What is Telemedicine?

Telemedicine is the online consultation with doctors for disease diagnosis, advisory, prescription payment and feedback for any ailment or medical siuation anybody is suffering from. This is a subset of telehealth which is concerned with overall health services by remote means.





According to the US Centers for Disease Control and Prevention, there are 1.25 billion outpatient visits per year in the United States. About one-third of outpatients (417 million) can be resolved with telemedicine. According to AHRQ of the US Healthcare Research and Quality Agency, there are approximately 168 million follow-up visits per year in the United States, 80% of which, that is, 134.4 million visits can be resolved through telemedicine services. The two services total a market space of approximately 585 million telemedicine treatments. In addition, according to statistics from many associations such as the American Cancer Society and the Epilepsy Foundation, there are 5.1 million critically ill patients each year who need to seek expert remote treatment.

A huge market naturally promotes the development of services and technology.

According to US medical authorities, more than 60% of health service providers and 50% of hospitals in the United States use telemedicine services to varying degrees. Remote imaging services are available in all states in the United States. Remote mental health services are established in 49 states. Each state has a variety of telemedicine consulting services centered on family medicine. According to MedGadget's estimates, by 2020, the US telemedicine market is poised to reach $6.77 billion. During this, the market will grow at a CAGR of 6.3%.

So what kind of policies, business models and medical services drive such mature market operations? The arterial network has collated this and recorded the real-time dynamics of the market.

What kind of policy support does US telemedicine have?

In 1996, the Federal State Doctors Association of the United States promulgated the "Current Practices for Interstate Medical Care," which stipulated the definition of interstate behavior, the requirements for medical licenses, the issuance of interstate medical licenses, and the preservation of medical records of patients. The Balanced Budget Act, enacted in 1997, states that doctors who provide telemedicine counseling services to residents in rural areas receive B compensation for Medican. This is one of the US's important insurance bills.

The Health Insurance and Medical Assistance Benefit Enhancement and Protection Act, promulgated in 2000, clarifies the method, duration, region and type of service for telemedicine compensation. The Standard Guide for the Correct Use of the Internet in Medical Practices, promulgated in 2002, clarifies that doctors must comply with the same standard practices for “face-to-face” medical practices for telemedicine.

The Patient Safeguards and Affordable Medical Expenses Act was promulgated in 2010. This Act increases the level of assistance and insurance compensation for telemedicine, shifting from project-based payment to medical value. In 2011, the US Centers for Medicare and Medicaid Services issued new telemedicine service rules to simplify the eligibility review process for telemedicine doctors and the hospital's telemedicine collaboration review process.

In 2015, the Medical Services Acquisition and Child Health Insurance Program Reauthorization Act was introduced. The factors used in telemedicine and remote patient testing were analyzed around the Act. In addition, hospitals and other medical institutions can apply for a $500,000 grant for medical equipment and technical assistance for telemedicine services in rural areas.

Not only has the United States improved its legislation at the federal level, but the states have also actively promoted legislation and played an important role in the development of telemedicine across states. From the February 2017 report from the American Telemedicine Association's "Analysis of the 50-State Telemedicine Gap in the United States," it can be seen that 13 states in the United States have passed the Telemedicine Act. Some Medicaid programs in 50 states cover certain Types of telemedicine services, with 11 states providing patients with telemedicine services with virtually no barriers.

In 2017, Teladoc's Texas State passed the Telemedicine Legislation Act at its 185th Legislative Assembly, abolishing the requirement that doctors can only provide telemedicine services after face-to-face contact with patients. This also provides a good policy environment for Teladoc's long-term development.

In November 2017, the US government passed the Veterans E-health and Telemedicine Support Art of 2017 to enable caregivers who were retired from the military to serve the general public.

These diverse policies from state to regional governments have given birth to a unique business model for US telemedicine.

Business model of American telemedicine companies

The United States is the most developed country in the Internet and has built the world's most developed medical network. The telemedicine service in the United States is based on the widely-covered Internet technology. It has the university as the core to provide technical support for telemedicine development. It has the integration of regional medical resources as the core of management. Also it is increasingly improving its payment mechanism to ensure the rapid development of telemedicine services.

AMD Global Telemedicine lists three possible service models that telehealth services can choose from:

1. Access the care model. This model provides care for those who are in remote areas or who are unable to provide care for them due to limited geography or resources.

2. Cost savings model. The goal of this model is to reduce costs by reducing the cost of going to and from the hospital and the cost of attending a clinic.

3. Market model. This model can extend the market covered by healthcare providers and provide services and expertise at greater distances, but this model relies heavily on policy support.

The Telemedicine Magazine defines three unconventional but successful telemedicine business models:

1. The model between agencies. An expert doctor at a hospital can provide their expertise to their local hospital or assist them in making a diagnosis. The medical center can contract with rural hospitals or other institutions that require on-demand expertise to be billed monthly or on a per-time basis.

2. Responsible care agency providing telemedicine services. Telemedicine technology companies and startups can provide services to ACO to improve the quality of care and reduce costs. ACOs that meet certain conditions of care will receive Medicare awards.

3. Serve corporate employees. Telehealth providers can provide telemedicine-based care to employers' employees through a combination of on-site kiosks and online applications.

To develop a telehealth program, companies must define a business model that is economically sustainable and can successfully meet challenges. There is no one-size-fits-all approach in this area, and companies must tailor their products to meet the needs of the community or market segments as well as state and federal legal requirements.

Taking Teladoc as an example, Teladoc's service model and business model combine the above various theoretical models. The specific pattern is determined by the patient's area, consumer intent, and spending power.

Users can seek telemedicine services from Teladoc at any time, with an average response time of 11 minutes (2017 stats). Teladoc's doctors generally only treat non-emergency diseases, including diagnosis of colds, flu symptoms, upper respiratory tract infections, ear and nose infections, and skin infections.

What kind of services does US telemedicine provide?

The purpose of developing telemedicine in China is to optimize the allocation of medical resources, and establish telemedicine facilities in grassroots hospitals so that people in remote areas can enjoy the services of the top three hospitals through video, and the remote video teaching can also be divided. Into the scope of telemedicine.

Unlike domestic telemedicine development, telemedicine companies in the United States mostly provide routine disease counseling and chronic disease daily care services. In this mode, the cost of telemedicine providers is very low and can be relied on as a physical hospital. For example, if an asthma patient receives a doctor's drug recommendation in the video, he or she can go directly to the pharmacy to download the corresponding prescription and take the medicine.

The routine service of a telemedicine service provider generally consists of two or three steps. For example, the seasonal allergy treatment steps are as follows:

1. Ask the patient some simple questions about allergic symptoms

2. Order the blood panel by the doctor, the patient can smoke locally.

3. Visit the doctor to check the results and the doctor will give follow-up advice.

The service steps for asthma are:

1. Video chat with the doctor, the patient tells the doctor about the symptoms of asthma

2. The doctor gives advice to the patient and issues the required medication

3. The patient can get the prescription at the local pharmacy and give feedback to the doctor. This is the situation after taking medicine.

The service steps for chronic diseases such as high blood pressure are as follows:

1. Video chat with the doctor and provide blood pressure information and drug use information to the doctor

2. The doctor can prescribe a prescription for the patient or recommend a new drug according to the patient's condition. He can give the patient a non-pharmaceutical recommendation to lower blood th pressure.

3. The patient can take the prescription to the pharmacy to take the medicine and continue to respond to the doctor's use of the drug.

There are also a few companies that offer some special telemedicine services.

SwyMed has developed a telemedicine backpack with a special tablet that is clearly visible in high-resolution lenses and screens even under strong sunlight.

In addition, the backpack is also equipped with two sets of modems and four sets of built-in antennas as an alternative to ensure maximum signal transmission and reception range. With two digital oscilloscopes in the backpack allow the physician to perform basic checks on patients remotely. This is aided with built-in battery that can last for about 15 hours.

When a natural disaster such as a typhoon occurs, the patient cannot be sent to the hospital for medical treatment in time due to poor traffic. The rescuer carrying the telemedicine backpack can detect the patient's physical condition in real time and pass the data to the doctor. The doctor can directly give instructions. Rescue personnel performed.

Another service at SwyMed is for telemedicine services with prisoners. The transfer of prisoners from prison to clinics will be subject to various risks and difficulties, and will also incur expensive costs. SwyMed now provides telemedicine support to doctors to avoid direct contact between doctors and prisoners and to reduce the cost of prisoner visits.

What kind of development will 5G medical care bring to American telemedicine

In the United States, where telemedicine is more common, services under 4G and private network conditions have been able to provide stable video transmission and IoT device data transmission. Medical resources in the United States are relatively evenly distributed. Telemedicine is part of everyday health care, herefore, 5G will not bring much improvement to the overall telemedicine service in the short term. But in the long run, 5G can still bring innovation to the US telemedicine service.

On April 30, 2018, telemedicine company American Well announced that it would acquire telemedicine company Avizia at the end of the second quarter (Avizia acquired telemedicine company Carena in 2017). To improve the ability of telemedicine services for acute care.

Telemedicine is an emergency medical service that is suitable for special situations. The development of 5G enables telemedicine to be used in more scenarios. For example, in an ambulance, telemedicine in a 5G environment can transmit more medical images. It can also provide patient information to doctors more quickly, enabling them to make decisions in advance. Ambulances can carry more devices that were previously unavailable due to network limitations. In addition, patients who cannot leave home can also receive care through telemedicine.

In addition, for American children's charities and residents in remote areas, 5G can make these residents who have difficulty accessing such services in the past better able to use remote services. This model is similar to the current development of domestic telemedicine.

There are also some areas that have not been explored in the past. In 2017, Hurricane Harvey and Irma hit the west coast of the United States, causing serious deaths. Many health care providers carry telemedicine backpacks to detect and treat patients without transferring patients. Telemedicine has played a great role in these two disasters, and this outdoor medical care requires the support of a stable network.

5G networks also bring problems such as security and privacy. 5G will increase access to the network, and lawmakers must develop new HIPAA regulations and try to protect consumer sensitive data under new technologies. Otherwise, risks such as medical identity theft, data theft, etc. will reduce the credibility of telemedicine. Based on privacy considerations, users may abandon telemedicine.

Distribution and introduction of American telemedicine companies

The Arterial Network provides a simple analysis and introduction of 22 large telemedicine companies in the United States. Among the 22 companies, there are 9 companies in California, 3 companies in Virginia and Texas, and 2 in Florida. The company has one company in Oregon, Minneapolis, Pennsylvania, Arizona, Massachusetts, and New York.

The services provided by these 22 telemedicine providers are mostly similar, with only a few companies offering special services. For example, Specialists On Call is a company for hospitals and doctors that acts as an intermediary in telemedicine services.

The services offered by another company, SwyMed, are also unique. These are such as providing telemedicine to prison inmates and developing outdoor equipment to provide outdoor emergency telemedicine.

M&A status of telemedicine enterprises

Under the huge market, many telemedicine companies are constantly innovating, and growing through the mergers and acquisitions. With acquisitions and other means to check their own business blind spots, there are also related practitioners in the medical field to enter the industry through the acquisition of telemedicine enterprises.

Teladoc has been active recently. On June 19, 2017, it acquired Best Doctors, the world's leading medical solutions consulting firm to improve the company's health insurance claims.

On June 2, 2018, Teladoc again attacked Advanced Medical, a remote care company, for $352 million to expand the Latin American market and the Asia Pacific market.

Founded in 1999, Advanced Medical has more than 450 doctors and operates in more than 125 countries, offering services in more than 20 languages. The company offers services such as behavioral care, expert advice, specialty drug management and remote basic care. The acquisition underscores Teladoc's determination to step out of the United States.

InTouch recently completed two acquisitions. In January and April 2018, it acquired the telemedicine platform TruClinic and ReachHealth to improve its telemedicine services, especially to improve care.

In March 2017, GlobalMed acquired Miami's start-up telemedicine TreatMD.GlobalMed which focuses on developing hardware and software to enable site-to-site telemedicine in hospitals and healthcare systems while TreatMD enables consumer-oriented telemedicine. The acquisition may mark GlobalMed's further move toward patient-oriented telemedicine.

In the fierce competition, some companies have encountered Waterloo. Practive Fusion, an electronic health record company with a valuation of $1.5 billion, acquired Ringadoctors in 2014 to advance telemedicine development. Today, the valuation of Practive Fusion has dropped to $100 million.

Telemedicine Platforms Seeking progress from differences

The mature medical insurance system in the United States, the uniform distribution of hospitals and the limitation of video streaming have limited the development of telemedicine platforms to a certain extent. However, the cumbersome appointment procedures and the cost of distance have promoted the development of telemedicine.

The most valuable part of development is the management of chronic diseases under telemedicine. After fully understanding the patient's physical condition, the doctor passes the real-time data to the doctor with the help of various types of testing instruments. In this case, the doctor can directly understand the patient's physical and emotional changes through video, and give advice on the next period of care. The accuracy of care recommendations under these conditions is high. The time and cost of patients traveling to and from the hospital are eliminated, especially for patients with limited mobility.





Domestic Internet medical care is not the same as that of the United States. It is difficult for any country to reach the US telemedicine level in the short term. The reason is that most of the US telemedicine companies cooperate with commercial insurance companies, and a large part of their profits come from commercial insurance companies. Domestic commercial medical insurance is still in the early stage of development, and residents' insurance is also based on national medical insurance.





Conclusion on World Telemedicine Industry

Restricted income is difficult to promote service upgrades. Therefore, this model of the United States cannot be directly copied anywhere else. Of course, all people do not have to completely comply with the US Internet medical development model. But where there are merits, others can still reflect on themselves and go for the best.