Finding the Front Door To Digitally Supported Healthcare

The entry point to healthcare has long been primary care, but this is changing rapidly. This is partly due to deficiencies in the primary care setting and the growth of retail clinics with high volume services at low cost. However, digital companies are now clamoring to be the new front door. This poses a choice between fixing something familiar or trying something new. It is also a choice with major consequences.

Few digital healthcare companies are more eager to become the first stop for healthcare needs than the oddly named Hims and Hers Health Inc. The CEO of this successful, publicly traded company recently shared his vision of the future of healthcare:

Our vision for the future is simple. We are building Hims & Hers into the new front door to healthcare. A new front door that will span dozens of medical specialties, welcoming customers of all demographics into a unified consumer platform that looks and feels and talks to them in a way that gives them confidence they’re in the right hands. I believe the majority of healthcare delivery will begin on a platform like ours in the future.

Digital solutions are surely the future of healthcare in many ways. The convenience of web portals is not debated, nor is the ability of digital platforms to determine clinical needs and quickly provide services or products to meet those needs. For example, it is possible we are reaching the point where more people are being exposed to CBT tools each day on digital platforms than from a psychotherapist.

The scope and depth of digital health services is still being explored and understood. There are specific ways in which digital tools may be found superior to office visits, but the question here is whether this should be the front door to care. The idea of a front door is that people start there, get their needs met digitally to the extent possible, and then have additional services like face-to-face visits as needed.

This is a classic business argument by digital supporters. They would argue it is best to start virtually with lower overhead costs and move to more expensive service delivery if needed. Also, they narrow a comparison of service delivery models to an examination of specific tasks. For example, can digital platforms train people in replacing negative automatic thoughts as well as a CBT-trained therapist?

Many people will learn CBT skills equally well online as from a therapist, and it can be done at lower cost digitally. It is likely that video sessions are also equally effective in addressing some healthcare problems, and again at lower cost than office visits. In fact, digital companies have catalogued which clinical symptoms can be assessed adequately in each modality.

The problem is not specific tasks or services but the critical importance of the front door. We need a highly trained person at the front door. The money saved on patients with straightforward, single issues can be lost quickly with those harboring complex comorbidities or problems that mask other problems. Even if a digital-first model has aggregate cost savings, some patients can be poorly served.

Digital healthcare services will continue to improve and grow. There are good arguments for scaling them up across multiple specialties, and the services will improve with better technology and more experience. Yet there will never be a digital or virtual service as skilled as an in-person physician, and so care should begin in-person. Clinicians should not just be inserted into an escalation protocol.

Digital companies not only argue that they perform better on cost and access factors than primary care, but clinical deficiencies within primary care are also widely noted. Behavioral healthcare is commonly cited as one of the weakest specialty areas for the PCP. However, digital platforms cannot solve everything in behavioral health, and once again, none are comparable to a trained behavioral clinician.

The front door to healthcare should be staffed by experienced clinicians who listen well and can discern problems, syndromes, and diagnoses that digital and virtual platforms miss. The primary care setting needs an influx of psychotherapists to bolster the skills of the PCP in managing behavioral problems. Therapists can help many primary care patients as well by referring to digital platforms for ongoing care.

Problems are best caught early, and the digital-first model is a new problem. Digital care is perfect in many situations. Yet it could be disastrous for an untold number of people in delaying or misdirecting care. Digital solutions can fix some primary care problems. Our therapists can fix others. High quality care will soon be defined as connecting many people digitally once they pass through the front door.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.