Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
HIStalk Practice Interviews Jon Freshman, CTO, American Well
Jon Freshman is CTO of American Well.
Tell me about yourself and the organization.
I’ve been in the technology sector now for a little over 25 years. I started out on a bit of an unusual path to get into IT. I actually have a master’s degree in environmental science. I was an environmental consultant for a number of years at EPA Superfund sites, but my passion was always for IT. While I was doing environmental consulting, I decided to start up my own company pulling in EPA dockets, data, and providing that as as resource for really large companies that were under the regulations of Superfunds. Over the years, I decided to go back to school, got my master’s degree in computer science, and started out over the first course of my tenure doing development on different enterprise platforms.
I was involved with CAD and manufacturing software. I was in development for the financial sector, and even did a brief stint with a company doing direct campaign marketing. Finally, I began to transition over to a role more on the platform architecture side, and that’s when I joined American Well back in 2007. Today, I’m basically responsible for overseeing all of our technologies related to our platform, and our product development. I also have a focus on our strategic technology partnerships.
We have a pretty diverse set of teams here. We’ve got engineering teams that focus across lots of different functionality, including our Web portals, IOS and Android apps, kiosks, and even telemedicine tablets. While each of these teams focuses on a different vertical, they all tie into our core platform and functionality. In addition to our core development teams, we also have teams that focus on integration, such as tying into EHR systems, and HIE patient portals. We know that, as the demand for telehealth continues to grow, we also need to really focus on how integrative that experience is going to be. For us, the technology needs to be much more than a simple direct-to-consumer offering. It really needs to be something that ties into a much bigger experience, so some of those integrations that I mentioned are part of the much bigger ecosystem that we want to be integrated into.
We tend to focus a lot less on just adding a feature here, a little bit of functionality there, and more on how can we really move the needle for telehealth in supporting patients and physicians across a diverse set of use cases because we need to service employers, health plans, health systems, and retail. In many cases, there’s some overlap, but in other cases, there’s actually quite a bit of diversity in how people want to roll out telehealth.
Given your tenure in telemedicine, how have you seen interest in and acceptance of it change over the last several years?
There was a heavy emphasis on education during the first several years at American Well. What is telehealth? What are the benefits that it provides? What’s the ROI for different use cases? Even the video conferencing phone platform itself wasn’t necessarily as widespread as it is today. We’ve got technologies today like Apple FaceTime. That hadn’t been introduced into the consumer market yet, so there was a lot of curiosity about what telehealth was and how it worked. It was more of a focus on educating people than why we’re better than a competitor.
Over the last three or four years, we’ve seen a real shift in awareness, and more sophisticated understanding by employers, health plans, and health systems as to what telehealth is and what the ROI is. We don’t have to give that explanation any longer. A lot of these organizations now have very established programs in place for telehealth and distance care. We now typically start a conversation with one of our customers around how we’re going to weave that experience into their workflows and use cases. We invest a lot in partnering with our customers, on integrating it into their big picture; being able to exchange patient data, physician data, and clinical data in real time are key factors for us.
Another interesting area that we’ve gone into in terms of integration is the introduction of our mobile SDKs. We have IOS and Android SDKs that allow our customers to project telehealth services directly within their own mobile apps. We don’t even require our customer to white label a version of our app anymore. They can literally have, with the touch of a button, a fully embedded telehealth experience within their own patient portal or other proprietary app.
We’ve also really focused a lot of the efforts around technology to make it much easier for telehealth visits to have an expanded universe of people that we can draw into that experience. For instance, we’ve introduced multiway video into our platform, allowing people to pull in or invite remote caregivers or translators into a telehealth visit. We find these really have a big impact on both patient and physician acceptance, because now we’re not just extending the reach of an in-person visit – we’re actually unlocking things that weren’t necessarily even possible before with telehealth.
What barriers, if any, do you feel still need to be overcome in terms of achieving ubiquitous adoption of telemedicine services?
I think that payment is probably a key a factor – when, where, and how physicians are getting reimbursed. Also, ensuring that the reimbursement is on par with in-person care. We’ve certainly seen an improvement with this over time because, at the end of the day, everybody’s got a vested interest in reducing healthcare costs. Whether it’s legislation, or the payers, I think they all have some level of commitment to ensure that telehealth is a success, because the demand is there for it.
Typically, it’s not that providers aren’t convinced that they shouldn’t do some sort of telehealth or telemedicine offering. I think most organizations today really do recognize the need. I think what we hear more often is just how they actually want to operationalize that offering. They need to consider things like, do they want to offer up telehealth for just a segment, a specific population, or just for follow-up care? Are they going to offer it for acute care as well? Are they interested in an offering that includes things like wellness, and behavioral health programs? I think these are probably the things that organizations are really trying to figure out, and less so whether or not they want to move forward. I think at this point, telehealth has wide enough recognition and adoption that we don’t really see a lot of people out there questioning the value of it.
From a consumer perspective, I think we’ve certainly overcome a lot of the barriers that we’ve seen, let’s say earlier in the decade, because a lot of the things that were prohibitive for patients have really been addressed, such as improved bandwidth on cellular devices, cheaper mobile phones, and cheaper laptops. Again, consumers are really a lot more familiar now with the notion of doing video in general, so it’s becoming much more intuitive for them. The other thing is, as more and more health plans and employers are adding telehealth as a benefit, the ability for consumers to readily have access to it is becoming more and more attractive to them.
Have you been encouraged by the attention CMS has given telemedicine over the last several years? It seems like its making more of an effort to incorporate telemedicine more into value-based payment models.
We’re definitely encouraged by the move of CMS to move forward in the recognition of the value of telehealth. I know there are a few things that have been recently introduced in particular; there’s a new Next Generation ACO, and depending on whether or not the ACO can get a telehealth waiver to operate in a remote area, it can definitely allow for expanded payment options in telehealth.
With the introduction of MACRA, there’s also the opportunity for us to place more of an emphasis on outcomes in telehealth, because we think that telehealth is a great way to offer continued patient engagement and more patient-centered care.
Speaking of patient-centered care, mental health seems to be an increasingly important part of holistic or primary care. How is American Well addressing mental health needs?
Today, we have two psychology practices on AmWell. One is for adults, and the other is for adolescents. At the end of the month, we’re also going to launch a psychiatry practice as well. We feel like it’s a huge need, because in many cases, there’s just lack of access for mental health providers.
Our offering started up a couple of years ago. Our view is that telehealth certainly can deliver just as high-quality care as traditional, in-person care. Certainly from an access perspective, it’s just so much easier to fit into a patient’s busy lifestyle, and so much easier for patients to do things like self-scheduling. On our platform, patients can go in, select a time that might be convenient for them, and then go ahead and schedule a visit. They can also call in to an 800 number as well, or they can actually have someone schedule it on their behalf.
Having a lot of different options to make it easier for patients to get ready access to mental health is incredibly important. We’re in the process of expanding our provider network even further, because of highly anticipated demand going forward.
Given the proliferation of telemedicine companies over the last several years, do you think we’ll see a bubble that might eventually burst? How will vendors have to differentiate themselves?
I think the key for success is about having a diverse offering. That can be defined in many ways. I mentioned a number of them before; the ability to use IOS or Android devices, the ability to use a kiosk, or a Web portal.
It’s much more than that, too. It’s the ability for us to really offer a rich and diverse set of services that will be key for us. We recently announced our services exchange, for example, where the idea is that consumers can get access to basically the best brands of medicine in the US by allowing health systems to extend their network of positions; they can actually project them onto other enterprise platforms. Cleveland Clinic for example, and has a service exchange that it’s setting up with Anthem’s LiveHealth Online app. We’re going to expand this over the coming months. There’s a much more diverse ecosystem among all our enterprise customers for offering different types of telehealth services. That’s something that I think, for us, to answer your question around differentiation, is certainly going to be a key factor.
Do you have any final thoughts?
It’s been really rewarding to see telehealth evolve over the past decade. It’s great to see that we can offer up simple and affordable healthcare options through our technology. Some of the really interesting things on the technology side that I think will help further evolve and define telehealth are going to be found in the next wave of wearables, and some of the new connected medical devices that are coming out on the market. I think these are going to really allow us to unlock additional use cases, even more than where we are today.
Jennifer, Mr. H, Lorre, Dr. Jayne, Dr. Gregg
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