American Well: A New Vision For Telehealth

Dr. Ido Schoenberg, Chairman and CEO of American Well, one of the leaders in the telehealth field, recently told us, “We look like our competitors from the outside, but we are taking a new approach to where telehealth can go.”

The telehealth (or “telemedicine”) segment of healthcare has been soaring, causing analysts to race to increase market forecasts. The global market has been estimated to reach $43 billion by 2019 (BCC Research).

Telehealth can traditionally be divided broadly between two segments: a) Consumer (or “Telehome”) and b) Provider (or “Telehospital/clinic”). In the first case a consumer can just go to the Internet or pick up the phone and call for a virtual visit with a doctor at any hour, from anywhere. The consumer, or the consumer’s employer, might also subscribe to a service that provided the doctor network.

In case b), typically a hospital or group of doctors, who wish to gain access to experts who are not on their existing staff may use telehealth.

Dr. Schoenberg, however, presents a different vision of telehealth, one that emphasizes “treatment of the patient in the community.” He points out that you “can’t compete with the trust that hospitals have in their communities.”

Focusing initially on the chronically ill, he envisions a healthcare delivery system that includes: connected devices that can monitor the patient; cloud-based big data analysis from partners such as IBM and Optum; delivery of information to healthcare providers in the community; delivery of services to the patient, in-home; and even ultimately delivery of medications to the home.

Driving this vision is the aim of dealing with the needs of people with chronic conditions. As Dr. Roy Schoenberg (co-founder and co-CEO with Dr. Ido Schoenberg) has stated, “Eighty percent of healthcare resources are spent on longitudinal care needed by twenty percent of the U.S. population … those patients with chronic conditions.” The RAND Corporation estimates that 133 million Americans – 45% of the population – have at least one chronic disease, such as heart disease, asthma, cancer, and diabetes.

What is the timing and status of this new vision for telehealth? Dr. Schoenberg states that all of the elements, except for home delivery of medications, are in actual early stages of operation today.

What accounts for the dramatic growth of telehealth in the past two years? Dr. Schoenberg points out that it took American Well, which he founded with his brother, Dr. Roy Schoenberg, eight years and $200 million in investment to get to where they are.

“We were solving problems with huge complexity,” he explains. The issue was not technology alone; there were issues of affordability, reliability, ease of use and legal barriers. The early system was browser based and hard to use, and faced the chicken and egg problem of getting enough doctors and enough patients. He describes the basic mission as “connecting two dynamic clouds of patients and providers.”

He says, “It came together almost at once.” The company now operates in 46 states. It advertises the ability to link patient and doctor within three minutes of an inquiry.

Mobile took hold in 2014 and its Amwell mobile app went from 20,000 downloads the prior year to 1.6 million. The company states that 60% of users chose to access its services through a mobile device. Revenue of the company (which is privately held) soared by 125% for the year. The company topped off the year in December, announcing a series C funding round of $81 million.

Dr. Schoenberg is well aware that the company’s vision requires support of providers and what he refers to as “deep integration into EMRs” (electronic medical records systems.) We’ve written a number of articles on mobilecloudera about the hurdles presented by the big EMR suppliers, led by Epic, who generally vigorously resist such integration.

Dr. Schoenberg does not minimize these difficulties. He points out that there are no industry standards for EMRs, making any integration a complex issue. He also acknowledges some level of integration may be better than none, at least at first.

The priorities, he states, are to insure: 1) continuity of information, so that basic information about patient contacts, whether in-person visits or digital contacts, are available to any doctor; 2) scheduling, which would allow a doctor to work into his/her daily schedule the online contacts as well as physical appointments; and 3) ensuring that reimbursements are received and that it is clear who will submit claims and collect co-pays.

American Well, he explains, is working with the major EMR providers, to implement the necessary changes. What is his assessment about achieving the necessary transparency? He states that he is “very optimistic.”

American Well has put increasing emphasis on helping providers, through new telehealth tools. Earlier this year, it released its latest product update, AW8, with numerous new features for doctors. These included specialized hardware, the Telemed Tablet that is designed to facilitate speedy contact with specialists.

The company has recently announced a string of deals with hospitals and payers, including: a partnership with Cleveland Clinic, which offers MyCare Online; being selected as one of three telehealth providers whose services will be covered by UnitedHealthcare; a partnership with Thomas Jefferson University Hospitals which offers online JeffCare.

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