The New Telehealth Economy

9 minute read
Digitalized healthcare and the ‘Internet of Medical Things’ is here—and it’s going to make access to health systems far more seamless and accessible. It’s a huge opportunity


Using tech to improve access to healthcare is nothing new: an 1879 Lancet medical journal discussed the possibility of using phone calls to reduce patient visits to the doctor’s office. By the 1920s, doctors in Australia were deploying radios and text telegraphy, a predecessor of today’s text messaging, to diagnose patients in far-flung areas. What is new is how emerging ideas in telehealth are converging with fintech innovations to change the financial side of healthcare.

Telehealth, or telemedicine, is the use of technology to enable healthcare providers such as nurses, consultants, and therapists to treat patients remotely, and to make it easier for people to access care when they need it. Despite digital communication advances over the decades—not least the introduction of the Internet—telehealth adoption remained relatively limited, until the pandemic forced us all online and into our homes for an extended period. The global public health crisis and a series of lockdowns made at-home, virtual healthcare a necessity. Covid-19 has sharply accelerated user uptake, research, government support, and industry investment in the telehealth industry. As a consequence, the global telehealth market was valued at $83.5 billion in 2022 and is projected to expand at a compound annual growth rate of 24 percent from 2023 to 2030, according to analysts Grand View Research.

The high costs of providing in-person care means telehealth could represent a huge opportunity. McKinsey estimates that $250 billion of current US healthcare spending has the potential to be virtualized. This could include, for example, psychiatric care, regular check-in appointments for chronic conditions, and training for medical professionals—all accessed via each person’s preferred device.

According to Jeff Lin, who co-leads J.P. Morgan’s Healthcare Payments business: “In competitive markets, like the US, health providers that fail to develop effective digital channels will lose out to those that do, especially amongst younger generations.”

Those new digital channels can incorporate payments in smart ways that not only reduce frictions, but improve the delivery of healthcare itself.

Care at your (digital) front door

As the scope of telemedicine and homecare increases, there’s a challenge that needs to be solved. The medical world comprises a whole assortment of different entities: a multitude of providers, health departments, and related services such as appointment bookings, video conferencing and transport. Many technologists have taken the view that, in the future, patients will use a consolidated, app-based, digital portal that brings all these disparate elements together into a simple, seamless, automated system.

Evernorth Health Services, the pharmacy, care and benefits solution provider of The Cigna Group, is currently working on their vision of this “digital front door”. “We’re actively launching a digital ecosystem that creates a seamless patient experience across the entire healthcare network,” says Matt Bennett, Evernorth’s Senior Vice President of Care Delivery. “Whether it’s primary care, specialty care, behavioral care or pharmacy care, the aim is to make it all accessible under one overarching app, with a supported data ecosystem.”

Healthcare payments are ripe for digitization

These digital platforms can integrate payment capabilities, or provide options to manage insurance coverage or reimbursement—something which can prove complicated in systems such as that of the US. Because those ecosystems bring together so many elements, payments can therefore be made more efficient, innovative and predictable, providing far greater transparency and control.

“It’s analogous to when you check in to a hotel,” says Lin. “At the hotel check-in desk, they give you an estimate of how much you think your stay is going to be, and they ask for a method of payment. In contrast, few people understand how much they may potentially owe when they go to see the doctor.”

As Lin continues, “Forty percent of consumers can’t pay a bill larger than $400. When you look at the macroconditions of the consumers, and how much they can pay, versus the reality of how large these medical bills are, you realize they may not be able to pay that $2,000, $3,000, $4,000 bill all at once. What options, or what things can you offer to be able to pay those bills in a way that is affordable, convenient, and simple for them?”

These options could include payment plans or financial products common in the retail sector, such as access to low-interest credit, or providing ‘pay later’ options where appropriate. AI-based systems could also help patients budget better and optimize their expenditure, by tracking their health needs over time and predicting potential upcoming costs.

Providing patients the ability to see all claims, what their liability is, and to easily pay their liability is a key part of Cigna’s digital front door strategy, says Scott Lambert, Treasury Managing Director and Assistant Treasurer at The Cigna Group. “It’s another place where we can remove friction,” he said.

"The aim is to make all healthcare accessible under an overarching app"

Digital payment systems could also provide a step change in the experience of care providers. “When we talk to hospitals or doctors, they often say it takes sixty to ninety days after the patient visits to actually get paid by a patient,” Lin says. “As well as helping patients, scheduled, pre-planned payments can help health providers manage cashflow.”

Another emerging model is subscriptions. Health industry forerunners are already offering digital care services that are accessed and paid for as part of a monthly package. UK-based blood testing app Thriva, for example, provides on-demand, at-home blood testing and feedback from a general practitioner. Users can subscribe to monthly testing to track their health in both the immediate and long term.

As pricing data becomes more readily accessible, this new level of transparency could also enable users to compare pricing and select the best-value providers. As Evernorth’s Matt Bennett puts it: “We go on our smartphones and read restaurant reviews before visiting them. We book hotels after comparing the best rates. We haven’t gotten here yet in healthcare, where it’s easy and accessible to understand which options are available to you, but we should be able to.”


The Internet of Medical Things

It’s not just about money management. The convergence of fintech with the ubiquitous internet of things could bring patients and providers an ever wider set of benefits.

Fast, widespread broadband and cellular internet connectivity has resulted in medical devices that can capture, analyze and transmit vast amounts of patient data. Many of these are everyday household items. Think of smartwatches that can track movement as well as health indicators such as blood pressure, blood oxygen, heart rate, time asleep, respiratory rate and wrist temperature. More specialized medical monitoring devices can monitor and chart the progress of specific health conditions. An implantable pacemaker, say, can send real-time information back to healthcare professionals.

This wealth of health data allows doctors to better prevent medical problems emerging or worsening in their patients. It also allows for more efficient management of chronic disease, which is by far the biggest area of promise for telemedicine. There are 100 million Americans with chronic disease, accounting for 75 percent of all medical spending.

Remote monitoring can not only improve healthcare, but it can reduce costs. Data from medical devices, such as those smart wearables, could be used to dynamically lower healthcare premiums or plans—imagine your insurance payments automatically reducing as data about weight loss or lowered cholesterol is fed back to insurers.

"You're starting to see telehealth and payments all merging together at once"

At its most sophisticated, the ‘internet of medical things’ (IoMT) could also allow payments to improve the delivery of healthcare itself. As the IoMT grows, it will likely result in far more automation in financial transactions. Machine-to-machine payments will allow connected devices to buy things on behalf of the patient without human intervention. For example, as a patient starts to run out of medicine, a connected dispenser could automatically order and pay for more. In rural areas, this could be especially useful, ensuring patients keep up with their medication schedules and don’t inadvertently run out.

Some believe that permissioned blockchains—distributed ledgers that can only be accessed by approved people—may be an efficient and secure way to automate payments between insurers, healthcare providers, and patients. Set rules and thresholds can be applied to these transactions—known as smart contracts—to make them programmatic and prevent overspending. Once information is recorded in a blockchain it becomes extremely difficult to tamper with, could reduce the chance of fraud, and facilitate highly secure storage and transmission of sensitive patient data.


Data is valuable, and the concept of selling one’s own medical information, although controversial, is already being explored by startups. There are major privacy and security issues that surround the emergent field of medical-data-for-sale—but, done ethically, it could give researchers and clinicians access to valuable information.

One non-profit is now attempting to buy medical data—which is anonymized and used for research purposes—in exchange for cryptotokens. Whether this model becomes commonplace is yet to be seen, but blockchain allows information to be stored with much greater security and transparency, which could make it a useful tool for the exchange or even sale of medical data.

Virtual worlds are seen by some technologists as an enabling concept for blockchain, and certainly extended reality is already finding a role in medicine. It has been used to host therapy sessions and addiction counseling, offer consultations and train medical students. Virtual reality (VR) company Amelia, for example, provides psychotherapists and their clients with VR headsets and an electrodermal response sensor that fits on the patient’s fingers, to measure their sweat response during sessions. Data, education and feedback on therapy sessions is then accessed via a VR platform. Some believe that, in the future, there is a possibility we might pay for these virtual services with virtual currency, as that may be the most seamless way to transact in these spaces. “As you give consumers more choice and more options to get their care, they start asking about what else is out there from a digital experience perspective,” says Lin. “So you’re starting to see healthcare, telehealth, and payments all merging together at once.”

Some of these ideas may seem far away from our current experience of healthcare. But as Evernorth’s Matt Bennett points out, whole industries can transform beyond recognition in a matter of years. “Remember back in the day, when you did all your banking in-branch, you waited in line, you filled out your deposit slip, met with the teller, and so on? Today, it all happens through digital and virtual interactions. The branch is there to support you when you’ve got a major need—one that lends itself to being in-person. That’s our intent as we look to the future. Instead of bringing patients to physical sites and settings of care, how do we use digital, virtual, alternative sites of care, to bring the care to the patient?”


Better payments can help healthcare companies deliver better care. Read how payments are powering healthcare ecosystems.