Primary care telehealth company HealthTap recently announced its expansion to support almost all insurance, including being in network with traditional Medicare. Co-founder and CEO Sean Mehra recently spoke with Healthcare Innovation about this development as well as changes he is seeing in the overall virtual care market.
HealthTap, which was launched way back in 2010, sees its model as different from most other virtual care providers in that it seeks to create long-term relationships between its primary care providers and their patients rather than just providing urgent care services online.
The company’s recent announcement is that patients in all 50 states can now use Medicare insurance when seeking virtual primary care visits on the HealthTap platform. With standard copays, patients have access to a wide range of clinical services whenever they need it.
Mehra said HealthTap is covered in-network by many payers, including traditional Medicare and a growing list of commercial and Medicare Advantage health plans. The company stresses that its payer-agnostic approach makes it a good option for both general healthcare consumers and any organization (accountable care organizations, Medicare Advantage plans, employers, health systems, retailers) looking for a scalable virtual care partner that can supplement and integrate seamlessly into a patient experience.
HCI: Could you talk a little bit about the expansion to support almost all kinds of insurance, including Medicare. A lot of virtual care providers don't go for the Medicare market because of reimbursement challenges. Why did you decide to go after that market anyway?
Mehra: Well, partially necessity, partially opportunity. We found that by marketing a long-term relationship with the same doctor, we were appealing most to people who have a chronic condition and need to see a doctor regularly and appreciate the relationship. People with chronic conditions tend to be older people, and older people tend to have government insurance, aka Medicare. So we are most valuable to a segment that is used to paying for their care a certain way. And there are certain regulations that require us to accept Medicare beneficiaries. Sitting outside of that system often makes you less appealing because seniors on Medicare are used to paying zero co-pay, or something very nominal like $20. The opportunity piece is it's a massively underserved segment. So not only is the demand the largest, there are very few providers at national scale that have gone out of their way to contract with Medicare, meet all of the Medicare requirements for billing Medicare, and built the technology to run the eligibility check for Medicare beneficiaries and build a Medicare plan with claims. It's interesting actually — a lot of telehealth companies of yesteryear focused on commercial plans. And the irony of marketing to commercial plans is while it is easier to sell into, because employers and private entities are easier to work with to get distribution, that’s young, healthy people. They get a cold once a year. It is not surprising then that telehealth stocks are down largely attributed to the fact that they're highly underutilized.
HCI: What's been happening with the telehealth market over the last couple of years? There was the huge surge during the pandemic, and then some companies that tried to get into virtual care have retrenched. What else is taking place?
Mehra: Well, there's a lot of things that have happened over the last few years. One is that consumer awareness has grown out of the necessity of the pandemic. So there is an awareness among consumers of the value of telehealth’s convenience and all its value propositions. You could say the same about physicians and their willingness and interest in seeing the patient virtually, and then realizing how much they really can take care of patients without needing to be in person. The other thing that happened is certain aspects of telehealth have just grown to significantly higher sustained levels — such as virtual therapy. Telehealth for mental health is just at a completely different level than before.
There are aspects of urgent care, or let's just call it telehealth as a convenient substitute for seeing a doctor in person. The doctor might say, ‘you don't have to come in and see me for your followup; just give me a call.’ It spiked during the pandemic because of quarantine, and then it kind of retracted, because people said, ‘well now just come back in to the office.’ But the macro trend, which is the percentage of all doctor visits that are virtual, will be going up and up over a two- to three-decade horizon. We are in the very early innings of that. Eventually, I would expect that, especially in primary care, 70 to 80% of visits will be virtual. I don't have the most recent data on me, but we're at much less than 10% now.
HCI: Have there been successful efforts by health systems to partner with virtual healthcare companies or do they not want to do that because they see a threat of “leaking” patients out of their system?
Mehra: Extremely good point, and this speaks to something that we're seeing as a market need that we can serve. Health systems, which are very proud of their trusted brands in their respective geographies, want nothing to do with eroding their brand. So they're hesitant to put trust in a third-party medical group to represent them. And they're worried about things like you said, leakage, losing a patient to a quote unquote, competitor. However, those are solvable concerns, because the underlying pain that they feel is universal, which is that primary and urgent care are often loss leaders. They are not profitable centers of business. They justify their existence through the referrals they send to their more expensive and lucrative specialists and procedures within the system. And a CFO at any of these health systems will want nothing more than a more capital- and cost-efficient way of doing primary care. Outsourcing is a very common practice in business to achieve the same thing at a lower cost. So the business case for outsourcing primary care and urgent care is strong. The operational concerns around trust, branding, integration, and referrals are addressable with the right commercial strategy.
At HealthTap we'll be announcing some partnerships later this year, all around this very idea. First and foremost, we can integrate with your EMR, which sounds like the craziest thing, but we can and will. So care will be coordinated between your docs and ours. We will uphold an extremely high quality of care with the right SLAs and quality control processes in place with transparency. So you can always monitor that the care we're providing is above or at par with the care you would have given, so there's no trust issue there. And then third, we will work out a workflow such that when a referral is generated by one of our docs, you can reach out to that patient and try to make sure they end up in one of your clinics. So these are solvable things, but to be honest, all of those things have not been commercialized successfully by any player yet. You have software companies that just offer that telehealth technology as part of the EMR, but say bring your own doctors and figure out the operational staffing on your own. You have community practices and clinics that can service you locally as outsourced vendors, but they tend to be understaffed with long wait times and not integrated with your EMR. So the combination of all of these pain points has not been addressed.
HCI: Can you talk about the physicians you hire? Are there certain types of doctors who are looking for that kind of position?
Mehra: At a completely rational level, every doctor sees the appeal of virtual primary care, which helps from a job recruiting standpoint: One, get paid the same, if not better; two, set your own hours to work as much or as little as you want; and three, work from anywhere. Rationally, those are very good value propositions.
Now, on top of that, we do apply some filters for the type of doctors we want. There's a DNA of doctors who want to just maximize their income, do as many transactions as possible, crank out volume, and be done with it. Those doctors do make great urgent care doctors, because that's kind of the nature of the job, it's kind of assembly line, quick in and out, do it as quickly as possible. However, there's another breed of physician that generates better outcomes and cost reduction for the healthcare system. And those are the types of PCPs who go into practice to take care of a panel of 2,000 patients for their career. Those people like to meet new patients, really establish trust, make sure that patient comes back at a frequency and interval appropriate for their condition or health goal, and proactively reach out because there's an incentive to retain and maintain that relationship. Those are the types of physicians we filter for because ultimately their desires are in line with ours. And then the icing on the cake is the fact that it’s a sexy startup with an innovative mission, lots of growth potential and sometimes there could be an equity kicker for a high-performing, long-term doc.
HCI: I understand that HealthTap has developed a generative AI physician assistant technology called Dr.A.I. Can you describe that?
Mehra: This is the beauty of being a practice with your own engineers and your own technology. How rare is that? We get to operationalize technology with much less bureaucracy than a big health system with an IT department and the conservatism that comes with those organizations — not to say that patient safety and privacy aren’t always table stakes. My point is that we saw a very safe and useful application of LLM out the gate and quickly launched it and have real-world data to show that it works really well.
The use case we took on was non-controversial, clinically, legally and operationally: the pre-visit patient interview. Think about the clipboard you always have to fill out before your visit. Everyone hates forms, online or on clipboards. And they're static. It asks the same questions to everybody, with no intelligent follow-up. Then think about all the time a doctor wastes in a short visit, asking you those intelligent follow-ups off of your clipboard responses. Not only can an LLM be prompted to do an interview for you in the right way, it can also be prompted to ask you intelligent follow-up questions. Where did the pain radiate from? When did you fall? How high is your fever? Then it can structure a summary into a readable paragraph format and into structured data in the SOAP note, saving the doctor not only asking the question, but then summarizing them in documents. So the physician jumps right into reading everything for 10 to 15 seconds, and then just focusing on the more complicated aspects of the case or the relationship building. We’ve seen that's been really powerful.
HCI: You have spoken about the value of building your own EHR solution. A lot of these primary care physicians who are coming to work for you probably have worked on traditional EHR software such as Epic, Cerner, and others. Do they tell you that they think yours is noticeably better for them?
Mehra: I would say an order of magnitude better. It is a very purpose-built EHR. It is is perfected for management of virtual primary care without any unnecessary bells and whistles. And it is also maintained and updated with the agility of a startup with a scrum system and biweekly releases. If a doc sends feedback and says, ‘I wish this drop-down for prescribing just worked a slightly different way or just pre-populated,’ our product design team can release a change — sometimes in days, sometimes in months — depending on the scope of the feature. Regardless, it's some order of magnitude less than the time it takes for an EMR to change how a doctor wants it to be.
HCI: Have you considered creating a software subsidiary to license your home-grown EHR to other people?
Mehra: In the journey of the company, in the middle messy years of growth, we licensed our software, and it was a miserable business, and we got out of it. We went back to just giving our own care on our own tech. We realized that being a technology vendor to health systems and plans is a nightmare. You're just a change management consulting shop, a VC-subsidized consultancy. And that's just not fun.
