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Telehealth War Stories

About a month ago, I had the opportunity to sit down with Roy Schoenberg, president and CEO of Amwell, to discuss his recent experiences during the COVID-19 crisis and his perspective on telehealth across the board. By sharing this conversation, I intend to help providers understand some of the current and future state of telehealth—not to endorse Amwell. The following was taken from my discussion with Roy:

Providers are telling us they’ve gone from fewer than 100 consults in a month to thousands—and then doubling that again the next month.

Roy: That is an understatement. We are seeing even more radical movement across the board.

We’re trying to understand the current state but also starting to pivot for the future. Has this crisis propelled the market into virtual care for the long-term?

Some changes are mostly temporary. The incredible spike in urgent care will probably decline when people get out of their homes, when providers return to their practices, and when people aren’t afraid of waiting rooms. There will be a new norm, but volumes will regress. However, other pieces are skyrocketing because providers are now seeing how they can use telehealth with their own patients; that won’t go away. That will probably move the needle more dramatically than anything else and fuel much of the growth in telehealth volume for years to come.

So many barriers have been removed. Clinician willingness, patient willingness, and reimbursements are changing and hopefully improving. We are getting daily requests from vendors saying that they are in telehealth and want to be measured. We want to be thoughtful and not just open the door for anybody.

A big challenge is analyzing and providing feedback on the market. We have to differentiate between different types of telehealth. Lumping things together ends up diluting the value of the insights. COVID-19 has emphasized that; there is a huge difference between what Zoom, FaceTime, and rudimentary video capabilities can do. There is a difference between systems that pool providers together to create immediate availability and systems that are built to allow providers to care for their own patients as part of existing or institutional relationships.

What are some of the biggest changes in telehealth as a result of COVID-19?

The experience of “incoming” patients is on the on-demand side of telehealth. We have seen giant waves of worried Americans who are sheltering at home. Volumes have increased tremendously, and that has translated to a lot of different adaptations for the patient experience, such as AI interaction with the patients and technological advancements that help patients endure wait times.

Being able to do video callbacks (hanging up but keeping your place in line) allows patients to do other things until the physician is ready to see them. That translates to a very different kind of experience and significantly reduces abandonment. In the dark days of March, people were waiting for two hours to get in front of a physician. That dramatically changed patient satisfaction. Even though volumes have only increased since then, we are seeing patient satisfaction ratings that are higher than pre-COVID-19 ratings.

Any technology is built to support some kind of reference volume. A typical rule is to build something that can handle a 100% increase in volume. If you build for more than that, you will be blamed for throwing away money.

The litmus test involves SLAs, uptime, and system reliability. I am very happy to be where we are today. The transition took a village. We had camaraderie across the board. Chuck Robbins, the CEO of Cisco, is a friend. I called him to ask for help. All the supply chains were completely drained, and Chuck said something like, “I have a truck. I’m going to put the servers you need on it. What’s the address to send the driver to?”

Vaughn Paunovich from Optum called up and said, “We’re looking at an avalanche. How can I help?” He sent some of his performance and optimization teams to help us for free. There are many more examples involving Intermountain Healthcare, Cleveland Clinic, Ochsner, and others. Telehealth has become a mission-critical operation, not just a convenient functionality. 

When you talk about what new service and product lines, what have you started and what went to the back burner?

The area that adapted the most was the area where we serve our health system clients. Most of the on-demand care came from the payer clients. But the biggest change was actually when health systems realized that they needed to change how they did business.

Hospitals were transforming to become COVID-19 centers. But there are people with heart failure and cancer that can no longer come to the hospitals or the outpatient clinics. Our health system opened up yet another front and asked their physicians to switch to telehealth. That wave was even bigger than the on-demand telehealth. The scheduled telehealth volume between clinicians and their own patients has increased 4,000%. That is the national average. Some institutions have gone above that.

When people come out of their homes, the volume of urgent care will definitely go down. But with the arrival of follow-up telehealth and the fact that Medicare opened up reimbursement for telehealth, the telehealth revolution is not going away. Physicians will continue to use telehealth for their existing patient populations. That is not urgent or on demand. That is physician-prescribed telehealth, which we have been working in for six or seven years now.

What does a new relationship look like during the pandemic?

People generally understand that enterprise telehealth is not free. When we engage with large enterprise systems, they understand that free means that if they have a problem, they are on their own.

Health systems don’t operate that way. They are focused on introducing capabilities that can adapt to their operations and strategy and that can support their clinicians.

A partnership is a long-term thing. And when it’s crunch time, our responsibility is to help our hospitals and payers and to throw the kitchen sink at the problem.

Have any customer requests been difficult to fulfill? If so, how have you responded?

There was some time when support was needed because the systems were overwhelmed. For the most part, the systems are now adapted.

Currently, the biggest challenge is seeing 40,000–50,000 new physicians on our systems in the course of three weeks. They hit the ground running. They want to do telehealth, and they are all experiencing new-user issues. Users have to do a lot of fussing around when doing telehealth (or using any technology) for the very first time but once they use it a couple of times, they get the hang of it and sail smoothly.

With so many physicians and millions of patients trying telehealth for the first time, there is a customer-support hill to overcome. Some of our customers understood the issues. Others—rightfully so—were too busy saving lives to care. The repeat users are definitely getting to a good place.

As you try to engage with customers and ramp up communication at an unprecedented level, what have you found to be effective (beyond what we’ve already talked about)?

There is a difference between peacetime and wartime. There’s no question that client communication is fundamentally important to maintaining a relationship and serving our customers.

Historically, when something goes wrong, the approach has always been to notify the client and be absolutely transparent. The next communication happens when we understand the problem and what needs to be done. That is because clients want to know not only that we are there but also when the issue is going to get resolved.

Taking time to aggregate information was okay during peacetime but is not okay in wartime. In wartime, people expect more agile communication on the war progress, so to speak.

We had to ask our individual customers what level of transparency they wanted. We got very different answers because people have different appetites for those kinds of things. Telehealth is becoming mission critical, and understanding individuals’ expectations about the frequency and depth of communication has become more important than making decisions about what is right.

We all have our hearts in the right place to really change the way people take advantage of technology to get better healthcare. We are here, and there are a lot of war stories to be told.


     Photo Credit: Adobe Stock, NIKCOA