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Joseph C. Kvedar, MD shared his keynote before the 2021 American Telemedicine Association. He addresses a regression that is underway from local providers dominating the delivery of telehealth to the national providers once again taking over the top spot. 


When I talk to other provider organizations, I hear common themes dragging them back into an in-person-dominant care model. Themes such as filling beds and charging facility fees come up repeatedly, not to mention the threat of lower reimbursement for telehealth visits compared to in-person.

I recently talked to a friend who works at one of the largest national payer organizations, which led to an important insight. From January through October of 2020, local providers (i.e., ‘your doctor’) generated 96% of their telehealth claims, and only 4% came from national providers (i.e., Teledoc Health, Amwell). Compare that to 2019, when 54% of claims were from national providers – and the trend is moving back in that direction.


Is this inevitable? We still live in a fee for service world and the financials don't work without the government money. If the government money comes in is that really a good thing or have we just added one more arm to the Frankenstein that is the healthcare payment system.

The government is the largest payer in this market, if you can call it that. They will have to consider what works best for the millions of lives under their care and in so doing have downstream impacts on all other lives. 

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