Dr. Roy Schoenberg, CEO of Amwell: 2020 is the year telehealth will mobilize healthcare

Back in the 1990’s I was charged with building Massachusett’s first secure network for public schools and municipal government, MCN.  Those were the Weld / Cellucci days, in which now Governor Charlie Baker ran the state’s day-to-day operations as the Secretary of Administration and Finance. It was a time of smart, Massachusetts-style, Republicans.  And one of the places they gathered was The Pioneer Institute. They are intellectually rigorous, data-driven thank tank that advocates for policy solutions using free-market principles, individual responsibility, and the ideal of effective, limited, accountable government.

Though I’m no longer part of the state’s educational technology leadership, I’ve listened to some episodes of their education policy podcast, The Learning Curve. A few weeks ago they launched a second, more general interest podcast with a Boston focus: Hubwonk. This week’s interview of Roy Schoenberg, the CEO of Boston-based telehealth pioneer Amwell, provides an insider’s look at the remarkable changes in telehealth use that have taken place during the global response to Coronavirus.

In this episode, Dr. Schoenberg recounts Amwell’s founding story, and how they’ve responded to a 30x (yes 3,000% growth) in their service’s uses in less than two months. I’ve been part of very fast product growth, such as MCN….but enduring this kind of growth curve is amazing.  You can listen below, or skip forward to key takeaways which I’ve time-marked and commented below.

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Time-marks and show notes:
4:50 – while Schoenberg had run a medical portal company, and publishers like WebMD were already influential, Amwell’s vision was to provide transactional medicine to “help patients get things done.” Disruption in other industries such as travel or banking shifted the transactional pattern of basis interactions. Amwell aspired to innovate at that level in medicine.

6:00 – their first customer was BC/BS of Hawaii – which makes sense because medical capabilities are segregated together even though its people are spread across islands. I personal think its important to remember that telehealth was originally created to distribute care to rural populations. Many of these systems may be financially damaged or closed by COVID19 disruptions — so as telehealth goes mainstream, its imperative that we make sure it works as well as possible for these original rural stakeholders.

8:50 – the state of play has gone beyond making the case for telehealth as necessary. The focus is now on finding ways to improve care by adding elements of technology in to the service design of healthcare.

10:35“we have seen the use of telehealth on our system jump thirtyfold.” Schoenberg observes that in COVID19, telemedicine is both enabling patients to receive care from home and its enabling doctors to practice from their homes. Once people know they can do that, it rebaselines their expectations for technology in care.  This is like the apple of knowledge in the Garden of Eden, once people know that care can be done this way its easier to demand it.

17:30 – what policy changes must be made, or be made permanent after COVID19 to support adoption? Cross-state licensure and Medicare must generalize telehealth’s use and simplify its payment requirements. Aging populations have a high need for the convenience and access of telehealth, and burdensome regulations result in a social injustice when they aren’t able to access care in the ways they need to.

24:00 – think of telehealth as a care setting. Not all procedures are right in your doctor’s office. Just as they determine proper care settings, they can determine when telehealth, phone calls, remote monitoring or other technology are the most useful. And this desirability may change patient to patient. In some cases, people face mobility challenges or require telehealth so they can remain living in their own homes. These are highly motivated consumers – and making telehealth work can improve lives and often allow lower costs treatment. “The place where we’ll see the biggest difference is in aging.” Telehealth will allow us to stay home much longer, because much of the monitoring and interventions we need will be possible where we want to be.

31:20 – post-show the hosts discussed the unintended consequence of laws that require the same payment for telehealth and in-person visits. In-person visits usually carry far more overhead expenses, which makes telehealth a potential higher margin of transaction. Though that will encourage telehealth adoption, it also prevents substantial savings to consumers, and effectively builds in a high-cost base for care at the exact time policy leaders are seeking ways to prevent healthcare from absorbing more of family incomes and GDP.

A few weeks ago I wrote on how important telehealth will be in the global recovery from Coronavirus, and my impression that the pandemic will be an inflection point in telehealth adoption. Dr. Shoenberg’s role as a pioneer and leader of a major telemedicine service is as informed of view of this space as one can have. Taking a page from the 1960’s – 2020 is the year people will sign-up, sign-on, and get more of their care online.

 

 

 

 

 

 

 

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