Here’s the rest of my interview with Keith Newton, Concentra CEO.  Part 1 is here.

MCM – How has the market reacted to the launch of telemedicine?

Newton – Early adopters are coming on board; like other new services in work comp, everyone wants it then there’s a bit of a lag after initial launch [as the more cautious wait to see what happens]. Most of big players – TPAs and insurers – are [looking at or considering] coming on board. It is much easier to adopt [internet-based medical “visits”] if it is as familiar as possible to all users. Adoption will be faster if there’s less disruption to the normal medical process.

MCM – How will Concentra charge for this service?

Newton – There will be no change to reimbursement, it is based on normal fees for office visits. Payers will see savings in efficiency and time savings for employer. [There may be] Other savings from lower ancillary costs from lower utilization.

MCM – Talk about licensure and regulatory compliance. There’s a lot of movement towards telemedicine in many states, and it seems a lot of confusion about what is allowed, what entity regulates TM, fees, etc.

Newton – There have been some licensure and certification challenges, we have 5 coordinators doing intake for 4 full-time MDs dedicated to this to begin; 2 in CA, 1 in MD, 1 in NV. One example is we have a Maryland physician driving to one of our Washington DC centers to do their Telemedicine work from there…[we’ve done] lots of regulatory compliance work.

State regulations aren’t keeping up with changes in telemedicine. We evaluated this on a state by state basis, every legislative branch has something going on with telemedicine.

MCM – Is this partially a defensive strategy to protect Concentra’s occ medicine business?

Newton – We’ve got to protect our turf a little bit…there could be some cannibalization of own practice, but ultimately we know 1 of 8 workers will access a Concentra practice for injury care – and telemedicine will enable us to add more of those visits without bricks and mortars expansion and the expense of that.

Our goal by the end of the year is 320+ centers and 100 dedicated worksites.

What does this mean for you?

I expect telemedicine is going to be the next big thing – and unlike a lot of the other fads we’ve seen in comp, it will have a major disruptive effect.

The largest occupational medicine company in the nation is jumping into telemedicine.

CEO Keith Newton and I spoke last week about Concentra’s rollout of its telemedicine program, following up on our in-depth discussion a month ago about the company’s plans and strategy.

The first patient interactions began a couple weeks ago with a limited rollout, and so far, patient reaction has been quite positive.  According to Newton, one of the first patients said “I love it so much I’m going to tell all my coworkers about it”.

Concentra is employing third-party technology vendor American Well’s web application to allow patients to “visit” Concentra’s physicians via the internet.

Here’s part one of our conversation.

MCM – What is Concentra’s approach to telemedicine today?

Newton – Our initial approach is to use telemedicine for [some] injury care and follow up rechecks with existing patients.  We have identified specific types of cases where [we will employ] telemedicine initially. Patients will be triaged 24/7 to an injury coordinator, then to an MD for secondary triage, then care [if appropriate via telemedicine]. We are also going to do PT and specialist care. There are a number of considerations including onsite staffing, load balancing, and reducing patient wait times. 20% or so of patients could be seen via telemedicine…California is our first state, we are initially doing visits from 7am – 11 pm; we’ll will add longer hours and multiple states over time.

MCM – Describe the technology you are using.

Newton -We met with 10-15 technology companies working in telemedicine to learn as much as possible. We are using American Well for the connection only, all back-end applications are internal Concentra applications so we access their technology…it is not an integration but using their tech for the “visit” and using Concentra’s Allscripts and Occusource internal applications for documentation [and other functions].

MCM – How are telemedicine interactions different from office visits?

Newton – You need the right intake coordinators and physicians. In a bricks and mortar setting [normal live office visit] there is lots of activity going on in the clinic. When you are on video it is just you and the patient, the doctors have to engage and show focus on the patient, connect with them one-on-one, maintain eye contact.That puts the patient at ease. This may make for better and stronger patient – physician relations and connections via telemedicine. It could also make in-person visits more productive and satisfying for patients and providers as they adopt that behavior for live encounters as well.

MCM – Tell me about the process Concentra used to prepare to see patients via telemedicine.

Newton – Internally we did about a hundred “mock visits” to make it as seamless as possible to make sure patient experience was made as successful as possible. [We] used internal staff as testers to provide feedback, improve the process and service. There will be continuing evolution; there are new tools arriving every day, some of which may be useful for incorporation into the telemedicine process. Things will look different in a few months – for now, we are looking to make it as simple as possible for any stakeholder – the payer employer or patient.

Tomorrow we’ll get into more details…

What does this mean for you?

Telemedicine is going to be highly disruptive to care delivery models, and has broad implications for all stakeholders. 

After a seemingly-unending flood of deals that stretched for several years, mergers and acquisition activity in the work comp services sector slowed a lot last year.

There was a brief flurry of activity after the election, a flurry that – with some exceptions – seems to have come to an end.

What’s going on?

Several things.

First, the workers’ comp industry is mature; service sectors have consolidated and there just isn’t a lot of “organic” growth – growth driven by an expanding industry. Software, artificial intelligence, drones – these are rapidly growing industries, where investors see opportunities for investments to generate huge returns.

That’s not to say there aren’t work comp companies growing by taking share from competitors, acquiring other companies, and expanding their service lines. Genex is one example; the company is buying up competitors and diversifying within a fairly narrow service sector.

Second, there are far fewer companies to acquire.  One example is the PBM (pharmacy benefit management) industry has really consolidated of late, with Optum and Express Scripts now the dominant companies in what used to be a highly fragmented industry. 13 years ago when CompPharma started there were perhaps a dozen PBMs with appreciable market share. Today, there are less than half that number.

The same has happened in bill review, utilization review, specialty services, and every other sector.

External factors not directly related to workers’ comp are also at work; perhaps none more important than the mindset of powerful people.

While CEOs are enthusiastic about potential business growth, their Boards are much more cautious.  Overall, US M&A activity came to a screeching halt after the election, dropping 40% since the peak in 2013. This is significant because corporate boards are populated by investors, bankers, former CEOs, and other luminaries tasked with the long-term success of their company, not short term headline-grabbing deals.

There are a couple of recent transactions in our space that make a lot of sense – PBM Express Scripts’ purchase of myMatrixx is one example. MItchell has been buying up smaller PBMs and other companies as it continues to pursue a sale of the company.  And investors are continuing to look for potential acquisitions; I hear from private equity firms looking for the next breakout service provider pretty much every week.

Countering the caution are a couple drivers that may not be as apparent to the casual observer.

There is a shipload of private equity money looking for deals, and PE firms need to use that money to buy companies. European funds are at an eight-year high and we aren’t far behind on this side of the pond.

Interest rates are still low; while they’ve trended up of late, compared to historical averages money is still cheap.

What’s the net?

Expect smaller deals to keep happening, but there’s much less enthusiasm for the mega-deals in workers’ comp services.