Tom Sullivan | April 27, 2020
As the industry is scrambling to fight the COVID-10 pandemic, care delivery is being transformed, with telehealth and other tools, in some ways that have the potential to reshape health care.
Amwell President & CEO Roy Schoenberg, MD, has a view into the pandemic response taking place among clients spanning health systems, payers, urgent-care facilities and clinicians in all 50 U.S. states.
Health Evolution Editor-in-Chief Tom Sullivan spoke with Schoenberg about the impact he is seeing thus far, what needs to change moving forward, and how sweeping policy changes made during the pandemic are likely to play out in the future.
Health Evolution: From your perspective, what are the important aspects of this pandemic that have not been widely recognized yet?
Schoenberg: We need to begin to look at telehealth as a federal infrastructure for load balancing, whether that’s managed by FEMA or another agency. Telehealth has become a necessary infrastructure. We need the ability to load balance clinical skills around the country in emergency situations.
Roy Schoenberg, MD, President & CEO, Amwell
Health Evolution: What do you envision a federal telehealth infrastructure looking like?
Schoenberg: We need a top-down operation that fully takes in the notion of health load balancing. That includes a central way to beef up the infrastructure with servers, mobilize supply, get FCC to help with bandwidth, make a call from the Oval Office to clinicians offering them a way to sign up to help people in other parts of the country. For example, we don’t have enough intensivists. It’s a rare specialty that lives in ICUs. We need to find a way to allow intensivists from around the country, or under quarantine at home, to be available to clinical staff running around between patients to give them guidance about what to watch for, what to change. That’s a whole new way the system is choreographed and it’s literally changing in real-time with the train out of the station moving at full speed.
Health Evolution: Are there conversations taking place around this? Or is someone already working to set this is motion?
Schoenberg: It’s coming from the ground up. These conversations are being had with the health systems that are in dire straits, thinking they’ll be overwhelmed with patients and run into bottlenecks. There is a way to connect all the dots, there is a way for them to pass services from one to another. We never imagined ourselves as a federal highway system but we’re getting health systems to talk to each other and throw intensivists over the wall to help. We need to understand where the puck is going.
Health Evolution: That’s challenging with information about the outbreak changing so quickly.
Schoenberg: To me the most glaring misunderstanding that’s out there — and this is true from the average joe to the White House — is that a lot of people are focusing on telehealth as accessible for all Americans. Don’t get me wrong, the use has been orders of magnitude more. While that much is true, regular care, like cancer or chronic conditions, is on hold. Everyone under the sun who doesn’t require open heart surgery right now is stranded. We will see another tsunami following COVID-19 of those people needing care.
Health Evolution: Given that the federal government relaxed rules around telehealth use, why is that not happening more broadly for non-COVID patients?
Schoenberg: Urgent care is a transactional blind date. Conducting follow-ups via telehealth is much harder to do. You have to get the right doctor, with the right data, in accordance with EHR, workflow, authentication, credentialing. That’s essentially taking the entire operation of a hospital and virtualizing it.
Health Evolution: In addition to relaxing HIPAA in certain circumstances, the government also made policy changes to state licensure and others. What do you expect the lasting impact of those temporary changes will be?
Schoenberg: We talk regularly to folks making those changes, HHS and the White House, some at the state level, and I can tell you there are going to be things that regress once the war is over. Then there’s going to be candid conversations about what we’re going to do next time. Some of the significant relaxing around reimbursement and parity are also going to regress back because people have to contain costs. One thing you can’t take back is you’re going to expose a lot of Americans to the plausibility of shifting some health care into the home, specifically the vulnerable, with multiple chronic conditions, in rural areas or people who can’t get out of bed. Once you take a bite of that apple and understand the possibility, you can’t take that back.