somewhat OT but pertinent

my wife and I use Weill Cornell doctors for a lot of our medical care. It’s one of the largest multi-hospital medical centers in NYC. Yesterday I received the following email from them. I have not used their video appts so this must have gone out to everyone. As well as Zoom investors, this may be relevant to Teledoc investors.


Improvements to Your Video Visit Experience

To our patients,

We are updating your Video Visit experience to bring you a faster and more reliable connection when you meet with your healthcare provider virtually.

As of September 9th, ALL Video Visits will require the installation of Zoom onto your personal device or computer.

What You Need To Know

You can download the free Zoom Cloud Meetings app by visiting the App Store or Google Play. If you choose to use a computer, download the Zoom Client for Meetings from the Zoom website. If you do not install Zoom prior to your Video Visit, you will be prompted to do so when signing in to your scheduled appointment through Connect.

Everything else about your experience will remain the same, and you should continue to log in to Connect to launch your Video Visits as you normally would.

Remember to log in to Connect at least 15 minutes prior to your appointment to allow sufficient time to complete the Zoom download and to follow the eCheck-In process prior to your Video Visit.

Your Video Visit remains secure with this integration of Zoom. Your information will still be protected with the same reliable security and the highest patient privacy standards that you have come to know and expect from us.


Having been on several Zoom meetings with
our doctors we find-

  • a simple phone call would have done fine
    especially a follow-up call with a doctor
    you know.

  • a lot of time is wasted waiting by the
    doctor’s assistant to set up the call- emailing
    ids and passwords. And then
    you are put into a “waiting room”.
    Have the doctor call
    on your (cell)phone when he is ready.

  • some doctors don’t even turn on their video,
    so again the phone would have done fine.

And naturally, if the doctor has to feel
or visually inspect close up or use an
implement, the video is not useful.


- a simple phone call would have done fine
especially a follow-up call with a doctor
you know.

For billing reasons, it seems unlikely that phone will become a long-term billable option. Video visits are reimbursed at this time. I do not believe that removing the visual component is viable, especially as there are important parts of physically examining a patient that would at bare minimum require observation. Just my two cents.


We have a Zoom visit via MyChart (Epic) this morning with a surgeon who is going to take a look at my son’s chest structure. Perhaps they will schedule an additional in-person meeting as a next step if the doctor has concerns, but I am impressed that they will be able to do at least an initial exam via zoom. I don’t have to drive to the hospital, park, find the right place to go, etc. etc. etc. especially since it’s my other two children’s first day of school. We’re a little busy around here.


a simple phone call would have done fine
especially a follow-up call with a doctor you know.

Good morning, tpoto.

Ha. Really? When’s the last time you tried to get your doctor on the phone? I can’t remember when my last time was that was successful. At the very best I MIGHT get a phone call from a nurse or some clinical assistant (usually days after my question) with a relayed answer to my question that might or might not have lost something in the translation. Then if I have a followup question I get “I don’t know, I’ll have to check with the doctor”. Lather, rinse, repeat.

I don’t know if that’d be any better with a telemedicine video call but I might hope that the procedure is sufficiently more formal that the doctor would actually make an effort to be there. Of course that’ll only last until the novelty of all this telemedicine stuff wears off.



Don’t forget that medical doctors are just one segment of the healthcare system. Physical therapists and occupational therapists specialize in movement dysfunction. One of the main components of any exam is observing movement. Video is quite adequate for that purpose, as well as demonstrating stretches and therapeutic exercises.

However, I believe the point Saul was making with his post is that Zoom is penetrating the healthcare industry and is likely to encroach on TDOC’s market share. While TDOC is not simply video conferencing, there is no reason Zoom can’t enter that space and acquire companies (and I would be surprised if they don’t).

I did not see the Livongo acquisition as a reason to exit my position, but I am increasingly confident that Zoom will dominant in all video communication spaces!


However, I believe the point Saul was making with his post is that Zoom is penetrating the healthcare industry and is likely to encroach on TDOC’s market share. While TDOC is not simply video conferencing, there is no reason Zoom can’t enter that space and acquire companies (and I would be surprised if they don’t).

I have no doubt that Zoom will be a big player in healthcare but I don’t see them competing head on with Teladoc/Livingo. Zoom adopted by healthcare doctors has a different mission than Teladoc/Livingo adopted by healthcare payors. As I said in a previous post:

You might object that Teladoc and Livongo are healthcare so why do I have such a large position? Many people see these companies as healthcare but I don’t. Their clients are healthcare payors who are looking for ways to save money by promoting more rational ways to deal with health. Their mission is to improve the functioning of the healthcare market.

Denny Schlesinger


I got the same email from Columbia yesterday.

A video call is better than a phone call - a physician can see the patient, how they hold themselves, their facial expressions, even their pallor if the camera has decent fidelity.

And imagine if your Apple watch (or some other device) had recorded a few weeks worth of blood pressure, heart-beat activity, blood sugar, blood oxygen, etc, that you could then upload prior to your appointment for review.

Looking for a little clarity here so could someone tell me does TDOC use their own video system and could they at some point transition to using Zoom as well? Isn’t the video portion of TDOC just one tool to reach their clients? I tend to agree with Denny, as usual, that it is the insurers that will provide the business for TDOC not providers. So just as Saul’s hospital system has switched to Zoom could not TDOC switch as well and continue to provide their service with a better video experience?

1 Like

I got the same email from Columbia yesterday.

Hi sunnym,

No surprise. Columbia hospitals and doctors, and Cornell hospitals and doctors, are part of one huge medical system in NYC.



Since Zoom is obviously the leader in video and Teladoc could care less about video, that just isn’t what they do. I could see Teladoc incorporating Zoom into their platform.



Many people in large cities rely on huge medical institutions, most of which use Zoom. But this is not all of medical care. And as others have pointed out, these institutions have long waiting lists for appointments. They are really not competing with the quick check by TDOC. The closest thing to competition is ER ( very expensive exposure to contagious diseases) and the “doc in the box” clinic, few of which are open 24/7 and where you are likely to see a NP not a doctor.
I think all can co-exist. Though I have no idea what TDOC share will be.

The LVGO part of the business is more obscure.There is a limit to insurance company sponsorship and so far not much evidence that people will buy it on their own. Even though there is a huge non compliance problem with diabetics, there is a reason for that, instant satisfaction beats delayed gain for many /most of us.

Most of our stocks are SaaS where we can see this huge tide of digital transformation at work, lifting all entries. I do not see anything as strong in health care. The pressure there is to make it cheaper and for politicians to win votes.


To answer some questions, yes TDOC could incorporate Zoom as their service but the question becomes “how many middlemen can exist between you and the provider?” At some point, the cost difference between TDOC and your hospital system disappears. Most people with insurance see little to no difference between TDOC and their HCS. However, most hospital systems have built-in their overhead (buildings, equipment) into your PCP visits, that’s the difference in price the insurers see. Like so many others, the pandemic and telemedicine’s rise was never built into their pricing. That will change. Insurers will build in a separate tier for telemedicine regardless if it’s for TDOC or your provider. At that point, this quickly becomes a brand game.

Teladoc will need to increase its brand awareness and marketing spend significantly. Right now, Teladoc’s marketing expenditure was just $18M in Q1. That will need to increase 10-20x to have exposure in the US. Fortunately, they have the financing to quickly ramp up their spend and awareness. Teladoc can also buy nationally. Your Healthcare system can only buy regional and their spends will be limited because telemedicine isn’t a moneymaker. These are huge advantages for Teladoc provided they use them.

I’d bet my bottom dollar that we’ll begin to see Teladoc TV commercials (TV remains the most efficient way to reach 50+ adults) begin after the Presidential election as TV prices and avails quickly return. At the lastest in Q1. They’ll need to catch the flu season. Teladoc can’t live on younger, healthier people and uninsured. At least, not live as they want to.

IMHO you begin to see Teladoc advertising as often as you see brand name meds (Cialis, Lyrica, Eliquis). That’s how they compete post-pandemic when everyone is coming after parts of their business.