Sunday, December 27, 2009

United Health Care and Telehealth

What does a corporation do when it is wildly successful financially and has lots of cash?

We in the medical field have looked on bemused at the plans of United Health for “telehealth.” I understand that United even set up demonstrations in the halls of Congress during the recent health care reform activities, wowing the Congress people.

What is telehealth? The use of communication and other technology to have a virtual visit with a patient. The patient is seen at a distance, miles or hundreds of miles away. It’s a pretty glitzy prospect, and who knows, maybe useful in some instances. Rural and remote areas, perhaps, if they can’t be manned by real people. Specialist visits, perhaps. We already have interpretation of imaging studies on line, so that doesn’t count as a new phenomenon.

Naturally my primary care colleagues are upset. It attacks our business, and it demeans what we do, in a way. People who think telehealth substitutes for a real caring person are unclear on the concept – but that’s so typical these days, techno-types think they can deconstruct and understand, when they can’t.

I understand this from a corporate point of view. United is an ultra-successful health insurance company, and has amassed billions. No wonder they didn’t want to be reformed, and the prospect is for even more billions under the health care non-reform legislation. When this happens to a company, they look for the next "disruptive technology," or they find a way to buy other companies in their field and make themselves bigger and even more predominant and successful.

Apple was good as far as it got, but what does it do for an encore? Ipod. Iphone.

Microsoft and Google were excellent, what do they do for an encore? Buy other adjacent companies, compete in adjacent markets like the iphone, for instance.

So what will United do to maintain its dynamism? It's hard to go around buying hospitals, medical groups, other insurance companies, etc. So instead it looks for a disruptive technology, and it thinks telehealth might be it. Gotta do something.

Personally, I think it will be a big failure. I think an insurance company cannot be the linchpin of medical services. Seems to me that it will be very hard for what is essentially a fiscal intermediary to make real substantial improvements in the medical care system, and if they were to do so, it wouldn’t be through technology. I think that transformation and disruption need to come from real providers of care, docs and hospitals, not financial intermediaries. But of course, first they have to get the money.

Budd Shenkin

1 comment:

  1. Budd, an interesting 'view at variance' on telehealth. I come from the other side as an editor of Telecare Aware ( but another 'reason why' UnitedHealth is interested in this (BTW it's American Well's system implemented through OptumHealth, their health management subsidiary, and called NowClinic) is that their traditional insurance line of business will be decimated by 'non-reform'. They are trying to convince a bunch of blindered bureaucrats to think well of them.

    As an observer, I believe this type of teleconferencing consult has a place, like 'MinuteClinics' do--in fact it's a telehealth substitute for that, in large part. And the fact it's pure private pay--$45/visit--is another interesting and 'free market' alternative for the consumer.

    Telecare Aware coverage