You’ve probably noticed how our lives are becoming more digital. We can increasingly shop, communicate, work, and learn online in ways most couldn’t have imagined just a few decades ago. New marketing campaigns and business models from innovators and disruptors alike suggest our health could be the next thing to move online.
Telemedicine has been around in various forms for nearly 50 years, but the internet has catapulted it into an industry that is expected to reach USD 16.7 billion by 2025, according to a Market Study Report published earlier this year. The 2018 HealthCare’s Most Wired report from CHIME revealed that 89% of participating healthcare providers offered some sort of tele-health services. This includes large physician networks, such as southeast regional network Novant Health, that offer video visits on demand.
In addition to conventional health networks, disruptors are also breaking in to the telemedicine industry. Prescriptions for conditions like hair loss, acne, migraines, anxiety and more are now available from online providers. Often the care is asynchronous, meaning a patient’s data is digitally recorded and evaluated by a care provider at a later time as opposed to a video call with a doctor. Some of the big asynchronous care providers are forhims (which also owns forhers), Thirty Madison (owner of cove and keeps), Care/of, and Nurx, though there are countless more. These businesses are hoping to bring health care into modernity by offering doctors and medicine through online platforms.
If you look at these companies’ websites, you’ll notice some similarities. They all have strong color palettes, simple language, and eye-grabbing images. In other words, they’re about as far from a doctor’s office as you can get. Gin Lane, the prominent web designer firm behind other successful brands like sweetgreen and SmileDirectClub, described its approach to designing the Hims site in a case study.
“The art direction has strived to be fun, as well as eye-catching, and honest … Our goal from the beginning was to set up a website that felt like a normal ecommerce website,” the case study reads.
First, the Bad News
Beyond the clever marketing campaigns, these companies are health care providers treating real conditions with real medication – the stakes are higher than the branding lets on to. Symptoms overlooked or overemphasized during an online consultation can lead to misdiagnosis and unnecessary prescriptions, according to Dr. Caren Campbell, a board-certified dermatologist. She said she’s seen this firsthand in patients that come to her after having seeked treatment online.
“While I think the marketing is genius behind companies like Curology, Hims and Hers, they lack the heart and compassion of the doctor’s office … you can’t beat that human 1:1 interaction for at least one initial visit. A doctor actually lays hands on you and examines your hair or skin as appropriate,” Campbell said.
According to a study from the DePaul Journal of Health Care Law, virtual doctor visits pose a risk of “depersonalizing the doctor-patient relationship, potentially damaging it irrevocably.”
Some conditions, like hair loss or acne, seem harmless enough but could actually be signs of a more serious underlying condition.
“You only see what the patient shows the cameraman. I can’t tell you how many times they’d photograph a benign lesion, then the patient comes in for a visit and I would find a melanoma somewhere else. You can’t diagnose what you can’t see,” Campbell said.
In the style of modern e-commerce sites, telemedicine websites can feel like they’re designed to give every visitor a prescription. Hims asks for your credit card information before you consult with a doctor. According to Gin Lane, they “positioned the ‘doctor visit’ to come after the checkout in order to make the purchase funnel seamless, and normal.” If a person is denied a prescription they’ll be issued a refund, but the company relies on selling the medicines for revenue. Cambell sees the danger in this business model. “They’re taught a simple plug and play treatment protocol. Unfortunately, many of these companies utilize mid-level providers … so the actual prescriptions aren’t always appropriate.”
Shifting health care to online platforms could also have potential security risks. Companies must do their due diligence and ensure their platforms are HIPPA compliant in order to protect patient information from the data breaches that feel all too common on the internet these days. According to the study from the DePaul Journal of Health Care Law, “when utilizing telemedicine, the burden lies with the practitioner or organization” to make sure that online interactions are “appropriately encrypted.”
Bringing the subscription business model into medicine is not without its hiccups. According to the hims terms and conditions, “Hims will charge you a recurring subscription fee in exchange for your right to access and use the subscription-only pages of the Site or the App.” This recurring fee will continue even if you let your prescription for the medication expire, a forhims customer service representative confirmed. Subscription box companies are notorious for charging customers for the services they no longer use, but charging a patient for medicine they’ll never receive seems especially nefarious.
Other newcomers to the asynchronous telemedicine field have distanced themselves from subscription service models. Kick, which specializes in beta-blocker prescriptions and performance anxiety, doesn’t require memberships. Instead, founder Katy Tripses told Reviews.com that customers “can request refills on their own time based on their own personal needs.”
Nenad Ćuk, co-founder and CEO at CroatiaTech, a technology development company that works in health care, pointed to another potential concern: “There is also a higher risk of telemedicine-related phishing attacks as well.” A telemedicine patient could receive a fake email asking them to disclose very sensitive information about their health, a situation that is nearly impossible if you’re visiting a doctor in person.
Now, the Good News
For many people, going to a physical doctor office isn’t practical, convenient, or even possible. Dr. Nicole Washington is a board-certified psychiatrist and chief medical officer at Elocin Psychiatric Services in Oklahoma. She provides telemedicine services in six states to high-level professionals. She said telemedicine “gives them the ability to see a psychiatrist without having to worry about travel time, so it takes less time away from their very busy days. Others choose telemedicine because it decreases the stigma associated with being seen in a psychiatrist office.”
The stigma surrounding mental health is well documented and can be detrimental to a patient’s quality of life and treatment outcomes. According to a study from Psychological Medicine, stigma was the fourth highest-ranked deterrent to seeking help for mental health problems. Men were disproportionately impacted. Many patients may feel more comfortable seeking help for stigmatized conditions online, which is where asynchronous health providers can help.
Forhims and forhers prescribe the drugs Sertraline and Propranolol “off-label” to treat conditions like performance anxiety and premature ejaculation, though the forhers blog recommends users try meditation or cognitive behavioral therapy – “a therapist (or really good book on the topic) can teach you how to” – before seeking medication.
Telemedicine practitioners will also point out the outcomes of telemedicine are as good, if not better, than in-office care. David Ezell, CEO of Darien Wellness, has practiced telemedicine since 2008 to treat patients across the country.
“I started when a client of mine had a suicidal boyfriend in a rural location. I successfully treated that young man and to this day have never met him in person. Ever since then I have worked with individuals as well as couples and even groups via HIPAA-compliant systems and seen outcomes no different than my in-person clients.”
A study from the American Journal of Managed Care supports Ezell’s anecdotal evidence and found patients who received remote care scored lower for behavioral health issues and had fewer hospital visits.
Telemedicine isn’t ideal for all patients and all conditions, but in certain cases it can be a real value-add – if a company understands that nuance. Steven Gutentag, the co-founder and CEO of Thirty Madison (the parent company of Keeps and Cove), said “we’re always here for our customers at every step of their journey. If it becomes clear at any point — from consult to diagnosis to continued care — that in-person care is required, we let our customers know.”
It’s clearly in the best interest of asynchronous care providers to keep their customers well-informed about their health. Gutentag said Keeps and Cove “believe deeply in empowering our customers and prospects to take control of their own health by providing them transparent, ongoing education around their chronic condition – from symptoms to management methods to new research in the field and more.” Forhims and forhers both host blogs dedicated to informational lifestyle content, much of which advises holistic treatment approaches and self-care.
Health care is a personal issue and there’s never going to be a one-size-fits-all solution for any condition. Telemedicine isn’t the answer for everyone, but its growing presence and adoption by patients promises to shape and inform the future of health care. .
Note: This article was updated on July 26, 2019, to add comments from the founders of Kick and Thirty Madison.