Stealthy telehealth startup Wheel just closed a $50M series B and CEO Michelle Davey is here to reveal the mystery behind the company’s very behind-the-scenes approach to selling white-label virtual care. The business model is built on a network of clinicians that Wheel has curated and credentialed specifically for virtual care delivery – for a rotating cast of clients, under any brand, at any time. Unlike the market-leading incumbent telehealth co’s that also sell virtual care infrastructure, Wheel does NOT have a patient front door, isn’t angling for one, and is so protective of its clients’ brands that Michelle won’t even name names about who her company is working with. She simply describes her clientele as those in the biz of “next gen” virtual care: retail players, care-plus-pharmacy-delivery startups, asynchronous care providers, labs, remote patient monitoring companies, and so on.
Wheel experienced 300% year-over-year growth — and 1200% growth from Q4-2020 to Q1-2021 — but is it sustainable as the pandemic wans and other plug-and-play telehealth infrastructure services also gain market traction and funding? And, what about the common criticism that telehealth is too transactional and that both patients AND physicians prefer the opportunity to build deeper relationships? Do providers really want to practice for multiple companies at the same time? We get a look inside Wheel’s 90% clinician retention rate to see what else might be satisfying the clinician’s need to connect, and talk about areas for growth now that the company’s received fresh funds.
“We have to look at telehealth as an operating system.” Amwell ($AMWL) President & CEO Roy Schoenberg has a way with analogies, and some of his best land in this interview as we get a highly detailed, insider’s perspective about how payers and health systems are rethinking telehealth as a result of their experiences during the pandemic.
Bottom line: The pandemic taught us that telehealth can be used to deliver a much wider variety of healthcare services than just urgent care and, so the whole idea of ‘telehealth’ is changing from healthcare product to healthcare infrastructure. Mental health care, physical therapy, medication management, primary care, and more have all moved to telehealth and, along with that shift, the “rules of engagement” around those services have started to change.
Payers are looking to become the “digital front door” for their members – providing primary care and navigation. Health Systems are increasingly looking to use their own docs for urgent care, rather than outsource that relationship and miss the potential to build trust with local patients. And, in all this, Roy argues that healthcare’s biggest buyers have stopped looking at telehealth as a “product” and, instead, are starting to see the opportunity to “rewrite their future” around a view of telehealth as infrastructure, as one of healthcare’s “foundational systems” intertwined with (and as mission-critical as) their EHRs or claims and eligibility systems.
My favorite analogy starts around the 20-minute mark, when Roy explains this operating system idea by drawing comparison to how individual Microsoft programs (think Word, Excel, Outlook, PowerPoint) would be infinitely less powerful if they were not running on the same operating system and able to easily transfer information. Another good one? How both the buying and provisioning of healthcare is being re-thought digitally, just as online shopping not only changed buying habits but also changed supply chain for retailers. If you’re looking to hear the latest on what’s happening in telehealth post-Covid, learn how things have changed for payers and health systems, AND also want to dip into Amwell’s market positioning a bit, you’ll love this deep-dive.
The American people can’t afford partisan politics that increase long-term healthcare costs.
When the GOP came to the table with a $1 trillion infrastructure proposal last week, I was pleased to see that they had increased funding for broadband access to $68 billion.
The President wants $100 billion for broadband expansion, but a meaningful increase before the soft deadline of June 7 was a positive step.
Politics aside, the pandemic made it clear how dependent we are on the issue of broadband internet access.after all, broadband underpinned nearly everything that was done to keep the economy on life-support during the lock-downs.
Without broadband access our ability to deliver education, run most businesses, and (most importantly) deliver healthcare, would have slowed to a glacial pace or – in some cases – ground to a halt.
The fact that the healthcare industry was able to make a lighting-speed pivot to telehealth during the COVID epidemic shows how quickly the government, insurers and providers can respond to deliver needed care. But, that pivot also exposed how social determinants of health, like economic stability and the built environment, still present serious challenges to care delivery for our most vulnerable populations.
“Telehealth has a much bigger role to play than just carrying out transactions,” says Amwell’s President & CEO, Roy Schoenberg, who joins Jess DaMassa for a sweeping philosophical discussion about how telehealth’s role will continue to evolve through the covid19 pandemic and the changes its forced on the healthcare market. Conversations about telehealth that were once about the value of improving “access to care” are now about the technology’s potential to drive “quality of care.” And Amwell – which says it is a “technology infrastructure company” focused on helping traditional healthcare players transition into digital distribution – is pushing past the old notion that virtual care is merely a “product to get a Z-pak.”
Roy gives us updates on Amwell’s much-buzzed-about partnerships with United Healthcare and Google, the later being focused on how the telehealth co is looking at integrating some of those famous Google technologies (think natural language processing, translation, and geolocation-ala-Maps) into virtual care delivery in a way that sounds like a lot more than just a “switchboard.”
Two other colorful Roy Schoenberg soundbites to tease you into this conversation about the immediate future of telehealth from the leader of one its biggest players: 1) “the notion that we are no longer looking at the home as an illegitimate place of care is drama in in every sense” and 2) “I think the next war-zone, the next place where there’s going to be a lot of heated confrontations and conversations, is state licensure.”
Looking for more proof that telehealth has truly become a global trend in healthcare delivery? Our “man-on-the-street” in Italy, Roberto Ascione, CEO of Healthware Group, offers a detailed state-of-play on virtual care uptake across Europe, including how policy-makers, entrepreneurs, and investors are playing much more significant roles in spurning an increasingly “digital friendly” healthcare ecosystem in the wake of covid-19. On the eve of Frontiers Health 2020 — one of Europe’s leading health innovation conferences, of which Roberto is Chairman — we find out how those backing healthcare’s quickly evolving “tele-everything” revolution are planning to come together to push this agenda even further.
Note: Frontiers Health takes place THIS WEEK, on Thursday November 12 and Friday November 13. Check out the full agenda at www.frontiers.health. Fans of WTF Health get a discount! Just use code FH20WTF25 for 25% off registration fees. See you there!
It’s the telehealth market reality check you’ve been waiting for! “Rogue” digital health consultant Dr. Lyle Berkowitz unpacks the numbers and the market potential for virtual care from the unique vantage point of a primary-care-physician-turned-health-tech-entrepreneur with nothing to lose. Having been 1) a clinician, 2) the Director of Innovation at Northwestern Medicine, 3) the founder of a health tech startup (Health Finch) that successfully exited to Health Catalyst, and 4) the former Chief Medical Officer at one of telemedicine’s biggest players, MDLive, few can boast such a wide-reaching, deep understanding of the inner workings of both the innovation and incumbent sides of the virtual care market — AND have a willingness to talk about it all with complete candor!
This is an analyst’s perspective on the telehealth market — with a twist of insider expertise — so expect to hear some good rationale behind predictions about how much care will remain virtual once hospitals and doctor’s offices return to normal, how “real” health system enthusiasm is for building out telehealth capacity to execute on the “digital front door” idea, and whether or not all these well-funded telehealth startups will have what it takes to win market share from traditional care providers.
BONUS on Primary Care: Is this the area of medicine that’s going to be the “battleground” where digital health and virtual care companies will be going head-to-head with incumbents for market share? Lyle says 50-plus percent of primary care “can and should be automated, delegated, virtualized, etc.” and boldly predicts that in 10-20 years we won’t even have primary care physicians anymore. Tune in to find out why starting at the 8:00 minute mark, where we shout out Crossover Health, Oak Street Health, Iora Health, and more.
Telehealth die-hards, don’t think for a second I’d miss this chance to also get some input on Teladoc-Livongo, Amwell, Doctor On Demand, SOC Telemed, the impending IPOs there, digital first health plans, virtual primary care, health systems (who Lyle hopes “don’t shoot themselves in the foot” with their opportunity to jump into the space) and, ultimately, who’s really going to ”WIN” in virtual care moving forward. For this, jump in at 17:00 minutes and hold on!
JUST before the Teladoc-Livongo merger was announced, I had a chance to catch up with Doctor on Demand’s CEO, Hill Ferguson. The future for telehealth, he said, is “bright green” — and I’m pretty sure it’s looking even greener now! Doctor On Demand has stood out among telehealth companies for being particularly early on virtual primary care and it sounds like they’re going to continue developing that line of business — in which they have key partnerships with Humana and Walmart — with the $75M series D funding they just received.
Add to that a brand-new, first-of-its-kind telehealth program for the Medicare Part B population, and crazy consumer-focused type UX features like same-day scheduling for behavioral mental health care (yes, that’s right, dynamic scheduling for healthcare is here, folks!) and you can start to see how DOD is strategizing to pull away from the pack.
With the competitive landscape shifting, especially after Teladoc-Livongo, how does Hill view the onslaught of new entrants like digital health companies who added telehealth in reaction to the COVID-19 pandemic, or potential unicorns like Ro or HIMS, who are focused on tying the prescription drug business into virtual care delivery? It’s the insider insight you’ve been waiting for in this era of ‘tele-everything’ healthcare.
Imagine three months from now when the predicted ‘second wave’ of COVID-19 is expected to resurge and we’re still without a vaccine. Telehealth has become the entry-point to care, widely adopted by patients both young and old. Now, when an elderly diabetic patient wakes up in the middle of the night with a dull ache on her left side and back, she doesn’t ignore the symptom, like she may have during the first COVID outbreak. Instead, she logs online to her local hospital’s website from a cell phone and accesses a simple questionnaire to report her health history and presenting symptoms. The whole process takes just a couple of minutes and she immediately hears back from her health provider with the suggestion to schedule an in-person appointment for further testing to rule out any kidney issues.
This patient doesn’t become one of the nearly 50% of Americans who delayed care during the initial COVID pandemic. She was able to access care without having to download an application or wait to schedule a virtual appointment during normal business hours. She receives virtual asynchronous care on-demand, coordinated to sync with her electronic health record. The next day, she receives a follow-up call from her primary care doctor to ensure her symptoms were alleviated with the over-the-counter pain medication she was prescribed.
I applaud the article written by Paul Grundy, MD, and Ken Terry, “Primary Care Practices Need Help to Survive the COVID-19 Pandemic,” in which they called on Congress to make health policy decisions that will provide immediate financial relief for primary care practices. We must mitigate the real risk we face: the highly possible shutdown of our healthcare system. Amid the coronavirus pandemic, the U.S. healthcare system has taken an enormous financial hit and primary care practices have been especially affected and are struggling to survive. As the authors point out, telehealth has taken the spotlight to fill the acute need for an influx of patients needing to access care under social distancing practices. Telehealth can increase access to care, relieve provider burden, reduce costs to systems, and improve patient outcomes. However, this is only possible with on-demand telehealth, or asynchronous care.
With about one month left on the existing 90-day Public Health Emergency that’s eased regulations and improved reimbursement to help make telehealth, remote monitoring, and other virtual care services easier for providers to implement and patients to use, health tech companies across the US are wondering what it will take to make these changes permanent. One of digital health’s few ‘DC Insiders,’ Livongo Health’s VP of Government Affairs, Leslie Krigstein, gets us up-to-speed on what’s happening on Capitol Hill and what we can expect moving forward. What changes will (literally) require an Act of Congress? And what can be handled by HHS and CMS? From codes and co-pays to e-visits and licensing, Leslie breaks it down and tells us whether or not we can continue to expect a ‘health tech-friendly’ agenda in Washington DC.
Telehealth has been a lifeline for many doctors and patients during the pandemic, and the decisions of CMS and many private payers to cover telehealth visits—in some cases, at full parity with in-person visits–has helped physician practices stave off bankruptcy. Assuming that these policies remain in effect after the pandemic, I agree with the commentators who assert that telemedicine will become a much larger part of healthcare.
Nevertheless, what that means is still far from clear. To begin with, telehealth visits may be adequate for some purposes but not for others. Historically, the technology has been used mostly for diagnosing and treating minor acute problems. Physicians were generally reluctant to take on more complex cases or treat chronic conditions without seeing patients in person.
Pre-pandemic, most telehealth encounters took place between patients and doctors who had never treated them before, using services such as Teladoc, American Well and Doctor on Demand that usually didn’t communicate with the patients’ personal doctors. Some larger physician groups had begun to use the technology with their own patients; but even in those groups, certain doctors were often assigned to conduct virtual visits with patients who were not necessarily their own.
Clearly, the latter barrier has been broken down, with nearly half of U.S. physicians in an April survey saying they were using telemedicine in patient care. While it’s unclear what kinds of cases these doctors are diagnosing and treating, it’s likely that the scope of practice for telehealth has been expanded to include some chronic disease care.
The main barrier to this expansion is that, in telehealth encounters, physicians don’t necessarily have the data they need to make sound medical decisions. To manage hypertension, for instance, the physician needs to be able to measure a patient’s blood pressure. If the patient has a digital blood pressure cuff at home, that data can be transmitted to a physician’s office; in fact, a smartphone app could show the trend of the patient’s hypertension over time. Right now, however, only a small fraction of patients have this kind of remote monitoring equipment.