Telehealth is dynamically changing the way both patients and physicians view healthcare. Nobody knows this better than Roy Schoenberg, co-founder and CEO at American Well. Roy introduced the patented service brokerage technology used by his company, which is currently the nation’s largest telehealth network. In 2013, he was appointed to the U.S. Federation of Medical Boards’ task force, where he helped deliver landmark guidelines for the “Appropriate use of Telehealth in Medical Practice.” With an MD from Hebrew University and an MPH from Harvard, Roy has the perspective and understanding needed to advance the healthcare industry through telehealth services. Here, Roy gives his thoughts on the current state and future of telehealth, and its role within the healthcare industry.
How has the FSMB Policy set the golden standard for telehealth?
Roy Schoenberg: Before the Federation of State Medical Board (FSMB), there was no real consensus in the market as to whether telehealth was safe or not. FSMB came in and legitimized the practice of telehealth, while also setting guidelines (see Model Telehealth Policy ratified April 2014). One of these guidelines is that the doctor-patient visit can happen only when there is a visual, synchronous interaction—essentially an audio/video functionality. The FSMB guidelines also required that patients have a choice of physician, as well as specified how documentation should take place. Overall, they stipulated over a dozen operating principles for telehealth, and in one clean swoop moved telehealth from the “wild, wild west” to a valid, standardized channel of delivery.
The telehealth market has come a long way since American Well was founded in 2006. How has the market migrated from being a “system” to an “ecosystem?”
RS: It started off with the singular notion that if you were able to get a patient in front of a physician, good things would happen. Then, we developed a better understanding of the technology behind telehealth, along with all the rest of the ingredients that make it clinically sound, safe, and valuable to both patients and physicians. This includes understanding payments (otherwise it’s cost-prohibitive) or understanding the importance of patient history, and then integrating with other systems that may have relevant information for the physician. Downstream care is also an important component. Then there’s the fact that it’s not just urgent care, but other types of healthcare that benefit from telehealth; chronic patient management, behavioral health and disease management are just a few of these. Telehealth has evolved from the simple understanding that technology can help get a patient in front of a healthcare professional, to the understanding that this is dimension of medicine.
How are telehealth product offerings going to evolve in 2015 and beyond?
RS: Part of the evolution will result from physicians better understanding the role telehealth can play in how they interact with patients, while at the same time being financially incentivized. We will also see a big change in the way these services are being paid for. Health insurance companies—who just a year ago were thinking about telehealth strictly academically—are now making telehealth part of the benefit structure. The regulators and the authorities that govern the practice of medicine are also taking two very significant steps toward telehealth. One is the Licensure Pact, which is going to allow physicians to treat patients of telehealth across state lines. The second is the coverage of telehealth under Medicare. We believe both will take place in 2015.
What new projects is American Well working on to enable innovation within the telehealth industry?
RS: We have opened up the opportunity for physicians to see patients remotely, which in itself opens up a whole world of opportunities. Apple’s decision to connect the iPhone to home medical devices means that American Well physicians seeing patients through the phone can be significantly more helpful. Because telehealth is becoming an ecosystem, there are so many more innovations that are possible, making it even more effective, accessible, and affordable.
What telehealth forecast do you find particularly interesting?
RS: In the commercial population, most people get their health insurance through their employer. In 2014, just about 15% of employers were offering telehealth to their employees as part of their medical coverage. That number is projected to move from 15% to 80% in less than three years. The expectation is that this is going to become the norm. I can’t recall anything in healthcare that moved from just a general notion, to the absolute norm in such a short period of time. This is going to dramatically change how the market operates, and how people view telehealth and its importance in healthcare delivery.