Teladoc Health supports whole person care through its virtual primary care solution Primary360, as well as urgent care, chronic condition management, mental health and other specialty care programs.
In a series of interviews, two Teladoc Health physicians and a therapist offered a window into a day in the life of delivering virtual care.
Vanessa Bonaparte is a regional clinical director with a focus on mental health, a recent career advancement. She joined the company as a therapist eight years ago. A licensed professional counselor, nationally certified counselor, and certified anger management specialist, Bonaparte ran a private practice and worked as a middle school and high school counselor for 21 years before moving into her current role at Teladoc Health. She went back to school to get a degree in mental health counseling and ran a private practice.
Teladoc Health has thousands of mental health counselors. On an average day therapists may see eight to 10 people, Bonaparte said. The majority of members she has seen are looking for help to cope with grief, are struggling with depression or experiencing anxiety. But life phases also spur people to seek counseling services from Teladoc Health.
“When I say life phases, I’ve had clients who were 18 to19 years old, saying, ‘I’m going to college now, what’s next?’ and just trying to figure that out. I’ve had people who are recently divorced who are trying to figure out what’s next. I’ve had people who were retiring, who had to figure out what’s next and need some guidance.”
Bonaparte is a big believer in whole person care. She regards Teladoc Health as a trailblazer in this area. For example, if Bonaparte sees a member for mental health care, but they are also having problems managing their diabetes, she will refer them to one of the physicians on Teladoc Health’s platform. When seeing a general medicine physician, the physician will do a series of assessments to determine whether they could benefit from speaking with a therapist. Bonaparte also likes the fact that many of her people she interacted with have kept regular appointments.
“When you’re counseling individuals, they become your caseload,” she explained. “So, you do keep the same clients for a while, and you decide based on the acuity level how long therapy is needed.”
Teladoc Health also offers services to support its clinicians, including a monthly virtual open house for support. Clinicians can also use the opportunity to email questions that may take more time to answer. Teladoc Health also hosts monthly training webinars to train providers on a variety of topics, such as how to do a safety plan or when to refer a patient.
For many patients, depending on their age and background, there is a stigma associated with seeking therapy. Bonaparte shared some insights on how she addresses this.
“The first thing any good therapist does is establish a rapport. When you do that, you’re creating that relationship. In the first session we talk about why the patient wants to get help,” Bonaparte said. “I’ve had a very successful career with mental health because when clients show up, sometimes they’re not always ready for treatment. That very first session is the most important one. That’s the time that I say to them, ‘What do you want to see different in your life?’”
Virtual Urgent Care: Meeting members where they are
Dr. Eric Perry is an urgent care physician with Teladoc Health. Every day is different, with most of the casework composed of new patients who see Perry on a first come, first serve basis. He is licensed to practice in 36 states and in Guam.
“There’re always a patient waiting. There’s never a moment where you’re sitting down waiting for someone to come to the virtual waiting room. With every individual I’m effective and efficient, but we give each member the time they need. A typical day begins at 6 am and ends at 2 pm. Many individuals come to Perry with upper respiratory infections, head colds, sinus issues, sore throats, chronic coughs, back pain, and earaches. Allergy season can be a busy time. Headaches are also a frequent issue for the patients he sees. One challenge Perry encounters is that the quality of lighting in the patient’s video or images can make a virtual care diagnosis difficult, but this can easily be fixed by working with the patient to move to an area with better lighting.
Asked for an example of a complex case, Perry explained that a member could come in with a cough but may have a medical history with multiple chronic conditions such as congestive heart failure, heart disease, COPD, and more. He has to determine whether the cough is caused by any of these conditions worsening, whether it’s an infection, or simply a common cold. He also has to avoid prescribing a medication that could clash with one the patient is already taking.
“You’ve got to decide is this heart failure or is this bronchitis or just a cold or COPD exacerbation. Of all the medications they are taking, whatever I’m going to give them, am I going to cause them to get sicker? If I want to give them something to help them decongest, is it going to make their heart rhythm worse than it is now?”
If he determines that a virtual appointment isn’t appropriate for the individual’s needs, Perry will recommend that the patient see their regular doctor for an in-person visit.
If a member has used Teladoc Health before, Perry can access their chart to see what the health issue was for their last visit, who they saw, and whether they were prescribed medication or not, which is very helpful for continuity of care.
Prior to joining Teladoc Health, Perry was a primary care physician in a brick-and-mortar practice for 20 years. But he noted that the constraints on primary care physicians—be it from insurance companies, government policies and various agencies or the time that’s allotted to see patients— have made it challenging to be a primary care physician.
“I realized that I was feeling unable to give patients the service that they really needed, almost to the point of harming the patient,” Perry shared. “They only give me 15 minutes to see patients. I got tired of that. I didn’t actually practice medicine anymore. I was more of a bookkeeper and a box checker.”
When the pandemic hit, Perry was already working with Teladoc Health as an independent contractor. But as the months progressed, he gradually moved to become a full-time telemedicine general medicine practitioner, a move that has not only renewed his passion for medicine but changed his entire life.
“It’s the best decision I ever made. I can work from almost any location with licenses across the country. I like the freedom to do that. It’s been great,” Perry said. “The patients are extremely appreciative not to have to go in [to a bricks and mortar office] for every little thing. They don’t need to take time off work to see the doctor.
We’re filling an important gap for patients who can’t get an in-person visit with a doctor in a timely manner. We’re saving them a lot of money and we’re saving lives.”
Virtual primary care — a lifestyle choice
Dr. Tiffany Hendricks, a primary care physician, opted for virtual care after initially working in a bricks and mortar primary care practice followed by urgent care. With a growing family, she found it tough to manage a work-life balance, so she moved to telemedicine.
Hendricks has a good idea what the coming day will look like, so the workflow is fairly predictable. She does leave time for “walk-ins” where patients may schedule an appointment on the same day. She has a 40-hour work week Monday through Friday and works a half day one Saturday each month.
She likes being able to provide virtual primary care to people in areas that lack easy access to primary care physicians. Between consolidation and primary care physicians leaving their practices in search of a less stressful lifestyle, “primary care deserts” may continue to grow and need to be served by virtual primary care practitioners like herself.
“I like the flexibility. I like being able to be home during my lunch break – go downstairs and make my lunch. If I have to take a break, like picking up my child from school, I can do that. It’s similar to the convenience patients experience and appreciate.”
Hendricks spends her day with a mix of seeing new patients and follow-up visits. She kicks off the day at 7:30 am by reviewing the medical charts of the members she will see that day, noting any medical images that have arrived since the patient’s last appointment. She typically starts seeing individuals at 8 am.
Before Hendricks sees a member, a medical assistant spends 15 minutes with them, recording their vital signs. Ahead of the first appointment, they are sent a blood pressure device that can also collect data on their heart rate. If the member hasn’t seen a provider for 10 years or so, there’s a lot of information they need to obtain from patients. For others, they review previous screening exams, such as a colonoscopy. If they’re a woman, the assistant reviews when the patient had their last pap smear or mammogram. For all members, they will go over any lab results and diagnoses they’ve already received.
The medical conditions she treats include chronic conditions, such as hypertension or diabetes that have been diagnosed by another provider. If necessary, she’ll order lab tests to screen patients for these conditions. For returning members she will do blood pressure or diabetes follow up and might check to see whether their prescribed treatment is working. This typically takes 15-30 minutes.
Hendricks then works with members to develop a personalized care plan and will assess whether they need to be referred to a specialist. If she has a someone dealing with headaches, she’ll examine and speak with them to assess the possibility of a migraine, an aneurysm, or a recent head injury. If necessary, she’ll refer them to a neurologist.
It’s not surprising that Teladoc Health clinicians value the flexibility and convenience of virtual care just as much as their members do. More importantly, virtual care is a career path a growing number of clinicians are embracing, particularly at a time when job burnout—which often comes at the expense of a family life—is at an all-time high. Teladoc Health continues to deliver on its mission and vision that everyone have access to the best healthcare, anywhere in the world on their terms, and that mission and vision also extends to offering clinicians the chance to serve patients on terms that work better for all.
Photos: Teladoc Health