Author. Beth Kutscher, Path to Recovery
Welcome back to Path to Recovery, a newsletter that will bring you weekly conversations on how the health care profession will recover from one of the most significant crises of our time. Click "subscribe" above or follow along using #PathtoRecovery.
Here’s what we’re talking about this week.
One of the most fundamental ways that the pandemic has reshaped health care has been the rapid adoption of telemedicine. Technology is now ubiquitous and a staple of care. While the volume of telemedicine visits has come down from its April 2020 peak, virtual care leveled off at the beginning of last year at a number 38x higher than prior to the pandemic.
Not only are there practical reasons to offer telemedicine — like decreasing the no-show rate, allowing clinicians to see more patients and, of course, controlling the spread of covid — surveys show that a sizable percentage of people prefer the convenience, particularly younger patients.
The shift has given an opening to a number of direct-to-consumer companies that connect patients to clinicians. The convenience sell is three-fold: not only can patients see a doctor or nurse practitioner directly from their living room, but they can often get an appointment much faster than an in-person visit and have their medications delivered directly to their homes. In that way, DTC companies aim to take some of the pressure off stretched doctors’ offices and pharmacies.
I sat down earlier this month with Varsha Rao, CEO of San Francisco-based Nurx, to talk about how the industry is changing. Nurx is a direct-to-consumer telehealth company focused on medications for birth control, skincare concerns and migraines. Like many of these platforms, it offers a self-pay rate for people without insurance.
Rao joined the company in 2019 after serving as chief operating officer of Clover Health. But her background spans travel, fashion and beauty. Here, she discusses why doctors and pharmacists are joining these companies and how Nurx fits into the larger health care ecosystem.
Let me know: How do you think direct-to-consumer telehealth platforms are changing the industry? What role do you think they play alongside traditional practices?
Below is an edited transcript of our conversation.
LinkedIn News: Tell me about some of your growth plans, both within women's health and outside of it.
Rao: We’ve been focused on building out areas of care that have been really important to our patients. We started off with contraception as a key area where a lot of people have had challenges accessing care. There are a lot of stigmas. It’s also the first place as a younger person where you’re really interacting with the health care system typically. Then we expanded to broader sexual health, so STI testing, HPV testing, and herpes. And then we continued to ask our patients about other areas where they needed care and so that's what led us to migraine.
About 35% of our patients experience migraines and we felt like that was really important for us to address. Over 55% of our patients have acne or rosacea challenges and so that was what led us to acne and rosacea. Coming up next we have new areas of service that we are launching this quarter. We’ll [also] look to continue to expand in dermatology like anti-aging. [Dermatology is] an area that we're going deeper in in general; our focus is really trying to be world-class in the areas that we're in.
LinkedIn News: When you say world class, what do you mean?
Rao: In a way that is a lot more accessible from multiple dimensions. It can take people three to six months, sometimes, to get in to see a neurologist. And we are enabling people to get support within 48 hours. The price point is also very different; it can cost hundreds and hundreds of dollars to see a neurologist or a dermatologist, and for us, our migraine service is $60 for the consultation. The medication is additional. And then for dermatology, our main consultation fee is $35, so very affordable and accessible.
LinkedIn News: You said something interesting in terms of how you compare to the traditional doctor experience. How do you work with clinicians? What's their interest in working with you?
Rao: I think we've built an amazing culture for our clinicians. We have virtually no attrition. Some of them are full-time on staff as a part of a professional medical corporation, but some of them are 1099 [contractors]. But most of them are spending over 50% of their time with us because we require that in order to be familiar with our platform and our protocols. The other thing is providers want to feel like they're really working on true health care challenges. And I think when you're working on areas like contraception, PrEP for HIV prevention, and migraine and dermatology, these are really important challenges that people are experiencing and it feels like they're making a huge impact, which they are.
LinkedIn News: Do you feel like this is the future of where medicine is going in terms of these sort of direct access points for patients?
Rao: I think that telehealth is incredibly important as the first port of entry because there are so many things that are so much more efficiently done through telehealth. And then there are also so many challenges around accessing care. Those are the reasons why I’m such a big believer in telehealth. That’s not to say that I think there isn’t an important element of meeting a provider in person as well. And so I see ourselves as being part of an ecosystem, not replacing an ecosystem. There's always going to be an interplay.
The quality of care that's delivered through telehealth is incredibly high. And so telehealth has gone from being viewed as a second or third option to really being a primary option of choice and very trusted.
Linked News: When you say you want to be part of the ecosystem, what does that mean? Are you building referral networks or how do you tap into the larger healthcare ecosystem?
Rao: We are very clear about the kinds of cases that we can handle. We refer out cases all the time for people who really need to see an in-person provider because you know they might be suffering from something that really requires a physical exam. We have relationships with providers in the community.
Pharmacists
It's incredibly challenging right now to find all kinds of health care providers who are going to be part of a new world of health care delivery. In this new world of telehealth, pharmacists have an incredible role to play. I feel that they may have been under-appreciated in working in a lot of retail environments where you’re on your feet for 12 hours a day or more. My understanding is it can be quite unpleasant in some locales where you’ve had the opioid crisis; they've had to handle really challenging patient interactions. And then I also think that many pharmacists may not be working to the top of their license in the sense that they’re often stuck doing a lot of administrative work. My hope is that, in this kind of new world, we can empower pharmacists with more technology and more support so that they can deliver the kind of care that most of them went to school to get training for.
Pharmacists are in a multi-dimensional environment. Many are in large chain pharmacies such as CVS, Rite Aid, Walgreens. These organizations will be required to incorporate telehealth into their daily operations. This will be a synchronous match to ask questions and offer information in face-to-face interaction, much like the clinician-patient telehealth contact. Telehealth providers offer SMS links when a telehealth appointment is desired. The integration of SMS and telehealth provides a unique connection asset.
