Even just a few years ago, saying “telehealth” in a hospital almost always meant site-to-site telehealth, or video visit hardware wheeled around the hospital on carts. Now, in more and more hospitals, it’s starting to mean direct-to-consumer video visits. But barriers to adoption persist, both when it comes to physician buy-in and adoption by consumers.

“The difficult part of this is the clinical disruption,” Brian Wayling, assistant VP of telehealth services at Intermountain Healthcare said at the mHealth and Telehealth World Conference in Boston last week. “On the provider side, it’s less about the technology. The fee-for-service vs the fee-for-value is still an argument for us. So even internally we talk with our ER providers and other people about introducing telehealth and ‘it’s a nice idea but still we need to pay the bills.’"

The provider started rolling out Intermountain Connect Care, their D2C telemedicine service, in January. It’s a whitelabeled offering from American Well. They rolled out services first to their own employees as a trial run, then to members of their own insurer, SelectHealth, and finally to the general public. But doctors were concerned about reimbursement and also about the quality and robustness of the technology.

“Care standards and practices are the next part of the conversation internally,” Wayling said. “Generally telehealth has been very big. But it’s still very much in its infancy. If you look at historical research and validation that’s gone into medicine in the last 50-plus years or so, we’re still in the first five years. So there’s very little true clinical research that’s been done in telehealth.”

Shawn Farrell, VP of clinical operations at Avizia, a provider-facing telemedicine technology vendor, said his company had also encountered some frustrated providers, often because reimbursement is still not where they would like it to be.

“I think one of the biggest frustrations we hear about is a primary care provider who hears of their patient using American Well or these other alternatives and they’re frustrated, as much as they see workflow piling up, they can’t provide this care to their own patients because they’re not being reimbursed for it and the system doesn’t support them being able to do this care. They can’t do it for the $49 a visit other organizations are offering it for. So it’s very difficult for them to compete in that market.”

On the patient side, both Wayling and Farrell said there’s a lot of interest from consumers, but it’s also a process to make the service a part of their daily life.

“If you walk into a restaurant and start asking people if they’ve heard of telehealth, once you explain it, they’ll say ‘Of course, that makes sense.’” Wayling said. “But the next step is getting it to top of mind. ‘I fell off my bike, had an accident, can I receive my care online?’ versus ‘I need to rush to the emergency room.’ That’s simply going to take time.”

That’s why Intermountain started out rolling out an on-demand service for urgent and emergency care and is now moving into a by-appointment virtual visit service for routine care.

“We’ll be adding scheduled visits at the end of the year,” Wayling said. “So instead of on-demand, which is the current service, if you have a relationship with a provider, we will be taking a look at that and saying, do you need a medication follow-up, let’s see how you’re doing, we can do that online. Again, the time, cost save for the provider and me as the consumer is immense if you can start doing that and really shift around the cost.”

Wayling said that according to a customer survey, about 67 percent of the people who used Connect Care would have gone to an urgent care. Twenty-three percent would have gone to primary care, 10 percent wouldn’t have done anything.

In general, Wayling and Farrell said, the trick to getting physicians on board with telemedicine is to get everyone to see it as an extension of normal care. 

“We’ve talked to a lot of people both in leadership and on the proverbial front lines, actual doctors, and making sure that people are comfortable with the service that we provide,” Wayling said. “With telehealth in general at Intermountain Healthcare, we never want to be a competitor to ourselves. We see this as an extension of how we provide healthcare to our patients, no matter where that provider is. We increase our flexibility to provide service.”

It’s a trend that’s increasingly common, Farrell said.

“We now see health systems seeing telemedicine as a lever for fulfilling their mission, for executing whatever their organizational strategy is and for achieving their goals, and this is very different from what we saw four or five years ago,” he said. “Intermountain or Cleveland Clinic or Mass Gen have been really leading the way in building enterprise telemedicine and telehealth foundations. A lot of those started with those acute care models, and now they’re moving into D2C.”