Editor’s note: The Pharmacy Podcast Show serves pharmacy businesses, including independent retail, long-term care, specialty, and small chains. During this interview, Dr. Jeff Kosowsky, Senior Vice President of Corporate Development of American Well, a telehealth company, discusses telehealth-like technologies in the pharmacy industry and health system pharmacies, including consultations and medication therapy management. The entire interview is presented here.1
Below, Telehealth and Medicine Today has summarized the key points by Dr. Kososwky during an interview with Todd Eury, Founder and Publisher of Pharmacy Podcast.
Mr. Eury: What are the challenges facing the health system today that your company is addressing?
Dr. Kosowsky: When healthcare accounts for 17% or 18% of the economy,2 pretty much everybody is a consumer of healthcare and every business touches healthcare. However, there is a mismatch between supply and demand, acceptability and convenience, and affordability and quality issues. And, there has never been a way to bring together “clouds” of physicians to address a patient’s health issue. That is the challenge addressed by America Well.
It started by addressing the miss-utilization of emergency departments, but has expanded into broader issues in clinical medicine, including continuity of care and the lifecycle of care (e.g., pharmacy, nursing homes, chronic care, pharmaceutical manufacturers).
Mr. Eury: How does Amwell distinguish its itself from other providers?
Dr. Kosowsky: American Well through our direct-to-consumer offering under our Amwell brand does not compete against our traditional healthcare system. We provide a platform that allows healthcare stakeholders to extend services geographically through telehealth. It expands the footprint and the touch of the provider into the patient’s home, literally.
Mr. Eury: How does American Well collaborate with a pharmacy, specifically.
Dr. Kosowsky: We’ve considered the different players in the pharmacy value chain—both the business and the clinical side. From a business perspective, pharmacies (and pharmaceutical manufacturers) want to sell more product, and increase prescriptions and traffic into the store. Clinically, there is a need to enhance the value of existing services by giving additional information about the administration of medications. We believe that telehealth has a role to play these areas.
For example, pharmacy chains have added staff clinics to their stores to drive traffic and also add a service. Telehealth is a way to do that without the full investment in staff. From our perspective, kiosks serve to deliver that service through physician-level visits, and it’s less expensive than the cost of a nurse practitioner. It also extends the hours that the pharmacy is open to its customers. This is particularly valuable to local pharmacies, because this is an “out-of-the-box” offering at minimal set-up cost.
Mr. Eury: How might telehealth be applied to improve the patient-pharmacist consultation?
Dr. Kosowsky: Most of our consumers gain access to healthcare through mobile devices, which offers an opportunity for a pharmacist to provide healthcare services anywhere and at any time. Importantly, however, one must consider the legal and regulatory issues associated with introducing these services.
As I published in a Pharmacy Times article, speaking to a pharmacist at the point of dispensing is probably the absolutely wrong time.3 The patient is feeling sick, or their child is sick. You’re standing in line, you’re tired, you don’t have much privacy. But once patients are home with time think, or not sure they are experiencing side effect, that’s the time when they might want to ask their pharmacist a question. Wouldn’t it be great if you could log onto a telehealth app for a private consultation?
Conversely, the platform allows the pharmacist to contact the patient for training or follow-up rather than having the consumer travel to the provider. As drugs become more expensive, the need for proper education and follow-up grows as well.
Mr. Eury: Are pharmacists embracing this technology?
Dr. Kosowsky: During the inception of any new technology there is pushback. However, as Bruce Japsen write in Forbes, “Momentum is building to give consumers more access to doctor visits via telemedicine, which offers access to physicians and patients via smart phone, tablet, or computer. Employers and private insurers are embracing the trend as a way to make healthcare more convenient and avoid costly and unnecessary trips to the emergency room or a more expensive physician’s office.”4
It cannot be overstated that the objective is not to build a parallel health service, but to complement and enhance the existing system.
Mr. Eury: What is the response by states towards telehealth services?
Dr. Kosowsky: Over time, states are coming to embrace telehealth. A few states are holdouts, and we are careful to only practice where it is legal. However, our analysis is that these remaining barriers will be removed soon. Over time, about half the states are mandating coverage for telehealth reimbursement, and about quarter of them are mandating parity for telehealth.
Mr. Eury: What is the response by insurers towards telehealth services?
Dr. Kosowsky: From the perspective of insurers, some of the largest are covering more and more patients for telehealth. The big holdout today is Medicare, and this relates in part to concern over the potential for abuse of the service. But even this is changing as Medicare moves towards risk programs.
Interestingly, as payers recognize the advantages of telehealth, they are encouraging it through lower copays for telehealth vs. in-office visits.
All of these issues are coming together and reinforcing each other, with the eventual strengthen of all areas of healthcare for the consumer at a more affordable cost.
- Pharmacy Podcast. The Health System Pharmacist and TeleHealth Strategies. URL: http://pharmacypodcast.com/podcast/the-health-system-pharmacist-and-telehealth-strategies/ Accessed 6/21/16.
- CMS.gov. National Health Expenditure Data. URL: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html Accessed 6/21/16.
- Kosowsky J. The potential for telehealth within the pharmacy space. Pharmacy Times. 2015. URL: http://www.pharmacytimes.com/publications/directions-in-pharmacy/2015/august2015/the-potential-for-telehealth-within-the-pharmacy-space Accessed 6/21/16.
- Japsen B. As Obamacare doctor networks narrow, telehealth wants to get in. 2016. URL: http://www.forbes.com/sites/brucejapsen/2016/04/08/as-obamacare-doctor-networks-narrow-telehealth-wants-to-get-in/#8459b477f939 Accessed 6/21/16.