5 Biggest Challenges When Scaling Telehealth Nationwide

scale telehealth company nationwide

It’s an ideal time for companies to broaden their reach to consumers and patients nationwide with virtual care. If you’re considering expanding your telehealth services to more states, we’ve outlined the top five obstacles you’ll need to plan for to deliver an exceptional brand and clinical experience.

As healthcare becomes increasingly consumerized, patients are expecting care to be available on demand, even for non-urgent needs. In order to meet consumer needs for near-instant care at an affordable price, innovators must grapple with the intricacies associated with precision staff modeling.

Telemedicine staffing is more complex than meets the eye—from managing clinical licensure across broad geographies to the inherent challenges of accurate demand forecasting.

Here we share lessons learned from the past few years of helping virtual care partners like you launch and scale telemedicine services. We believe that with proper planning, future companies will innovate faster, increase patient access to care, and drive down costs for everyone.

  1. Healthcare workforce shortages are here
  2. Navigating state medical licensure is cumbersome
  3. Mid-level practitioners are cost-effective but complex
  4. Telehealth demand forecasting is variable
  5. Management of opportunity costs is critical

1. Healthcare workforce shortages are here

Ironically, while your mission as a virtual care company is to deliver better, more accessible care, your biggest challenge may be simply finding the individuals to provide such care.

Causes of physician shortages

According to a 2019 report from the American Association of Medical Colleges, there’s a projected national shortage of nearly 122,000 physicians by 2032. The shortage is primarily due to an increase in patient demand due to an aging population with longer life expectancy, but clinician burnout and retirement are also major factors.

For the past few decades, the traditional healthcare system has treated our care providers like commodities instead of the highly-skilled, empathetic professionals that they are—subsequently causing them to burn out at alarming rates.

The reasons contributing to clinician burnout are bountiful, including:

  • Excessive workload, unmanageable work schedules, and inadequate staffing
  • Administrative burdens
  • Workflow, interruptions, and other distractions at work
  • Organizational culture of their workplace
  • Lack of job control, flexibility, and autonomy
  • Inadequate professional relationships and social support

In addition, our industry is losing a large percentage of care providers to retirement. As of 2020, the vast majority of baby-boomer clinicians are now hitting retirement age, causing a steep decline in the number of physicians and other specialists actively practicing.

This is an unsustainable situation that must be addressed as we work to revolutionize healthcare.

Not only is the delivery model important to how we care for patients, it’s central to how we retain clinicians over the long term. Remote care jobs for clinicians can create the opportunity to turn around this dire trend.

How to solve the clinician shortage

To combat the low supply of clinical care providers, telehealth companies need to move away from the 1:1 employment model and leverage economies of scale.

Since one of the biggest logistical challenges can be matching specific patient care needs to the appropriate licensed clinician among a sea of clinician specialties, you’ll need a way to efficiently navigate and deliver quality care as you scale.

Working with a company like Wheel enables you to leverage a clinical network and workforce technology that makes the most of scarce clinician resources. Our platform enables clinicians to work across several types of services, while simultaneously empowering companies to take advantage of this shared clinician network.

This is our focus at Wheel: solving the toughest inefficiency and scale challenges, so you can focus on what YOU do best.

2. Navigating state medical licensure is cumbersome

    Scaling your telemedicine practice to a national network of trusted clinicians provides its own unique challenges. Regulatory requirements governing patient care by appropriately licensed providers differ on a state-by-state level—adding complexities that must be considered and addressed as you scale regionally or nationally.

    Providing telemedicine across state lines

    Federal telemedicine laws mandate that a patient located in a particular state can only be treated by a clinician with a medical license for that state. This makes it difficult for virtual care companies to align clinical resources with patient demand at a macro level. In addition, projecting patient demand also requires nuanced forecasting based on geography, time of day, day of the week, and seasonality.

    Why multi-state medical licensure matters

    With the advent of remote work and virtual care, there is a growing trend of physicians seeking licensure in two or more states. And while the interstate licensure laws are more strict for midlevel providers, it’s also possible for APRNs (nurse practitioners) to garner multiple state licenses.

    Having a few clinicians on your team that are licensed in multiple states can make scaling your care delivery more manageable—and affordable.

    However, accessing and managing multi-state licensed clinicians only sounds easy.

    It’s burdensome for clinicians to keep on top of multiple state licenses, education requirements, and renewal deadlines individually. It’s even more challenging for companies to continuously monitor a clinical team and report licensing status to the boards.

    How to deliver compliant, nationwide telehealth services

    An automated process of matching the right clinician with the right license to the right patient—instantly—is the solution virtual care companies need to manage compliant statewide virtual care.

    Wheel guarantees rapid, compliant care delivery by combining a tech-enabled platform with a curated clinical network of board-certified clinicians licensed in all 50 states including D.C.. Our focus is centered around managing this heavy lift, so you can stay compliant and free to focus on growing your business.

    3. Mid-level practitioners are cost-effective but complex

      Having a mix of physicians and mid-level clinicians (nurse practitioners and physician assistants) is at the heart of creating an operationally efficient and cost-effective practice—especially in telehealth. While creating the right balance of clinicians can positively impact your bottom line, the associated operational challenges complicate the upside, making it unviable for most companies to leverage.

      Benefits of leveraging mid-level clinicians

      Diversifying your provider type with a healthy ratio of physicians to nurse practitioners (NPs) and physician assistants (PAs) offers two key benefits: lower operational expenses with equivalent effectiveness of care.

      • Lower operational expense. Physicians are more expensive to have on staff, as compared to PAs and NPs who may have the same scope of practice depending on the treatment area and their state(s) of licensure.
      • Equivalent effectiveness of care. Systematic reviews of mid-level healthcare workers’ quality of care have shown there’s no difference in regard to the effectiveness of care compared to higher-level clinicians.

      Regulatory challenges for mid-level providers in telehealth

      Mid-levels have a tremendous amount of regulatory restrictions associated with their ability to deliver care. In fact, most states have restrictive rules for both NPs and PAs that require the oversight of a delegated physician to provide collaborative supervision. Depending on the state, these supervision requirements can vary by geographical distance, frequency of interaction, and scope of oversight.

      • High cost. In states like Texas, California, and Florida, collaborative supervision often involves a contract or agreement with a physician that can cost the nurse practitioner—or their employer—upwards of several thousand dollars per month.
      • Geographic limitations. States like Georgia require NPs to practice within specific geographic boundaries of the supervising physician.
      • Scarcity of physician collaborators. There are currently no networks or convenient resources for NPs and PAs to establish a relationship with a potential delegating physician. This means finding a physician collaborator is often done through friends, family, and personal networks which is challenging and unscalable at best.
      • Operational burdens. Companies engaging mid-level clinicians also must report to the state boards that the supervision requirements are in good standing, which requires dedicated resources to track and maintain.

      How to leverage mid-level clinicians in telehealth

      There’s no doubt that to affordably scale your virtual care offering you’ll need to incorporate a judicious mix of mid-level clinicians and physicians. To alleviate the operational and regulatory burden, you’ll need a partner with deep regulatory expertise that can manage the complicated (and changing) oversight regulations for collaborative supervision from state to state.

      At Wheel, we not only manage this operational lift but yield our company partners significant savings on operating expenses to give you the edge in delivering the highest quality, compliant virtual care.

      4. Telehealth demand forecasting is variable

        Accurately projecting the demand for your virtual care offering may be the most arduous task you’ll face when creating a successful program. Forecasts are rarely fixed or predictable in the world of telehealth.

        Experience working with a multitude of healthcare companies has taught us to never expect forecasts to be spot on—they will always shift. COVID-19 is a great example of a national health crisis upending companies’ original plans and increasing patient demand for virtual care.

        It’s best to approach forecasting as an art—not an exact science.

        Considerations for predictive modeling in telehealth

        Numerous factors affect virtual care demand variability.

        • Increasing competition: With an uptake in telemedicine adoption comes crowding of the space. The erectile dysfunction market is anticipating a CAGR of 6.5% by 2023, which is likely to increase demand but also decrease sales of individual care providers due to market crowding.
        • Patient demographics: Your patient demographics will dictate your program’s potential engagement level—but telemedicine adoption patterns are dramatically shifting. As consumers look to virtual care for routine health needs, urgent care, and chronic condition management, engagement patterns are likely to change and affect forecasting.
        • Seasonality of competing conditions: Cold, flu, and even allergy visits are known to produce an uptick in clinical service demand with the changing of the seasons. What’s less obvious is that concurrent demand for lifestyle “competing conditions” like ED treatment or dermatology can decrease within a target population during peak cold and flu seasons.
        • Access to broadband services: Broadband access is variable state-to-state. When planning a wide geographic service expansion, consider the ratio of populated to rural areas and the corresponding internet service reliability.
        • State-by-state modalities: Utilization will not be the same across states with different modalities. For example, states that require video-only telehealth may have slightly lower utilization than states that allow for video, audio, chat-based, or asynchronous care.
        • Optimism bias: People tend to overestimate the probability of positive events and underestimate the probability of negative events happening to them in the future—which can affect business decision-making. A number of factors can explain unrealistic optimism, including perceived control, sunk costs, or loss aversion.

        How to meet patient demand with precision in virtual care

        To effectively meet patient demand without over- or under-staffing—even when demand projections are fluid—it’s critical to leverage patient visit analytics in aggregate to improve your forecasting ability over time.

        Wheel helps virtual care companies embrace the volatility of forecasting with a tech-agnostic analytics platform and flex-based clinical staffing that can dial up or down within 24-48 hours of a dramatic shift in service demand. When the unexpected happens, we’ve got our clients covered.

        5. Management of opportunity costs is critical

          What’s the downside of missing your target forecast? Opportunity costs. As any finance or operations executive can attest, opportunity costs can have a significant impact on the business, both financially and on the future patient pipeline.

          Developing staffing models for telemedicine

          Staffing too many clinicians without patient demand wastes financial resources. It’s expensive to pay clinicians to “stand by” waiting for consults—especially when patients don’t show up. When the sunk cost of clinical staffing isn’t offset by revenue, the bottom line is damaged and pressure increases to make up the shortfall.

          The opposite scenario can be just as detrimental. If your demand models lead you to understaff, having a patient show up without an available clinician trained and ready to deliver care can result in a poor brand experience, lost revenue, or even worse—a lost patient.

          The complexity lies in designing the perfect staffing model in each state you’re providing services in—during the times, days, and weeks patients need you.

          On a given day, you could be overstaffed in California, but understaffed in Texas. Due to the regulatory puzzle of state licensing, you won’t be able to fluidly shift your supply to meet demand. How do you solve for this?

          Leveraging flex staffing for telehealth

          Some argue that you need a more precise forecasting model to combat demand flux, but as outlined in the previous section, that’s nearly impossible to achieve.

          The solution lies in on-demand, flex staffing—having access to a deep supply of clinicians trained on your brand of care, and licensed in your serviceable states.

          Wheel offers this resource to virtual care companies through a revolutionary cost model, charging most clients only for the consults or care delivered. Imagine the savings as you prepare to service five, 25, or even 50 states with variable forecasting. With Wheel, telehealth staffing models are made much simpler, as we manage higher volumes of aggregate client demand. We are able to smooth out that demand across our nationwide clinician supply—ultimately passing the savings along to you.

          Growing your virtual care services with Wheel

          We help companies scale as fast as possible, compliantly, and affordably while empowering clinicians to more readily embrace virtual care. We achieve this through in-depth training, quality assurance systems, and innovative technology that powers telehealth expansion—all white-labeled to drive your brand experience.

          The result? Companies offering virtual care services can expand nationwide with operational efficiency while passing along savings to patients—saving upwards of 60% when compared to hiring and managing clinicians directly.

          Let Wheel be your secret weapon to achieving an unprecedented level of flexibility and speed to market as you expand.



          Want to learn more about how Wheel can help you expand rapidly? Schedule a meeting with our sales team or contact us to get answers to your questions about scaling your virtual care program nationwide.

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