The rise of the digital front door

A month ago, I came back from Nashville where I had been attending ViVE, a healthcare conference that operates at the intersection of the digital and legacy healthcare worlds. Again and again, I heard the same words from the digital health leaders of health systems… ‘digital front door’.

A month ago, I came back from Nashville where I had been attending ViVE, a healthcare conference that operates at the intersection of the digital and legacy healthcare worlds. Again and again, I heard the same words from the digital health leaders of health systems… ‘digital front door’.

To briefly define this before we get into it, the "digital front door" is a term used to describe the initial point of engagement between patients and healthcare providers through digital means.

Really, building a digital front door for healthcare comes down to one thing, accessibility. But why should we care? Because we are now at another turning point. This is a point where the legacy health systems are beginning to integrate a lot of the technologies we are so used to outside of healthcare into their own product experiences. With a new generation of enabling technologies that provide an easy-to-use platform for ‘legacy healthcare’ players.

A brief history of care delivery

Before we look forward, it’s interesting to see where we’ve come from. In the late 19th and early 20th century, most care was provided in patients' homes. There wasn’t a need to visit a hospital as for the most part, a doctor could bring the majority of what was necessary with them and the use of specialised medical equipment was still in its infancy. X-rays were discovered in 1895, widespread aseptic surgical techniques didn’t come about until the late 19th century and much of the modern equipment we are used to today, even if ‘invented’, wasn’t in widespread use. A doctor armed with only a stethoscope, forceps, scalpels, and retractors was all that you would get if you fell ill at the time.

As specialised tools came about, there was a need to go to a centralized place to get access to these potential life-saving tools. There was also an emergence of medical specialities which happened around the same time as medical knowledge expanded and discoveries in various fields accelerated. The chances of getting access to a specialised cardiologist or any other ‘-ologist’ in a rural American town were pretty slim at the time.

Over the 20th century, this trend accelerated. We had the emergence of new pharmaceuticals and the ability to mass-produce anything from antibiotics to vaccines for rare diseases. Care also became more patient-centred. Previously, care had typically been ‘paternalistic’ with doctors making decisions without involving a patient or considering their preferences or values. The term ‘Whole person health’ definitely wasn’t in use. As knowledge advanced and society evolved, this shift led to the development of patient-centred care, which emphasized a partnership between healthcare providers and patients, shared decision-making, and a holistic approach to care that considers the patient's physical, emotional, social, and cultural needs.

And then comes the 21st century. An era of rapid innovation spurred on by technological achievements. EMRs have become extensively utilized throughout the United States, facilitating more integrated care models. In recent years, the adoption of value-based care (VBC) has notably increased in popularity, becoming a prominent approach in the healthcare industry. The use of mobile health apps, wearable devices, and remote monitoring tools has increased, empowering patients to take a more active role in managing their health and facilitating better communication with healthcare providers. A digital front door now exists that patients and providers can take advantage of!

The Innovators and Early Adopters

A digital front door to healthcare is a recent invention. I still remember my first virtual interaction with this. It was 2017 when I was on holiday in Sweden. I wanted to get something checked out by a doctor and was told about a platform called Kry. I remember being pretty apprehensive, ‘healthcare through a telephone?’ I thought to myself. ‘This didn’t seem at all right!’ But I went through with it and jumped on a 15-minute video call. I was reassured by the provider, they answered some questions and I hung up. Instead of the trip to and from a doctor's office and waiting, I had just spoken to a medical professional, for the first time, from the comfort of my hotel room. After this interaction, I was convinced that virtual care was going to play a big role in the future of care!

But even in 2019 after Teladoc had been around for 17 years and Zocdoc for 12 years, only 8% of the US population had actually used a telemedicine service.

Pre-covid, adoption and innovation in the space were generally slow for a number of reasons. Telehealth adoption faced various regulatory challenges, including restrictions on licensing, reimbursement, and practising across state lines. Reimbursement policies, especially amongst payers were initially slow to cover Telehealth services and then there was generally the issue of technological limitations and resistance to change due to fears around the quality of care, patient privacy and potential liability issues. Overall this didn’t make things easy for entrepreneurs or providers who wanted to offer this service to patients.

This trend towards virtual care would likely have continued to climb slowly if it wasn’t for Covid, and during this time, many of the regulations which had hampered adoption were lifted or relaxed, which allowed this market to see a rapid rise in both adoption and awareness.

The late majority

The adoption curve shown below was introduced by Everett Rogers, an American sociologist. The diagram breaks down how a product or service is adopted into 5 groups based on their willingness to embrace new innovations.

We have entered the late majority in regard to healthcare organisations that are offering their members or patients a digital experience of some sort (excluding a website). The problem is that for the most part, this is still relatively primitive.

The challenge now is working with established large health systems to create a digital front door that maximises accessibility, the patient experience and the quality of care. I believe that this will be a key focus for the US healthcare market going forward. So what does this look like and who are the potential winners?

The winners

I’m fortunate that I get to work with a number of digital healthcare companies in my day-to-day work with Sanctuary Health. And many of them provide a ‘digital front door’ to a number of patients who traditionally may have struggled to receive care.

Patients are the obvious winners in this case, as the digital front door offers them easier access to healthcare services, more convenience, and greater control over their health. Whether it’s booking appointments, accessing medical records, or consulting with healthcare providers remotely. This simplicity in theory should result in improved accessibility for a number of individuals who traditionally may have found it harder to get access to care. Examples of such companies include:

  1. Eleanor Health: Comprehensive, personalized addiction treatment services through a combination of virtual care and in-person support, making addiction care more accessible to a broader range of individuals, who may find it difficult to access care due to stigma or discomfort in face-to-face interactions.
  2. Included Health: A care concierge platform that connects LGBTQ+ individuals with culturally competent healthcare providers, ensuring that members of the LGBTQ+ community can access safe, understanding, and appropriate care.
  3. Sword Health: Digital physical therapy solution using AI and wearable devices, enabling patients to access personalized physical therapy programs remotely, reducing the need for in-person visits, which can be difficult for those with limited mobility.
  4. Twenty-Eight Health: Telemedicine platform focused on women's health, offering accessible and affordable birth control, emergency contraception, and sexual health services through online consultations and discreet home delivery.

We’re also seeing the rise of enabling technologies that empower providers to launch or scale their digital offerings. Wheel and League are both examples of these kinds of companies. Payers, Health Systems and Clinicians (in Wheel’s case) can launch a digital offering at a fraction of the time and cost that it previously would have taken. And the truth is, health systems for the most part need these enabling technologies to provide great virtual care. I mean, just take a look at Highmark Health’s website.

This is a healthcare company that did $27bn in revenue last year and its website looks as though it was built in the mid-2000s. Going back to the adoption curve, healthcare definitely sits in the ‘laggards’ category for technology adoption. But digital experiences are becoming the norm, and 41% of consumers would now consider switching to a provider that offers a better digital experience. I foresee enabling technologies as big winners.

The digital divide

But it isn’t only good news. Many of us, myself included take fast broadband for granted, as well as the proliferation of digital devices. But many people, especially those in low-income households or rural areas may lack access to these resources, limiting their ability to take advantage of the digital front door's benefits.

A related issue is that of ‘digital literacy’. Navigating digital healthcare platforms and tools may be challenging for individuals with limited digital literacy or proficiency in using technology.

And finally, language barriers. Many digital front door tools and platforms are designed primarily in English. Nearly 25 million people in the United States (8.6%) are defined as limited English proficient. This barrier may prevent them from fully utilizing digital services to access healthcare.

Breaking down Wheel

A recent Rock Health report on the consumer adoption of digital health had a nice quote:

Health data sharing only moves at the speed of trust, and right now it’s slow going

I would like to take it a step further, the adoption of new technologies (not just data) moves at the speed of trust, and nowhere more so than in healthcare. The ability of health systems to have on-brand platforms, that work well, like those created by League and Wheel will drive further adoption faster.

So let’s take a look at one of these companies innovating in the space. Although there are a plethora of companies building these enabling technologies, Wheel is one of the biggest in the space, having raised $215m after raising a $150m series C in January of last year.

Wheel was founded in 2018 by two former Telehealth veterans with a simple premise: to provide clinicians and healthcare organizations with a seamless experience that enables them to offer high-quality, cost-effective, and accessible virtual care to patients.

Wheel’s product could not have come at a better time and rapidly cemented its position in the market, filling a previously unoccupied niche. Two of the biggest challenges providers have faced when launching virtual care offerings are regulatory issues and technological limitations. For some context, 75% of hospital communication still takes place over fax and it is rare for health systems to have significant internal engineering and product teams.

These systemic challenges make it hard for large provider groups to spin up a digital offering quickly and efficiently.

Wheel addresses these challenges by providing a comprehensive virtual care platform that connects healthcare organizations with a network of clinicians who are ready to deliver virtual care. The platform streamlines the process of onboarding, credentialing, and managing clinicians while also ensuring that they receive the necessary training and support to provide quality care.

This all contributes to the transformation that’s going on in care delivery, making it easier for healthcare organizations to not only access and manage clinicians for virtual care services but do it in a way that is simple and easy for a patient.

What about Epic

What would a healthcare-focused blog be without mentioning Epic? For all of Epic's faults, one thing that they have seemed to get right is the Epic MyChart app.

It is consistently at the #1 spot for Medical apps on the app store, has a 4.6-star rating on both the App Store and Google Play, and has over 100m+ patients using the platform!

Clinicians may not love using EPIC’s EMR but patients love MyChart! Epic’s MyChart app could warrant an entire blog in itself but it also raises an interesting, what does the future look like

Throughout this blog, we’ve looked at two main categories: Picks and shovels (the companies powering the digital front doors of legacy health such as Wheel, league and to some extent epic, although they maintain the Epic branding) and then the digital native care providers like Eleanor and Included Health which are built with a digital front door as one of the main value propositions to patients. At the end of the day, they all provide care to patients. So what does the future look like as we move down this adoption curve?

A fundamental shift in care

For specialised care, such as dealing with certain populations such as LGBTQ+ patients or specialised conditions I believe that we will continue to see the success and adoption of the digital native companies that can bring expert providers together to provide care. But on the other side, in an industry like healthcare people go to brands they trust. If providers such as Northwell can build incredibly effective digital front doors, patients would be more likely to congregate there than some plucky startup. The real question then is can these legacy companies build digital front doors that compete with the venture-backed startups of the world? Only time will tell

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