A large Michigan health plan is going even more digital in order to stay competitive.

The hospital market is consolidating—and shrinking. In 2016 there 5,564 U.S. hospitals, down from 6,100 hospitals a decade earlier, according to the American Hospital Association. Since 2010 there have been more than 500 hospital mergers including 89 in 2016, according to an analysis by PwC Health Research Institute. So far in 2017 there have eight big hospital merger deals valuated at over $1 billion each such as the intended merger of Beth Israel Deaconess and Lahey in Boston.

Hospitals also are no longer the only place consumers are turning to for medical care—including online.

For example, drugstore chain CVS Health operates more than 1,000 Minute Man walk-in clinics nationwide. CVS and Walgreen Co. also are among a wave of non-health system companies moving into offering patients more digital doctor options, including for dermatology consults.

“We (hospitals) are no longer the only game in town,” says Joe Brennan, senior director of MedNow for Spectrum Health System.

Spectrum Health is a non-profit health system with 11 hospitals and headquartered in Grand Rapids. Mich. The health system was an early adopter of digital healthcare among hospitals in Michigan—including the first to offer a telehealth service for patients both inside and outside the hospital, Brennan says.

In 2006 Spectrum Health began posting average prices for many of its common procedures on its website and in 2008 added information on what Medicare, Medicaid and commercial health insurers paid the health system on average for procedures. In 2009 Spectrum also launched an online cost estimator based on the average prices listed for nearly 250 adult procedures.

Two years later, Spectrum updated its MySpectrum digital healthcare portal with features that allow patients to set up a family account, access benefits and eligibility information from Spectrum’s Priority Health plan, view growth charts for children and see immunization records. The MySpectrum portal also enables patients to view lab results, e-mail their doctor, renew prescriptions, request appointments for routine doctor visits and preregister for some procedures, pay bills for hospital services, and track health conditions, allergies and medications.

In 2015 Spectrum introduced MedNow, a consumer telehealth program for online care for cold and flu, earache, pink eye, sprains and strains, sinus problems and other less serious conditions. MedNow also includes online consultations for cardiology, diabetes, infectious disease, wound care, vascular services, oncology and other follow-up care, and virtual tools that track and review patient heart rates and other important data.

Unlike many other health systems that use an outside telehealth services provider—and outside providers—to treat patients via digital doctor visits, Spectrum Health built its telehealth technology in-house.

“We were the first health system in Michigan to have a comprehensive approach to telehealth including for the consumer,” Brennan says.

In the last year as Spectrum has shifted the marketing of MedNow away from traditional advertising such as billboards and to personalized e-mail campaigns and advertising via social media. That’s had an impact: The number of MedNow digital doctor visits has more than tripled in the past year to about 9,000 telehealth consultations from 3,000 consultations.

This summer Spectrum Health will release its latest MedNow update—an Android and Apple app for digital doctor visits. Spectrum sees digital and mobile healthcare as a strategic priority and a competitive advantage, Brennan says. “So much of how patients live today is digitally,” he says. “Hospitals that don’t embrace going digital will find patients going elsewhere.”