By JESSICA DaMASSA

There are few better positioned to speculate on what’s next for telehealth than Roy Schoenberg, co-CEO & President, of Amwell. After 15 years, more than $710M in total funding, and probably the best analogies out there for describing telehealth’s potential as a disruptive technology, Roy weighs in on just how unprecedented COVID19 has been for the uptake and evolution of virtual care.

“Historically, people thought, could telehealth be as good as a physical visit? The reality of COVID,” says Roy, “has literally opened the door to the question, can telehealth be better?”

From the near-term “new wave” of telehealth that has already begun to “eclipse the urgent care telehealth” to how Amwell’s clientele of clinicians, healthcare delivery systems, and payers are shifting to accept the idea of the technology as “the start of healthcare,” Roy talks of a future of telehealth that is “entrenched inside the system.” And how Amwell is meant to act as “facilitator.”

“When we start thinking about telehealth as a switchboard — not as a product, but as an infrastructure for the redistribution of healthcare — we’re talking about a completely different experience for us as Americans on what healthcare is available to us and how we can consume it.”

“To me, and I’ll fast forward to the end here, we want to get to the point that telehealth changes our expectation when we grow old as to where we can grow old. We want to be in a place where we can stay at home…where we don’t have to be in the ‘belly of the beast’ to get healthcare.”

How far away is this future that Roy describes, midway through telehealth’s biggest year yet? Is the appetite there among incumbents? And what of those Amwell IPO rumors? How might that kind of funding help rush things along? Tune in to this episode of ‘WTF Health – What’s the Future, Health?’ with Jessica DaMassa to find out.

Full Transcript of the Interview:

Jessica

Hey, it’s Jessica DaMassa with “WTF Health – What’s the Future, Health?” We are getting insight scoop on everything happening in health tech from some of the biggest names in the industry. And so what conversation about telehealth would be complete without this guy right here? We have Roy Schoenberg. He is the president and co-CEO of Amwell. Roy, it is so exciting to talk to you. How are you?

Roy:

Thank you. It’s great to be with you, Jessica.

Jessica DaMassa:

Oh my gosh, I can’t imagine how busy you must be.

Roy:

We don’t complain. We can’t complain. Telehealth seems to be the name of the game right now. So we’re riding the wave, I think with many others, but it is a big time for telehealth.

Jessica DaMassa:

Oh my gosh. Okay. So I want to hear all about exactly what kind of a big time this is. And Amwell… obviously, your company, you’re one of the leaders in this category and there is lots of news going on about not only the industry, but also about Amwell. We’ve heard some IPO rumors that we may or may not address later. You guys closed a massive funding round, $194 million in May. So tell me a little bit, I guess about, let’s start with what’s going on. So what have you been putting that funding to use for so far?

Roy:

Well, I’m sure that everybody at this point is a little bit aware of the role of telehealth in COVID. It started off maybe even four or five months ago as the thing you use for convenience maybe to, in the middle of the night, if your child is crying or you have a rash or a flu to get a simple antibiotic. And it has literally almost overnight became the first line of defense for everything in healthcare. Not only that most Americans, especially during March and April, and now actually more so in some parts of the country, were asked to stay at home and socially isolate. And not only that they were concerned about COVID, but anything else that they had going on in terms of healthcare, all of the places that you would normally go to get healthcare were locked up, physician offices and urgent care centers and retail clinics. And nobody wants to be in a waiting room of a hospital right now. All of these disappeared.

Roy:

At the same time, a lot of the clinicians of all the different disciplines were also home. Many of them were told, “You can’t come in if you’re a primary care physician or whatever it is, you’re going to be isolating, sheltering in place as well.” So they were stuck in their homes. And the reality is that at that point in time, telehealth became from a novelty or from something that people thought, “Oh that’s a good way for healthcare to modernize,” became almost overnight the only way by which clinicians could do their job and practice their art and do what they were responsible for doing with their patients. So literally within the course of a couple of weeks, we have seen an incredible, we call it unprecedented, the title where fill in the blanks in terms of what kind of giant word you want to put in there.

Roy:

But we’ve seen an incredible, incredible hiking in telehealth. It started off with a wave of urgent care telehealth, which everybody’s familiar with. That was, and it is still about 10 times what it was at the beginning of this, some time in March. But I think more importantly, we’ve seen an entire avalanche of a new kind of use of telehealth where clinicians who actually have a relationship with patients with chronic patients and cancer patients and so on, physicians who are in a hospital are now using telehealth in order to support, maintain, and follow up on those patients. And that wave of telehealth has somewhere along the way eclipsed the urgent care telehealth, which was the name of the game just until February or March. And that has grown in some cases 30 times, 40 times the volume that it was a couple of months ago. And what people say is that this, I think the term is that that genie is not going back in the bottle or that toothpaste is not coming back into the tube. And that really is forcing everybody to completely rethink how the healthcare system should operate in a world post COVID. So it’s definitely been a fun time in telehealth.

Jessica DaMassa:

All right. I want to unpack some of this stuff, because you said a lot there. I want to address this toothpaste that has come out of the tube. I don’t think I’ve heard that one yet in reference to telehealth. That’s pretty cute. And so I want to go back though to what you’re talking about in terms of how unprecedented this is. And I would like to get your input on this. Amwell is a company that’s been around since the beginning. You guys have birthed the sector more or less with a few others. 15 years, is this really as unprecedented a time in telehealth as we think it is?

Roy:

Yeah. So you really can break it down to a lot of the historical barriers of telehealth, which I think everybody has heard about over and over again, so they’re not that interesting to repeat. Reimbursement, licensure, all of that kind of fun stuff. I think we’ve seen over the last couple of years a growing acceptance of telehealth by consumers, funnily enough, who are for lack of a better word, are open to embracing technology that makes their life better. So there was less of a concern there and that worked really well. The part that really, really changed is actually on the clinician side of things.

Jessica DaMassa:

Tell me more about that.

Roy:

That’s kind of a little bit of an unusual observation, but I would say that historically, and that’s true for us and for Teladoc and for other companies as well, most of the telehealth that’s out there in terms of volume that’s doing urgent care is utilizing clinician services of clinicians who are participating in telehealth programs. But the vast majority of healthcare doesn’t happen with the clinician that are on our network or Teladoc network or whatever it is. Most healthcare happens by clinicians who are in their offices in the hospitals and everything else. And for the most part, adoption by them has been growing steadily, but nothing to write home about. Nothing that is a headline in the newspaper. That changed.

Roy:

And the reason for that was that almost overnight, a lot of the health care institutions, we don’t think about it when we think about COVID, but a lot of the health care institutions out there, the way they survive is by essentially doing patient encounters, which translates to a lot of fun stuff like claims, submissions, and adjudication and everything else, but that’s how they get paid. And that’s how they pay for the buildings and everything else.

Roy:

And that disappeared overnight. So suddenly the financial reality of the healthcare industry that is tightly driven to the volume of patient encounters was under an existential threat. And the translation of that was, it is no longer to be the discretion of everybody to decide if they want to try it out or taste it and maybe opine on it and maybe try it on a Sunday afternoon when they have time. We have to, as an industry, transition to telehealth to survive. And that drive to telehealth has a completely different kind of firepower than the curiosity about telehealth. And the result of that is that the number of clinicians around the country that have been not only exposed to telehealth, but have been literally asked to transition everything they do into telehealth in order to continue to work in the institutions that they belong to, that has forced a completely different adoption curve of telehealth to clinicians.

Roy:

And the one thing that we all know, like it or not, healthcare is driven by the clinicians. We as patients, we actually do as we’re told. We’re probably the one person that it doesn’t matter how strong our character is, when we sit in the doctor office and the doctor tells us, “This is what you need to do,” we say, “Yes. Okay. That’s what I’m going to do.” So the reality is that a lot of healthcare is really driven by the physician’s decision of what’s the right thing to do next. And the fact that physicians now, in huge numbers, are telling their patients to use telehealth, that is a very different reality than before COVID. And to me, that is kind of the secret ingredient of why that toothpaste is not coming back.

Jessica DaMassa:

Okay. How do you make sure that that stays the case? How do you prevent these clinicians from going back? Right now they’re more or less, as you said, they’re forced to deliver care this way because inpatient visits are not necessarily an option, especially in some places that are hotspots. So how do you make sure that their experience with telehealth right now is so sticky that they want to stick around and continue to provide telehealth or deliver certain kinds of care via telehealth services, as opposed to returning back to the same old office visit and what they’re comfortable with? How do you do that?

Roy:

I think, maybe to be a little bit humble about it, I actually don’t think you can make clinicians do anything. Or maybe that’s an exaggeration, but for the most part-

Jessica DaMassa:

Spoken like a true clinician, right?

Roy:

Well, years ago when I was doing clinical care, but the reality is that what they do is driven from true good motivation of, I want to do something that is the right thing for the patient and something that allows me to sustain my ability to care for the patient long term, which is to maintain a practice and have a life and everything else. And it is the balance of those that at the end of the day drives what they do. I think the reality is… it’s not about, payment is important. Of course you have to pay clinician for the work they do like any other person that works.

Roy:

But I think that the experience the clinician had over COVID is that their ability to interact with a patient is so gratifying and liberating to the patients that they care about, that it is going to be almost unreasonable for them to withdraw those services and say to patients, “Hey, even though you are 82 and you’re frail, and you have all of these different things that make it really hard for you to keep the cadence of followup that we need to do to take care of you, and even though we actually did it really, really well over the last three months in telehealth, take the bus.”

Roy:

At some point, that doesn’t make any sense anymore. And when all the pieces of the puzzle that are necessary, like making sure that it is encrypted and secure and making sure that it is paid for and making sure that it is tied into the EHRs and it’s tied into the scheduling system and how my staff as a clinician can support me in handling patient. When you’re taking all of these barriers out of the equation, which many of them have been taken out of the equation, you’re left with a, I don’t call it a humanitarian or human question of, how can I say no to this when this is such a powerful way to make the life of my patients better?

Jessica DaMassa:

Yeah.

Roy:

And that will resonate differently with different people. But I think at the end of the day, this isn’t about Amwell persuading people. It just makes sense. And that’s very powerful.

Jessica DaMassa:

No, it is very powerful. And I’m curious too, as you talk about some of the things that have traditionally provided barriers against uptake have been kind of lifted in all of this. And I think it’s interesting to hear you talk about what you feel like individual clinicians are learning about telehealth as a result of having some of those old constraints lifted. What are some of the other things that you have been learning about the appetite for telehealth, maybe on the consumer side, or I know that private practice product that you guys just launched is giving you kind of these insights into the physician part of things. But you’ve got a lot of health plan clients. I mean, some big health plan clients, and you guys have big healthcare provider clients as well. So what have you been hearing on that side? What new things have been revealed now that the restrictions have been lifted on that side of the world as well?

Roy:

So where do I start? How much time do we have? I think we are, as I said, we’re in a very unique position. I think very unlike many of the other telehealth operators out there. The difference with us is that we’re kind of equally footed. We have one very strong foot on the consumer, employer, payer side of things, and we serve big chunk of the country there. And we have an equally strong footing on the clinician side of things, on the provider and practice, and very importantly hospital and delivery network and health system part of things. And the systems are actually built to bridge the two. Now, this isn’t the pitch for one architecture or another, but the fact that we are essentially being a conduit between the patient side of things or the consumer side of things and the delivery side of things opens up the door to real opportunities that we never thought about.

Roy:

So for example, I can tell you that we are turning a corner in thinking. Historically people thought about, could telehealth be as good as a physical visit? For more than a decade, that was the name of the game. Can it be safe and good enough and whatever it is? The reality of COVID has literally opened the door to the question, can telehealth be better? And the reason for that is not to say that a remote physician is better than a physician that’s in front of you.

Roy:

But rather to say if we think of the way that we envelope a patient that has a serious medical condition and we throw telehealth into it so it allows us to, for example, check up on them for a couple of minutes, three times a week without actually incurring office visits and the whole hoopla that goes around that. Does that allow us to actually be much more attentive to the changes in their condition? Maybe changing their medication more frequently, to understand if there are side effects. If they have cancer, can support them by other ways… by way of nutrition and behavioral support and everything else. Can we actually rethink the way we surround patients with healthcare in the presence of telehealth that will allow us to change the cookbook of medicine, medical practice?

Jessica DaMassa:

Yeah.

Roy:

And I know that this sounds almost pithy, it’s almost kind of high level, but the fact that this conversation is literally now carried in both the health system side of our customers, as well as on the payer side, the health plan, side of our customers, who are saying, “Let’s actually kind of not throw telehealth as an added thing into everything that we offer. Let’s actually think from the ground up and say, maybe telehealth is the start of healthcare. Maybe that is the gate by which people enter when they have an issue.” And I can tell you that that translates into some really astounding conversations, both on the delivery side of healthcare as well as well as on the care side.

Jessica DaMassa:

If you want to gossip about those astounding conversations, feel free to let us know what you’re thinking there. One question I have for you is, I guess from your perspective, what’s the next iteration of this then? You talked about this as like, okay, if this is the way in to developing a better opportunity for care delivery for patients, we’ve been hearing all sorts of things. Just earlier this week, Glen Tullman published on it, an article about this “consumer directed virtual care” as he’s calling it, talking about how telehealth is important, remote monitoring has a place, but there’s also this kind of other set of services that get added on there where we’re looking at data and things are ambiently collected so that patients can kind of take initial steps to prevent things from going wrong before we get there. What do you think is going to get added on to telehealth in order to make this new care delivery model really come to life? What’s the next thing in terms of what you’re looking at right now?

Roy:

So I think, maybe to use an analogy here, and I’m sure that people are sick of Amazon analogies, they’re used everywhere. But, Amazon started by selling books and it was actually a very brilliant choice by Jeff Bezos at the time, because he really kind of introduced the notion of online retail in many ways, and books are a great product to flush the pipes with. They don’t go bad. You know what you’re getting. You ship them, you can track them, you can pack them, they’re square. You can actually pack them very neatly. And he figured out the notion of FedEx and credit card billing and PSI, all of the different kinds of compliance elements and returns. So it was a really, really good way to flush the pipes of online retail.

Roy:

And then he extended it into the store that sells more things. And then further went into the third stage, which is now Amazon sells stuff that actually are not in Amazon warehouses. You have a lot of things that you buy from end producers of merchandise that goes through Amazon to you, but Amazon is not the one fulfilling it.

Roy:

Funnily enough, I actually think that telehealth is going to go exactly through those stages. History tends to repeat itself. Urgent care was the books. It’s the way to get everybody comfortable. It’s not very sophisticated medicine. It’s not life threatening to anybody. It’s convenience. It’s simple. No big deal if it didn’t work very well. Of course, it needs to work very well. But it’s a really, really simple kind of product to get people to feel comfortable. Then, the next step was a lot of the delivery side of healthcare – big  health systems are starting to use telehealth with their own patients that’s a little bit more like the Amazon store that has a lot of Amazon products in its facilities and sends it to patients. So that’s where we see a lot of health system.

Roy:

But the third step is the one that is the most exciting, which is, if we’re able to connect the pipes and make this feel like a network – which, by the way, the technology is built like — we’re able to have a completely different understanding on how healthcare services can travel. Which opens up the door for things that historically we never thought about, like load balancing of healthcare around the country. Think about places in the country that are flushed with healthcare, with good healthcare, and areas around the country that are not necessarily flushed with them. Think about areas that are devastated by hurricanes and fires and viruses. Think about the notion that there are cancer patients in certain parts of the country that don’t have the knowledge of how to treat cancer that exists in large metropolitan areas.

Roy:

When we start thinking about telehealth as a switchboard — not as a product, but as an infrastructure for the redistribution of healthcare — we’re talking about a completely different experience for us as Americans on what healthcare is available to us and how we can consume it. To me, and I’ll kind of fast forward to the end here, what that translates into (and I think that’s the part that I’m personally very, very passionate about) we want to get to the point that telehealth changes our expectation when we grow old as to where we can grow old. We want to be in a place where we can stay at home, where we don’t have to be in the belly of the beast to get healthcare, and all of the different disciplines surround us, rather than force us to go and seek, and, worse, try to patchwork the different disciplines that we need to see. I think that opportunity is right in front of us. And in that sense, telehealth is going to work like retail and it’s inevitable. It’s not me or you or Amwell or anybody else. I think that train is out of the station.

Jessica DaMassa:

All right. I am going to turn your analogy on you, my friend.

Roy:

Sure.

Jessica DaMassa:

And I’m going to ask you if all right, if you’re going to make an Amazon analogy here, to telehealth, right. So if you’re the Bezos here.

Roy:

I didn’t say that. [laughter]

Jessica DaMassa:

I am just saying if you’re…[laughter] Clearly, there’s only a handful of companies that I think at this point, right now, have the capital, the size, the scale, and the reach to be considered the Amazon of telehealth.

Roy:

I think the reach is important.

Jessica DaMassa:

Yeah. Right. Okay. Fair enough. Okay. But I’ve got you here with me right now. And so I’m curious, especially, and not to go… I know you can’t comment on the IPO rumors one way or the other, but the fact that they are there, I think indicates something about the market for this and where things are going potentially next. So as far as you’re concerned, you’re at the helm of this Amazon-like empire here that could completely redefine the way that we grow old in the future. What are you looking at next for the business? You have a lot of funding right now. You’re growing. Things are going well. We know you’ve launched some new products, like I mentioned earlier, that physician private practice one, which I think is very cool. It’s like a Shopify almost for telehealth in terms of private clinician practices. But where do you have your sights set then in terms of what’s next for Amwell?

Roy:

So I think you actually kind of hit a lot of different of the important kind of things on the head there. First of all, and I can’t comment about IPO rumors or whatever it is, I’m aware of the fact that they’re out there. And it’s great to be in a position where people can talk about those kinds of options, because telehealth is real.

Jessica DaMassa:

Yeah, exactly. Yeah.

Roy:

The adoption curves and the volumes and everything else and, literally, from the Rose Gardens through HHS and Medicare and everything else, telehealth is the name of the game. Which of course makes companies who do telehealth be in the center of things, which of course opens up a lot of opportunity. And you mentioned our funding and so on. The one thing that I would say, however, is that this is also the point where you can make mistakes. You have an avalanche of adoption and we fully feel the responsibility to make sure that we are actually not the bottleneck, that we are the facilitator. We’re the ones that allow natural evolution of adoption of that technology to happen. And if we do a good job, then we actually don’t matter that much. We’re in the background. We are allowing clinicians and patients to interact naturally. We facilitate that under the hood, but it’s not about teaching people how to use Amwell.

Roy:

To do that, that’s actually very, very hard to do. That’s kind of the transition, and I know I use too many analogies, but that’s a transition of when Google was a search engine to “Google” becoming a verb, right?

Jessica DaMassa:

Yeah.

Roy:

You don’t think about it, you Google stuff. And I think that is something that we see on the horizon, where telehealth becomes part of the natural way in which patients and clinicians interact. To do that, however, you have to care about the details. You have to really, really understand clinician workflow. You need to understand their reality. You need to understand the rules of engagement that are very complicated in healthcare. And to do that right, to become transparent, there is tremendous amount of investment that needs to go into there. And that’s a lot of the stuff that we’re doing. You mentioned some of the new products that were introduced.

Roy:

At the end of the day, there is a common theme between all of these, which is try to assimilate into the reality of traditional healthcare. Not create a product, an app for urgent care, which is a godsend when you need it, but is sitting aside of the regular healthcare delivery. But rather be entrenched inside the system. That’s a very, very significant lift. We would not be able to do it unless we were, as I mentioned, equally nested on the payer/consumer/patient side of things, as well as on the provider delivery side of things. But that is an incredible opportunity that we have in front of us. And we’re very serious about that.

Jessica DaMassa:

How do we not mess this up? Because you started that by saying we don’t want to, with all the eyes on this and this opportunity in front of us. And just even listening to you talk about everything up until this point in terms of how thinking around telehealth has changed and the conversation has shifted. So how do we not mess this up? And I say “us,” not just the telehealth companies, but even more broadly, the other health tech companies that are maybe in things that are adjacent? Digital health, digital therapeutics, remote monitoring. How do we not mess this up right now?

Roy:

I think we have to listen. Which is really important when you deal with healthcare. And I think it’s really important to always take a step back and ask yourself if what you’re doing is actually going to move the needle on where it matters. You can move a lot of needles, but for example, I’ll be the first one to tell you that I think that the application of telehealth for urgent care is really, really important. But the vast majority of healthcare paying and expenditure and volume is not in the flu, it’s in diabetes and heart failure and what Glen is doing and some of those things, and maybe that helps Glen in some way. But I think that the reality is we need to look at where healthcare happens, tough as it may be, and find a way for technology to weave into that and give it wings. And if we’re able to do that, then we’ve moved the needle on people’s right to expect better health care experience going forward than what was before. And we are seeing that happening in front of our eyes.

Jessica DaMassa:

All right. Last thing for you, toothpaste back in tube, what do you think? No? Yes?

Roy:

No.

Jessica DaMassa:

Are you sure? No, it’s not going back.

Roy:

It is not.

Jessica DaMassa:

This is it. This is here to stay.

Roy:

This is here to stay. Yes.

Jessica DaMassa:

All right. Well, you have to come back and talk to us if there is any news in September that we had heard, you have to come back and talk to us, even if you acquire something cool. I would like to hear about it.

Roy:

It’d be a pleasure.

Jessica DaMassa:

Thank you so much for letting me pick your brain.

Roy:

Happy to come back whenever you want.

Jessica DaMassa:

Fantastic. And I have to say, I really like that little Amwell throw pillow behind you.

Roy:

Oh yeah.

Jessica DaMassa:

That is super nice. For a big pillow fight later, right? Right. Thank you so much for stopping by and letting us pick your brain. It’s so exciting to hear about your vision for the future of the sector of the industry. I really can’t thank you enough. Thank you again for joining us. I’m Jessica DaMassa here with Roy Schoenberg, the co-CEO and president of Amwell. Thanks to everybody for watching. We’ll talk to you guys soon. Check out more of these videos up on wtf.health, or find me on YouTube. Just search WTF Health. Thanks so much for joining us.

Roy:

Thanks everyone.