Health 2.0: American Well and the Advent of Paid Telemedicine
If, like many people, you find it difficult to see a doctor without making an appointment weeks in advance and sometimes wonder why you can't ask quick medical questions by phone, email or some other means short of turning up at the office, the startup American Well has a solution for you. Well, the solution is actually for your doctor and your insurance company, although it might eventually end up helping individual patients as well.
American Well -- one of several "Health 2.0" startups that aim to transform healthcare via the Internet's interactive and community-building features -- basically aims to enable a form of "telemedicine" by which doctors can offer medical advice via video chats. Relatively few doctors will currently even talk to patients over the phone, much less use email, IM or online video, and one big reason is that they aren't reimbursed by Medicare or private insurance for doing so.
So instead of arranging this sort of patient consultation on its own, American Well aims to strike deals with health insurers who can then use the startup's technology to connect their members to doctors via the Web on extremely short notice -- just 30 seconds, according to CEO Roy Schoenberg. Doctors on these video chats can offer diagnoses and even prescribe medication, Schoenberg says.
The real innovation here is on the business side. By working through insurers and their physician networks, American Well sidesteps the question of who gets paid and how by piggybacking on the health-plan's infrastructure. What's more, Schoenberg argues that this form of telemedicine will help insurers broaden their business by allowing them to effectively sell access to their doctors on a per-televisit basis.
It's a fascinating idea, although whether it's a good idea or not remains a wholly separate question. Video chats with random doctors -- OK, random doctors who happen to be in-network with a particular insurer -- is going to strike a lot of people as a sort of drive-by medicine, which could obviously lead to some terrible outcomes. Video may offer a somewhat better window on a patient's symptoms than a phone call, but it's still awfully limited in terms of what a doctor can learn about a patient, as she can't take a pulse, palpate an abodomen or get a blood-pressure reading over the Web (not yet, at least). There are other practical limitations, too: Somehow, I also doubt that tele-doctors are going to be particularly comfortable prescribing controlled painkillers over the Web.
More to the point, though, I can't help wondering whether telemedicine is anything more than a marginal medical sideshow. American Well is basically a convenience service that allows people to pay a presumably modest fee for quick medical advice. In itself, there's nothing wrong with that -- many people will obviously pay for convenience, and if American Well really is getting into that niche first, they may well benefit handsomely. But it's far from clear that this sort of service will have any impact on the overarching problems in healthcare, particularly escalating medical costs and insurance premiums that are steadily pricing individuals and employers out of the insurance market.
Still, it's impossible to dismiss American Well out of hand. There's a reasonable argument that it could help mitigate a looming shortage of primary-care physicians, and the company itself argues that it believes it can expand access to healthcare for the uninsured and underinsured, who might otherwise clog emergency rooms or go without care altogether. I've written a bit about American Well elsewhere, but for a much more detailed look, you could do much worse than to check out David Williams' recent podcast with Schoenberg that explores these and other issues. (Those who prefer text can skim the transcript instead.)
Here's a brief excerpt from Schoenberg on how American Well might change healthcare:
Everybody talks about universal health care. And everybody realizes that that needs to be tied with either raising taxes, or finding another means of supporting it. It is a huge cost to the government that will eventually translate to getting money from somewhere.Image via Flickr user PinkMoose, CC 2.0What we're doing here is â€"in a pretty nimble wayâ€" we're opening up the healthcare system for on-demand acquisition of health care services in a way that is accessible to anyone in the street, anyone that has access to a phone, or anyone that has access to the web, allowing them to acquire services without government intervention, without any major subsidies. It is really their determination when they need care, and it is right there for them.
The impact of this means that you're now exposing the health care system to the entire uninsured population in a meaningful way without having to do any kind of major transformations and overhauls to the budget. Whether it is this presidential candidate or the other presidential candidate, when you flip this on, health care becomes available to the uninsured population for the cost of the transaction. That simple, technological solution may actually be much more disruptive and pervasive to the market than everybody thinks.
