Direct To Consumer (DTC) Telehealth: Does The Industry Need More Regulation?

In this episode, Nathaniel Lacktman, Chair of Foley & Lardner's national Telemedicine & Digital Health Industry Team, visits with Quinn Shean, Managing Director at Tusk Strategies. They discuss the current state of direct to consumer (DTC) telehealth services, advice for entrepreneurs, what makes for good asynchronous telemedicine policy, and what the virtual care industry can expect to see in 2020.

“If you're requiring that every patient interaction is going to require a video in places that have low broadband, you're furthering health inequities with a policy that you were hoping was going to broaden access.”

“The rise of DTC telehealth … is not an invasive species, but rather the result of shortcomings in the existing way that traditional healthcare is provided, and new expectations of the upcoming patient population.”

“You can take some of what you've learned from selling [other online goods] to engage patients, that type of marketing, but you better realize you're not selling mattresses and razors. Bring on a medical advisor. Build out an informal network of your medical team.”

Read and download a free copy of Foley's recent 50-state telemedicine law research survey at New 50 State Survey of Commercial Insurance Laws Reveals Progress.

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Podcast Transcript

Nathaniel Lacktman

With me is a particularly distinguished guest, Quinn Shean, Managing Director at Tusk Strategies. Quinn provides regulatory advisory services, and devises and implements solutions for clients to achieve their mission, including engagements in telehealth and technology sector.

I have heard you speak at conferences on telehealth and DTC services, and just generally talk shop in the industry, but I would presume that most of our listeners haven't met you yet. Maybe tell us a little bit about yourself and your role at Tusk.

Quinn Shean

I am currently at Tusk and I work as a regulatory and policy advisor to both large corporations, as well as start-ups. My initial background is I worked in politics for about three years on state campaigns, and my favorite types of projects were always around health policy.

I then practiced law for about five years at two major law firms doing pharmaceutical and medical device work, primarily product liability on the defense side. Then when I had enough of that, I had the opportunity to join Tusk.

I had worked with our founder, Bradley Tusk, back in my political days, and when he offered me the opportunity to get out of the law firm and try something new, of which I really wasn't sure what I'd be doing, I said, "That sounds good!"

Tusk is an interesting model. We started out as a company that served as a political and regulatory strategist for large corporations. If you were a corporation and you were facing a tax issue in many different states, we would come up with the strategy, build the team on the ground, and run a campaign to either fight it or support it, depending on what the issue was. Our founder realized that this model, and how we work, was particularly well suited to start-ups, who are often fighting entrenched interests or incumbents. Their innovations might not align with whatever the current regulatory structure was. He was brought on as Uber's first political consultant about eight years ago, and when that went well, decided to expand the practice to also be advising these types of entities.

With both start-ups and big corporations, we do everything from shaping policy, helping them tackle regulatory hurdles, helping with communication strategy, supporting or opposing legislation, securing partnerships, and working on procurement.

Nathaniel Lacktman

The CEO might get all the attention for the idea, but the team behind the idea ... Is that you? Is that fair to say?

Quinn Shean

No, we have a great team here and it's a lot of people that formerly worked in government, who know how regulators and government and legislators think. When I was practicing as a litigator you only have a certain number of tools at your disposal within the confines of how the legal system operates, and what I love about Tusk is when we form campaigns, or we're helping companies trying to shape and change regulations, your toolbox is kind of endless. No idea is too far out there. It allows you to be really creative.

Nathaniel Lacktman

What is DTC medicine, and where do you think it fits into the healthcare industry at large?

Quinn Shean

That's a really good question. I don't know how much that's been unpacked yet—before we go on to what are the benefits and questions we have about that model—but DTC telemedicine is being framed as kind of the new rise of companies that are engaging with patients directly without a brick and mortar presence, and often in an integrated model that combines everything from the patient initiation, diagnosis, treatment, and then ultimately, prescription fulfillment for those customers that want it. The concept of DTC is not entirely new, in my opinion, and I see it as these companies are building on a kind of established infrastructure of initiating care directly with patients and meeting them where they are.

Nathaniel Lacktman

Essentially, a different way of approaching medical services.

Quinn Shean

I think what they've done well, if we're talking about this kind of new crop of venture backed companies, is they've taken different elements of established, approved upon infrastructure—like asynchronous structured interviews that we've seen health systems do, and ideas of mail order pharmacy fulfillment that we've seen pharmacy companies being able to do—and they've incorporated that with a customer experience that's really personalized to users.

They've done that very well, and they've found a way to bring in new patients into the healthcare system, or patients who've been away from the healthcare system for a while. I think the new part of this model that we're seeing is really the integration of everything, and the ways that they have been able to engage new patients in this mode of healthcare delivery.

Nathaniel Lacktman

Well, it's certainly popular, right? I would think that traditional hospitals and medical groups have been advertising, right? They put up billboards, they take out ads in newspaper, they send letters to people's house saying, "Hey, I'm going to do a chat at the library. Why don't you learn about spinal fusion?" But it's nothing of the type of scale, or almost like a hockey stick in the popularity of this DTC telehealth. What do you attribute to that rise in popularity?

Quinn Shean

I think it's a confluence of things. We've already seen healthcare generally finding more appeal in the, for lack of a better term, convenient care market. We've seen the rise of urgent care clinics. We've seen retail care clinics. We've seen, alongside that, care outside maybe the traditional brick and mortar primary care physician.

But alongside all of that, we've also seen customers or patients being asked to take more control over their own healthcare by being more in the driver's seat of having to make decisions and pay out of pocket. Then the third part of that is, we're seeing a more informed populace across the sphere, of wanting to be more accountable about their own health and make decisions.

Nathaniel Lacktman

What do you think about the advertisements for DTC telehealth, as compared to maybe just traditional brick and mortar medical practices? How are they doing it different, and maybe better, or worse?

Quinn Shean

I think one of the things I would say about coverage of DTC generally, is some are taking more risks than others, so it's hard to necessarily generalize.

What I do think that they're doing is speaking directly to patients, and they're using marketing techniques that have been taken up across a variety of industries in this new digital space. They're meeting and engaging patients in ways they understand, sometimes in a way that breaks down numerous stigmatized conditions. But I also think, when we talk about the marketing, we need to make sure that whatever critiques or questions we might have about marketing, those don't necessarily equate to poor care delivery. I think there's been a conflation of the two, that if you're uncomfortable with how somebody is marketing on a subway, or reaching patients in that way, therefore, they're receiving substandard care. I think that's a misplaced criticism.

I would be interested in what you think, Nate.

Nathaniel Lacktman

I think they're doing a great job. I think health plans, for years, have been pulling out their hair saying, "Please engage with your primary care. Go to your doctor. Don't let conditions go untreated."

Now, finally, we have a wave of healthcare companies saying, "You know what? They're right. Let's do a better job getting people excited, getting people engaged in medical care." Now, it may be condition...