What happens to patients when telehealth companies close?

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Bthe uzzy, venture capital-backed startups and big tech companies that have promised to disrupt healthcare are actually doing it — including shutting down services early adopter patients can rely on.

Following its agreement to acquire primary care technology company One Medical, Amazon has announced that it will end its own virtual and in-person health service Amazon Care, which covers 40,000 patients, by the end of the year. ‘year. Telehealth prescription company Cerebral, which has used pandemic-era regulatory flexibility to virtually treat mental health conditions like ADHD, has largely halted prescriptions for controlled substances in light of federal regulators’ scrutiny. and state. Dozens of other health-tech companies are cutting staff or closing lines of business, doubting sustained consumer and employer demand.

While some companies say they are helping patients find care elsewhere, the turnover could disrupt patients who have no other options for in-person care or prescribers where they live who cannot enable other services or who lose their health records in the shuffle between providers, experts tell STAT.

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“Failure can be good, but just recognize that when we break things or fail quickly in health care, we leave someone’s health on the other end of the line,” said Brian Hasselfeld , Senior Medical Director for Digital Health and Innovation. for Johns Hopkins Medicine and a practicing internist and pediatrician.

Amazon told STAT that customer service teams, clinicians and care coordinators are available to assist existing patients throughout the year to help them transition, and that it will share patient records. on demand. Cerebral, which launched its ADHD treatment program in 2021, no longer writes controlled substance prescriptions for new patients; patients with established prescriptions can continue to get them until mid-October. The company did not share more specific details about its plan to transition these patients to other clinicians.

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Hasselfeld said patients signing up for employer-based, direct-to-consumer health services could expect more continuity, and companies could do a better job of communicating these risks to patients, said Hasselfeld.

“If I have a recurring grocery store I go to and they decide not to sell something, I can just move on to the next grocery store,” he said. “Unfortunately in a direct to consumer [health] model, there is often no partnership between a consumer-patient and a healthcare professional to help weigh these risks and benefits.

Patients might need to weigh the benefits of convenient, on-demand and largely virtual care against the risk of losing it very suddenly. “They have to ask themselves, ‘Am I entering into this health care transactionally, am I okay if it’s a temporary relationship?’” said Hasselfeld.

Confusion also bleeds into their expectations of traditional healthcare, which still faces licensing and reimbursement hurdles that make it harder to treat patients virtually. Primed with direct-to-consumer services offering ongoing text and video messaging visits with clinicians, patients increasingly expect traditional healthcare providers to be digitally accessible. “The last thing you want is for a patient to have an acute, pressing healthcare question, and be surprised at what they can and can’t access,” Hasselfeld said. “Avoiding surprise is the priority.”

Michael Maniaci, a physician who leads Mayo Clinic’s home care program, is optimistic about the innovation taking place in virtual care, including the involvement of upstart providers. But he said he’s also concerned that for-profit companies moving in and out of patients’ lives could ultimately hurt quality and trigger a backlash.

“The fear is that someone will come in for the wrong reasons and mess things up, until the government says, ‘We don’t think it’s a good idea because of bad results,'” Maniaci said. “CMS will not support us, commercial payers will not support us. Regulatory and legislative changes cannot happen because the bad actors are there.

Some of these disruptions are unavoidable and necessary to generate new, more convenient services for patients, said Duke law professor Barak Richman. “No one is advocating cementing the status quo in place and there is a great need to experiment with new technologies and new delivery systems…some of these experiments will work and some will not,” he said. declared. “The balance is that we’ve been married to stability, and not married enough to change and improvement, and innovation.”

Casey Ross contributed reporting.

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