GP Phone Home: Israeli HMOs Are Turning to Personalized Telemedicine

Economics of system are unproven, many doctors are resistant, but patients like the time and cost savings

Meuhedet HMO's ad for its new telemedicine service: "Your doctors, at the clinic and on your phone"
Lior Noderman

It’s hard to miss the new billboard campaign launched by the Meuhedet health maintenance organization. Billing itself as “Meuhedet Hybrid Medicine,” it features the image of a friendly doctor holding up a smartphone and promises “the next generation of medical services – a combination of digital era innovation and the professionalism and personal connection of Meuhedet doctors.”

In practice what it means is that patients can choose between a traditional doctor’s appointment in the clinic or a video call with the same doctor.

That kind of remote healthcare has been around for years in Israel. The difference in the Meuhedet Hybrid program is that instead of a call from whichever doctor is available you get to speak to your personal physician with your medical file in front of him or her. It offers not only a personal connection but consistent attention from the same medical professional.

The HMO offers the service through a telemedicine company called American Well, which is based in Boston and founded by the Israeli brothers Drs. Ido and Roy Schoenberg.

“We invested a lot in adapting digital medicine for the Israeli public, combining it with traditional our excellent traditional community medicine,” said Sigal Regev Rosenberg, Meuhedet’s CEO. Among its advantages, she noted, was that it enabled members who live in remote towns to consult with big-city specialists.

Still, the Meuhedet Hybrid program is still in its early stages. A visit to its website showed that only 66 of its 1,276 family physicians are registered for it. Among pediatricians, only 42 out of 602 are registered and among gynecologists just seven of 553. The HMO promised that the numbers would be growing quickly. “More than 500 of our doctors a now completing specialized training that was developed by Meuhedet,” it said,

Meuhedet isn’t the only Israeli HMO going into telemedicine big time. Leumit launched its service at the end of last year, enabling members to consult by video call with their regular family doctors and pediatricians. About 150 doctors of the much smaller HMO now participate. It says it handles about 1,000 telemedicine appointments a month.

The two biggest HMOs, Clalit and Maccabi, are starting pilot programs now, each of which includes about 25 doctors and both plan to expand the programs.

Even though it’s early days for personalized telemedicine, Israel’s HMOs are investing heavily in it, in part because they now realize that the hybrid model is proving harder to implement than they expected,

“The big challenge isn’t the technology but in recruiting doctors, So, at this stage none of the HMOs can promise that it will grow to tens of percent of their doctors,” said one senior HMO official who asked not to be identified. “It might not even get far at all, among other things because of the opposition of quite a few doctors to it.”

Others are more optimistic, saying the HMOs will be able to overcome the initial suspicions of doctors, if for no other reason than that the public wants the option and the HMOs and their doctors can’t refuse them.

In fact, the growth of personalized telemedicine isn’t due to its superior economics but because of public demand and competition between the HMOs. For members, it has a clear economic benefit – saving the time and cost of a visit to a family or children’s doctor.

Clalit, for instance, launched its first telemedicine program in 2009, offering off-hours services. More recently it expanded it ti include service during regular office hours and the result is has handles about 400,000 consultations a year now.

Maccabi offers several kinds of services, the biggest of which in called MOMA. It treats 7,000 people from home by a team of doctors representing several specializations, Maccabee also provides a telemedicine program for pregnant women, as well as breastfeeding consultations and help with quitting smoking.

For the HMOs the cost of setting up a telemedicine operation is relatively modest. Estimates are that Meuhedet’s relatively costly program runs at about $50 million spread out over several years and to be adjusted depending on achieving various milestones.

Israel’s Health Ministry, meanwhile, has been encouraging telemedicine with a several-million program by building its own telemedicine system at a cost of several million dollars for use at no cost by the public healthcare system.

On the other hand, in contrast to the banking industry, which has closed branches as more and more services are done online, Israel’s Health Ministry has barred the HMOs from closing clinics. Nevertheless, the HMOs hope they can save money on the costs of individual doctors by enabling them to use their time more efficiently.

On the other hand, the HMOs fear that if the barrier to a doctor’s visit is lowered by telemedicine members will consult with their physicians more often and costs will rise. To test the waters, the HMOs have been rolling out their services cautiously.