It's been a busy few years for virtual care, to say the least. In the wake of the COVID-19 pandemic, companies have elbowed their way into a seemingly flush market, while patient interest in telehealth has waxed and waned.

Now, many patients and providers are asking: What will telehealth look like five or ten years from now? How do we go beyond synchronous video visits – and how do we ensure equitable access to whatever improvements are made available?

Claus Jensen, chief innovation officer at Teladoc Health, says the question isn't just about what other kinds of healthcare can be made virtual. It's also about using clinical, technical and logistical tools to help patients make the best health decisions. 

Jensen spoke with Healthcare IT News about what he sees as the future of telemedicine, how the decades-old giant has dealt with scrappy newcomers and what's on the horizon for the company.

Q. What changes have you seen throughout the course of the pandemic as we've seen telehealth use rise and fall?

A. The pandemic proved conclusively that there is a time and a place for stuff that's not necessarily directly tied to brick-and-mortar.

Before I joined Teladoc, I worked for Memorial Sloan Kettering. If you can do cancer care in a hybrid setting, you can do most things in the hybrid setting. And we figured it out – because we had to. 

So that's a done deal. And everybody's talking about: What else can you make virtual? But I don't actually even think that's the right question. It's the beginning of the right question, but it's only the first half – and it's the easy part. 

Because if you're thinking about what people actually want, you want a level of sophistication. But you also want the convenience. You want the intimacy, you want the holistic understanding, you want the history, you want the "you know me" kind of feeling that you got from the kind of doctors that we had maybe 100 years ago. 

And for a long, long time, that's been irreconcilable, because we've become more and more specialized. And technology was not at a point where you could put the pieces back together.

Q. So how can we put those pieces back together?

A. There's a second paradigm shift, which is: How can we help [patients] in a unified fashion, make better decisions? We, as patients, make a lot of decisions in healthcare. And half of these decisions are not necessarily well-founded. So we don't always make rational decisions. And helping people make good decisions is hard.

The same thing goes with the provider side, because they don't always have the pieces. If you only see half the picture, you don't necessarily give the patient good advice. 

So how do you solve that problem? It's a much harder problem than setting up a virtual capability. It does rely on technology. But it starts with clinical expertise. If you don't actually understand the clinical spectrum, and if you don't have a real focus on clinical quality and clinical efficacy, you're probably not going to help people make better decisions. 

You also need the technology side. You can't always meet in person with the best oncologist in the world or the best heart surgeon in the world. Because there's only so many of them. So how do we use technology to bridge the gap?

And then the third part is logistical science. This is a hard problem. And if you don't think about the partnerships, the logistics, all the blocking and tagging that happens when you try to match up millions of people that have needs with hundreds of thousands of people that might be able to help, and do that in the context of trying to make the best possible decision to give them a journey of better health – you're not actually solving the problem.

You have to think differently in the healthcare system. Someone has to step up to say: I'm not trying to replace the existing healthcare system. If all I did was take the existing system and built a parallel system that was virtual, does that really solve anything?

Q. How does Teladoc figure into this?

A. What we're trying to do is to be the amplifier that makes the system better instead of replacing it. So when we talk about virtual care, think hybrid.

Because we don't actually think that we can replace everything out there – nor are we trying to. We're very conscious that we are a clinical science provider, a technology science provider and logistical science provider with a role of making everything better. 

What makes this really hard is we have to be able to slot our capabilities in a configurable fashion into whatever setting they get applied to.

It's meaningful, because it is possible to disaggregate the towers of solutions that exist today and help put them back together better.

Q. What would that disaggregation – and putting it back together – look like? 

A. If you think about a virtual visit, people will usually say, "I need a solution for telemedicine." Well, do you? Or do you need components that can do different things – like scheduling, like making sure you get the lab tests you have to get, like having an experience for the provider that fits into their work environment.

And on the consumer side, wouldn't it be nice if you had the ability to see not just what you're doing in that visit, but at the same time, in the same experience, access to "How am I doing on chronic condition management? What happened last time I saw a mental health provider?"

And then, between all that, you've got a whole bunch of communication and logistics to need to figure out which provider you should actually see. 

I just gave you one very simple example. People think of that as a solution stack. But it all has to happen in context. It shouldn't matter for those consumers what kind of engagement you're having now if you still live in the same experience. 

Take Disney as an example. What did Disney do? Well, they created this magical universe where every single piece of the universe is actually connected. And you'll literally live in the Disney universe. I mean, you're inside the Disney magical universe. That doesn't exist in healthcare. What if it did?

"Look, healthcare is a $19 trillion dollar kind of industry, just from a U.S. perspective. There's more than enough for all of us."

Claus Jensen, CIO at Teladoc

Q. Some patients or providers may have been slow to adopt telehealth, even amidst the pandemic. How can stakeholders, including members of Congress or digital innovators, ensure that everyone is able to buy into this new normal you're describing?

A. We have to be laser-focused on two things: Removing friction and choice. 

Let's talk about removing friction, and what that might look like. Let's say that you have hypertension – a pretty typical condition for a lot of Americans and a bunch of other people across the world. What if we could give you a blood pressure cuff that is pre-registered to you? All you have to do is put the cuff around your left arm, lie down, sit still and push a button. 

We would like you to install our mobile app, and that will give you more insight and more engagement. But if you don't, that's OK. Because the blood pressure cuff is enabled to send data points to our back-end servers. It's hard to imagine something that's less friction than that.

You can imagine doing some of the same kinds of things with other types of diseases.

On the provider side: The thing that providers hate the most is lack of context, that they literally have to move from where they're doing most of the work to somewhere else to do whatever it is they have to do. So how do you solve that problem? How do you make sure that the EHR is integrated into your telehealth solution? 

You actually try to emulate the way a clinic works. You make sure that if they like to use Teams, they shouldn't have to learn another audio-video kind of tool if they already have one. So our ability to integrate that is important. That's the low friction. This user-centricity is really important.

As for choice: It's not an either-or. It's about choosing both on the provider side and on the consumer side, what is the engagement mode that I want to use for this part of my health journey? You will have providers that don't like telemedicine up front. But that doesn't mean that the data points that come out of those encounters are not important.

And it doesn't, by the way, mean that you couldn't schedule the visit with that provider in a way that was nascently digital. There's all kinds of things you can do under the headline of choice to tie together physical-type encounters, hybrid-type encounters, and fully virtual encounters. 

And we talk about virtual care. Most times, when people talk about virtual care, they literally mean, I'm doing what you and I are doing right now on a video chat. I'd rather talk about virtual-first, or virtual-centric, which represents the ability to say, "Well, you can start virtual, if that's what you want. You can continue virtual, if that's what you want. But we will also help you orchestrate your needs, as it ties into the physical parts of the ecosystem." 

Call that the last-mile integration, or whatever else you want to call it, but it shouldn't be an either-or.

Q. We've been doing a lot of coverage about this huge flood of newcomers to the market: All kinds of companies are making their way in to take advantage of this telehealth flush. How is Teladoc responding to that influx, and what are your plans to maintain your stake in this clearly very fertile market?

A. The reality is, there are different problems to solve in the healthcare ecosystem.

There's a problem to solve that says, there is a [narrow] solution that I can either do better or cheaper, or that doesn't exist. If you look at many of the newcomers, they're in that bucket. There are a few exceptions, but most of them are laser-focused – as was Teladoc, if you go back 10 years.

You can innovate at the level, where you're saying, "I choose a problem and I'm going to innovate inside the bucket of that problem." Or you can choose to innovate at a different level, which is, "How do I get better at putting all the pieces together?" You can call that transformation. In this case, actually, integration is transformative when done right. 

We do both. We will continue to develop, let's say, about new chronic conditions. We will also continue to partner with other companies. More importantly, we will innovate. 

I spend less time worrying about how to compete with the newcomers and spend more time thinking about how we can plug into the bigger story and make sure that healthcare as a whole becomes better. 

Look, healthcare is a $19 trillion dollar kind of industry, just from a U.S. perspective. There's more than enough for all of us. You don't need to be the best at every single part. We do need to be the best at putting the pieces together.

Q. Can you give me any hints as to what's on the horizon for Teladoc?

A. The whole partnership with Microsoft is public: We'll make it possible to use Microsoft Teams if you want to, as a provider.

You will see us have a more meaningful sort of ambient presence in hospital settings.

Ambient is an important word, because, if the technology is visible and abrasive, it doesn't necessarily meet the needs. But if we continue to evolve our ability to have specialists deploy their visual and audio presence into operating rooms, ICUs, etc., across the world, that's meaningful. 

We'll start putting together the signal and the data-driven referrals. But referrals here are between different chronic-condition programs. So imagine this: What if you had one integrated place to go, one way to see all the connections between mental health, obesity, hypertension, diabetes, CKD, and heart failure?

Most of the people that are afflicted by one chronic condition have at least two, and having three or four is not atypical. So, instead of having to go to different places, what if all those signals in that entire engagement model were put together in one place? 

So those are a couple. 

If you look at another area, I'll say that in the Primary360 area, launching a virtual option for a primary care visit is just the beginning. Our ability to integrate into the last mile and actually truly partner up with whatever your local physician group is, is the continuation of that thought. 

So all these are things that require a lot of work. But we finally have the technology that allows us to attack those kinds of problems. In a one- to two-year timeframe, all that is doable.

This interview has been lightly edited for clarity.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.