FYI: Telehealth Platforms for RDs

Today’s Dietitian
Vol. 28 No. 2 P. 18

If you’re a dietitian on social media or in a professional networking group, you know that opportunities to provide MNT via telehealth abound. Thanks to venture capital investment, large telehealth companies can connect patients with dietitians through virtual platforms. Many platforms utilize AI functionality and target patients with insurance coverage, often offering free or low-cost visits. A food-as-medicine lens is also popular among both practitioners and patients. Some of the most well-known companies include Berry Street, Fay, and Nourish. This article explores the benefits and potential drawbacks of telehealth from both patient and provider perspectives.

Overview of Telehealth Platforms

Telehealth platforms vary in size, scope, and services, but most serve a variety of disease states nationwide, accept commercial insurance, and some accept Medicare, Medicaid, or self-pay options.

Most sites claim that >90% of clients can meet with an RD for free, a compelling feature for patients. These platforms often allow patients to compare RDs within the network, with simple onboarding processes and, in some cases, next-day appointment availability. Clinicians can often select their niche populations, such as pediatric feeding disorders, sports nutrition, or chronic disease prevention (eg, CVD, diabetes, weight management). Compensation structures and part- vs full-time roles are typically outlined on their application portals, and social media groups and threads provide further insights.

Reasons RDs Choose Telehealth

Working through a telehealth platform is an appealing option to many RDs who are looking for a change of pace or the opportunity to create an improved work-life balance. Patricia Kolesa, MS, RDN, says, “Prior to joining Nourish, I was working full-time as a clinical dietitian. With Nourish, I can say yes to growing my business, while working less hours to stay full time.” Shannon Tokarski, MS, RDN, left a 20-year career in bariatrics to embrace the flexibility and improved pay that telehealth provided; she is currently with Nourish and Teladoc. Kalyn McCoy, MPH, RDN, LDN, shared a similar story, stating that her previous work with Foodsmart allowed her to leave her on-site clinical position. In a nutshell, some of the top reasons RDs are making the transition to these telehealth platforms include the following:

• flexibility to balance work and personal life;
• ability to grow or maintain private practice while employed full time;
• to avoid clinical burnout, institutional politics, and lower pay in traditional settings;
• access to a nationwide patient base; and
• convenience of working from home.

The Benefits

Although there’s some variability in benefits across platforms—with some companies requiring a certain number of hours to be worked before making them available—they can offer powerful incentives. From a dietitian perspective, Kolesa says, “Patient reach is one of the top benefits. I appreciate that I can see patients across the country who may not have had access to a dietitian.” Cathy Dyer, RDN, NBC-HWC, agrees, saying, “Berry Street has an advertising budget I could never match. They keep my calendar filled. That’s valuable.”

Offering compelling supportive features, these platforms may boast many of the following perks:

• flexibility for RDs to choose their patients, hours, and days on the job;
• a greater reachto enable RDs to serve clients across states, including rural areas, and patients with disabilities or other underserved populations;
• access to resources like licensure reimbursement, marketing support, EHR systems, and AI charting tools;
• perks like CEU stipends and easier access to a network of colleagues for support;
• opportunities for nonpatient-facing roles, leading pilot programs, and other avenues fostering professional growth; and
• financial benefits such as paid time off, no-show compensation, office budget, and bonuses.

The Challenges

Every job has a downside, and the biggest for telehealth is on par with what you might see in an on-site clinical setting: no-show patients. Unlike a salaried role, most of these companies do not reimburse fully (or at all) for no-shows. This can result in inconsistent income, something Kolesa laments. McCoy has experienced this as well, and says, “Sometimes clients cancel unexpectedly due to insurance denials. It feels abrupt and disappointing.” McCoy has learned to be discerning regarding which platforms provide the biggest benefits, as she has been employed by six of them and currently works for Season Health, Berry Street, and ModifyHealth.

Taking stock of some of the biggest concerns RDs on these platforms express, they can be summarized as follows:

• hourly pay can lead to inconsistent income and underpayment relative to revenue generated;
• there can be unpaid administrative burdens like charting, onboarding, and meal log review;
• RDs may wrestle with licensure complexities when there may be different processes, fees, and timelines for each state they’re required to maintain licensure in;
• patient no-shows, cancellations, and technology challenges;
• continuous screen time and online counseling can be draining and increase risk of burnout;
• telehealth may draw patients away from and negatively impact small practices; and
• meal planning programs and charting AI tools required by the platform may lack room for individualization.

Impact on Small Private Practices

Local, independent private practices may struggle to compete for virtual insurance-based patients, due to the better marketing, billing, and administrative resources of large companies. Differences in insurance reimbursement rates can also make equitable pay difficult.

Although larger telehealth platforms may alleviate some struggles experienced by the small private practice-owning RD, these smaller independent private practices may yet offer some unique benefits of their own, including the ability for RDs to offer in-person sessions and the potential to build referral streams from other local clinicians.

Long-Term Viability

Stephanie Gomez, MS, RDN, LDN, is among those who believes telehealth is here for the foreseeable future. She says, “Americans have become accustomed to the convenience of telehealth appointments.” Yousef Elnahrawy, RDN, MPH, who works for Foodsmart and Nourish,is cautiously optimistic, saying, “Telehealth companies are growing, but priorities may shift away from improved health outcomes … only the future will tell.” Tokarski disagrees and says, “I see telehealth as a short-term opportunity. With the amount of time needed for onboarding and licensing, it may not always be worth the pay.”

Some RDs view telehealth as a long-term career, especially for populations needing remote care. Others see it as short-term or supplemental due to licensing hurdles, unpredictable caseloads, and compensation issues that may ultimately see it fall out of favor with more RDs. However, many platforms may be likely to grow with technology and insurance coverage, especially if they can demonstrate measurable health outcomes. Some of the concerns expressed—like burnout, administrative burdens, and compensation struggles—are also not unique to telehealth and are concerns voiced by RDs in other areas of practice as well.

Advice for RDs Considering Telehealth

Kolesa encourages RDs who are interested in joining one of the popular telehealth platforms to ask more than one provider about their personal experience with different platforms.” As an example, she says, “A simple search for ‘Nourish’ in a dietitian Facebook group will lead to past posts and comments about the role!” As someone who has worked for six telehealth platforms in the past 5 years, Kolesa knows a thing or two about the pros and cons of different platforms and the importance of doing homework to find which options an RD might be best suited to. McCoy recommends using common sense to sort through offers. She says, “If it sounds too good to be true, it is … make sure that you research the companies the different platforms partner with.” If you’re feeling ready to sign on, the following are some additional tips to consider:

• brush up on counseling skills, especially motivational interviewing;
• plan for setting clear boundaries and establishing self-care habits while working online;
• starting out part time at first to test the role before committing full time may be prudent;
• keep realistic expectations about what frustrations may emerge around tech troubleshooting, navigating insurance complexities, and being confronted with variable patient engagement.

Takeaways

Regardless of whether you’re fully invested in these large-scale telehealth platforms, they are undoubtedly making nutrition education and care more accessible. They help increase awareness of RDs and accessibility of nutrition services and could potentially help raise RD valuation over time, due to this broader exposure. Syrah McGivern, MS, RD, LDN, says she likes working for Nourish because she can see clients in rural locations who have limited in-person options. Gomez believes these platforms have increased awareness in the public regarding what dietitians do and why they’re so important. She says, “More people have heard the word ‘dietitian’ in the last decade than since the beginning of the profession,” and it’s hard to argue with that.

— Alexandria Hardy, RDN, LDN, is a nutrition consultant, writer, and early intervention therapist in Lancaster, Pennsylvania.