Too Popular To Get In The Room – Part II

It’s amazing to me that a company that hasn’t launched yet has been at two conferences with standing room only (in the hallway), but that is the story for American Well. At both Health 2.0 and at the WHCC 2008, the crowds packed in to hear Dr. Roy Schoenberg (CEO and founder) speak. Fortunately, I had scheduled a meeting with him offline so I got to spend an hour talking with him about what they are up to.

So…who are they:

  • “American Well has created a new healthcare marketplace where consumers and physicians can come together online to acquire and provide convenient and immediate healthcare services. Using the latest technologies in Web communications and digital telephony, American Well extends traditional healthcare services to the home setting.”
  • Roy is a physician who previously founded CareKey which was sold to Trizetto.
  • Their solution (launching at the AHIP conference later this year) plans to create a win-win-win for patients, providers, and payers:
    • Patients get a convenient, easy to use solution for anytime access to physicians. (Depending on the payer model, they may get a lower copay.)
    • Providers get a new revenue stream, access to new patients, and an opportunity for a new business model without traditional limitations and costs (i.e., space, office staff).
    • Payers get a new service to offer patients which should avoid urgent care and emergency room visits ultimately saving them money.

Some of the basic questions (coming from a blend of the press kit and our conversation):

  • Don’t we already have this? Most services today are e-visits which are asynchronous (not live or interactive) while these are live visits.
  • Will this be covered by my insurance? Yes. Payers are their clients.
  • How will this compare with the retail clinics? It has the same concept of convenient, no-appointment care, but it is in your home and it is provided by physicians. Additionally, the patient has the option to choose the attributes of the physician they want and evaluate the experience.
  • Will the patient or the physician be required to have certain hardware (e.g., web camera)? No. This can be done with a web camera or just over the Internet or just over the phone.
  • Is the physician flying blind (i.e., having no data about the patient)? No. The idea of working with the payers is that they can have access to claims information about the patient. [This is a big step from other ideas I have seen. We talked about batch access and real-time access to the data which they apparently have both options.]

Roy is a very engaging and comfortable CEO. You can tell that he feels passionate about the idea and has been here before. He talked about being disruptive to the system but the importance of disrupting one area not the entire system with your solution. [This is a good point that I have never heard someone stress before.] Listening to him talk about working with the payers and comparing this to different models made me realize: (1) they basically have created a solution where the payers are their recruiter (for MDs) and their marketing arm (for consumers) and (2) will we see a place where there are additional tiers of copays (i.e., $5 for an e-visit, $10 for a virtual visit, $15 for a retail clinic, $25 for an office visit, $50 for an urgent care visit, and $100 for an ER visit).

I liked a couple of his vivid phrases. He talked about the need for high deductible patients to have a “GPS to navigate smartly” through their options. He also talked about an “end of days PPO” which (if my memory serves me) was referring to the open access to primary care and specialist through the American Well platform. We talked a little about the type of users they might expect from acute (urgent) to preventative (purely convenient) to chronic. It made me wonder in the last situation whether you could see plans pushing a visit for conditions where adherence or compliance with therapy is an issue and they are concerned about the patient. We also talked about their workflow type solution to capture data and push it along to the next visit to (for example) a specialist. It made me realize that there is probably a big drop off in visits to specialists based on the lag to get an appointment. If my PCP recommends I talk to someone, but it takes me a month to get an appointment, how likely am I to go?

I had a question about why you wouldn’t put the care team (MD, RPh, specialist) all on the session at the same time. I think his response about the challenges in doing this made a lot of sense. You put people who don’t know each other into a real-time session without a facilitator and would likely end up (in my words) with too many cooks in the kitchen.

Given all the talk about PHRs, I wondered how patients could extract information from their virtual visits and pull it into their PHR. He told me that this was part of the service and since they come from the PHR world, that makes a lot of sense. Since this also might create a two-way opportunity for the PHR to be used by the consulting clinician, it might actually impact PHR utilization and make it a more valuable tool.

Obviously, one challenge will be managing supply and demand especially around peak times. He talked about how many requests they get today (pre-launch) from MDs who want to participate. [Given the frustration I hear from many physicians, I believe it.] He talked about their matching algorithm along with their plan to predict volume and type of skill set needed to proactively recruit real-time logins (i.e., I predict we will need 3 oncologists in the next 10 minutes so let me send a call / e-mail out to 20 and see if they can log-in).

The patient will get a standard 10 minute interaction which is managed by the system and as the time elapses, there will be a gentle reminder. The physician will have the option to slightly extend the “visit” from a care perspective at no additional cost or offer to add 5 minutes at a cost directly billed to the patient. I wondered (perhaps naively) why you couldn’t just extend it for another 10 minutes with another copay, but he reminded me that no plan was going to allow you to go to the same doctor multiple times in the same day.

The other thing that I thought about but we didn’t discuss is the opportunity to use this for MTM (Medication Therapy Management) which is a service provided around Medicare Part D from pharmacists to patients. Could this become virtual which would make it more scalable.

Overall, very interesting. With 2 young kids, I know of many emergencies. As a working professional who travels a lot, I know the challenge of making appointments and even talking with my physician. I look forward to testing this service out later this year.

One Response to “Too Popular To Get In The Room – Part II”

  1. I went to their site a few weeks ago to see if they had launched because I could not get an appointment to see my doctor, and didn’t feel like waiting at a walk-in. I had a pain in my nose for two days. I am looking forward to seeing AW in action and having that immediate access to a physician. I do have many questions though: how long will it take during the session for the MD to get up to speed with a patient’s conditions? Where’s the safety net for allergies and drug drug interaction, etc….? I have a chart at our local walk-in clinic for this, and a chart at my PCP, plus three incomplete EHRs (iHealth, WebMD, Revolution) that I only have access to – perhaps I can roll these into American Well’s EHR for all their MDs to access? Am I being charged for the MD to look at my EHR? Can I get prescriptions from just an online visit?

    Looking forward to their launch nonetheless and to be able to have that access at anytime.

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