Popular Demand Driving Telehealth to New Heights
This week I am talking to Roy Schoenberg, MD, MPH (@RoySchoenberg), President and CEO at Amwell (@Amwell) a telemedicine company based out of Boston with one of the largest telehealth ecosystems in the world.
Like me, Roy found his path through medicine and into technology launching a series of companies until founding Amwell around the time that technology and the internet were starting to bring widespread positive impacts to our world. We discuss the potential for technology to bring about real positive change in healthcare overcoming the early resistance and indeed over-optimism for what was originally possible
Fast forward and Telemedicine is a native solution in healthcare with all systems delivering some form of remotely accessible care. As he describes it, it is just another “care setting” and simply an alternative place to interact with patients, driven by practical needs and thinking about what is best for the patient.
Listen in to hear where Roy sees Telehealth going, the “power of the people” to bring “by popular demand” the delivery of healthcare using every available means. As he describes it “the Telehealth train has left the station”, are you on board are watching it depart
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
Today, I’m delighted to be joined by Dr. Roy Schoenberg. He’s the president and CEO of AmWell. Roy, thanks for joining me today.
Roy Schoenberg
Thanks for having me there.
Nick van Terheyden
So as I do with all my guests, I think it’s important to get a little bit of context, before we get into some of the details of your history and how you arrived at this point in your career. Tell us a little bit about your background and your journey to this point.
Roy Schoenberg
Sure, I’ll probably take the shorter version of it. But as you can, as you can hear from my accent, I wasn’t I wasn’t born here. I was born in Israel many, many years ago, trained in medicine there and then gradually started gravitating towards technology, which was, you know, this was the dawn of the internet and a whole lot of, you know, very nice things to to follow. And has been involved since since then, in three different companies that created various different solutions that utilize technology for healthcare very much inside the healthcare world. And then moved from Israel to Boston, for a stint at a at a local university here instead. And back in, back in 2006, when it became apparent that, that technology and the web and the internet can actually do much more than just, you know, put content on pages. We started them well, with the thinking that if we could allow clinicians who have the time to see a patient or not in front of one at the point in time, to be seen by patients who need to see clinicians, but have challenges and getting in front of them. Maybe we’re onto something. Later, this became telehealth. But that was that was the beginning. And we’re, you know, we’ve been there ever since.
Nick van Terheyden
Well, so first of all, you and I share a little bit of common background, but most people pick up that I’m not from around these parts, you pick up that deep Alabama, I’m sure. So, you know, I’ve said this on the show before and you know, won’t be a surprise to some people. But you know, telehealth was two years away for the last 10 years. And I was saying it was still two years away. And that was dating back to the NASA times when they were doing telehealth with their astronauts. You know, interesting, I learned just recently that Apollo 15 had some very significant medical details that wasn’t publicly known at the time for one of the astronauts, but they were covering so you know, there’s a long history, and we got to this point, pandemic arrived, and suddenly, everybody was doing telehealth, you know, you seemed like a true seer of the future, I’m sure at this point, and hopefully in a good position. But we’re still sort of muddling through this help us understand where you think things have gotten to at this point with the acceleration. But then I think some people are pausing and going, is this what we really want?
Roy Schoenberg
Well, I think this is this is not unlike a lot of other technologies. The people that develop technologies are usually over optimistic about how quickly they’re going to get adopted. Because if it’s great, I mean, how could it possibly not be the best thing since sliced bread. And it’s true about a lot of technologies. I think in healthcare, it is even more so because there are a lot of subtleties and a lot of dimensions in healthcare, that are not immediately visible. When we go to see a clinician, it isn’t just about getting a medication or treatment, it’s a lot about reassurance. It’s about trust, it’s about knowing that at the point where we are vulnerable, we’re in good hands. And when you build technologies that in any way you look at them, reinvent the way that people are interacting with clinicians. Getting those parts rights is something that goes way beyond technology, it’s an art. It is people’s interaction, for not just you know, screens or videoconferencing. And I think the part that has changed dramatically, you know, with COVID Is that like it or not, maybe maybe because it was shoved into our throats, you know, during COVID. I think that people crossed over to the point where they were getting comfortable with maintaining relationship with clinicians over this technology. The video conferencing was always okay. We’re better with yours and you know, bandwidth and all those kinds of things. But it is really about how people learn to maintain a comfortable relationship with clinicians that made the difference. And I will be the first one to say that that part should really be attributed not to the technology or the telehealth companies like like us and others, but rather to primarily clinicians, that, in my mind, have taken this technology over to a new ocean of opportunities, because they realize that they’re going to maintain those relationships over it. And that is why probably it took a while to get here. But we’re in a different place now.
Nick van Terheyden
Yeah, I think credit where credit is due. And you’re right. It was the adoption. In Part force, I think there was, you know, I put a spectrum of folks there were some that were absolutely pushed. And while I’ve got no choice, no problem, all the way through to folks that were already there going really you’re only just here. But you’re right there was this generalized. Actually, this is a lot better than people had imagined, certainly, for those that were on the negative side. And I think we’ve seen the expansion that has been good for for everybody. But it’s come with some challenges. I mean, it’s it’s it has its own limitations. It’s two dimensional, I think we’ve seen a little bit of fatigue with this, it needs to be seen in the context of, you know, a broader sense of taking care. How do you see that developing now, given what I would imagine is a two to three year accelerated learning opportunity for everybody involved?
Roy Schoenberg
Yeah, I think the I think the world balance, the word balance is probably key here. In a way, telehealth is a care setting. To those who are not in the midst of health care lingo. The care setting can be a physician office, it can be an outpatient clinic, it can be an ER, it can be an inpatient bed in a hospital, these are all care settings that have been very well defined within the country construct of care delivery. We know today that there are things that you can do in each one of them that are appropriate and things that you cannot, if your PCP is going to have an open heart bypass operation in their community practice. That won’t go very well. I think the understanding is that these technologies are not an alternative. These technologies must be woven into the way that we surround our patients and to different patients at different times, they will offer different value. Sometimes, you know, we we got familiar with telehealth as a convenience instrument, right. I mean, people who had the flu and you know, needed a Z Pak very quickly. So it served along the line of quickly getting a solution. The value of telehealth for an elder patient who lives with cancer in their home, or lives with a chronic condition in their home, and have the ability to be maybe even every day being checked up upon by their nurse or their clinician in their home to see how they’re doing or they’re taking their medication. Do they have side effects are they are they comfortable? By the way, there are other dimensions of not just medication like you know, behavioral elements, and so on. When we start thinking about the technology utilized in that way, what we give those patients who are at home is the opportunity to actually stay there longer, which is where people want to age, I’m giving these as two examples. You know, on one hand, you have the blind date, give me a CPAC. With the other side of maybe I can actually stay home longer before I have to be sucked into a skilled nursing facility or something else. This just gives you a better understanding of where the technology can be applied. proper application of the technology is an art that we’re still learning. It depends on patient’s comfortable comfort level with it, it depends on clinicians comfort level with it. It depends on reinventing the notion of collaborative care because you have a lot of different people that can interact with the patient. And then there’s a whole fun stuff that people don’t like to talk about, like what are we going to do with with reimbursement? What are we going to do with payment schedules? What are we going to do with with our values, you know, inside institutions and you know, efficiency metrics and, and where’s the record going to be 15 million other things that we have to rethink completely in a world where healthcare surround patients over technology rather than in its buildings but You know, kind of coming back to the answer of your question, I think that it is, it isn’t right or wrong, it’s whether you’re using it with the right balance for the patient that’s in front of you.
Nick van Terheyden
Yeah, I like that a lot. And, you know, as I’m thinking about the patients who jumped into this, and we saw a spectrum, I mean, I think it’s, you know, it’s important not to discount some of the inequity that already existed that, you know, got amplified through some of this. You know, I’ve heard some, you know, quite frankly, awful challenges for some people who ended up having consults in their car, because that was the only place that they could have not typically on the clinician side, but, you know, lack of privacy, lack of available resources, you know, those things. And, you know, those are challenging problems. But I think in general, it expanded access, and people adopted it. And, you know, ultimately, I think we’ll see it as to your point of, it’s just a care setting, I think, is the appropriate way to see it. But how do we adapt and adjust to this new world? Because that’s completely different to where we were before, even though we had it, it just, it wasn’t part of the care setting. I mean, it was just an outlier. I want to say, I mean, it shouldn’t have been, but it was, how do we get there? What are the new What’s the new age for this?
Roy Schoenberg
Well, the good news, maybe a bad news too, is that the trainers out of the station, right? We can say whatever we want, this is not going to stop for anybody. And in its evolution, sometimes it’s going to be pulled by people that live in geographies that have access challenges, sometimes it’s going to get pushed by healthcare institutions that can become more efficient by doing for example, post surgical follow up some telehealth rather than consuming the resources, you know, of an in hospital visit and so on. It’s going to come in a lot of different flavors, because different populations will be more amenable to it, that’s a good thing. In some cases, that also extends the digital divide with patients, people who are less technologically savvy and so on. But it is out of the station, because it is now inevitable that some part of our health care will be carried out over technology. And it’s shocking that we’re having this conversation because on any other industry, you would say, of course, part of how that industry operates is over technology. But funnily enough, in healthcare, we managed to kind of push it and push it and push it away from us. I think that, you know, maybe the analogy that I would think of is if you think about Amazon, everybody relates to Amazon, right? If you think about Amazon, for many, many years, the ingenious model of selling books online, was really the first 10 years or so of Amazon. And it’s a brilliant model not to sell books, which was how bad analysts were evaluating the value of Amazon, how many books could itself, it was a way to understand how to create online retail infrastructure. How do you discover the goods? How do you procure them? How do you price them? How do you package How do you sell them? How do you return them? How do you get a credit card to the naysayers at the time that didn’t like to plug a credit card into a website, and so on and so forth? What’s the return policy and all of that kind of stuff. And then once Jeff Bezos and friends realized that they had that in place, it became the store of everything. And then we cannot, you know, any retail organization that didn’t adjust and adapt, disappears. That is, sadly, or, or maybe positively is what is going to happen inevitably with healthcare. And organizations, be there on the payer side on the risk side of things or be there on the delivery side, that will not begin to speak this language and find how doing their business over technology, complements and potentially enhances what they traditionally did before. I think not me saying this, but in any other industry. If you look, if you reject it, it does not spell good news. So there’s going to be trial and error. There’s going to be a change in the landscape. There’s going to be new innovators that are going to prevail and are going to become much larger in this new world. There’s going to be change in the rules and regulations of healthcare. I think that the battleground on what are we going to do with state lines and state licensure is is just in front For us, I think it’s inevitable we have to think about it. I think the model of care of how a local PCP in West Texas, God bless them for the work that they do, could actually recognize that the care of their leukemia patient could benefit from their ongoing interaction with an oncologist from Dana Farber in Boston. And egos will have to change, right? We clinicians don’t ask for directions, right? I mean, we, we like to think we know what to do with the patient, but the world of knowledge and how to manage that patient will now be essentially crowd sourced to a lot of specialists that are coming from different places. All of these are enormous changes to how we’re going to experience healthcare.
Nick van Terheyden
For those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Roy Schoenberg. He’s the president and CEO of AmWell. We were just talking about the changing landscape of the delivery of care. I think, you know, as you rightly cited, you know, an update to the rules and regulations. In fact, just this past week, the Honorable David Shulkin, published a piece talking specifically to that point. You know, highlighting that the VA has been doing that there’s, there’s no borders in the VA, there’s these sort of little channels that exist that allow for obviously, you know, the logical practice of medicine. So I think, you know, as you rightly say, that train has left the station, if you’re not on board, the train, you’re watching it leave. As you think about this, and the changing landscape. What does that look like for you?
Roy Schoenberg
Well, I think the biggest change for us has been that, you know, we were fortunate enough to be there with, you know, with with technology at the time that people were beginning to use telehealth, like books, urgent care, for the most part, it’s a very simple product. You know, usually it doesn’t have a history, it doesn’t have a future you’re connecting with a clinician who’s available. You see them they get they do something with you and everybody parts ways. And that gave us the ability to be involved in the telehealth, discussion for a lot of organizations on on the health plan side and on the delivery side. Now, we have to change. And we have to change because the aspirations of these organizations on how to use this technologies couldn’t be more different than where they were even five years ago. Every health plan has to offer an urgent care benefits to its membership. Every employer has to offer health, you know, telehealth urgent care benefits. But health health plans are rethinking primary care altogether. Health Systems are thinking about how their clinicians can cover for services over technology rather than be staffed into a floor of every building in every one of their campuses. The the the notion of how we surround patients that are at risk, before they get into a hospital after they leave the hospital during the time where they are under readmission risk, or whatever it is, all of these conversations are now being held at the boardrooms of all of these organizations. And what we need to do is to understand where the puck is going to be. And I would say that if there is any attributes that I would I would use to characterize where that puck is going to be is that it will not be an end product, these technologies will become foundational platforms of how healthcare is being rendered, just like other foundational platforms in healthcare like EHRs, claiming the eligibility systems payment system, prescription routing systems, and so on. These are all domains of technology on which healthcare lives in digital care delivery platforms, which is my better way of describing telehealth these days. I think he’s joining the ranks of those as a foundational platform. It needs to be built completely differently because of it.
Nick van Terheyden
So as I listened to you, I think, you know, it’s not it’s no longer telehealth, or you know, digital health delivery, but just health. It’s part of that care setting. premise that you described, you know, very succinctly as the appropriate delivery of care in whatever channel Um, is the appropriate channel. We can’t put to the side the issue of the regulatory and the the billing and so forth. Because that’s still going through its ruminations, we see a little bit of this push pull, the floodgates are open. Now people go, Oh, you know, maybe it’s different. How do you see that developing?
Roy Schoenberg
If you ever, if you ever took a bet on how speedy the government is going to be, I think you pretty much kind of always lose. I think the, like, put it this way, I think there’s a silver lining. Historically, regulations moved with the decision making and the alignment and the consensus of the people that did healthcare, the doctors, the hospitals, the health plans, you know, and so on Medicare and et cetera. And he took a while every change took a while. Glacial is the word. I think the difference here is because these technologies uniquely represent a completely different kind of healthcare experience to patients, we will be so much better off in the way that we experience healthcare, if these technologies were allowed to take their rightful position in the delivery of care. There is the notion that we’ve never heard in healthcare, which is popular demand. This is going to be driven forward by people that say, it makes no sense for me to not be able to get the health care I need, because I live across state line. And on the other side is the oncologist that I need to see. And nobody will persuade me that we are all better off by preventing me from getting the care that I need. These are the kinds of arguments that you never heard in healthcare before. But it is the power of the people that is going to move this technology forward. And frankly, I think like the French Revolution, it’s unstoppable.
Nick van Terheyden
I have to say, I applaud that perspective, and, you know, concur, 100%, the idea that you can put this particular genie back in the bottle, and explain to anybody that you know, that really expert individual who knows my case, my individual details, because he lives in a different state can’t be seeing me through whatever means is, you know, quite frankly, unacceptable. And I like that popular demand is going to drive drivers towards that. So given that as the sort of undercurrent, what are you excited about for the coming months?
Roy Schoenberg
I think we are literally just crossing we’re going over a corner, where we think of these technologies as a way to do health care, on our phone or in our home. So we think about it as a change in the place where healthcare happens. The part that I think is more exciting, is when we think about these technologies, changing how we are surrounded by healthcare, healthcare itself, the practice of medicine, is going to change the arrival of automated care, automated companionship, digital companionship in the home, those are things that are unraveling right in front of us. And I’m excited because I have a hope that when I grow old, that is going to be how the world will surround me with what I need. And I think we’re seeing this happening. So we’re lucky to be here. Yeah, I
Nick van Terheyden
concur. I always express this that, you know, my desire to, I don’t want to say fix the healthcare system, because I bristle a little bit when people say it’s broken, it’s not broken. It’s working as designed, we need to change the design. But it’s not an entirely altruistic notion. I’m looking for it to be fixed so that I have an opportunity to access the care that’s necessary as I need more and more of those services. And, you know, as you describe it, I think this popular demand and, you know, once again, it’s this silver lining, I hesitate to say it from the pandemic that has pushed us forward. And founders, you know, in this position that says, what we did before is unacceptable. And this is the way that we move forward. I’m excited with you, Roy. As usual, we’ve run out of time. It just remains for me to thank you for joining me on the show. Thanks for joining me.
Roy Schoenberg
Thank you, Nick. Thank you for having me. It’s a pleasure to be here.
