Telehealth will help increase access to care and meet the demands of today’s convenience-minded pet owners
The client journey is undergoing an evolution of sorts. Traditionally, when pet owners had questions about pet care, they would almost as a knee-jerk reaction go to the veterinarian at his or her brick-and-mortar clinic, says Chad Dodd, DVM, president and CEO of Animatas Consulting LLC.
Now with access to near limitless information, clients are spinning it back on their terms. Most pet owners will do some form of research – on the issue, or the clinic they want to visit – before they even walk through the doors. They’ll still use the veterinarian for particular kinds of services and input, but they will also go to other places in the digital space, such as an affiliation with a breeder group or adoption group on a social network.
“There are so many resources now that as a consumer, they are really starting to reframe how they get access to this information and these services,” Dodd says. “And like everything else in the consumer world today, if you can make it easy for them to get access to it, that’s what they are going to gravitate toward.”
In the context of veterinary services, veterinary clinics have to evaluate how they are giving clients the best access to care. And if it’s just pet owners in general, if they are looking for information about care, is there a mechanism in which they can connect with veterinary care professionals?
Those aren’t questions your veterinary practice customers need to shy away from. In fact, Dodd says in many ways veterinarians are in a prime position to benefit from these changing dynamics, if they’re properly equipped to capitalize on them. “Last time I checked, veterinarians are still the credentialed source, they have the state licenses to practice medicine, so they know a lot about what your pet’s needs are.”
Access and continuity
Solutions getting the most attention seem to fall under the telehealth umbrella. At their most basic function, telehealth solutions provide access to care in the most convenient way for consumers. “Can you provide access to care, can you provide continuity of care, and can you do those in an engaging way in which clients can stay connected with you through their fingertips and smartphones,” says Dodd. “That is the heart of what we are looking at here. It can go from the pre-appointment, the in-clinic, the post appointment, but it has to do with all those aspects of helping me do what’s best for my pet, and making sure I get access to the information, services, and the level of care that I deem necessary for my pet.”
Dodd uses a parallel to human health as an example. Sometime in the last 12 to 18 months, most people in the U.S. that had healthcare coverage from an insurance company probably received a notification from their carrier that they now had access to telehealth services. The insurance providers promoted that as easy access, but also as a way to drive down the cost of human medical care.
In veterinary medicine, we are not necessarily looking at trying to drive down the cost, Dodd says, “because it’s actually quite affordable.”
“What we are talking about is access to care,” he says. “So then the business models come into play. My health insurance company wants me to access my primary care physician, and for $10, I can do a consult over the phone or through video. In the veterinary profession, we don’t have insurance companies covering these types of consultations services. We don’t have payer-provider situations. We basically have a cash-based business model where they are paying for services. So these business models need to be adapted.”
Dodd says we are seeing some interesting new approaches to incorporate the use of a telemedicine service. “Not as a replacement, but as a compliment,” he says. The technology piece involves getting the solution to work within the veterinary clinic’s workflow. The business component means “making sure that you are providing the level of care that you want to provide as a veterinary professional, but also be able to build a business model that works for your practice and your clients,” says Dodd. “So those are some of the fundamentals that we are dealing with. I don’t think that it’s about the technology. I don’t think it’s about the experience of that technology. Rather, it’s about adapting it into the use of your workflow. That’s where veterinary practitioners have to work with their broader team and figure out how are they going to stay relevant with their clients, and these happen to be the tools in which they can do that with.”
Flip the script
We’re already seeing elements being implemented in the market. Dodd says one company that is doing this is Fuzzy, which provides members with real-time access to veterinarians for health questions, behavioral advice, and immediate help for emergencies. Fuzzy veterinarians come to the clients for regular checkups and vaccinations, and mail preventive meds directly to them every month. If clients have a question in between visits, they can chat with a veterinarian on the app. “Everything you need to keep your pet healthy
is included in a simple plan,” the company says on its website. Their current market territories are New York City and San Francisco.
“They’ve flipped the whole veterinary service piece around to be consumer centric,” Dodd says. “They bring healthcare in home. A lot of that is wellness services. They’re not doing surgeries in people’s homes, but they are doing a lot of these wellness, preventive care services that have really been the lifeline of many practices. That’s a natural extension then to have a subscription-based service where you not only get access to the doctors who come in to take care of your cat’s routine vaccinations and examinations, and maybe they do some bloodwork and send if off to the reference lab, but you also have this continuity of care. As part of being a ‘member’ of that audience, that service provider, you now have this continuity piece where you can pick up your phone, contact your veterinarian and do it on terms that work for you as a busy consumer, busy pet owner.”
Consumers are willing to pay for services on their terms, but you have to build a system, says Dodd. Some third-party systems have developed the technology piece – the ability to text, chat, do video consults, capture video and send it either in real time or a bit later. That capability is there, but marrying those with the business solution aspect that ties it into the veterinary practice and allows for an e-commerce transaction to happen – that’s where the demand will be, at least from veterinary clinics seeking out these solutions.
“That’s really what they are providing, whether it’s for a one-doctor practice or some of these conglomerate practices, [third-party systems] are providing this as a solution. Even there – you have to look at it as an incorporation to how care is provided, and not just ‘Hey, here is some new technology, download this app and when you need it, log in.’ That probably isn’t going to be the best user experience.”
The consumer value equation
When choosing telehealth solutions, veterinary clinics will need to do their research for their client base on what their value equation is for these services. The classic consumer value equation is benefit over cost.
For instance, look at how much money pet owners spend on Halloween costumes. A few years ago it was about $25 million. This year it might have been $30 million, Dodd says. “People would say that’s silly, why would they do that? The consumer made a choice that says value equals benefit over cost. They’ll spend $10 to put a tutu on their poodle or dress them up like Batman. They are willing to do that.”
In the case of veterinary clinics, it’s about providing a level of care. How do you put a price on peace of mind? “What are the types of things that consumers would be willing to pay for?” If the doctor on the receiving end of a telemedicine consult could help the pet owner triage and make sure the thing their pet just ate isn’t an emergency situation, would the pet owner find that worth paying a fee? Would a client who was told their pet is diabetic want or need instruction on how to properly give insulin at home be willing to pay for that instruction? “If that is something I can coach them through when they are doing it in the comfort of their home, would that be something a client would pay for? Do they see value in that continuity of services?”
More on the horizon
The majority of developments in the telehealth/telemedicine space have been focused on companion animals. However, some groups are interested in providing telemedicine services to large animal veterinarians. These are veterinarians who help with rancher operations, feedlots, and even a lot of equine practitioners, says Dodd. “They’re looking at these service providers because this is a nice way for them to extend their services. We know as an industry there are some challenges around the number of large animal veterinarians that are servicing patients today, it’s a limited number, and their ability to reach communities that need those services is important, so telemedicine could be a part of that.”
AVMA continues to want to help in this space. “There is a lot of pilot work that’s been going on trying to understand how do we help individual practices take something like this technology and put it into action? It goes from a kind of awareness that these services are available to start looking at how practices are using it.”
Dodd anticipates seeing a focus on more integrated plans, such as wellness plans, because now there are third-party companies that can help an independent practice establish a wellness plan and do it in a way that’s good for the patient and practice. “Sometimes wellness plans may be good for the patient, but not too good for the bottom line of the practice,” he says. “In working those types of plans together, telemedicine will be a part of that.”
Artificial intelligence is also something to keep an eye on. Amazon has started work using AI in human healthcare with the ability to look through medical records and try to improve care. “We haven’t done that in animal health that I’m aware, but I suspect there will be some groups working in that space.”
Diversity of Models
Categories to better understand the increasing diversity of telehealth offerings
In a presentation given to animal health industry stakeholders at the CATalyst meeting, Chad Dodd, DVM, president and CEO of Animatas Consulting LLC, and Adam Little, DVM, co-founder and Chief Technology Officer of FuturePet, provided three categories to better understand the increasing diversity of telehealth models, their uses, and the providers offering these services.
Tele-Consulting. The way it’s defined here is a veterinarian in a brick-and-mortar practice setting is in front of a client and patient, and is using technology to consult with a specialist. For instance, the primary care veterinarian is in the exam room, with the client and patient, and they’ve decided to teleport in a specialist, say in oncology or cardiology. That three-way conversation between client, specialist and primary care veterinarian is happening together.
“In some instances getting access to a specialist in veterinary medicine may mean you have to drive 2-3 hours,” says Dodd. “This helps because there are more primary care veterinarians than specialty veterinarians. It’s a very specific sliver of the telehealth space but it’s an important one because it does help to draw in that relationship between a general practitioner and specialty practice.”
Examples: VetNOW (www.vetnow.us/)
VetNOW TeleHEALTH is an all-in-one, cloud-based collaborative platform offering a full spectrum of virtual veterinary services.
Tele-Advice. Companies creating tele-advice solutions are very conscious of the fact that there are limitations – based on U.S. law, both federal and state – on what you can and cannot do if you don’t have a veterinary-client-patient relationship (VCPR) established. For instance, if you reached out to a veterinarian via a social network or digital solution that was out of state and did not have a VCPR established, there would be limitations to what they are legally allowed to provide.
You can consider Tele-Advice like triage or general advice, says Dodd. The veterinarian can’t make a diagnosis or prescribe something, and they have to be careful with how they communicate their interpretation of what’s happening with the pet. “It’s a specific area that has to do with making sure people are not overstepping their bounds and unlawfully practicing medicine.”
Companies that have developed Tele-Advice solutions are essentially providing some advice to a consumer that’s asking general questions in regards to their pet’s healthcare. The great thing is, if you talk to these groups, they’re actually helping drive veterinary visits, says Dodd. “They are triaging clients who have a question. Maybe it’s a general question that can be answered, but oftentimes it’s a question that is answered by ‘You might want to schedule an appointment with your veterinarian so he or she can properly evaluate your pet and make sure nothing serious is going on.’ And then that drives the conversation. Tele-Advice is around general advice, and also this idea of triaging.”
Ask.Vet helps a pet owner with questions about his or her pet’s health and behavior. The triage process can determine the seriousness of the situation and tell the pet owner when he or she needs to make an appointment to see a veterinarian in person. Pet owners can live chat on their mobile device or computer, with a licensed veterinarian. There is a monthly subscription fee for unlimited use, or a one-time charge for a single session. Visit https://www.ask.vet/
Tele-Medicine. Some companies have developed services for veterinarians who have already established the veterinary-client-patient relationship. These would fall under the Tele-Medicine category. “They can provide pretty much any kind of consultation consistent with their professional qualifications and license, that’s appropriate for that pet,” says Dodd. “These companies are providing a veterinarian in practice with a service to where the veterinarian can connect with the client, and the client can interact with the veterinarian, and that veterinarian can use their professional knowledge and understanding about that pet’s condition to help that patient figure out whether they need care, or providing follow-up care – the types of things that would typically fit into what they would do if they were in the practice. However, with these services, the veterinary-client-patient relationship must be established before detailed advice is offered or given.”
Example: TeleVet (www.gettelevet.com)
TeleVet enables pet owners to connect with their veterinarian remotely through a mobile device to help treat and diagnose the health condition of their pets.
• Add text details, pictures, and videos to your consultation for your veterinarian to review.
• Chat with your veterinarian one on one with consultation instant messaging.
• Set up a video chat or phone call appointment with your veterinarian to really dig into the details.
• Schedule followup appointments with your vet to check up on your pet’s healing progress.
• Review previous consultation records to keep track of your pet’s health.
AVMA, AAHA release veterinary medicine telehealth booklet
The American Veterinary Medical Association (AVMA) and American Animal Hospital Association (AAHA) have teamed up to develop a booklet to help veterinarians navigate the issue of telehealth in veterinary medicine.
“The Real-Life Rewards of Virtual Care: How to Turn Your Hospital into a Digitally Connected Practice with Telehealth” was designed to serve as a primer to help veterinarians get started on the path to becoming fully equipped, digitally connected, telehealth-ready veterinary practices. Much of the content is drawn from the AVMA’s Telehealth Resource Center, (avma.org/telehealth), which contains more in-depth information for those looking to learn more about the topic. The booklet outlines the case for virtual care in the veterinary profession and answers questions about how to establish digitally connected practices.
“Virtual care is one of the greatest opportunities in veterinary medicine today; it’s also one of the greatest challenges,” said Dr. John de Jong, president of the AVMA. “This new resource from the AVMA and AAHA is a great first step to educate veterinarians about what they need to know to provide these types of services in a responsible manner.”
The booklet outlines the case for virtual care in the veterinary profession and answers questions about how to establish digitally connected practices. It addresses such questions as:
• What exactly is virtual care?
• How does virtual care relate to telehealth?
• Where does telemedicine fit in, and what’s the difference?
• What do veterinarians need to know to get started?
In addition, the booklet includes a case study on how one veterinary practice successfully adopted a virtual care service model, and an easy-to-follow implementation guide outlines the steps clinics can take to seamlessly integrate virtual care.
“As the conversation surrounding telemedicine continues to develop, it’s imperative to provide veterinary professionals basic information so they understand the nuances of providing virtual care,” said AAHA President Darren Taul, DVM. “We are pleased to have been able to collaborate with the AVMA on this important project.”
Telehealth: Customer Experience
VCA Animal Hospitals introduce voice command through Amazon’s Alexa
VCA Animal Hospitals announced that pet owners can now receive their pets’ healthcare reminders and book appointments through Amazon Alexa.
Once pet owners enable the VCA Animal Hospitals skill after linking it to their online VCA account, they then can simply open the skill by saying:
• “Alexa, open VCA”
• “Alexa, ask VCA when my pet is due for vaccines” or
• “Alexa, ask VCA to book an appointment for my pet”
According to eMarketer, smart speakers are the fastest growing consumer technology since the smartphone, and a recent study by Adobe forecasts that nearly half of U.S. households will own a smart speaker by the end of 2018. “With smart speaker ownership growing and the general public becoming more comfortable using these devices in their everyday lives, the VCA Animal Hospitals skill aims to offer convenient and accessible ways to manage pet healthcare,” VCA said in a release.
“As a leader in the pet healthcare industry, we’ve made it our mission to provide pet owners with the best possible experience through continued innovation and digital transformation,” said Brendan Lynch, VP of Digital Strategy for VCA Animal Hospitals. “For us, that means making every interaction between pet owners and our animal hospitals as convenient and easy as possible.”
Currently, VCA says it has more than 3,000 iPads in its animal hospitals, which include proprietary mobile apps for checking in pets, two-way text messaging with pet owners, and giving medical staff on-the-go access to their patients’ medical records. VCA also launched the myVCA pet owner app in 2018, which offers:
• Personalized and easy-to-follow pet care advice and tips based on a pet’s species and age
• 24/7 live chat capabilities with an on-call veterinarian to answer immediate pet health and wellness questions
• Access to healthcare reminders and medical records
• The ability to book a pet’s appointment in less than a minute
“The ultimate goal of introducing these newer tech-forward offerings like the VCA Animal Hospitals skill is to create a more seamless customer experience when it comes to pet healthcare, and to make sure we have healthier pet patients,” said Aaron Frazier, VP of Client Experience for VCA Animal Hospitals. “Whether it’s at your local VCA Animal Hospital or through Alexa, we want to be part of every pet’s healthcare journey while helping pet owners along the way.”
Telehealth: A.I. Pet Advice
MyPetDoc encourages people to talk about a pet’s problems
New app uses artificial intelligence to help worried pet owners decide on a next step.
By Ken Niedziela
Editor’s note: The following article originally ran in the July 2018 issue of Today’s Veterinary Business, a sister publication of Veterinary Advantage.
What’s better than a video conference between a veterinarian and an advice-seeking pet owner?
Cal Lai, co-founder and CEO of Vet24seven Inc., thinks it’s a simple conversation with Amazon’s Alexa.
“Nobody wants to be seen on camera,” Lai said. “Our brains don’t like to see you and talk to you in two different dimensions.”
What Lai and business partner Edward L. Blach, DVM, MS, MBA, introduced in July during the American Veterinary Medical Association convention was MyPetDoc. The free voice app, compatible with Alexa devices and eventually with Google Assistant-enabled devices, is designed to help dog and cat owners decide what to do with their ailing pet.
MyPetDoc communicates verbally with users through a series of decision trees, a technology based on a combination of human and artificial intelligence. The starting point was 35,000 engagements with the Mountain View, California, company’s Ask.Vet service.
“We did some analysis and realized that we had what no one else had: recorded conversations between consumers and veterinarians,” Lai said.
“What we decided to do is take that and create an artificial intelligence model around it, create a triage chatbot that can respond to a question. … It allows a consumer to talk to Amazon Alexa and have a real conversation.”