Significant Science

I have already written about American Well and since that time I have been able to talk on the phone with its president and chief executive officer, Roy Schoenberg, MD, MPH.

That chat has convinced me that American Well is set to become a transformative player in the American healthcare system via its system of Online Care. This is not hype. This is reality.

Since my first article I have gained a better understanding how American Well works vis-à-vis how consumers use it, its customer base and its technology.

I envision as readers of this interview those who work in the health plan industry, physicians, health economists, state legislators, health policy analysts, those who advocate for the chronically ill in the workforce and in the home setting and savvy consumer members of health plans who might want to bring American Well to the attention of those who administer such plans. I urge those people to view these video clips of Dr. Schoenberg simply, persuasively and really unanswerably making the case as to why American Well benefits everyone involved: patients/consumers, physicians and other healthcare providers and the health plans that engage the services of American Well.

Folks, this is not a slick pitchman at work, but a thoughtful physician/technologist making a case for a service that anyone who cares about efficiency in healthcare and better care for people we love (and for ourselves) should know about. Who would have thought that a single company has the potential to do the following:

• Bring back into medicine the legions of primary care physicians who have left the field out of frustration with the red tape and the headaches of running small practices
• Address the crisis in primary care that has resulted in needless physical, emotional and financial hardship for patients due to the lack of timely attention to medical issues the neglect of which at the primary care level results in otherwise preventable emergency room visits or hospitalizations
• Help health plans keep costs down and differentiate themselves from their competitors, serve patients and keep their providers happy by offering nearly instantaneous Online Care and an unparalleled, unprecedented level of access for primary care doctors and their patients in the office setting to specialists around the country via Online Care networks during office visits. No more slogging around town or their states for patients for referrals. Consultations and expertise right then, right there.
• Help health plans leverage what they already have: large networks of healthcare providers, many of whom (think young physician parents or physicians caring for ailing spouses or parents) would leap at the chance to practice medicine (which they love) from home, and enrollees in the health plans who would leap at the chance to talk to a doctor at a time of their own choosing in any setting that they choose that has Web access (which this days is most anywhere that they can use a smart phone).

Health plans these days need to think creatively and American Well is the answer. Make consumers happy by providing care 24/7. Address morale and retention problems among your providers. Keep costs down by keeping, say, diabetics as healthy as possible and out of the hospital and emergency rooms (or, alternatively, expeditiously getting them into them when that is the obvious and sagest course). Increase adherence rates for those on hypertensive and similar medication regimes. Keep people well and keep convenience uppermost and costs down.

Talk about win, win, win for all concerned. Clearly, this is something that not just health plans but that policymakers who shape the legislative and health landscapes and consumers who lobby for the adoption of rules that favor innovative thinking in the health sector should know about.

Here are the key points I picked up from Dr. Schoenberg.

I asked him on the phone if American Well has any genuine competitors. Apparently not. How can that be? After all, the ability to access Online Care (which is what used to come under the now somewhat dated rubric, “telemedicine”) has been around for some decades. Why has American Well been able to take the lead in terms of visibility and technologically? Schoenberg’s response is that he and his brother Ido Schoenberg, MD
chairman and chief executive officer of American as physicians saw the possibilities of Online Care and leveraged their previous experiences as successful tech entrepreneurs to patent many of the key technologies that would build on American Well’s on head start. These are shrewd cookies—good luck, would-be competitors. Moreover and interestingly, Schoenberg said on the phone that American Well is not really a healthcare company but a technology company.

One problem I foresee for American Well is that it a bit difficult to explain to new audiences what American Well is. It uses the term “broker.” What should those of us interested in American Well call it and designate it? A health technology and services brokering firm? A technology firm in the healthcare sector? All of the above?

But no matter what you call the company, the timing in so many ways is ideal for American Well to do well by doing good. For instance, there is the concept of the medical home and American Well seems like the ideal technological vehicle to really create that for increasingly Web-centered consumers, as personified by one of the leaders of the E-patient movement, e-Patient Dave.

And American Well is working with Microsoft to leverage the power of the personal health record. Indeed, American Well seems to be the dream service for health policy wonks, health technologists, E-Patients, consumers tied down with chronic illnesses, consumers who are in relatively good health but who need quick access to primary and specialized care sporadically, physicians who want to practice medicine in as hassle free and patient-centered circumstances as possible and health plans who want to win plaudits from plan members, providers and policymakers alike while seeing genuine, quick improvements in their bottom lines without having to create from the bottom up the intricate system that American Well can offer to and maintain for them.

Now I shall play skeptic. When I enthused about American Well to a very smart colleague of mine in healthcare, her first question to me was, “Fine, but how is quality of care monitored?” I asked Schoenberg that question on the phone and he pointed out that the health plans already have such quality assurance systems in place and that the beauty of American Well is that it is a relatively straightforward add-on to existing systems.

One of the things that I misunderstood about American Well at first is that I took it to be simply a system that would enable individual doctors to get into the world of Online Care relatively easily a la Hello Health.

But on the phone Schoenberg made clear that although he finds Hello Health an interesting company and a neat concept, American Well’s customer base consists of entire networks of healthcare providers as managed by health plans such as Blue Cross Blue Shield of Hawaii and Blue Cross Blue Shield of Minnesota. Those are quite disparate markets and illustrate the promise of American Well vis-à-vis succeeding nationwide. And interestingly, a broad swath of the political and health policymaking establishment in Hawaii seems to have embraced American Well as a vehicle to address the crisis in primary care and access to healthcare in general in that state. And, apparently, some lawmakers not only there but elsewhere want to mandate access to American Well-supported services in their states. One wonders if this will play to the advantage of the health plans American Well caters to, in that it might generate customers for them that they had not previously served or would it dilute its appeal to them as American Well or American Well-type services grow more common?

And on the matter of potential rivals down the road, Schoenberg mentioned on the phone that he has been somewhat surprised but pleased by the interest in American Well that large employers and non-health plan health networks have shown in American Well’s services. But he also pointed out that such networks would need a critical mass of providers available 24/7 and that large employers would probably be better off working through health plan providers that already use American Well services or lobbying those that don’t to do so rather than try to create provider networks of their own. Given that there are health networks (say the Mayo Clinic or the Cleveland Clinic) that may indeed possess such critical masses as well as being respected, recognized brands, one wonders if they are potential rivals or potential partners of American Well in the Online Care space.

American well provides both behavioral health and clinical-type medicine online. In some ways, American Well is ideal (i.e. care in the privacy of one’s home) for the treatment of illnesses that still carry a stigma in some circles (e.g., depression, PTSD).

There are still unanswered questions about what sorts of conditions American Well is ideally suited for. Everything from anxiety disorders to emphysema to bouts of the flu and earaches? Can patients swiftly get prescriptions and have them delivered to their home or arrange for quick pickup that very night? Do patients actually disrobe in the privacy of their homes in front of their computers if need be (and how secure is the system in that case?) or are the conversations between patients and providers mainly that? Can they upload digital photos they have taken themselves of rashes, for instance? Can they upload data from home medical devices? Does it have technologists who specialize in optimizing American Well products for the coming mobile revolution?

I have been to several conferences in the past year e.g., Health 2.0 and the Connected Health Symposium and chatted with representatives of federal agencies such as the VA about their need to offer health-related online services to Web-savvy cohorts of veterans and active duty military personnel. Keep an eye on, therefore, American Well’s relationship with the TriWest Healthcare Alliance. We shall see what those in the federal and state governments learn from American Well in that respect and whether American Well will expand further into government-related health services given the Obama administration’s healthcare IT-friendly policy program.

American Well also provides consulting services vis-à-vis healthcare metrics. A little touted by it but probably lucrative sideline and a convenient in to big companies like Aetna.

And since talking to Dr. Schoenberg I have had the chance to talk on phone with the equally pioneering and visionary thought leader in the fields of Online Care and the Care-at-a-Distance (which was a new term to me), Dr. Daniel Sands of the health division of Cisco’s Internet Business Solutions Group who talked about the absolutely fascinating product Cisco HealthPresence.

I asked Dr. Sands if HealthPresence presents a competitive challenge to American Well given that HealthPresence appears to leapfrog American Well in that HealthPresence enables patients (with help from an attendant) to actually do things such as (and I am quoting from Cisco here) enter physiological data such as that derived “…from a variety of medical devices such as a stethoscope, blood pressure cuff, pulse oximeter and other diagnostic equipment.” I asked Dr. Sands if such capacities of HealthPresence obviated the need for American Well.

Not at all, said Dr. Sands. He said he sees HealthPresence and American Well not as rival services but as offering healthcare consumers and medical providers a powerful, complementary synergy and mutually reinforcing platforms in that both Cisco and American Well are working towards the goal of creating services that enable providers to provide care wherever and whenever consumers and providers need it and, again, to prevent unnecessary and costly hospitalizations and, in the case of the elderly, rehospitalizations only a few days or weeks after discharge (the latter which Medicare often doesn’t cover, thus incentivizing for brick and mortar institutions the use of services such as American Well and HealthPresence).

Dr. Sands gave the example of a healthcare plan engaging American Well to provide online care to its customers and, in the event that one of its physicians after an video conference a patient via the American Well interface decided that a patient (particularly one in a rural area far from a doctor’s office) should undergo certain tests could arrange for such tests via a mobile version of HealthPresence, thereby obviating the need for slogging back and forth for the patient between primary care doctor and far distant specialty testing facility, the burden of traveling to which Dr. Schoenberg so compellingly illustrates in his public presentations on American Well.

Dr. Sands made the point that many healthcare administrators of brick and mortar healthcare institutions see Care-at-a-Distance not as a threat but as an opportunity to extend their presence via mobile technologies out into the hinterlands, which they are currently hard-pressed to serve and that such technologies as HealthPresence will enable them to leverage their existing networks of home healthcare providers and further the concept of “aging in place.” As I listened to Dr. Schoenberg and Dr. Sands I was grateful that there are such innovative thinkers and companies such as American Well and Cisco that really are making a world in which the elderly and the chronically ill can get care in the home or at a short distance from home and that someday hospitals, patients, health plans and society at large will not be slammed with the enormous costs of hospitalizations that need not have occurred in the first place. And, interestingly. Dr. Schoenberg was Dr. Sands’ student at Harvard. Talk about effective teaching! I wish I had been in that class.

I didn’t get the chance to ask Dr. Schoenberg questions such as: What exactly do you provide in terms of software and support to health plans? What is the minimum number of providers the health plan should support? Do you have special services for an older demographic and how are do you address matters of accessibility for the disabled? I suggest checking out its Web site and exploring such matters further.

To sum up, American Well is one of the most promising companies in the healthcare industry. It is creating a new paradigm of care and making the most of the Web for the benefit of patients, medical providers and health plans. It is transforming the zero-sum equation that has hobbled the American healthcare systems for decades. Think about American Well the next time you are in a doctor’s office as you wait (and wait and wait and wait) to see the doctor—assuming you can get an appointment before you either die or end up in the emergency room.