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It's an interesting time in medicine, to be sure. I'm a primary care physician and I own my practice. Just 2 docs trying to make it work and for now it works just fine. I also have a small position(about 2% of my total port) invested in Teladoc.

Agree with the previous comment up-thread about how in this country, at least for now, health insurance companies (including the federal government vis a vis Medicare) are going to be the ones who decide whether Teladoc eventually succeeds as a company. The payors control the system for the most part. Blue Cross and Humana and United Healthcare and the two or three other larger payors nationally are interested in telemedicine only insofar as telemedicine visits save them money. They really don't care about the health of their customers (my patients). Healthy patients tend to cost less, and they do like that, but it's the low cost they really like - not necessarily the health part! If telemed generally can be proven to save money (presumably by increasing the opportunities for healthcare providers and their patients to get together and prevent hospitalizations and other "big ticket" health expenses), then telemedicine will flourish because insurance companies get to keep more premium $$, and not because patients like the convenience of telemedicine or it makes them more healthy or any of that stuff. Insurance companies, in my experience, only care about patient satisfaction when there is enough choice in the marketplace for patients to actually choose a legit competitor. When those choices are few, they tell patients to pay up for the choices they want or to go pound salt. They say it nicely, but that's the message. So, the argument that with regards to telemedicine "the genie is out of the bottle and there's no going back" only goes so far, in my opinion. Insurance companies can stuff that genie right back where it came from, if they wanted to.

Here's the point of my post though, and my wondering about Teladoc as an investor who also happens to have some professional skin in the game, and maybe a little bit of practical experience about how all this works on the ground. What is it about Teladoc as a company that will make insurance companies (and perhaps to a lesser extent large health systems or very large private group practices practices) choose Teladoc over the other options, including the option of designing an in-house telehealth system for themselves? Are they cheaper than other options for the payors? Livongo offers some great tools that have really enhanced the offering Teladoc makes, but so does(for example) a privately-held company called TytoCare, which offers smart devices that patients take home to monitor weight, blood pressure, blood sugar, etc. and allows doctors and patients to manage chronic disease more closely together. Apparently, TytoCare can provide these add-ons to existing systems. They do exactly that for the largest health system in Louisiana, Ochsner Health, which owns or operates 40 hospitals and over 100 clinics. Ochsner built their own telemedicine functionality beginning 7 or 8 years ago and currently (according to their online information) use TytoCare as a partner. This is merely one example that I know about, but I suspect that other large systems across the country have done the same. Personally, I use another solution from a company called Updox for telemedicine visits. I like it a lot, it interfaces with my EHR pretty well and it's much more user-friendly than Zoom, especially for elderly patients. I wouldn't consider Teladoc at this point for my practice, unless Blue Cross Blue Shield of Louisiana(which controls about 30% of my gross revenue in an average year) or Humana (another 30%) or the federal government (CMS) declared that in order to get reimbursed for telemedicine services I had to use Teladoc. And that's sort of the point.

I'm considering exiting my position in Teladoc for these reasons but I am intrigued by the new offerings all under one roof, so to speak. I'm going to hang in there for another quarter or two and see what the growth trajectory looks like. And whether the insurance industry decides to continue to allow this sort of medical care to flourish post-pandemic.

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