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Is Telehealth Ready for the Amazon Approach?

American Well's new Exchange, unveiled this week at the ATA conference in Minneapolis, offers an online marketplace for providers and consumers.

- Can a telehealth network be run like Amazon?

American Well is ready to put that theory to the test, with the announcement at this week’s American Telemedicine Association conference that it’s opening up an online telehealth marketplace. Called "The Exchange,” the enterprise platform will give payers and providers the opportunity to design and market their services to the general public.

“We’re connecting everybody,” company co-founder and CEO Roy Schoenberg said during a packed breakfast presentation, during which he compared the new service to the rise of Amazon in 2005 and its forced reshaping of the bookselling industry.

But while American Well’s announcement got all the requisite press attention this week – it even merited a story in the New York Times – healthcare providers and others in the space are biding their time. Will this change the future of healthcare, as Schoenberg predicts, or could it tuck neatly into the existing ecosystem as another service line?

To be sure, the new platform comes with a strong pedigree. Boston-based American Well is one of the largest telehealth providers in the ecosystem, comprising hundreds of payers, large businesses and health systems. The company started with a simple, self-branded platform for health plans and businesses looking to give their members/employees a quick link to primary care services from the home or office, and has since built out its network to include a provider-facing platform and one for consumers.

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With The Exchange, American Well looks to bring all of those options onto one platform, giving health systems an online storefront for their branded services and allowing consumers to stroll around and pick what they want, regardless of where they’re located. Early adopters include Anthem Blue Cross Blue Shield, the Cleveland Clinic and Florida’s Nemours Children’s Hospital. Anthem will be opening its LiveHealth Online service on the Exchange, while Nemours plans on expanding its pediatric telehealth services to Pennsylvania and Delaware later this year.

John Jesser, vice president of provider engagement strategy for Anthem and president of the health plan’s LiveHealth Online service, said the online marketplace is a natural next step in the telehealth market, where consumers are gaining the power to choose what services they want. That consumer demand is going to dictate the market’s growth, and it puts pressure on health systems to create an attractive offering.

Health systems like Nemours, one of the nation’s premier children’s hospitals, have that name-brand recognition.

“The connection is there – The Exchange really helps with demand and supply,” said Shayan Vyas, MD, Nemours’ medical director of telehealth, who spoke at the American Well ATA breakfast alongside Jesser. For Nemours, he said, that demand is driven by families who need the hospital’s pediatric services but aren’t near the hospital.

Schoenberg sees The Exchange breaking down barriers that now confine telehealth to silos of care scattered across the country – a good hospital here, with an online array of services for its patients and others in the geographic area, a specialty clinic there, looking for a way to reach consumers who might need its specific type of healthcare.  In between are the health plans looking for the best services for their members and the consumers just looking for a right-now service to treat a sinus infection or check out their child’s cough.

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“The Exchange breaks down silos of healthcare delivery and connects every stakeholder in the industry – those who seek care, deliver care, and pay for it – to make great, trusted healthcare more accessible,” Schoenberg said in a press release accompanying the ATA announcement. “We want to do for healthcare what Amazon did for book stores initially, and online retail, ultimately, which is to establish a national platform on which online healthcare runs. Importantly this platform is not just about connecting consumers to more doctors. Rather, we can connect consumers with the best provider brands across the United States as part of a national, virtual healthcare system.”

Of course, those on the platform will need to be wary of licensure laws in each state, an ongoing challenge that American well and others hope will be solved through interstate compacts for doctors and nurses. Then there are the states, like Texas and Arkansas, who set restrictions on first-time telehealth use, as well as issues of reimbursement and payment parity. For the time being, The Exchange might more resemble a mall with closed stores and wings under construction.  

In the halls of the Minneapolis Convention Center, ATA attendees wonder whether health systems want to market themselves like booksellers on Amazon, or whether consumers will eventually choose more “personal” platforms to get their healthcare, leaving The Exchange to serve a large but limited market of specialty care and one-off visits.

Salt Lake City-based Intermountain Healthcare, a multi-state network with its own impressive array of telehealth services, said it’s keeping an eye on The Exchange, possibly using it to connect with travelers or remote patients.

“It’s definitely an intriguing idea that we are going to look at closely,” Brian Wayling, Intermountain’s assistant vice president of telehealth services, told the Times.

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Chances are, that’s what a lot of health systems are going to do for now. 

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