Future of Telehealth, Hybrid Care After the Public Health Emergency

November 21, 2023 - Now that the coronavirus pandemic has become more manageable, how has the evolution of telehealth taken shape and how can the industry improve hybrid care?

When the coronavirus pandemic gripped the nation and in-person care grinded to a halt, telehealth was the natural substitute. In Medicare alone, telehealth use shot up by 6,067 percent from 2019 to 2020. In 2021, telehealth use was stable at 38 times the rate of pre-pandemic utilization.

But as the public health emergency ended and the tool became more of a fixture of the healthcare system, utilization evolved and hybrid modalities came to the fore, blending in-person and telehealth care.

In this episode of Industry Perspectives, Frank McGillin, chief executive office at The Clinic by Cleaveland Clinic, covers a range of topics including hybrid care, finding a good partner for joint ventures, and the latest from The Clinic.

But I think it's a matter of not saying, "How do I add telehealth to what I used to do all the time?" It's saying, "Okay, now that I have all these tools in front of me, how do I design an optimal pathway that's going to deliver better care, better patient experience, easier for the doctor, and ultimately save some money for the health system?"

Kelsey Waddill:

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Healthcare news is packed with headlines about new joint ventures, mergers, and acquisitions, but how do healthcare leaders choose solid partners to move forward with? In this conversation with our VP of editorial, Kyle Murphy at HLTH 2023, Frank McGillin, chief executive officer at The Clinic by Cleveland Clinic, gives us some insight into how this process works by sharing a bit about the partnership between Amwell and The Clinic, and he also touches on the evolution of telehealth and hybrid care. Here's what he had to say.

Kyle Murphy:

So Frank, thank you for joining us today. Can we hear a little bit about your background and what brings you to HLTH and where have you been professionally?

Frank McGillin:

Well, first off, thanks for having me. My career has revolved around the intersection of healthcare, technology, and consumer marketing, or consumer products. I spent a large part of my career at big companies, Phillips, Johnson & Johnson. And about 10 years ago, I moved over [into] the startup world: two different digital health technology startups where the first one was trying to help provide drug-free solutions for chronic pain, another one had a really novel approach to cardiac monitoring. And I think what has really appealed to me in the startup world was the ability to move faster, to innovate, be creative in a way that it's hard for large companies to do.

I joined The Clinic by Cleveland Clinic in 2000, and we're a joint venture between Cleveland Clinic and Amwell, which is kind of unique. So we've got two owners, one is a 100-year-old academic medical center, one of the best premier hospital systems in the world, breakthrough innovation on many medical areas, and Amwell, which is more of a technology and--the DNA of a technology startup. So, we're kind of an interesting place in that we have a foot both in the old world and the new world, and it's both interesting and as well as provides opportunities.

Kyle Murphy:

When you first started with it, did you kind of have some target use cases that you were thinking about in terms of, all right, this is an obvious place to go, or were you throwing a lot of things at the wall and trying to figure out what would stick?

Frank McGillin:

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The vision of the company as we were started was how to use technology to unlock access to Cleveland Clinic expertise. Cleveland Clinic has 3,500 specialists, top of their field, and it's great if you're in Cleveland or you're in Florida, London, or Abu Dhabi, but what about the rest of the world? So, our initial focus has been on expert second medical opinions. So, how do we help the patient who may be in rural Iowa who was told they have cancer, was told they need a heart valve replacement, was told that they have a neurological condition, and they're trying to figure out, what do I do next? They don't know who to turn to. They don't necessarily have connections in the industry, but they know they want to have the confidence of speaking to a world specialist. So, we're using the telehealth technology to make it possible for that person to speak to an expert, to make sure they're on the right path, to understand what options are available that they may not hear about in rural America or some other part of the world.

Kyle Murphy:

How did the joint venture come together? What was the evaluation process like? How do you find the right partner to go forward with, and I guess, what's the communication like in a joint venture when there's multiple stakeholders owning it?

Frank McGillin:

So, the venture started before I joined the company, but it was really the vision of Dr. Tom Mihaljevic, CEO of Cleveland Clinic, and Dr. Ido Schoenberg, CEO of Amwell. And Cleveland Clinic and Amwell have been partners for years. And the thought was, "Well, what could we do by setting up a separate company that would be hard for either of us to do alone?" So, that was really the genesis and it's what we've really been working on for the past couple years.

Kyle Murphy:

I'm curious with the pandemic and the fact that telehealth moved from this kind of... It was something on the periphery to very much mainstream nowadays. Was the pandemic kind of a confirmation that this type of approach is really a smart kind of future-looking or future-proof kind of way of going about improving that access to these second opinions, these high quality opinions, I would say, medical opinions?

Frank McGillin:

The pandemic was an accelerator, and if you think in 2019 versus today, the technology's improved, but technology was not the issue pre-pandemic. The issue was consumer acceptance, it was also clinician acceptance, it was also reimbursement...

Kyle Murphy:

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Yes.

Frank McGillin:

...so the financial. So, the pandemic basically got all of those obstacles and took all those obstacles off the table. Patients realize that, "If I can access my physician, I can access a specialist without taking a day off of work, that's a pretty cool thing." Doctors and physicians realize that it was more efficient for themselves, as well as their patients. They realize their patients enjoyed it, the reimbursement is being figured out, and much more open to telehealth as an alternative. So, I think it really forced society to look at telehealth differently. It's created on some levels, I think, tremendous positive. It's created some false expectations. People are like, "Oh, telehealth is down," but if you look, the water table is at a much higher place today than it was before, and it's opening the door for more hybrid care.

Kyle Murphy:

Can we talk about just hybrid care in terms of, obviously, telehealth is really good for... Mental health access has gone through the roof and it's been a big win, but there's still that human touch component that has to occur. Certain things have to occur in a hospital or a clinical setting. How do you figure out the appropriate time or decision for ensuring that the right care gets delivered at the right time, at the right place?

Frank McGillin:

So I think it ultimately starts with looking at an individual facing a specific condition and say, "How do you design a care pathway around them?" So, let's take a chronic condition like hypertension. What are some of the elements that result in excellent care for a patient living with hypertension? And then designing a care pathway around there and say, "what can we do remotely? What can we do using remote patient monitoring? How can we use telehealth to check in? What are the touch points or what are the signals where you really need to have a face-to-face meeting or diagnostic test, et cetera?" But I think it's a matter of not saying, "how do I add telehealth to what I used to do all the time?" It's saying, "Now that I have all these tools in front of me, how do I design an optimal pathway that's going to deliver better care, better patient experience, easier for the doctor, and ultimately save some money for the health system?"

Kyle Murphy:

You mentioned those outputs or measures. How do you measure success? Where are you getting that feedback from? Are you talking to the patients in terms of asking their experience? What are the clinicians saying? I'm curious.

Frank McGillin:

So, we measure a couple things. First off, we use Net Promoter as our vehicle to measure the patient experience. So, everyone who comes through our program answers a Net Promoter survey and we look at the numbers. But more importantly, we look at: what are the comments? If someone loved us, why do they love us? If someone was disappointed, why were they disappointed? And we act on that and we go through every survey and every response and we take action. We do a similar thing with the physicians who support the program, what's working, what's not? Is there more efficient ways to deliver the medical records to them?

So, it really is patient [satisfaction], provider satisfaction, and then the next question, and it's really important to the health plans and employers we're doing is: well, how do we measure ROI? And for [that], we look at: are we changing the trajectory for their members, their employees? Are we changing diagnosis? Are we recommending different care pathways? We find two-thirds of the time, we're recommending either a change in the diagnosis or a change in the care pathway, and, generally, that's saving money.

Kyle Murphy:

Where does The Clinic go from here? Do you guys have a roadmap in terms of what you're doing? I guess, what's the timeframe that you think about in terms of new innovations or maybe expanding services or things like that?

Frank McGillin:

We're looking at a couple angles. First off is we're looking to make our current services much more broadly available, partnering with large players in health plans, but then we're looking at: how do we take this model further and how do we attack some of the large cost drivers of healthcare, whether it's chronic disease or otherwise, where we can use technology and use expertise and magnify the benefit?

Kyle Murphy:

And then lastly, the conference here, I guess, what are some of the things that you're looking at? How do you evaluate? There's obviously a lot of participation from a lot of different technology providers, developers, and what have you. How do you go about looking or evaluating? And maybe "this is something that we could incorporate, or do something similar," or "do we just simply bring in another partner who's got that skillset that we might be able to leverage?"

Frank McGillin:

Well, they have to have the word "AI" on the booth, or else I won't look at it. [laughs]

I'm a firm believer in partnership as a way to, particularly in healthcare.... Obviously, there's a lot of buzz around AI. Things can have a lot of potential. We're in a great position in the fact that Amwell is doing some incredible technology development with their new Converge platform, as well as some of the other [innovations] they're working on. So, we're tapping into that, but we're also looking to the outside to say, "what are some of the unique challenges we have as we're looking to expand our model and bringing in other technical solutions?" So for me, it's always exciting to be here and see what's new and what's happening.

Kyle Murphy:

One of the things that I've noticed now, it's been a big focus on strategic partnerships where, I guess, provider organizations in particular are realizing they just can't do it themselves. They really want to focus on the clinical care management side, and they want to leave the technology to a specialist or outsource. I guess, what you guys are doing is bringing it all together. Do clinicians, the ones that you work with, do they really care so much about the technology? Are they more concerned with being productive and being efficient with what they're doing?

Frank McGillin:

It varies on who the clinician is. Some people fancy themselves a tech expert, others just like to get it out of the way. I found in life as you're working and whether it's within your company or across company, creating that collaborative spirit is important. At the end of the day, I think people want to have an impact. They want to be listened to. They may have great ideas, they may have crazy ideas, but I think the more you can engage them, I think the more effective it'll be. We've been lucky in the fact that our North Star has always been around, "how can we help you help more patients?" And that's resonated well with the physicians we work with, and it's a great team of 3,500 specialists at Cleveland Clinic that we're lucky to work with every day.

Kyle Murphy:

Incredible work. Well, thank you so much for joining us. We really do appreciate it. We wish you safe travels back.

Frank McGillin:

Thanks for having me, great chatting.

Kelsey Waddill:

Listeners, thank you for joining us on Healthcare Strategies | Industry Perspectives. When you get a chance, subscribe to our channels on Spotify and Apple and leave us a review to let us know what you think of this new series. More Industry Perspectives are on the way, so stay tuned.