Zoom Blog on Telehealth

[SaulR80683]

They ended the blog by “Don’t Forget to Share this post” so I didn’t hesitate to post the whole thing.

Transforming the Medical Landscape: Telehealth Before, During & After COVID-19
October 6, 2020 6 min read

Transforming the Medical Landscape: Telehealth Before, During & After COVID-19
Sometimes, innovation is driven by necessity. The worst global health crisis in 100 years forced the healthcare community to change where and how it cares for patients, and telehealth has risen to play a number of critical roles during the COVID-19 pandemic.

Healthcare organizations are now using high-quality video to:

Provide care to patients directly in their homes
Enable providers to continue seeing patients and keep their practices open
Assemble global teams of medical experts for consultation and collaboration
Allow frontline healthcare workers to examine patients remotely to conserve PPE and reduce their risk of exposure
With providers now seeing 50 to 175 times more patients via telehealth since the pandemic started, many in the healthcare industry believe that telehealth has evolved more in six months than in the last decade. Let’s take a look at how the pandemic has changed how we think about healthcare, and what we can expect post-COVID.

Before COVID: Barriers to adoption

Telehealth has been around for decades, but direct-to-consumer adoption didn’t take off until recently. When most people got sick, they went to the doctor’s office instead of logging on for a video visit — that’s just how it was.

Part of the reason was limited coverage for virtual visits. In a 2019 survey, 77% of physicians flagged reimbursement uncertainty as one of the biggest barriers to widespread telehealth adoption.

Medicare, for example, had strict rules when it came to reimbursement for telehealth. Patients had to live in a designated rural area and travel to a special facility for their telehealth appointment. While it helped patients access specialists they might not normally be able to see, they still had to travel — sometimes many miles — to receive care.

Some providers were reluctant to adopt telehealth, fearing it was unreliable or would affect their bottom line. And while most patients who tried telehealth liked it, the technology simply wasn’t widespread enough to attract more than 11% of consumers in 2019.

During COVID: Telehealth transformation

That all changed when the pandemic hit. Medical facilities and private practices closed, and no one knew when they’d be able to reopen. In response, the CARES Act expanded telehealth coverage for Medicare, which became a turning point for virtual care. Providers could finally collect Medicare reimbursement for telehealth visits provided in the home.

Health systems quickly spun up new telehealth solutions or expanded existing programs to ensure continuity of care for their patients. Amazingly, nearly 1.3 million Medicare beneficiaries received care virtually in the week ending April 18, 2020, compared to just 11,000 visits in the week ending March 7 — days before pandemic restrictions were put in place.

Bringing healthcare into the home

Using technology to reach people directly in their homes during the pandemic didn’t just reduce coronavirus spread, it revolutionized the way providers treat patients. Telehealth has become essential to:

Providing primary and urgent care for common ailments like colds and earaches without exposing patients to the coronavirus
Conducting mental health appointments
Triaging patients with COVID-19 symptoms from home
Remotely monitoring patients with chronic conditions like heart disease or diabetes
Supporting healthy lifestyle changes, such as weight management or medication adherence
Virtual visits have played a role in reducing no-shows and appointment cancellations, which cost the industry billions of dollars a year, and nearly 75% of telehealth patients reported high satisfaction with their experience.

Telehealth for inpatient care

As coronavirus cases surged across the U.S., hospitals and medical centers used telehealth for inpatient care as a way to prioritize the safety and well-being of patients and medical staff:

Virtual rounding reduced the number of frontline workers entering a patient’s room by allowing doctors to see and treat patients from the hallway using mobile devices
Hospitals could bring in specialists from around the world to virtually consult on a patient’s care
Family members could stay involved with patient care, ask questions, and communicate virtually with providers
In the most difficult situations, including end-of-life care, video communications gave family members the ability to spend precious time with their loved ones in the hospital
Other telehealth benefits

Expanding telehealth helped strengthen public health systems and improve health equity by reaching populations that have long been underserved or struggled with access to care. People living in rural areas, patients lacking reliable transportation or the ability to take time off work, and those with medical conditions that made it difficult to leave the house can now get care when and how it’s most convenient for them.

In addition to enabling quality care delivery, telehealth has changed the competitive landscape for private healthcare, giving providers opportunities to provide cost-effective, convenient care to an increased number of patients. This introduces new revenue streams while allowing providers to save money, address resource shortages, and maintain a competitive edge in an increasingly consumer-driven healthcare market.

After COVID: Preparing for the future of telehealth

We don’t know when the COVID-19 pandemic will be over, or what the world will look like once it is. What most experts agree on is that 2020 has transformed the global medical landscape. Patients and providers alike are now more familiar and comfortable with telehealth, so it’s hard to imagine asking them to go back to the way things were.

So, what can providers do to prepare for the future of healthcare? First, assume the demand for telehealth is only going to grow. Consumer adoption of telehealth more than tripled from 11% in 2019 to 46% as of April 2020, and Frost & Sullivan predicts the telehealth market will see a sevenfold growth rate by 2025.

If you deployed your telehealth program in response to COVID-19, now’s the time to move your approach from reactionary to strategic. Continue to build a competitive program of telehealth capabilities and offerings, enabled by a robust digital platform, to reach more patients and gain market share.

Your telehealth solution should:

Have high-quality, reliable audio and video, so you can communicate with, examine, diagnose, monitor, and treat patients virtually, even those with low bandwidth or outdated devices

Meet all your clinical and administrative needs, including integration with patient charts, medical devices, diagnostic tools, and other clinical applications, to streamline patient care

Enable HIPAA/PIPEDA compliance, with rigorous attention to keeping patient data secure and private
Have a user-friendly, easy-to-access experience that accommodates all patients, including those with special accessibility needs and low digital literacy

Offer flexible options and capabilities that support your practice’s customized workflows
Telehealth will continue to play a major role in a hybrid model of care that emphasizes treating patients where and how they prefer — at home, on the go, or in person. With this shift, the industry will reduce costs, waste fewer resources, increase access to care, and improve patient outcomes.

Learn more about Zoom for telehealth and discover how hospitals, health systems, and providers are using Zoom to improve patient care and experience.

Don’t forget to share this post

https://blog.zoom.us/transforming-medical-landscape-teleheal…

[rockleppard]

Saul,

Thank you for posting this article which contains some very important confirmatory statements about telehealth tailwinds. David Gardner has discussed this repeatedly on his RBI podcast (and elsewhere of course), particularly as it relates to the promise of an investment in Teledoc (which soon will of course include the very attractive, hypergrowing Livongo assets via acquisition).

In addition to maintaining a (small) position in Zoom (among my 10 total stocks), I have been a very active investor in TDOC/LVGO starting a year ago having already increased my average cost basis by 3-4X during that time. I now have 23% of my portfolio in LVGO/TDOC which is tied with my 23% stake in Tesla which among other names (TTD 16%, DDOG, MDB, OKTA, MELI) have contributed to my 150%+ YTD performance. I am holding with two fists my shares of TDOC, LVGO, TSLA (in since 2012) and TTD (in since 2018) which I believe will all (continue) expanding quickly moving forward given investing tailwinds.

I do think the future is significantly bright for telehealth leader TDOC/LVGO and expect these shares to really take off with the next few quarterly earnings reports and as the acquisition closes and becomes increasingly integrated. I also expect continuing growth in ZM shares but just not as significant as the growth I expect in TDOC/LVGO.

Check out the statements from the article you posted:

“With providers now seeing 50 to 175 times more patients via telehealth since the pandemic started, many in the healthcare industry believe that telehealth has evolved more in six months than in the last decade.”

“…the CARES Act expanded telehealth coverage for Medicare, which became a turning point for virtual care. Providers could finally collect Medicare reimbursement for telehealth visits provided in the home.”

“Amazingly, nearly 1.3 million Medicare beneficiaries received care virtually in the week ending April 18, 2020, compared to just 11,000 visits in the week ending March 7 — days before pandemic restrictions were put in place.”

“Virtual visits have played a role in reducing no-shows and appointment cancellations, which cost the industry billions of dollars a year, and nearly 75% of telehealth patients reported high satisfaction with their experience.”

“…telehealth has changed the competitive landscape for private healthcare, giving providers opportunities to provide cost-effective, convenient care to an increased number of patients. This introduces new revenue streams while allowing providers to save money, address resource shortages, and maintain a competitive edge in an increasingly consumer-driven healthcare market.”

“Consumer adoption of telehealth more than tripled from 11% in 2019 to 46% as of April 2020, and Frost & Sullivan predicts the telehealth market will see a sevenfold growth rate by 2025.”

Do these factors sound like investment tailwinds to you…??? My goodness, to me this is staring us in the face with opportunity. The TDOC/LVGO shares haven’t taken off to another level since the TDOC/LVGO deal was announced last quarter because I believe investors are awaiting information on the deal closure and also additional earnings data. But I feel with conviction that it won’t be long until these shares accelerate meaningfully. ZM of course has seen considerable appreciation all year, and I do expect growth to this name as well given their gold standard product and brand, and their increasing business optionality (including of course telehealth).

Continued good luck to all.

-Rockleppard

[SaulR80683]

My goodness, to me this is staring us in the face with opportunity. The TDOC/LVGO shares haven’t taken off to another level since the TDOC/LVGO deal was announced last quarter because I believe investors are awaiting information on the deal closure and also additional earnings data. But I feel with conviction that it won’t be long until these shares accelerate meaningfully.

Hi rockleppard,

While the TDOC shares haven’t advanced since July, they are up 160% YTD which isn’t something to scoff at. (That’s from $86 to $223 !!!). That certainly includes allowances for some of the adoption that they’ve seen.

Best,

Saul

[draj]

Telehealth solutions should among other things,
Offer flexible options and capabilities that support your practice’s customized workflows
Telehealth will continue to play a major role in a hybrid model of care that emphasizes treating patients where and how they prefer — at home, on the go, or in person. With this shift, the industry will reduce costs, waste fewer resources, increase access to care, and improve patient outcomes.

This comment, in fact the entire post affirms the current and future importance of telehealth. IMHO it corroborates the proposition, offered here in several posts that The TDOC acquisition of LVGO was a critical and positive strategic move for both companies. The original impulsive response to the acquisition was that this would be detrimental to LVGO rapid growth prospects. All of the positive developments reported above and elsewhere would point to a slightly different outcome, namely that such a slowdown might be less than imagined an in fact the combined operation might be in a position to sustain significant growth comparable to that of most of the favored companies popular here.

cheers

arnie

[RoyGeeBiv]

Don’t forget to share this post

Yes, but that’s a “mailto” link. Copying an entire post breaks TMF forum rules, and violates most copyright restrictions. Best to use a “fair use” summary and a link to the source.

🆁🅶🅱
post tenebras lux
For not in my bow do I trust, nor can my sword save me.

[rockleppard]

While the TDOC shares haven’t advanced since July, they are up 160% YTD which isn’t something to scoff at. (That’s from $86 to $223 !!!). That certainly includes allowances for some of the adoption that they’ve seen.

Best,
Saul

Hi Saul,

You are absolutely right that returns within the past year have been outstanding which I reflected upon, perhaps worded poorly, that my one-year returns on TDOC/LVGO were 3X-4X during this time:
"In addition to maintaining a (small) position in Zoom (among my 10 total stocks), I have been a very active investor in TDOC/LVGO starting a year ago having already increased my average cost basis by 3-4X during that time".

The more important point I am making though is that I think TDOC/LVGO investment returns from here will be VERY significant and that performance on TDOC/LVGO shares since July do not reflect the expected significant growth tailwinds to be captured and increasingly announced hereafter.

I hope that helps clarify.

Best,
Rockleppard

[qazulight]

Saul,

If you haven’t already seen this 5 year old Ted Talk I highly recommend you watch it. Basically we have the technology to see a persons respiration, heart rate and temperature via video. This is passive observation. I assume blood pressure and glucose would be a little more invasive as would weight.

https://www.ted.com/talks/abe_davis_new_video_technology_tha…

But a few years ago, my colleagues at MIT developed what they call a motion microscope, which is software that finds these subtle motions in video and amplifies them so that they become large enough for us to see. And so, if we use their software on the left video, it lets us see the pulse in this wrist, and if we were to count that pulse, we could even figure out this person’s heart rate. And if we used the same software on the right video, it lets us see each breath that this infant takes, and we can use this as a contact-free way to monitor her breathing.

There are products in the field now. They are clumsy and limited. However, with the application of the newest video power from Nvidia and evermore powerful cloud AI, this is a technology that is no longer just a dream.

I suspect that you, in your usual fashion, will jump into your time machine and find out who will make the most money off of this.
.

Cheers
Qazulight

[foodles]

This blog post confirms what many other articles have pointed out recently regarding the current and expected continuation of growth for telehealth. And some of it obviously points directly to LVGO/TDOC without calling them out explicitly. For instance…Remotely monitoring patients with chronic conditions like heart disease or diabetes. Supporting healthy lifestyle changes, such as weight management or medication adherence.

While Zoom will definitely benefit from the growth in this sector, telehealth is merely one vertical for Zoom. It is the entire business for TDOC/LVGO, and why I agree with Rockleapard that TDOC/LVGO and the combined company will see phenomenal growth in their business and stock prices in the future.

Because of ZM’s great run up after earnings, they are currently my largest holding, but LVGO is still #2, and I’ve been buying TDOC since a week or two after the merger was announced and I realized the combined company is going to be an even bigger disruptor in a massive industry. Once the merger is completed, the new company will leapfrog back over Zoom to be my largest holding (if relative position sizes stay the same until then).

I’m perfectly fine with ZM and LVGO/TDOC battling it out for my top position size. BTW, CRWD and DDOG are a close #3 and #4 which could always have a surprise pop themselves and become my largest holding.

Have also started building positions in PTON and DOCU as some new up and comers to take the place of my old guard MDB, ESTC, OKTA, and NFLX, all of which I may finally exit, after having trimmed them all down to approx 3% holdings each. Only problem is taxes, as I already have a huge tax bill for 2020, and don’t particularly want to double it by selling out of those positions completely. Good problems to have…

[XMFRob]

The TDOC/LVGO shares haven’t taken off to another level since the TDOC/LVGO deal was announced last quarter because I believe investors are awaiting information on the deal closure and also additional earnings data. But I feel with conviction that it won’t be long until these shares accelerate meaningfully. – Rock

Teledoc’s recent revenue growth was upper double digits, Livongo around 100%. Combined growth should be in the 80%+ range, IMO. That growth rate and high margins should take care of the share price pretty quickly. ASSUMING no upheaval in US medicine, I’m thinking 2021 should be a pretty good year for shareholders… not that 2020 has been a disappointment for us. And we still have 3Q numbers coming, which should be astounding. Again.

As it turns out, our stakes are pretty similar Rockleppard. Mine is a bit under 22%, with a very healthy (or unhealthy, depending on viewpoint) portion of it in call options.

Rob
Rule Breaker / Supernova Starshot Home Fool & STMP/MTH Maintenance Coverage Fool
He is no fool who gives what he cannot keep to gain what he cannot lose.

[BobbyBe]

I have an allocation to Teladoc and the more I think about the merger, the more it makes sense.

I ask myself, “which patients are going to benefit most from the adoption of telehealth?” The answer to that question, I believe, is “patients with chronic conditions”. If you have a chronic condition, you’re more likely to want to check in with your doctor regularly.

Most of us only use the doctor when something stops working. And for that, an in-person check up is going to often still be the best. The doctor can palpate an injury, check your range of motion, etc. If you need blood drawn, or any sort of procedure, you will still need to go in.

People with chronic conditions, like diabetes, will really benefit from being able to check in with their doctor more regularly. This benefit is compounded if the patient is using lifestyle medicine solutions such as those provided by Livongo. The doctor can check your data, see how you’ve done for the week, and you can discuss strategies for improving/keeping things up. It’s a chore to drive to the doctor every week. Not so much if you can meet online.

I didn’t see the synergies between Livongo and Teladoc until very recently, and I think they are very powerful.

[CMFSoloFool]

The blog mirrors my own observations from inside the industry. But there is a bit more to it.

Telehealth is not new, but it was languishing until COVID broke out. COVID was the tipping point that triggered immediate adoption, and the tech evolved at lightning speed to enable it. And thankfully, it proved to be a key lifeline for many providers, many of whom were forced to shutdown their practices, and could not have resumed without telehealth.

There is still a long way to go to improve telehealth. For example, it’s not possible to collect specimens remotely, or to diagnose certain ailments that require touch or special imaging capabilities. But technical innovation is bridging a lot of the gaps. For example, we have a client who is doing remote eye exams, literally operating the equipment from across the country, while the patient is siting comfortably in a small facility assisted by a non-certified technician. I also know some doctors who do remote x-ray and MRI reading via secure cloud based systems, while they are on the beach or half way around the world.

But here is the key indicator to watch out for; Prior to covid, CMS required telehealth providers to apply a CPT modifier code on telehealth claims, which reimbursed providers at a fraction of in-person visits. Furthermore, there were restrictions that limited patient access to telehealth, so there were multiple disincentives that held back adoption.

After COVID broke out, CMS suspended the coding requirements, lifted the access restrictions, and has been reimbursing providers at full rates. They don’t even require coding claims as telehealth. But this is likely temporary. CMS is not saying how long the hiatus will last, but many within CMS and in the industry think it is not a question of if, but when CMS reverts to pre-covid rules. And that could have significant impact on TDOC and similar stocks.

During this CMS hiatus providers should be upgrading their EHR and claims systems so they can continue to perform telehealth visits after COVID is conquered. Feedback from clients and patients is very positive on telehealth, and I think many people like the convenience and would continue to use it after COVID. But for many providers’ with sunken cost in physical practice infrastructure justifying telehealth may be tough if the reimbursement rate reverts to being fractional again.

I don’t anticipate this will happen until well after a vaccine is out and the majority of the country has overcome the pandemic. But it bears watching carefully over the next 2-3 quarters. Just food for thought.

[AnalogKid70]

“If you need blood drawn, or any sort of procedure, you will still need to go in.”

I think this could eventually change also and be done remotely. There is already “mobile phlebotomy” where techs will come to your house to draw blood. Guardant reported doing this more during the height of the pandemic. I could see more and more “mobile sample collection” companies to support the telehealth expansion. Not possible for all procedures, but I think many could be done in someone’s home.

[JWB001]

This may be OT, if so, my apologies and please do not reply here. Email responses are welcome in any case.

I am a long-time lurker and almost-never poster, but I think I see a value-add I can contribute.

AK70: I could see more and more “mobile sample collection” companies to support the telehealth expansion. Not possible for all procedures, but I think many could be done in someone`s home.

I agree. I think there are any number of adjacencies that could be offered virtually, IRL, or by a hybrid model. There are already many health services being delivered to homes, for example, this (trimmed) list from https://www.hopkinsmedicine.org/health/caregiving/types-of-h…

Nursing care. The most common form of home health care is … nursing care [matching] the person’s needs… it may include wound dressing, ostomy care, intravenous therapy, administering medication, pain control, etc. (JWB: this could certainly include alternative therapies such as acupuncture/pressure, energy healing modalities such as Reiki and others, etc.)

Physical, occupational, and/or speech therapy.

Medical social services. Medical social workers provide various services to the patient, including counseling and locating community resources… Some social workers are also the patient’s case manager, if the patient’s medical condition is complex and requires coordination of many services.

Care from home health aides. To help the patient with his or her basic personal needs such as getting out of bed, walking, bathing, and dressing.

Homemaker or basic assistance care. While a patient is being medically cared for in the home, a homemaker or person who helps with chores or tasks can maintain the household with meal preparation, laundry, grocery shopping, and other housekeeping items.

Companionship. Some patients who are home alone may require a companion to provide comfort and supervision. Some companions may also perform household duties.

Other services providing basic comfort to the patient, [for example] providing emotional support, or helping with paperwork.

Nutritional support. Dietitians can come to a patient’s home to provide dietary assessments and guidance to support the treatment plan.

Laboratory and X-ray imaging Certain laboratory tests, such as blood and urine tests, can be performed in the home. In addition, portable X-ray machines allow lab technicians to perform this service at home.

Pharmaceutical services. Medicine and medical equipment can be delivered (to the) home, (as well as) training … on how to take medicines or use of the equipment, including intravenous therapy.

Transportation. There are companies that provide this to patients who require [it] to and from a medical facility for treatment or physical exams.

Home-delivered meals. Often called Meals-on-Wheels, many communities offer this service to patients at home who are unable to cook for themselves. Depending on the person’s needs, hot meals can be delivered several times a week.

Some of these services can be delivered by telehealth, others would need physical delivery, but I can imagine many of these needs could be met on a hybrid basis. I can easily imagine many of these services being bundled and offered by a single company.

just my $0.02

Jackson

p.s. I am everlastingly grateful for this board and the generous investors who post here. I have learned so much and continue to do so. My portfolio’s performance since I began investing in accordance with the principles espoused and demonstrated here has simply astounded me. Discovering this board and learning these principles has been profoundly life-changing. Many, many thanks to all; I wish you health, happiness, prosperity and success in all your endeavors.