How To Start A Telemedicine Business: A-Z Guide
Telehealth Business Model Canvas, Startup Costs, Software Features, Service Pricing, Workflows and more
Introduction
Telemedicine has finally crossed the chasm. Telemedicine had long been a technology that over promised , but undelivered. That changed during the Covid pandemic, when telemedicine adoption skyrocketed overnight and for a period of time, the healthcare delivery primarily followed a telemedicine first model. As things have now returned to normal, physical visits have become the norm again. But the potential of telemedicine is now well understood. Given the potential reduction in healthcare costs, the regulatory aspects are largely shaping up to be telemedicine friendly. Healthcare startups who initially adopted a video call based model are now evolving their offerings to include remote patient monitoring and other asynchronous modes of telemedicine. Healthcare incumbents including medical practices and hospitals are now competing against healthcare startups, and are exploring suitable models which allow them to incorporate telemedicine into their existing offline workflows.
As many aspects of healthcare delivery get virtualized, there will be a myriad of opportunities related to telemedicine. Healthcare incumbents and telemedicine startups who are coming forward to take advantage of these telemedicine business opportunities, have to grapple with a number of issues including navigating the regulatory aspects to setup a telemedicine company, choosing a telemedicine software platform that can meet their existing and future requirements, developing a suitable business model for their telemedicine business, figuring out pricing for their telemedicine services, setting up their patient provider workflows and addressing marketing aspects. Based on ContinuousCare’s experience of dealing with hundreds of healthcare businesses including clinics, hospitals, telemedicine startups, home care services, pharma, insurance and others, we have developed this guide to provide answers to some of the questions and issues that typically need to be addressed when you are starting a new telemedicine business or service.
Intended Audience
This article is meant as a guide for anyone who is looking to start a telemedicine service or business. This includes:
- A clinic or hospital who is looking to launch a telemedicine practice along side their existing services or looking to launch a hub and spoke model.
- A healthcare startup who is starting a telemedicine business - focused on video consultations, remote patient monitoring or other offerings.
- Healthcare Service Organizations focused on areas like Employee Care, Home Care services who want to start telemedicine services to compliment their existing offerings
- Pharma, Insurance or Medical companies planning to add a telemedicine offering to their existing business
- Doctors and Nurse Providers who are using to leverage telemedicine in their practice or are looking to start a telehealth nursing business
What is telemedicine?
As the name suggests telemedicine is healthcare delivered from a distance.
- Telecommunication technology allows care providers to overcome the barrier of physical distance and engage and treat patients from afar.
- Telemedicine includes patient provider engagement that happens over any of the communication channels like SMS, WhatsApp, email, telephone calls, video calls, mobile apps or through robots.
- Telemedicine takes different forms like a video call between patients and providers; text consultation that happens over an web or mobile application; telemonitoring - a remote monitoring program where patient symptoms and readers are sent to a remote providers; robotic surgery delivered from afar.
- Telemedicine can also take place without the patient being directly involved - remote analysis of radiology reports, remote interaction of providers, remote virtual boards where a provider interacts with a remote panel of experts
What is telemedicine being used for today?
The field of telemedicine is evolving very fast, but here are some of the common use cases for telemedicine today.
On Demand Video Calls
Patients and their care givers interacts with their healthcare providers over a video call based on patient demand. This is usually based on preset appointments, though healthcare startups sometimes use appointment less workflows.
Virtual Second Opinions
Patients can seek seek virtual second opinions from afar.
Virtual Follow-Up Visits
Many hospitals are now using telemedicine for virtual follow-up visits and patient check-ins
Remote Patient Monitoring
Health devices capture patient health readings and transmit them to remote providers or systems, which interpret and monitor the patients health
Chronic Care Management
Patients with chronic health care conditions are enrolled in care plans and telemedicine technology is used to engage and treat the patient.
Emergency Medicine
Tele-triaging and helping avoid unnecessary ER visits
Post Discharge Care
Telemedicine is used to stay connected with the patients post discharge and ensure they stack on track with their medications and to keep a check on possible post discharge complications.
Care At Home or Work Place
Telemedicine is now an integral part of many homecare services or corporate care businesses that manage the well being of employees.
Benefits of Telemedicine
The Covid pandemic resulted in an overnight change in healthcare delivery. Like many industries, a large percentage of healthcare delivery too went virtual. In the US, consumer adoption of telemedicine shot up from 19% in 2019 to 46% by mid-2020. A similar shift played out in most other parts of the world. For most providers and patients, the Covid pandemic provided their first experience with telemedicine. Behavior adoption happened overnight and though things have largely returned to normal, telemedicine usage has not fallen back to the pre-pandemic levels. Providers continue to use it for the many benefits that telemedicine provides:
Increase revenues with flexible schedules
For providers telemedicine provides a new revenue opportunity. By adding telemedicine only consultation slots, providers can now increase their accessibility and earn more revenues, while retaining complete control over their schedule. Equipped with good telemedicine software with build-in appointment scheduling, providers can open up new slots at their convenience - week-ends, late evenings, one-off slots, anything is possible.
Increase Efficiency, Increase Revenues
With efficient telemedicine software, providers are able to see more patients in the same amount of time, compared to in-person consultations. Telemedicine visits are typically 20% shorter than face-to-face visits. This increased efficiency translates into more revenues.
Saving on practice overhead costs
Compared to the overhead for physical consultations, telemedicine visits come at a significant lower cost. The VHA reported an annual reduction of $6500 per patient participating in its telemedicine programs. Typically besides the telemedicine software solutions which are typically available on cost effective SAAS subscriptions, the overhead costs are quite minimal. This can translate into a significant cost saving, especially in cases where providers are able to increase their overall consultation volume without having to increase their physical infrastructure.
Happier employees and better work-life balance
One of the biggest benefits for providers, is that that telemedicine helps them achieve a greater level of work life balance. A Doctor on Demand survey found that 78% of physicians found that remote working increased their work life balance. For providers in many specializations, it might be possible to transfer a percentage of their consultations to a virtual telemedicine mode. These virtual consultations gives providers greater flexibility with respect to their personal schedules and establish a better work-life balance. For many providers, vacation planning is challenging time, due to patient care commitments. Telemedicine gives providers better flexibility over their personal and family life. For healthcare organizations, telemedicine software implementations also translate into happier patients.
Monetize the previously unmonetizable consultations
Providers typically do not get compensated for various activities like review of medical test reports, follow up consultations or quick over the phone consultations. In many countries, patients demand and expect direct access to their providers over the phone or chat applications and this level of access is considered the norm. With the advent of telemedicine, providers can now used paid telemedicine consultations to provide patients with a reasonable alternative. For providers this can be a game changer as it helps them reclaim their lives and ensure that their personal life is not punctured by an endless stream of patient phone calls and WhatsApp messages. It goes without saying that providers also see an increase in revenues by restricting their direct availability in a calibrated fashion. And better still many of these consultations are now reimbursable as well.
Reduce No-Shows and Cancellations
No-Shows and Cancellations are a big source of revenue loss for most healthcare organizations. Telemedicine helps combat this in a number of ways:
Pre-Payments can reduce no-shows
In cases where providers choose to accept cash payments for booked appointments, no-shows are typically minimized because patients would typically do their best to avoid a loss of revenue.
Reduce No-Shows and Cancellations
Paucity of time, travel/distance are some of the main factors for no-shows and cancellations. This can often be a key factor for rural healthcare. One community center reported that with telehealth adoption, no-shows dropped from 15-20% to 5%. By providing patients with the flexibility to switch from in-person to virtual telemedicine consultations, providers can significantly reduce the revenue loss resulting no-shows and cancellations.
Alternate Bookings
Equipped with the right telemedicine software, providers can easily take advantage of no-shows and consultations, to reach out to patients in real need and accommodate their needs through a virtual telemedicine consultation
Innovative Care Models
Telemedicine gives providers the opportunity to personalize their care as per the needs of the patients. Providers could tailor care to take into consideration the patients condition, age, physical travel and other relevant factors, allowing patients options that blend physical in-person care with telemedicine based patient engagement. Flexible telemedicine software platforms will allow providers to blend physical care with different virtual care models which could involve video calls, questions/text consultations, remote patient monitoring or care plans. Innovating on healthcare delivery models translates into increased revenues.
Improve Patient Outcomes
As various clinical studies have shown telemedicine programs can make a significant difference with respect to patient outcomes. A capable telemedicine software platform gives enables providers a range of options to engage with patients virtually. It is well proven that increased patient engagement especially with respect to chronic care, medication adherence and patient education results in better patient outcomes.
Improve Patient Satisfaction
Increased accessibility and engagement with telemedicine translates into improved patient satisfaction levels. Virtual visits consistently rank higher on patient satisfaction compared to in-person visits.
Expanding Patient Reach
Adding a telemedicine service component help redefine the traditional boundaries of distance that apply to real world healthcare organizations. Providers are able to extend their reach and provide care to patients especially in rural settings.
Virtual Second Opinions
Telemedicine also helps providers benefit from patients who want to engage with providers for second opinions virtually. Telemedicine enables them to reach out to a wider range of providers on a specific medical problem. Virtual second opinions can prove to be a significant revenue stream in the case of hard to reach specialists.
Stave off competition
The pandemic changed the trajectory of digital healthcare adoption Healthcare is rapidly evolving and evolving forms of healthcare delivery are chipping away at the healthcare pie. Adoption a comprehensive digital health telemedicine solution allows providers to compete better in the market. Digital health solutions and telemedicine software that are typically available on a SAAS model. This allows telemedicine startups and businesses to rapidly expand their offering without a significant capital investment.
Reduce ER Visits and Admission Rates
Telemedicine solutions help reduce unnecessary ER visits by providing a virtual access to providers who can then remotely triage patients and redirect them as required. They also help hospitals reduce re-admission rates through increased patient engagement and reduction of exposure during hospital visits.
Starting A Telemedicine Business
The first obvious step towards setting up a telemedicine service, is obviously to setup a company. If you already have an existing business and you are looking to start telemedicine in your existing medical practice or you are looking to start a telemedicine program, then then section might not be relevant to you.
On the other hand if you do not yet have a registered telemedicine business then here are some things to consider:
- If you are considering a virtual only service, you might be wondering if you need to register a company. If you are planning on claiming insurance reimbursements, then keep in mind that insurance companies typically need a physical address. So being online only might not be an option and you might at least need a virtual office with a physical post box.
- In many countries, you might need licenses from the relevant authorities to operate a healthcare business, to provide telemedicine services and to prescribe medications. In case you are an virtual startup operating across boundaries, do keep in mind that some countries require that you have an employee or maybe a medical officer stationed in the country.
- Where should you incorporate your company? That can be a pretty odd question, with the obvious answer being the country where you currently live in. However if you are a startup planning to raise funds from venture capitalists and angel investors, then you might also want to consider your options. In some cases incorporating your healthcare startup in an investor friendly country like the USA might make fund raising much easier. There are various companies like FirstBase who can handle this remotely for you. This route might however have legal implications, so do explore it from various angles before deciding.
- If accepting payments from patients online is a consideration for your business, then you will need a payment gateway. Keep in mind that many payment gateways consider digital health to be a high risk industry and might not be willing to give provision a payment gateway account for your telemedicine startup. So you will need to find a payment gateway that is willing to integrate with a telemedicine software platform.
In some cases a global payment gateway with a multi-country presence like Stripe, PayPal, Square, PayU might be able to provision a telemedicine capable payment gateway account in one country, but would not be to do so in another country. You will need to look at the fine print of the country specific terms and conditions to understand this better.
One option you can consider is using a solution like Stripe Atlas that allows you to incorporate your telemedicine company in US, provisions you with a linked Stripe account that allows you to collect patient payments irrespective of your country. However repatriating the revenue back to your country can sometimes be complicated, so do explore your options in this regard as well.
So how long does it take to start a telemedicine startup?
Well this largely depends on the regulatory requirements of the countries you operate in. Accordingly the answer to this question can vary from a few hours to a few months. The latter applies in countries where you have licensing requirements and reviews where you need to demonstrate that you comply with all the requirements.
Choosing a Telemedicine Platform
The telemedicine software platform typically sits at the center of your telemedicine business. So what are the various factors that you need to consider when finalizing your strategy for the telemedicine software solution? Assuming that you have finalized on the business offering, target customer and target market and business model, then you are well positioned to finalize on the telemedicine software.
Features: What are the features you need?
Brainstorm to get a list of all possible features. How do you visualize the telemedicine software working? What are the telemedicine software features required to solve the business problems that you are targeting? What are the unique features that you will help set your apart? You can approach this exercise from a number of angles as listed below:
Your vision
Visualize all the features that are required for the business problem that you are trying to solve. How do you visualize the patients connecting with providers? A basic telemedicine solution will at least have 3 user roles - patients, providers and administrators. Usually there would be many more roles. Put yourself in the shoes of your each user type and map out the user journey's.
Your competitors
It is likely that you already have one or more telemedicine competitors in the market. Explore the solutions they offer and create a wish list of features.
Your users
One very useful exercise is to actually talk to each of target user types and get their perspectives on what is important to them. This might help you help you unearth some unique perspective that could be the differentiating factor for your telemedicine business.
Legal/Regulatory Requirements
Regulatory and legal requirements can often have a big say in the feature set your telemedicine product needs to support. So do explore the legal and regulatory requirements that will be applicable to your telemedicine business.
Group the features together based on functionality or modules so it is easier for you to reason and think about them.
Once you have considered all possible features and have a comprehensive wish list of telemedicine app features, the next step is to determine the priority of these features. The prioritization of features is critical because it is not practical to expect your complete wish list of features to be available from day 1. Irrespective of whether you choose a SAAS telemedicine software solution or whether you choose to custom develop your own telemedicine solution, it is unlikely that all your requirements will be available at launch.
A simple way to do this is to list out all the features in an Excel sheet and then prioritize them as Priority 1, 2, 3, with the Priority 1 being the features you absolutely need for launch, Priority 2 being features needed in the medium term and Priority 3 are nice to have features
Another option would be to lay out the features into a roadmap broken down by quarter or some other suitable time-scale.
Standard Features in a Telemedicine Software Platform
Below is a categorized list of features that you will typically need. For your convenience there is also an XLS version of this feature list that you can download here. It contains columns for priority and timeline that you can fill. You can use this as a starting point for your evaluation and prioritization of telemedicine software as described in the above sections
Download the list of Telemedicine Software Features
Patient Portal
A Patient Portal is a web application where your patients can login and securely engage with you. One of the questions that frequently comes up is should I just have a telemedicine mobile app? Do I need a web patient portal too? The reality is that a web based solution is very important if not more important than a mobile app. For apps that are not used very frequently (WhatsApp would be a high frequency usage app), users typically prefer to just use the web and avoid having to download an app. Hence it is quite important that you consider adding a web patient portal to your telemedicine solution.
Depending on your actual telemedicine business model, you can always consider starting with the web first and then adding in the mobile apps in a second stage, once you have sufficient patient usage and traction. Some capabilities that your patient portal should support:
- Allow patients to register and sign-up with your telemedicine service
- Provide searchable listing of your telemedicine providers, their detailed medical profiles and allow patients to book consultations with them.
- Allow patients to book and avail of the various telemedicine services you choose to offer. These services typically include video telehealth consultations, question based telemedicine consultations, remote patient monitoring programs or care plans and appointments for walk-in consultations.
- Access and update their health records. Depending on your telemedicine business requirements, this might be limited to a basic patient health profile or it can include a more detail patient record that covers their medical reports, medications, allergies, hospitalizations, co-morbidities and more. If you also deal with care plans and remote patient monitoring, then it is important that patients have the ability to update various health trackers via the patient portal.
- Download Prescriptions, Lab Orders and Consultations: For most telemedicine businesses, the prescription, lab order or consultation note is the end point of a consultation. Hence providing patients access to their prescriptions, lab orders and consultation notes as downloadable PDFs is a critical function.
- Manage their associated family accounts.
- Support patient education initiatives.
Telemedicine Video Consultations
Video Consultations are typically the key telemedicine service offered by most businesses. Here are some of the key features to be considered for Video Consultations:
Appointments for Video Consultations
Many telemedicine businesses choose to follow an appointment based workflow for video consultations. Appointments typically allow patients to book telemedicine video consultations based on a combination of their chosen provider, a specific service that is offered by the provider, a specific time-slot based on the providers calendar and other factors.
Waiting Room based Video Consultations
Some businesses prefer to use a no-appointment flow for the video consultations. The Appointment vs Waiting Room workflow is discussed in more detail later
Video controls
Basic controls like pause the call, mute the audio, toggle the video.
Screen share
Screen sharing is important for providers to be able to be able to share educational materials or other material with patients during the telemedicine session.
Multi-user video calls
Multi-user telemedicine sessions involving patients, family members, care givers, providers, translators and other other user roles.
Low Bandwidth Capabilities
The ability for the telemedicine software to work in low bandwidth environments and toggle between audio only mode and video enabled mode based on the bandwidth conditions.
Call Recording
Ability to record the telemedicine call and archive it.
Chat and File Sharing
Chatting and exchanging files during a video session.
Notifications and Reminders which are a critical element in patient engagement and minimizing no-shows and last minute cancellations of the telemedicine session.
Text Consultations/Patient Questions
Text Consultations/Patient Questions are also a very effective form of asynchronous telemedicine consultations. Many telemedicine businesses have found Text Consultations to be a key revenue generating service and one that is surprisingly popular with patients. Some key aspects of this feature:
File Uploads
The ability for upload medical reports and other documents during the text consultations
Setting patient expectations
One of the key advantages of text consultations is that it is an asynchronous form of telemedicine. This however makes it imperative to set the proper expectations for patients and ensure that patients are aware about timelines regarding the consultations.
Flexible Follow-ups
Providers need the flexibility to be able to structure the text consultation exchange as per their requirements
Patient Records
patient record are a critical element of any telemedicine consultation solution. Some telemedicine solutions might either choose to exclude this completely and just choose to integrate with existing systems while others provide an inbuilt patient record system. Typically patient records would comprise of the patient profile, health conditions, allergies, medications, hospitalizations, comorbidities, surgeries, family history, social history, contraindications, vaccinations and health trackers. Health Trackers can be extensive and there are hundreds of potential trackers across various medical specialties. It is however important to have at least a few basic trackers for the vitals.
Remote Patient Monitoring and Care Plans
The Covid pandemic shook up the entire healthcare industry and while things have reverted back to their pre-pandemic baseline in many cases, Remote Patient Monitoring(RPM) is one area that is continuing to witness significant adoption post pandemic. Combined with device integrations and remote patient monitoring, care plans present a great revenue opportunity for healthcare businesses. They allow telemedicine businesses to maximize the revenue per patient, while improving patient outcomes. Some of the basic features expected in RPM Telemedicine software are:
Flexible Care Plans
The ability to create and manage flexible care plans bringing together care-teams, health trackers and different forms of online consultations.
Subscription Payments
Integrated subscription payments allowing providers to create different packages that meet their care needs and financial objectives.
Integration with trackers and health devices
Care Plans can be integrated with trackers and also consumer health devices allowing patients to send data directly to their providers from their connected health devices
Patient Engagement
Allow patients and providers to engage in the context of their health data and individual health data readings
Adherence Tracking and Reminders
One of the key advantages of text consultations is that it is an asynchronous form of telemedicine. This however makes it imperative to set the proper expectations for patients and ensure that patients are aware about timelines regarding the consultations.
Care Teams
Putting together care teams comprising of different provider types and the assigning them roles and responsibilities for a particular care plan.
Family Accounts
Family accounts are a critical feature in any telemedicine software. It is quite common to have the tech savvy members in a single family manage a number of accounts or have an adult create accounts for his or her elderly parents or young children. Giving patients the ability to create these family accounts and switch between these accounts as required is standard feature in most telehealth software applications.
Prescriptions
The end point for most telemedicine consultations would be a prescription that can be shared with the patient. Most telehealth software would therefore include the ability to create prescriptions branded with the business details during each consultation which can then be available to patients via the web patient portal or the patient mobile app. Key aspects to consider:
- Downloading these prescriptions as PDF documents is a critical requirement for many telemedicine businesses or startups.
- Branding prescription documents as per the business requirements and incorporating the necessary fields required by the regulation.
- Integrating with a list or database of frequently prescribed medications, so providers can save time during each telemedicine encounter, instead of having to repeatedly type out the details of each medication during each telemedicine encounter
- Sharing the prescription with a partner pharmacy who can fulfill the request
Patient Encounter Notes
Encounter notes is obviously a basic function and most telemedicine software applications would provide an option for this, allowing providers to capture their SOAP notes detailing the patients symptoms, their observations, assessments and treatment plans. Providers should be able to easily generate prescriptions, lab orders, create new appointments, set health goals as part of the encounter.
Lab Orders
Similar to medical prescriptions, providers also need to be able to create Lab Orders during a telemedicine encounter. Key aspects include:
- Creating lab or imaging orders during a patient encounter
- Available to patients to view and download the lab orders as PDF's
- Allowing Lab Technicians or other user roles access to the lab orders without accessing the rest of the confidential patient data
- Sharing the lab order with a partner diagnostic lab who can fulfill the partner request
Configuring your telemedicine services
As a telemedicine startup or business, your providers will typically provide a number of services to patients. These services might differ in their duration (length of the telemedicine consultation), the pricing that you charge for this consultation. So a single specialty medical clinic might choose to create services like First Visit (30 minutes), Follow-up Visit (15 mins), while a multi-specialty hospital or multi-specialty telemedicine startup might choose to create telehealth services based on their departments like Dermatology Consultation (15 min), General Physician Consultation (15 min), Psychiatric Consultation (1 hour) etc all with different price points. Your telemedicine software solution should be able to accommodate these use cases:
- Flexibility to create and manage different telemedicine service types with different price points and taxation rules
- Link services to providers and consultations, so a patient can book an appointment slot with a provider for a specific service
Telemedicine Appointment Scheduling
There are different workflows that you can employ for a telemedicine startup. In most cases, your workflow would involve an appointment based flow. Even in cases where you don’t use appointments for your primary workflow, you might still need appointments for other use cases. An efficient and precise Telemedicine Appointment Scheduling software is therefore a must have feature for a telehealth startup or business. From a patient perspective, appointment scheduling software is key to ensuring effective and timely care. Some key capabilities for telemedicine appointment scheduling software:
Provider Calendars
Providers should be able to define their schedules precisely down to the minute and specify the services they provide during each of the calendar slots. Providers should also be able to block off time on their calendars to prevent telemedicine appointment scheduling during those periods.
Real time appointment scheduling
An appointment scheduling system that can allows patients and providers to book appointments taking into consideration the provider available slots, services all calculated in real time.
Rescheduling and Cancellations
It is important that providers and administrators have the ability to reschedule appointments or cancel appointments based on the requirements of the patients or providers.
Self-Service Online Telemedicine Appointment Bookings
The telehealth appointment software should allow patients to book and manage their own telemedicine appointments. Patients should be able to see a calendar of available slots for a their chosen provider and telemedicine service. The self-service appointment booking is offered through the web patient portal or the patient mobile application.
Schedule Manager
A comprehensive schedule manager that allows the practice administrator or appointment coordinator to view and manage the telemedicine appointments is a basic capability. It is also important to be able to book appointments for a specified patient.
Appropriate Roles
Telemedicine start-ups typically have workflows that differ from traditional healthcare organizations. Some of them employ website chat or call-center based workflows for their telemedicine based appointment bookings. It is important that the telemedicine software provides appropriate user roles that allow such workflows, so these appointment bookings can be done without compromising patient privacy
Appointment Reminders and Notifications
Sending automated appointment reminders and notifications are critical to be able to reduce no-shows and last minute cancellations for telemedicine appointments
Practice Locations or Branches
If your telehealth business has physical branches or virtual branches, then you would need the telemedicine software to provide a practice location/branch feature. You should be able to assign employees and providers of your telemedicine business against each of these practice locations.
User Roles
Except for the use case of solo providers offering telemedicine services to their patients, it is expected that telemedicine software will be able to accommodate the multiple user roles that are typically found in traditional healthcare organizations like hospitals, clinics or new age virtual care services. Telemedicine software would typically need to provide roles for different user types like care providers, nurses, administrators, patient coordinators, finance team members, pharmacy team members, lab team members, appointment coordinators etc. These roles are important to ensure compliance requirements and that organizations are able to restrict access to sensitive data to just the required individuals.
Notifications and Patient Engagement
A flexible notifications system that allows patient engagement through various channels like Email, SMS and Push Notifications is very important feature of a telehealth software platform. The notification system should typically integrate with all the relevant telemedicine features, provide reminders and alerts, patient engagement pushes, besides allowing engagement with patients on a one-on-one or group basis.
Patient Education
Patient Education is a key aspect of patient engagement. While it possible to use external channels like social media and newsletter management software for this purpose, it often helps to have some form of an patient education solution directly integrated into the telemedicine software platform so it makes operations significantly easier.
Device Integrations
Adoption of consumer health devices is growing exponentially and has accelerated post pandemic. While the consumer adoption of these devices has always been robust, providers have always been reluctant to consider this data in their diagnosis. However this is fast changing. Recent studies have shown that providers are increasingly willing to take this data into account, especially since they themselves are active users of these consumer health devices. As the adoption of Consumer Health Devices increase, these devices will increasingly play a big role in telemedicine consultations. In addition to this, there are third party systems like Apple Health Kit and Google Fit, that have achieved a critical mass of users with millions of users using these services to store their data. It is important for any telemedicine software solution to provide a set of consumer health device integrations that are complimentary to the target patient demographic of your telemedicine business .
Telemedicine Mobile Apps for Patients
Do you need a Telemedicine Patient Mobile App for your telehealth startup? What advantage does a mobile app bring to your business? Mobile apps are definitely a factor that add credibility to your business and it can provide a better user experience. However do keep in mind that it adds to your development costs. Furthermore it can also have a significant impact on your marketing and cost of customer acquisition. If you do decide to go ahead and add a mobile app for your patients, then what are the features that you need to add into the mobile app? Ideally the mobile app should offer patient all the features that you provide on the platform. This would typically include the ability to login/register with your business, book appointments, do video consultations, make online payments, ask questions/text consultations, subscribe and engage in remote monitoring plans and other relevant features you might have. One big advantage that mobile apps bring is the use of push notifications to engage with patients, though this is now possible with web technology as well.
Telemedicine Mobile Apps for Providers
Do your providers need a mobile app or will it be sufficient for them to use a web interface? In case you do decide to provide mobile apps to your providers then you will need to prioritize between the features that should be made available via the app. Patient management, Appointment Scheduling, Video Consultations, Text Consultations, Remote Patient Monitoring are some of the basic functionality that you will probably need in the provider mobile apps. In general, it would be quite reasonable to restrict the functionality on the provider mobile app to the set of provider use-cases that your business requires. Administrative functionality can be restricted to the desktop web interfaces
Platform APIs For Telemedicine Businesses
Depending on your telemedicine business requirements, APIs can be an important consideration in deciding a telemedicine software platform.
Some telemedicine platforms will provide most of your features in a box and if this meets your requirements, then API's might not be a high priority consideration. If you are a new telemedicine startup just launching, then it is worthwhile to find a platform that can meet your immediate and future requirements. An All-In-One Telemedicine Platform can be really helpful in reducing you’re the overall costs of your software stack and it also eliminates any API dependent development activity. This is definitely convenient as it helps reduce your costs and it also means you do not have to deal with multiple vendors.
On the other hand if you already have an existing EMR in place, then you might find it important for your telemedicine software platform to integrate with the EMR. Other such situations might be that you have an existing appointment booking system in place or you have an existing RPM system that your team already uses.
APIs will be important to enabling any such integration requirements that you have today or in the future. You should also attempt to understand the scope of the available APIs and understand the type of integrations they can support and the future development plans for these APIs. In summary, APIs are very important from the perspective of future proofing your business. Even though you might not need them today, it would be prudent to assume that you will need APIs at some point in the future and choose a telemedicine solution that has you covered. The ContinuousCare platform provides both an All-In-One Telemedicine platform as well a robust API, thereby giving you the best of both worlds.
Payment Gateway Support
Unless you have insurance based flow, collecting payments from patients is bound to be a top priority when building your telemedicine business workflows.
You will need to find a suitable payment gateway provider who can provision an account for your telemedicine business. Most payment gateway solutions will charge a fixed monthly fee plus a percentage of the transactions that are routed through them, so you would need to look around to find the most suitable and cost-effective option. Other factors like maturity of dashboards, availability of reports, reliability, robustness and other factors need to be taken into consideration as well when making a decision. The ContinuousCare platform provides out-of-box integrations with 16+ payment gateways globally, giving your telemedicine business a easy to use plug and play solution.
Also keep in mind that not all payment gateways will support telemedicine businesses. In many countries patient originating healthcare transactions might be considered high risk due to various regulatory factors and payment gateways might not provide you with an account. It is always advisable to check directly with the payment gateway and ask about support in your specific country. Keep in mind that even though, a payment gateway might provision you an account in one country, they might not be able to do so in another country. This is especially relevant to telemedicine businesses that plan to operate across multiple countries.
Patient Credits/Discounts
Features like patient credits and discounts are important for user promotions and other marketing schemes. They allow you to market to patients and provide them some form of discount or reward for using your telemedicine business service. Common scenarios include:
- Granting credits to certain patients or to corporate patients as an incentive to use your telemedicine business services. These credits can be redeemed against the online services you provide. The payment module should be able to handle this transparently.
- Another common scenario for telemedicine businesses is the handling of cancellations. These might arise due to various factors including provider unavailability, poor network conditions etc. In such situations the telemedicine platform should include in an inbuilt wallet that allows you to issue credits in lieu of the cancelled consultation. These credits can then be redeemed when booking a new consultation. This approach is better than having to refund the actual payment back to the user and it ensures that you do not lose revenue. Also keep in mind that payment gateways might get concerned if you have a high level of refunds and an inbuilt credit system, allows you to deal with this without having to involve the payment gateway. Ideally your telemedicine platform should handle all of this transparently without the need for any manual intervention.
- Credits can also used to implement a loyalty program where you can grant credits to patients for their continued usage of your telemedicine business services. These credits can then be availed against their future usage.
Control Panel for Telemedicine Software Platform
As a telemedicine business you need a robust system that allows you to manage the entire business from an easy to use, robust interface. Here are some of the critical aspects that you need to ensure are part of your telemedicine software control panel:
Provider/User Management
Provider and user management is a critical component of any telemedicine business solution. Most telemedicine businesses will need to frequently add in and remove new providers and employees, assign roles and make other changes. Being able to manage the provider profiles is another key factor. Patients typically make their decision regarding their telemedicine consultations based on the provider profiles. Provider profiles will comprise the provider designations, specializations, work experience, academic qualifications and achievements.
Patient Functionality
Controlling patient registrations, being able to quickly add/remove instructions for newly registering patients based on your marketing programs, managing patient groups and categories and other such features.
Departments
Creating and managing departments based on your organizations requirements
Payment Controls
Tax rate management, currency controls, payment gateway configurations
Patient Terms and Provider Terms
You need to be able to control the terms and conditions for your patient terms based on rules and regulations in your country and also based on the telemedicine business services you provide. Patients need to consent to these terms when they signup for any of the services you offer.
Compliance, Privacy and Data Storage Requirements for Telemedicine Software
Depending on which country your telemedicine business operates in, you will need to explore the list of healthcare regulation and data storage requirements that might apply to your telemedicine application.
Data Storage Regulation for Telemedicine Software
Some countries are putting in place legal requirements that mandate that the health data resides within the geographic boundaries of the country. In some cases it is sufficient that a copy of the data resides within the country. There are also some countries which prohibit the data from leaving their boundaries even for temporary processing. Some of the countries which are known to have data storage regulations include UAE, and France. Many other countries like Brazil, Thailand, Nigeria have established laws that are modeled on European GDPR regulation, that permit the storage of data in other countries provided they provide adequate levels of protection. Many countries like India are in the process of rolling out their data regulation laws. Based on these requirements, you will need to determine your hosting requirements and check on the data center capabilities of your telemedicine software company.
Compliance Requirements for Telemedicine Software
You need to be aware of any healthcare compliance and data/privacy regulations like HIPAA and GDPR that might apply to your telemedicine business. Many countries are putting in place their own data and privacy regulations and many of them are based on them on GDPR. These typically have implications for digital healthcare as well. You need to explore these regulations to understand the implications of this in terms of feature set of the telemedicine platform and your business services.
Data Security for Telemedicine Software
Data Security is obviously a critical aspect for a Telemedicine Software Platform. Here are some of the key aspects that you need to consider when developing your telemedicine software solution:
Data Encryption
As a telemedicine software platform, you need to ensure that the data transmission is encrypted. The data needs to be encrypted during transition and also at rest
WebRTC
If your telemedicine software platform allows video calls, then you are probably going to be using the WebRTC technology for the implementation of the telemedicine video calls. You need to ensure that the connections are secure and the audio and video data streams are encrypted.
PHI
Ensure that your telemedicine software platform deals with patient health information in ways that is inline with the data regulations in the country in which your telemedicine business is operating. In many cases data and privacy regulations would prohibit the transmission of patient health information over public data networks.
Security Infrastructure and Features
Does your telemedicine software platform have the security infrastructure in place - is it protected by an enterprise grade firewalls with frequently updated security rules? Do you have digital security certificates, encrypted passwords and other necessary security features?
Usability of the Telemedicine Software
Usability will be another key factor to consider when developing/evaluating your telemedicine software solution. Telemedicine platforms would need an easy and intuitive flow. Keep in mind the nature of your patient base. One useful exercise would be to develop a set of patient personas who you expect to be using your telemedicine business service. Think through various attributes like age, gender, demographic, family status, geographic location, career, technology access, problems, motivations and intentions. Once you have defined a set of personas you need to think through the user experience from their perspective. There are also other exercises like user interviews that you could consider when finalizing on the user interface,
Keep in mind user experience can have a direct impact on your revenues and one well known study showed that 88% of users will not return if they have a bad experience.
Robustness of the Telemedicine Software Platform
You need a telemedicine platform that is robust and can grow with your telemedicine business. Many telemedicine businesses might start small, but can be expected to grow over time. A telemedicine software platform should also be engineered to scale up rapidly to handle unexpected surges. The first wave of Covid-19 caught the global healthcare system by surprise and telemedicine adoption shot up to unprecedented levels overnight. Such events are thankfully quite rare, but it does drive home the need to ensure that you have a robust system in place to start with. So in summary you need a system that can grow with your telemedicine business, but should also be able to scale up fast if you need it tomorrow.
Scalability requirements of your telemedicine service
Some important numbers you need to think through:
Number of simultaneous users
The most important aspect that you will need to consider is the number of parallel or simultaneous users you expect to be using your telemedicine business service. You might have millions of registered users, but if only a few users are using your telemedicine software platform at a given point in time, then your scalability requirements might not be that significant.
Expected growth
How many users do you expect at launch and how do you expect this to grow?
It is however important to be realistic with respect to your growth expectations. The reality is that you might not be able to model the expected usage levels before you launch the telemedicine business. A realistic approach is advisable especially if you are a new telemedicine startup, because high scalability does have an associated cost implication and telemedicine startups typically need to be cash conservative.
In the cases of healthcare organizations like clinics, hospitals it should be possible to model the expected number of parallel telemedicine users and overall growth numbers by examining other data points that are already available. Some questions that will help arrive at an answer are below:
- How many healthcare providers do you have and how many appointments do these providers have per day?
- What percentage of the providers time will be set aside for telemedicine consultations? What time are these slots being allocated? Is that a traditionally busy time for the providers?
- How many visitors do you have to your existing website and other online properties on a daily basis? How many online appointments do patients currently book via your website today?
- How does your marketing team plan to promote the telemedicine business services?
- What has the response to been to prior digital initiatives?
On the other hand if you are telemedicine startup without an existing patient base and you are starting from scratch, then it would be very wise to start conservatively. It would typically take time for your marketing team to find the right marketing mix to fill up all the available provider slots. Nonetheless it is useful to put in some thought and attempt to model some numbers so you have a starting point for your telemedicine software platform requirements.
Fault Tolerance, High Availability and Data Backups
When setting up your telemedicine software platform, you also want to ensure that it is fault tolerant. Nothing is perfect and hardware failures though very rare events can be expected at some point. When they do happen you want to ensure that the users of your telemedicine service do not experience any down time or data loss. This is possible by ensuring that you have redundancy built into the system, so that when one component fails, another one can take over immediately. You also want to ensure that you redundant real-time backups of your data.
Type of Services
Another factor to keep in mind is the nature of the telemedicine services you plan to offer. Although many people consider telemedicine to be synonymous with video calls, there are actually a number of different types of telemedicine services that you can offer to patients. Each of them have different scalability requirements. So for example if you are offering telemedicine video calls, then you need to be concerned about the number of parallel telemedicine video calls that the platform can support. On the other hand if you dealing with text consultations then this might not be a concern.
Platform Technical Support
Telemedicine applications typically involve video technology, mobile device integrations and external service integrations. Many of the underlying technologies might be changing rapidly themselves. Additionally applications also have to contend to rapidly changing operating system versions and mobile device versions. Your hosting provider can develop issues or network failures might occur. All of these are besides potential bugs and issues with the telemedicine software platform itself.
While technical issues might be infrequent, they are inevitable. Technical support is therefore going to be an unavoidable part of operating a telemedicine platform. When issues occur and your users encounter issues, you will need a technical support team who you can rely on to step in and address the issue.
Telemedicine Software Platform: Custom Development or SAAS Model
Irrespective of whether you are planning to custom development of a telemedicine solution or whether you are considering using an off-the-shelf SAAS telemedicine solution, it is very important to that you are clear on what the nature of your business model. and the business domain would obviously have a big bearing on your choice of a telemedicine solution. At ContinuousCare we provide you all possible options including White Label telemedicine solutions, customization and custom development options.
What Is Your Telemedicine Business Model?
First of all you need to be clear on the business model for your telemedicine service. A business model in simple terms is the answer to the question - how do you plan to run profitable telemedicine service? Below are a list of typical telemedicine business models for healthcare startups and incumbents:
Virtual Care Programs
Medical practices and hospitals choose to create virtual care programs that sit alongside their existing in-person programs. These typically take the form of dedicated telemedicine video visits, usage of telemedicine for follow-up visits, remote patient monitoring and care plans.
Direct to Patient/B2C virtual services where patients are serviced by a set of healthcare providers you aggregate on the platform. The providers could direct employees or usually they work on a revenue share agreement. Direct to Patient services also choose to further specialize based on patient demographic, health conditions and other factors. Direct to patient services are typically favored by healthcare startups who adopt a telemedicine first model.
Employee Healthcare
A B2B2C model which serves the employees of corporate customers.
Kiosks
Manned or unmanned kiosks where patients can connect with a central panel of remote healthcare providers.
Pharmaceutical or Medical Device Companies
Pharma companies or medical device companies who seek to build a telemedicine business based on their provider network.
Insurance Networks
Insurance companies who seek to provide telemedicine services to their patients to improve patient outcomes.
Outsourced Chronic Care
Telemedicine services that provide outsourced chronic care management services hospitals and other healthcare organizations.
Each of the above models operate in very different ways. The target customer, the value proposition, the marketing/sales strategies, the revenue and cost models all vary quite drastically. Alexander Osterwalder's Business Model Canvas is an excellent tool that can help you think through the specifics of your telemedicine business model. This is described in the next section.
What about the actual services that you offer your customers? Some of the common service offerings are:
Virtual Calls
Virtual calls with video/audio are synonymous with Telemedicine. Covid-19 has really accelerated the adoption of virtual calls and as per one study 32%+ of patients across all age groups would have preferred a virtual care visit over a physical visit if both required a co-pay.
Question based consultations
Patients can ask providers detailed questions with accompanying documents and files and providers provide a response after evaluation. In many countries where video calls are challenging due to low bandwidth conditions, this asynchronous form of tele-consultations are very popular.
Care Plans
Care plans are typically subscription based plans that bring together virtual calls, symptom monitoring, text chat or question based consultations. Continuous care models can typically be modelled for most scenarios and some examples are care plans for chronic care, post-discharge care, elderly care, weight loss plans, mental health plans etc.
Business Model Canvas for Telemedicine
A Business Model Canvas for Telemedicine is shown above. Below are some notes that you will find useful when walking through the different parts of the Business Model Canvas. You can download a copy of this Business Model Canvas for Telemedicine Businesses here
Partners
Some of the possibilities are listed below, but there will obviously be many more depending on your unique business model.
Telemedicine Platform Software Provider
The software provider who is going to be developing and maintaining your telemedicine software platform. The telemedicine software will always be a work-in-progress that needs a constant stream of new features and changes to keep up with the changing technology and competition. Hence they will be one of your key partners, unless this is an in-house function.
Providers, Hospitals, Clinics
In case you are a telemedicine startup, you might be partnering with various individual healthcare providers and external care provider organizations to deliver your services.
Pharmacies
Medical Laboratories: Your telemedicine service might be interacting with various pharmacies and medical laboratories on behalf of the patients using your service.
Other services
You service might need to interact with insurance or pharma companies or you might be interacting with other services for remote diagnosis expertise.
Key Activities
What are the key activities that you need to execute on to be able to deliver the telemedicine service? Some of the typical ones would include:
Telemedicine Business Operations
Bringing together all the parts to ensure that you can provide the required services to your customers. This can of course be broken done into a fine grained set of key activities that you need to be performing on an ongoing basis to grow and expand your telemedicine service. For a typical telemedicine service this would include the scheduling, fulfillment and post visit engagement.
Platform Development
The technology platform will always be in development and will need to be continuously upgraded with new features on an ongoing basis.
Key Resources
In the Business Canvas terminology, resources are what you need to deliver your service. For most telemedicine services this would typically include:
Healthcare Providers
The healthcare providers who help you deliver the telemedicine services, especially if they are directly part of your service
Telemedicine Software Platform
The telemedicine software solution which would typically consist of mobile apps and web applications that bring together a whole range of features, are a key resource for the delivery of your telemedicine service.
Value Proposition
What is the value proposition of your telemedicine business? The value proposition that you aim to delivery through the telemedicine service would of course vary widely depending on the specifics of your business. However telemedicine businesses are typically multi-sided and have to cater to the needs of both patients and providers. They might choose to monetize both sides or would more typically just stay focused on the one side. Depending on your business model, the value proposition of your telemedicine services is likely to include one or more of the following:
Convenience
Allow patient to consult with providers at their convenience. It reduces travel and saves time and money. Get instant e-prescriptions for common ailments.
On Demand Service
Eliminate wait times. Use telemedicine to connect patients to providers on demand
Improve access to healthcare
Help patients access experts and specialists easily
Improve Healthcare Outcomes
Use telemedicine to improve healthcare outcomes through better accessibility and patient engagement
Improve efficiencies
For care providers, it helps increase efficiency and reduce practice overhead, reduce ER admission rates
Improve revenues
If you are setting up a telemedicine service for a healthcare organization like a hospital or clinic, then increasing revenues through reduction of no-shows and appointment cancellations, finding new revenues by monetizing previously unpaid follow-up and report review consultations, increasing patient reach, monetizing virtual second opinions might be a key value proposition
Customers
Who are your customers? Who does the telemedicine business serve? The majority of telemedicine businesses are direct to customer, but these are not the only types. Here are some other options
Direct to Patient
Your telemedicine business directly serves patients who might be paying out of their pocket or you get paid through insurance reimbursements
Corporates
If your business model is employee healthcare, then you are in effect employing a B2B2C telemedicine model and you are serving the employees of your corporate customers
Educational Institutions
You might be providing healthcare services to educational institutions like schools or colleges.
Kiosks
If you are in the kiosk segment, then you might be setting up manned or unmanned kiosks to connect patients to a panel of providers and your customers are probably the organizations where you embed the kiosks
Insurance or Pharma Companies
You might be acting more as a platform provider and providing a solution to insurance companies or pharma companies
Hospitals, Clinics
Your business model might be to serve existing healthcare organizations and provide part-time telemedicine providers for their online consultations, or provide outsourced expertise for remote patient monitoring or provide telemedicine radiology services.
The patient demographic and the specializations you choose to serve, can have a very important bearing on the revenues of your telemedicine business. B2C startups for example may choose to stay focused on specific segments, especially in early stages before broadening out. Some examples customer groups are below:
Gender
Men's Health, Women's Health
By Specialization
Mental Health, Sexual Health, Cancer Care, Skin Ailments.
By Life Phase
College Students, Menopause
Specific Health Conditions
Autism, Diabetes
Immigrants
Spanish immigrants living in United States
This kind of focus on specific customer segments can make sound business sense. For example mental health, sexual health, dermatology are areas that are proven to work well with telemedicine. Take mental health for example, because of the stigma associated with mental health, many patients prefer to seek help online instead of in the physical world. Mental health is also an area where the Life Time Value (LTV) of a patient can be very high, as repeat consultations are the norm. The other benefit of a focused approach is that it is easier to build a brand and it can also have significant implications with respect to the customer acquisition costs. So Mental Health for example is a great space to start building a B2C telemedicine business, because of its higher LTV and lower CAC, on account of the fact that patients actively seek out online solutions.
Customer Relationships
How does your telemedicine business maintain the relationships with your customers. This would obviously differ widely based on your customer type and based on the LTV of each customer to your business. The higher the LTV of each customer, the more in-person, touch heavy nature of the relationship. Telemedicine businesses would typically employ one or more of the following options for sustaining their customer relationships:
Broadcasted patient engagement
Patient education material, other health notifications and reminders that are sent via email, SMS or push notifications.
Community Support and Engagement
You might choose to adopt a community model and use the power of a community to engage with your customers. This model however is usually employed for B2B businesses and might not work for healthcare services.
One-one patient engagement
If you are offering chronic care management services or care plans, then they might involve some form of one on one patient engagement.
Dedicated Account Managers
Again depending on your business model and customer type you might follow an account manager model, especially if your business follows a B2B or a B2B2C model
Channels
What are the customer acquisition channels for your telemedicine business? This can again vary very widely depending on your definition of a customer and whether you are running a B2C or B2B2C or a B2B. It will also depend on the CAC (Customer Acquisition Cost) and LTV (Life Time Value) of each customer. The higher the LTV the more you can afford to spend in terms of CAC. The general rule for a healthy business is that LTV > 3 x CAC. A list of some typical channels:
- Physician Networks, Insurance Networks, Hospital Networks
- Direct Sales
- Distributors, Resellers, Affiliates
- PPC Campaigns: Google Adwords, Facebook, LinkedIn, Twitter, Instagram are some of the well known ones. There are thousands of paid directory listings that also employ a PPC model that can be highly effective
- Website, SEO
- Content Marketing and Blogging
- Social Media: Facebook, Twitter, LinkedIn
If you are operating a B2C business model, then it is likely that the online channels like Social Media, Content Marketing, SEO, PPC Campaigns are your key channels. B2B and B2B2C are on the other hand typically built on a relationships and the other channels might be more suitable, depending on your customer type. Some of the online channels like LinkedIn PPC+ Content Marketing can also work very well in this segment.
Revenue Streams
What are the revenue streams for your telemedicine business? Again this is dependent on your business type. Some common revenue models in the telemedicine world are:
Recurring Subscriptions
Patients are charged a recurring subscription for availing telemedicine services through your platform. The services offered might be a set of video visits, care plans or remote patient monitoring. The care providers might get a percentage of these revenues. Insurance reimbursements might also be involved.
Pay per consultation
This is probably the most common model in the telemedicine business and patients typically pay out of pocket with the providers getting a percentage of these payments. Insurance reimbursements might also be involved.
Pay per patient
This model is common in employee healthcare or insurance models follow this model. In some cases this is actually tied to the service utilization, while in other cases the businesses manage to negotiate a flat fee irrespective of utilization
Costs
What are the costs for operating your telemedicine business? Some of the high level categories here would be
- Sales & Marketing Costs
- Customer Support Costs
- Product Support Costs
- IT Infrastructure Costs
- Telemedicine Software Development Costs
- Medical Consultants Costs
- Personnel Costs
Pricing for telemedicine services
How much do you charge for telemedicine services you offer? Here are some factors that you need to consider when finalizing your pricing:
Insurance Reimbursements
In insurance based healthcare systems like in the US, insurance reimbursements will typically determine the pricing. In many states in the US, the reimbursement is in line with the in person visits.
Physical Healthcare Establishment
For existing hospitals and clinics starting telemedicine services, it typically makes sense to keep the pricing of the telemedicine services inline with the physical visits. Though telemedicine helps establishments reduce the practice overhead, it typically requires a significant volume of telemedicine revenue, before they can consider different options in terms pricing.
Existing Market Pricing
In cases where none of the above apply, then you are probably a telemedicine startup looking to work out optimal pricing for your services. Telemedicine services typically involve providers who provide services on a revenue share model and are this is essentially a market place model. Here is good guide for finalizing your pricing and below are some of the key factors that you need to consider:
Margins
Unless you service is fully backed by artificial intelligence, your revenues will typically be a mark-up on the fees that is paid to the healthcare providers for each consultation. The existing market rates for physical consultations across specialties and years of experience, will give you a baseline on what the providers would typically expect.
Competition
Typically you will have at least one competitor in the market and it would be very helpful to identify their pricing strategy. A high level of market competition would typically mean that competition for providers is intense and your margins might be lower as a result.
Provider Differentiation
It is inevitable that factors like experience, reputation or other factors might result in some providers being in more demand and getting more consultations than others. This will typically need to be taken into account with respect to your margins and maybe your service pricing. Accordingly you need a software solution that can support differential pricing for providers and for different services.
Volumes
The volumes of telemedicine consultations would obviously be one of the factors that you need to consider in modelling pricing. When thinking about volumes you also need to take in consideration the repeat volumes, since you are saving on the customer acquisition costs by selling to existing customers. Also do remember that repeat volumes will vary across customer segments based on medical specialization, health conditions and other demographics.
CAC and LTV
The other all important factor to take into consideration is your Customer Acquisition Cost and the customer life time value (LTV). Does your pricing level make sense with respect to CAC and LTV? Do the pricing levels put your business in a healthy space? Determining the values for CAC and LTV will typically just be high level guesses till you have some actual data to deal with. It is however essential that you keep a close watch on your LTV/CAC ratio and if it is an unhealthy ratio, then you should be considering small pivots that will take your telemedicine business into a much more healthier space.
If you are a telemedicine startup working your pricing, there will always be a temptation to fix on your pricing based on what your competitors offer. It is however advisable to model things out in a business plan to understand how the pricing impacts your break-even point and growth trajectory. You should aim to differentiate your business offering sufficiently so that it allows you to command a higher price from patients. A strong brand and a perception of quality can always be a competitive advantage with respect to pricing.
Process or Workflow For Telemedicine Business
This section discusses some of the operational points you need to think through when finalizing the workflows for your telemedicine service. Most of this is suitable for video call based services.
How can patients book a video call?
Self Service Online Appointment Bookings
This is typically the best option if you have a very limited resources. Most telemedicine software will allow you to setup a precise schedule per provider and allow patients to access those schedules online and book a convenient slot. The self-service booking model has a number of inherent advantages from both a provider and patient perspective:
Minimizes costs and efforts
From a provider perspective it limits the number of human touches that are required per appointment, which of course helps minimize the costs.
Convenient for Patients
The self-service model is of course very convenient for patients as they can make the bookings at any time of the night or day and can make the decisions after reviewing all the necessary information. A significant percentage of self-service bookings are also made outside hours.
Higher Revenues
For organizations with a large number of providers, the self-service model typically translates into higher revenues, as patients can book an appointment of their choice and outside office hours. Giving patients the slots they want also reduces no-shows and cancellations, making a significant impact on revenues
Patient Satisfaction
Online appointment booking is typically a very efficient process and patients love the convenience of being able to book online and reschedule or cancel at their convenience.
Upfront Revenues
In case where patients are paying online, it also helps the organizations cash flow as patients will book up appointment slots well in advance.
Higher ROI on Marketing Efforts
Ensuring that everything happens online is also great from a marketing ROI perspective. It allows you to pinpoint more precisely which our your marketing efforts are driving revenues.
There are however some pre-requisites for a self-service model to work and these include:
Precise Scheduling Capabilities
Your telemedicine software platform will need a very robust appointment booking system. It should be able to handle a variety of uses cases and provide all the necessary features. These include being able to accommodate precise provider schedules including working and non-working hours, the services that are available during each slot and the varied pricing across services that the providers offer.
Available on web and mobile
Patients should be able to book the appointments from both desktops and mobile. A good percentage of the booking will happen on the go, so the ability to support mobile based bookings is very important.
Appointment Management
The administrators should have the necessary level of control to manage these appointments, which might require rescheduling them or cancelling them if required. The telemedicine software should also provide significant options in terms of user roles and ensure that the patient data access is restricted to only user roles with the required access.
Phone Based Bookings
The adoption of online booking is still relatively low and most organizations continue to follow phone based appointment bookings. These are typically routed to the receptionist or in the case of very large organizations, this might be handled by a dedicated call center. Some organizations choose to support both self-service bookings as well phone based bookings.
Provider Booked Appointments
Providers can typically directly book the follow-up appointments for the patients. In some cases organizations (especially clinics and hospitals) may choose to make restricted use of telemedicine video calls and might leave it to the discretion of the providers to choose the best model of engagement for a particular visit.
Chat Based Bookings
Many telemedicine services choose to provide chat assisted bookings. This can be a really effective combination especially when used alongside WhatsApp Business chat.
Technical Support for Patients and Providers
Telemedicine services are based on technology and it is inevitable that you will need to support users when they encounter problems with the technology. This is more challenging with real time models of telemedicine, as you have to contend with scenarios that might be beyond your control. These problems can include bandwidth or connectivity issues which can sometimes impact specific internet routes or websites and result in frustrating user experiences. Telemedicine services typically also have hardware or software dependencies that are beyond your control like the quality of the users camera, faulty microphones, speakers, unsupported browsers, problematic mobile phone operating systems with specific bugs that impact your service.
Both your patients and providers would be impacted by technology issues and depending on the level of your telemedicine practice, you would need to provide support for them. The typical support channels would include:
FAQ's
FAQ's can be a really effective tool in ensuring that you do not get inundated with trivial support requests that can be diagnosed and solved by the users themselves.
Self Diagnosis/Quality Check for Video Calls
If your telemedicine business involves video calls, the you should insist on adding a self-diagnosis/quality check option as part of your work flow. The bulk of the issues with video calls will typically be due to connectivity issues, speaker or connectivity issues and a self-check option helps users sort this out themselves instead of reaching out to your support team.
Online Chat Support
Your telemedicine software should ideally provide a real time chat option for patient support.
Email oh Phone Support
Patients or providers should be able to contact your support team via email or phone in case they need assistance
Video Calls: Appointments or Waiting Room Flow
One of the important considerations for video call based telemedicine services is whether to employ an appointment based model or whether to use a no-appointment waiting room model. The appointment based model is quite straightforward - patients will book an appointment for a specified time and the video call happens at the specified time. The no-appointment waiting room flow allows patients to check-in to a virtual waiting room and wait till a provider can see them.
Most telemedicine services prefer to use the appointment based flow for the following reasons:
Better experience
Neither patients nor providers have the luxury of wasting time and waiting endlessly. A fixed appointment time helps set expectations and ensures that patient satisfaction levels are high. For providers it also eliminates anxiety of having to deal with an ever changing patient count in their waiting room
Provider Availability
Provider availability is typically limited. For a small telemedicine service with a limited number of participating providers, it will be extremely challenging to ensure that patients can engage with a provider in the required specialty in a reasonable amount of time. Unpredictable provider availability when coupled with a no appointment waiting room model can have a significant impact on patient experience and hence business revenues. Operationally this can be a very challenging model
Summary
Telemedicine adoption has hit critical mass due to the pandemic. Patients love the convenience, cost savings and increased accessibility. For providers and healthcare organizations, telemedicine helps reduce overhead costs, provides flexibility and better work life balance, provides new revenue streams, improves patient outcomes and patient satisfaction levels. Telemedicine is definitely here to stay and is expected to play a key role in transforming healthcare delivery in the coming decade.
Starting a new telemedicine service or setting up a new telemedicine business can be challenging. You will need to address the various aspects of setting up a new telemedicine company if you don't already have an existing one. Additionally you will need to comply with legal requirements and regulations that are relevant based on your country.
Choosing a telemedicine platform or developing a new one is a significant undertaking. The telemedicine platform is a critical component of your telemedicine startup and you need to carefully evaluate the feature set you need, prioritize the required features and then evaluate the options that you have. You would need to aim to find a solution that is feature rich, robust, secure, usable and well supported.
Once you have the telemedicine software in place, you need to fix on your telemedicine business model. If you are an existing healthcare business like a clinic or hospital, then this might be a relative straightforward proposition. But if you are a new telemedicine startup, this will require extensive evaluation to find a telemedicine business model that fits in with your market and meets your business growth objectives. The Business Model Canvas is a great tool to help you finalize the business model and it can be used to evaluate all the different aspects of your telemedicine business.
Pricing your telemedicine offerings, will require you to consider different aspects. Pricing can be one of the most critical aspects for a telemedicine startup and it is important that you adopt a pricing formula that will realistically help you achieve your business objectives instead of just pegging your pricing to competitor pricing.
Finalizing the optimal workflow for your telemedicine business is another critical activity and is closely associated with patient satisfaction levels and operational efficiency. Choosing a flow for patient bookings, providing technical support to patients and providers and call flows for availing telemedicine service are some of the important aspects to take into consideration.
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