, in which Branson invested, provide feedback to patients based on the symptoms they give. They tend to generate revenue from employers interested in whittling down healthcare expenses and whose employees tend to have high out-of-pocket costs. Users tend to get whoever is qualified to provide medical advice in their community. Some also offer the services to consumers for a flat fee, such as $50-$60.

What’s interesting is the scope for specialty medicine in this area such as dermatology.Dermatologist on Call is a direct-to-consumer mobile platform that lets users take a picture of a rash or mole and send it to the company and receive a response from a dermatologist in three business days. Second opinions are also another part of the model. MDLive recently partnered with Children’s Hospital of Pittsburgh to offer second opinions in pediatric cases. For $3,0002ndMD customers can speak with two to five specialists, depending on their condition, after providing lab, test results and a physician’s assessment or recommendation for treatment a few days before.

The healthcare kiosk has the feel of stepping into some futuristic pod. HealthSpot andSoloHealth are the dominant companies in this space. HealthSpot users connect with a physician online and tend to play an active role in the exam by using one of a handful of electronic medical devices such as a thermometer, stethoscope, an otoscope to get a better view of an ear and a dermascope to get a better view of a rash or skin problem. Non-emergency medicine tends to dominate in telemedicine and kiosks are no exception. Each of the devices transmits an image or reading to the physician on the other side of the screen. It’s formed a joint venture with Cleveland Clinic after doing a pilot of the service for one year which raises some interesting questions about which directions it could go in. It’s also providing its kiosk service through an employer wellness plan by Kaiser Permanente to one of its company clients.

With healthcare kiosks and many of the online models, the physician tends to be someone the patient hasn’t previously met. But the founders of these businesses take the view that access triumphs familiarity. SoloHealth has kiosks in retail sites and lets consumers in high-traffic retail locations monitor their blood pressure, central vision and weight, as well as get a health-risk assessment. Users can identify and contact local physicians. WellPoint and Coinstar are among its investors.

The highest profile national drugstores are still experimenting with how they approachtelemedicine through in-store clinics. The furthest along appears to be Rite Aid. It embraces both telemedicine through the in-store clinic and the online experience. Its NowClinic is available at 58 of its stores through a collaboration with UnitedHealthcare’s Optum Health Solutions. It started with nine stores in Detroit in 2011, but now has a presence in stores around Baltimore, Philadelphia and Pittsburgh. In some states providers — doctors or nurse practitioners — can prescribe medication based on their diagnosis. But it also offers 24/7 access to providers online. Users log in and complete their contact details and health history. They can also get a copy of the physician’s summary sent to their primary care provider and integrated into their health record.

CVS uses nurse practitioners to provide telemedicine services to patients in the presence of a nurse. Although its initial focus has been rural communities where Medicare tends to reimburse for telehealth care, an increasing number of states require private insurers to cover telemedicine, including California. That’s where CVS is piloting telehealth in 28 stores. Walmart is collaborating with Humana to provide telemedicine access in a handful of stores at Humana Health and Well Being Centers.

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