In 2020, we’ve seen a surge in demand for and attention to telehealth services due to the COVID-19 pandemic. Amwell (NYSE: AMWL), formerly American Well, is one of the leading providers of telehealth services in the United States. The Pulse sat down with Chairman and co-CEO Ido Schoenberg to learn about the company, its culture, and the future of telehealth globally.

The Pulse: Can you please share a brief overview of your background?
Ido Schoenberg: I am a doctor, and as you can see, I’m not young anymore. This is my fourth venture. All of our companies had one mission in common; to truly improve healthcare and the way it is accessed. My brother Roy and I started Amwell about a decade and a half ago, and we have been at it since then. We recently went public and still see a big future for the company for decades to come.

To give you a few examples of prior ventures, I started a company called iMDsoft, which automates intensive care units and operating theaters, together with my wife. We were one of the first, if not the first, to create a virtual ICU. This company was sold years later to TPG, but I left it sort of halfway through the life cycle. You can tell when I left because you can see how sales went up dramatically when my wife took over as CEO [laughing].

We also built a company called CareKey, which creates personal health records and care management solutions for health insurance companies. This company was later acquired by TriZetto, which is now part of Cognizant. It was one of our initial experiences trying to connect participants in the care continuum who hadn’t been connected before – namely nurses and care coordinators in health plans with consumers with serious illness.

The Pulse: You founded Amwell in 2006 – a time when most people were not yet thinking about virtual care delivery. How did you decide to enter the telehealth space?

IS: When we started Amwell, it was a pretty daring idea, especially considering it was illegal at the time. Things that we take for granted today, like the Zoom conference we are talking through right now, those didn’t exist 15 years ago. Roy and I had sold our third company at the time, and as serial entrepreneurs we wanted to do something different. We had a serious debate about the big problem we wanted to solve. At the time, healthcare was focused on documentation and everyone was obsessed with electronic medical records, but we believed the main challenge was access.

E-commerce was just beginning at that time – Amazon was still selling books! We thought if we could take a page from what they were doing and try to bring technology from that world into healthcare, we could potentially democratize healthcare. We could allow many more people to get services that they normally couldn’t afford or didn’t have in their physical location. The whole notion of Amwell really started from this idea that care does not need to be provided in the same place that care is rendered.

The Pulse: On the note of access, how have you seen telehealth transform care delivery in rural settings? What are initiatives Amwell is pushing to take this even further?

IS: The initial step of telehealth – called telemedicine at the time – was to really overcome distance. That is a very small part, and maybe the least important part, of telehealth. Telehealth has the opportunity to recreate the actual model of care. Not by replicating the traditional model of care, but really by changing it.

Hear Ido describe the full telehealth model of care here:

The Pulse: With COVID-19 and events like the merger of Teladoc and Livongo, we are seeing some big changes already in Telemedicine. Looking at the future of what we can do with telehealth, where do you see us in 10 years versus today?

IS: 10 years is a long time. What you are going to see is that healthcare is going to begin to move in technology speed, not healthcare speed. Many things will change, and the model of care I described earlier is a great example. It will result in aging gracefully in our home and much more efficient and better care for everyone.

However, there are many things that will not change. Trust will remain a key factor in healthcare. If I have a serious illness like cancer, I really don’t want to hear it from a robot; I want a human who is empathetic to be with me. Or if I am going through chemo or another type of treatment, I really want a team that I can see and feel. The need for care providers is not going anywhere.

But care providers will actually be bifurcated into two types: people that execute the science and are very empathetic and accurate and people that are geniuses who write the amazing algorithms that tell us what to do. Much of the middle part will be automated using natural language processing, artificial intelligence, and many other technologies.

The challenges in healthcare are still going to be there 10 years from now, unfortunately, as it relates to risk management. There is always going to be a finite amount of money available to reach a goal. I think every dollar will go much further in terms of return, but that does not make the challenge of how much to spend and how to cover it go away. So, the role of payers is not going to disappear, although it will change to accommodate everything we said earlier.

There is going to be an enormous new opportunity as it relates to patient engagement and building those new care plans. Scientists will rethink how we treat people, taking into account more information, faster analytics, and a better ability to deploy different interventions. Today, because care is connected to location, there is enormous inefficiency. You need to replicate – you need a pediatrician every few miles so every mother can access one. Once some of what you can do is virtual, you can redistribute healthcare services in new ways and load balance in a different infrastructure.

The Pulse: You mentioned that especially in some areas people will always want in-person care. Typically, we would think this is in the specialty care world. In 2019, Amwell partnered with Cleveland Clinic to launch a new joint venture designed to help increase access to specialty care from high quality experts. What does this joint venture say about where the telehealth industry is going?

IS: Connection in healthcare is very complicated and something people do not necessarily want to do. There are over 2,000 hospitals today that use our platform. They are amazing centers doing holy work. When you think about it, there are very few people that are lucky enough to get care at Cleveland Clinic, which is considered the #1 heart center in America. If you want to get care at Cleveland Clinic you are limited: you likely need to travel. With technology, we can disseminate these capabilities and allow the unique people who understand the clinical flows to share their genius.

Our JV with Cleveland Clinic is fairly new. We started by focusing on automating second opinions to allow many more people to reach and get an opinion from Cleveland Clinic. In the future, we are looking to expand our services to allow patients to access more and more remote capabilities. The current platform is meant mostly for patients, but connectivity should not be assumed in telehealth to be only between a patient and a doctor. Sophisticated care is a multidisciplinary task.

It is important to note that we do not necessarily mean that Cleveland Clinic is the only institution people should interact with. We believe many other brilliant academic centers around the world are going to use the abilities that we create and participate in doing the same thing.

The Pulse: I would be remiss if I did not mention the global COVID-19 pandemic and how it has transformed the telehealth market. We have seen a huge surge in demand for telehealth this year. What do you predict the lasting impact of COVID-19 will be on the telehealth market?

IS: I’m not sure I agree that COVID transformed telehealth. The stars aligned long before COVID, but I would totally agree that COVID was a giant accelerator because it forced people to stay at home – not just patients but also doctors. When you are locked in your home, it makes a lot of sense to try to connect digitally.

The numbers are pretty amazing. Last year, only 22% of U.S. providers tried telehealth. Saying it less optimistically, 78% didn’t, which is surprising. This year, 80% of U.S. providers tried telehealth, and 90% of them said they are going to continue to use telehealth after the pandemic is over, and that is very important. What happened is many people tried telehealth for the first time and started to understand its power. There were a lot of barriers that were already removed, but one last critical barrier was the psychology of telehealth. For many people its not normal to interact online, and you need a little push in order to have them experience that. COVID gave that push, if you will.

What COVID did to institutions was made them realize that digital connectivity should not be an afterthought; not a hobby, not the thing you do after you finish work in the hospital after hours. Rather, it’s a required infrastructure to really enable healthcare.

In the future, the word telehealth may just disappear…it will just be called care. When I talked to my lawyer last time over the phone, we didn’t call it tele-lawyer. It was just a normal interaction. That is what is going to happen in healthcare, and it is going to happen quite soon. When I look to the future, I can see many things that are done today, even in ICUs, happening in the home. That is incredibly important because if someone, god forbid, has three weeks to live, do they really want to spend those last three weeks in a dimly lit corridor somewhere without their family? It’s also cheaper and sometimes clinically better to be at home, as the home is much less contaminated than the hospital. At home you get encouraged and you get the will to live.

The Pulse: I would love to hear a bit about your experience as a business and healthcare leader as well. We all saw Amwell’s huge funding round in the spring and IPO in September. What has it been like leading a company through such rapid, unexpected, and vital growth?

IS: I’m not sure about it being unexpected or quick…From my vantage point, it took 15 years.. When you open the first business plan of Amwell, the story of who we are and our mission of what we are going to be is there. We may have misestimated what it would take to get there – how much money, time, people – and the enormity of the barriers that were there.

The IPO is helpful in a number of ways. Obviously, it allows for more access to capital and creates a currency that allows us to look at organic and inorganic growth to realize our mission. It also changes our shareholder base. Now, you know your shareholders trust you because they can sell at any time if they don’t. Obviously, the great level of transparency is very encouraging to partners and clients. They know exactly where the company is, they know what is going on, and they are comfortable with what we deliver.

Looking back at this journey, there are 3 things that were critical to our success: people, people, and people. Culture, really, that was reflected in these people, is everything. I am very encouraged by our mission, by the fact that I know I am surrounded by a lot of people truly passionate about democratizing healthcare.

Hear Ido describe the 3 pillars of Amwell’s culture – Customer First, One Team, and Deliver Awesome:

 

The Pulse: You co-founded Amwell with your brother, Roy. What is it like working with family? Any advice you would give to entrepreneurs looking for their own co-founders?

IS: So first and foremost, you need to realize that every team member is part of the family. My biological family is not necessarily separate from my Amwell family. Working with family has its advantages and disadvantages. You have an automatic trust and familiarity with the people. Like everything else, it really depends on what the relationships are.

I don’t think you should necessarily rule out working with family, but like everything else, whether its family or not, it’s very important to define roles and responsibilities. It’s very important to create clear accountability in an organization, so people know what they are in charge of, what their goals are, and whether they achieved them or not. When it’s a family, there is an automatic temptation to cross those lines. You need to be able to separate those areas.

We’ve been doing it for many years. My earlier company iMDsoft was with my wife and other companies were with my brother and so on. But the common theme was a clear discussion, an honest and continuous discussion, about who is responsible for what. That’s an important recipe for making this work.

Interviewed by Poorwa Godbole on December 11, 2020