American Well Co-Founders Drs. Roy and Ido Schoenberg on Apple Heart Study and the Future of Telemedicine

Roy and Ido Schoenberg – American Well

Mark Masselli: This is Conversations on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, just a few weeks left for shopping for H anukkah
and Christmas, but we want to remind our listeners ther e is even less time to
shop for health insurance on the insurance market place, December 15th is the
last day for the health exchange, for most Americans December 15th is the final
day.

Margaret Flinter: Consumers who have a couple of years of experience are now
much better equipped it seems to navigate the online health insurance
marketplaces, a motivation out there.

Mark Masselli: A lot of motivation but a lot less time and that’s a real concern for
those fighting in the trenches to get the word out a cross the country and we will
repeat the website again healthcare.gov.

Margaret Flinter: And speaking of ways that we use online portals for healthcare
purposes that brings us to our guests today, brothers Dr. Ido Schoenberg and
Roy Schoenberg are the co - founders of American Well, a telemedicine support
company that is now one of the big players in telehealth. They have recently
partnered with Apple to conduct an innovative new large scale health study. The
Apple heart study is seeking data on the preva lence of atrial fibrillation one that
often goes undetected and is a leading cause of stroke.

Mark Masselli: The Schoenberg brothers lead American Well which is providing
a telemedicine component to the study and we are looking forward to hearing
more ab out it Margaret.

Margaret Flinter: And Lori Robertson will be stopping by, the Managing Editor of
FactCheck.org. But no matter what the topic, you can hear all of our shows by
going to www.chcradio.com .

Mark Mass elli: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter, we love hearing from you.

Margaret Flinter: We’ll get you our interview with Roy and Ido Schoenber g of
American Well in just a moment.

Mark Masselli: But first, here is our producer Marianne O’Hare with this week’s
Headline News.

Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. Well
sign up for health insurance for 2018 on th e insurance marketplaces shuts down
on December 15th, some folks may get an extension for those purchasing

Roy and Ido Schoenberg – American Well

insurance on the federal exchange December 15th is your last chance to apply
for coverage, but there are some exceptions if people are signing up for plans
that don’t exchange in 2018 that did in 2017, the health law allows for special
enrollment period. Also there are a couple of other circumstances such as
change in marital status or employment, but this year has got something different
as well, peo ple who were impacted by the hurricanes in Puerto Rico, Texas and
the South East are eligible for extensions as well. As long being evidence
supporting a link between birth control pills and breast cancer, but a more recent
study reveals the risk could be just as pervasive in low dose birth control. A
decade long study looked at 1.8 million Danish women comparing cancer rates
among those women who had been on the long term low dose birth control.

Study revealed a small but statistically significant lin k between hormone based
birth control use and increased risk of breast cancer. Researchers saying
considering the millions of women around the world who rely on birth control, this
study should raise some concern. Huntington’s disease is a devastating
se ntence impacting neuro and mental capabilities before attacking the body.
And at the moment there is no available treatment other than drugs to treat some
of the symptoms, but researchers of the City College of London have had some
dramatic success with a new approach injecting a new compound into the spinal
column that lowers the level of the toxic proteins said to fuel Huntington’s results
in the initial trials were so dramatic, the drug maker Ionis Pharmaceuticals has
opted to license the drug ahead of more large scale trials. I am Marianne O’Hare
with these Healthcare Headlines.

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Mark Masselli: We are speaking today with Dr. Roy Schoenberg President and
CEO of American Well and his brother and co - founder Dr. Ido Schoenberg,
Chairman and CEO o f American Well, a telehealth service company whose
mission is to improve access to quality care. Previously the brothers co - founded
care key, a provider of advanced care management software. Dr. Roy
Schoenberg was the 2014 recipient of the American Tele medicine Association
Award for leadership in the field of Telemedicine. Roy Schoenberg earned his
medical degree from Hebrew University, and MPH from Harvard. Ido
Schoenberg earned his M.D. from the Sackler School of Medicine. Ido and Roy
welcome to Con versations on Healthcare.

Roy Schoenberg: Thank you for having us.

Mark Masselli: And Roy I want to start with you, you both have been leading in
the health information technology field and there has been a lot of buzz recently
about the latest collabo ration, a new type of heart study in partnership with Apple
and Stanford and I wonder if you could tell us more about the Apple Heart Study
and the role American Well is going to play in it?

Roy and Ido Schoenberg – American Well

Roy Schoenberg: Sure Mark, a lot of people got excited about Te lemedicine
over the last couple of years, it has really skyrocketed in terms of adoption and
use and value, but if you realize what corner of telemedicine has gone by when
the Apple Heart Study was announced, you know, if you think about the way that
medic ine has always been, they are really two ways in which medicine
intervened, either we showed up when we were very sick or in some ways
healthcare developed ways in which occasionally if we were willing to do so, it
would take a snapshot of where we are and try to identify earlier certain
diseases, colonoscopies or mammogram, you know, at a certain age, but with a
heart disease, we try to cross a certain line because for the first time we are
saying healthcare is not going to wait until you show up with a ce rtain healthcare
condition but rather we are actually going to go to where you are, we are going to
kind of live with you and try to do our best to understand whether certain things
that are happening with you and your body may indicate that some kind of
t reatment or some kind of intervention is needed, that’s a radical departure in the
philosophy of how we do medicine and I think this is really the corner that the
Apple Heart Study signifies.

Margaret Flinter: Well I think it’s a fair assumption that the 33 million Apple
watch users are likely to be more highly motivated perhaps than other health
consumers, so I am wondering how are you preparing clinicians to respond to
what could be a significant volume of patients seeking medical advice because of
what turns up?

Ido Schoenberg: Yeah as you can imagine we did things through many
scenarios in American Well to try to support those amazing organization Apple
and Stanford, but we see something pretty amazing that the first time that the
tool that is used b y consumers which [inaudible 00:06:58 ] is not a medical
device, it can be so instrumental to help us understand something that could
have a potential far reaching clinical impact. Once we hold the study we will be
able to show to find people that could wa rrant medical attention far sooner than
any other medical intervention. So we have this tool that we use every day, that
listens to our body and we have this most sophisticated algorithm, not everybody
have access to their best thought leaders in Stanford everyday but now in a very
democratic way everybody could benefit from their type of thinking. And then we
are able to close the loop with board certified providers that show up much
quicker than any other alternative to help navigate and understand a fi nding and
that to me is the core innovation.

Mark Masselli: I think our listeners would be intrigued by your long time
collaboration as brothers, physicians, and innovators and I wonder if you could
tell them about how you both got started together on th is path to innovation in
implying new technologies to the healthcare space, what influenced you to delve
into health informatics and the Telehealth arena specifically?

Roy and Ido Schoenberg – American Well

Roy Schoenberg: I think in big capital letters constructive you know sibling rivalry
r eally helps but if I kind of go back, it really hasn’t been kind of a eureka [PH]
cerebral process of finding what it is that you want to do. Everything that we
have done through the three companies came from a kind of visceral experience
as human beings that made us consider is there a way to remove an obstacle
from something that we did, just to give you a sense, both of us are physicians
when we were young during our training, one of the things that a young training
physician does is spend the night in an intensive care unit. And all of these
machines and instruments that yell at you that something is going wrong with the
patients in their beds and it is a very scary experience. The first company that
we constructed was a company that essentially said why can’t we connect the
computer to all of these alarms and alerts and try to algorithmically make sense
out of them so that only then we start screaming at the young physicians who are
spending the night at the ICU trying to help. So the fear drove us t o develop the
first company. The second company was something also very human, we were
running around as patients, you know, you walk from one physician to the other
and the other one doesn’t have your record that needs to do your blood test
again and the second company that was created was all about can we just pass
records to where patients go, rather than have patients go to where the records
are.

In American Well when it started, you know, you could get a lot of things done
over the web, you had the Expedia of the world, Amazon to buy stuff that you
wanted, you had online banking, you could order foods, all of these services
have one thing in common, they deliver some goods to you and in healthcare at
the time, the only thing you could do is actually read articles. For most of us is
seeing a physician, that thing was not possible through online services and when
we started American Well, it was exactly the mission statement of the company
to create the capability to do just that.

Margaret Flinter: Well you’ve also been pragmatically working on the
monetization of telemedicine protocols for a while as well and I see great value in
making cost more transparent, maybe you could share with us some of the
challenges that you faced and why do you think th e system now is finally ready
for this kind of disruption?

Ido Schoenberg: Well when we started, many people were very concerned with
Telehealth, you cannot feel the patient, you cannot put a hand on someone’s
body and provide a physical examination, som e doctors were worried that their
relationship with their trusting patient is going to be influenced, you know, in
theory I can go home and there is nothing good on television it wouldn’t be
fantastic for me to talk to some great doctors and the health pla n and the
employer would need to pay for it. So a lot of resistance that you have seen
actually in many of cases had a lot of merits and in many ways some of the
services of telehealth today are not made equal. I mean, I would agree that if I
am talking to someone that I never met and provide a prescription, this type of

Roy and Ido Schoenberg – American Well

interaction has very limited value and that’s not what we are trying to do, it’s a
combination of the cost of healthcare is enormous and it’s not sustainable, the
access is really broken, the people spend too long waiting to see a doctor and
pay too much and these are very, very strong drivers to try to create a new
model, but the solution is not to find a cheaper doctor but the solution revolves
around true efficiencies that are possible when care is moving into the cloud. So
our mission is not necessarily to help people find a quick doctor in a box in a
cloud and get a prescription, our mission is to help our trusted doctors to treat
patients who are not in the room. What American Well is doing is trying to take
the community of providers that we trust and allow them to interact in a way that
is fully reimbursed and is safe and secure with the patients that they interact with
and allow this to be financed by the different types of pairs in the system and
allow smart innovators like Stanford and Apple to say, “Okay, now that care is
possible in the cloud, how can we use this opportunity to truly improve care?”

Mark Masselli: We are speaking today with Dr. Roy Schoenberg President and
CEO and Dr. Ido Schoenberg, Chairman and CEO of American Well. They have
recently partnered with Apple and Stanford to conduct a new heart health study.
Roy I like what you said earlier about your focus, “We want to make things
better.” And I am sure that’ s one of the reasons you have won accolades from
the American Telemedicine Association for your work, Roy I wonder if you can
tell our listeners what you’ve learned in this process and how both the regulatory
and [inaudible 00:13:27 ] landscapes have evolve d to better support the adoption
of telemedicine.

Roy Schoenberg: Well Mark how do you squeeze 11 years of battles into a one
minute answer, but start of American Well a little bit over 10 years ago, the first
time that we have deployed the telehealth so lution that we created which was
with our long lasting partner, Blue Cross special of Hawaii on the day that it was
rolled out there was a message to all physicians in Hawaii, if you do this thing,
your license may be revoked, this was the starting point b ut I think just about 5
years ago, the change in perception for the first five years of the journey, people
thought of Telehealth as an alternative kind of medicine and as you can imagine
that created a tremendous amount of fear of disintermediation and th at someone
is going to take people’s jobs away or physicians or the relationship in just
around five years ago, people started realizing that telehealth isn’t a different kind
of healthcare but rather a different channel for the traditional healthcare, it’ s a
way to redistribute the good healthcare that was developed in this country for you
know for hundreds of years.

And the moment that people started realizing that this is not a different kind of
healthcare that a lot of the fear starts subsiding and w hat we have seen that do is
that pretty much all of the key institutes that drive healthcare in this country
started moving the health insurance company started introducing telehealth into
their benefits. The hospital started introducing telehealth into t heir patient
portals, physicians started bringing it into their daily workloads and the regulators

Roy and Ido Schoenberg – American Well

you know politics apparently is always kind of late, late in the game, started
changing the language of a lot of antiquated rules to say yes good healthcare
can happen when the patient and the physician see each other and this is the
biggest change that I think allow the domino effect that cause that kind of break
neck growth we are seeing now in telehealth.

Margaret Flinter: Well I would love for you to com ment a little bit what you have
learned from consumers and this process, what have they told you about what
they love, what they like to see changed and what they like to see that may be
doesn’t exist yet in this telemedicine venture that you’ve created?

Roy Schoenberg: You know what we have heard from consumer over the years,
first of all makes healthcare less painful for us, easier to consume, it needs to be
more convenient, it needs to be immediate, it needs to be transparent, it needs to
be at the sam e cost or below over the services that we usually get, and if you can
do all of that kind of stuff and maintain quality we are in. And then on the flip
side, the other consumers of telehealth which are the providers have said that
platform has to resonate with the consumers to make sure that they find us, the
brands that they trust to deliver the best healthcare through this kind of
technology. And once we’ve built the system such that consumer gets all of
those capabilities we started seeing everybody be coming very happy and
cheerfully using the system.

Mark Masselli: You know I want to pick up on part of what Margaret just asked
about what doesn’t exist and may be a question for both of you Roy and Ido,
what are the greatest opportunities out there for disruption and may be what
challenges need to be solved to get there?

Ido Schoenberg: You know people talk a lot about Telehealth, but the truth of the
matter is that only 3% or so Americans are using it. It’s convenient, its affordable
and in our opin ion there are few things that are still missing, the service needs to
be trusted. When you talk to a call center and you never can call him again and
he cannot see you and he doesn’t have an access to your record, of course that
many people are concerned with such a service. One of the important drivers for
ubiquity is going to allow an infrastructure that will connect my doctor looking at a
screen that look it every day to interact with patients who are not in the room.
The second element relates to awa reness, consumers can get telehealth in one
of three places, the intranet of your employer, the app you never knew your
hospital head or the website of your health insurance company. I am sure you ill
agree those are not perfectly suited places to engage with your doctor. What we
are going to see coming quite soon is some of the people that really know how to
present options to consumers taking part in this process. Wouldn’t it be great if
one day I can wake up in the morning and say, “Hey, Bixby or Alex a or Siri I have
a headache, I have a symptom, I have a concern and I would like an environment
that is truly consumer focused to present my clinical and financial options, and I
want to be able to choose from things that we trust.” So these are two thing s that

Roy and Ido Schoenberg – American Well

are truly happening in front of our eyes right now which are some of the
remaining barriers. So when you move care online, they are so many new things
that you could do, there are so many efficiencies financial and clinical that are
simply not poss ible when you go to a certain room and talking to one person
rather than creating a data reach interactive collaboration that happens in cyber
space. These are two things that are truly happening in front of our eyes right
now which are some of the remain ing barriers.

The other thing that is happening is that when you move care online, there are so
many new things that you could do in order to improve care, there are so many
efficiencies financial and clinical that are simply not possible when you go to a
certain room and talking to one person rather than creating a data reach
interactive multidisciplinary collaboration that happens in cyber space.

Margaret Flinter: We’ve been speaking today with Dr. Roy Schoenberg
President and CEO and Dr. Ido Schoenb erg, Chairman and CEO of American
Well, a Telehealth Services company whose mission is to improve access to
quality care and to make it more transparent and affordable for consumers by
using mobile and web technology, you can learn more about their work by going
to americanwell.com or follow them on Twitter at American Well. Doctors
Schoenberg, thank you so much for joining us today on Conversations on
Healthcare.

Roy Schoenberg: Thank you very much.

Ido Schoenberg: Thank you very much.

Mark Masselli: At Conversations on Healthcare, we want our audience to be
truly in the know when it comes to the facts about healthcare reform and policy,
Lori Robertson is an award - winning journalist and Managing Editor of
FactCheck.org, a non - partisan, nonprofit cons umer advocate for voters that aim
to reduce the level of deception in U.S. politics. Lori, what have you got for us
this week?

Lori Robertson: The house and senate have both passed tax overhaul
legislation, they are now working on reconciling the differ ences in the two bills in
a conference committee. Let’s take a look at provisions in the bills pertaining to
healthcare. The house bill would repeal, and the senate bill makes some
changes to a medical expense deduction. Under current law, those who ite mize
their taxes can deduct out - of - pocket medical expenses that go above 10% of
adjusted gross income. So if your adjusted gross income was $40,000 and you
and your spouse and an independent had unreimbursed medical expenses of
$6,000 you could deduct $2, 000 of those expenses. For tax year of 2016, there
was a temporary exemption for those aged 65 and older allowing them to deduct
medical expenses that exceeded at 7.5% of adjusted gross income but that
exemption went away in 2017. The house bill eliminat es the deduction entirely,

Roy and Ido Schoenberg – American Well

an estimated 8.8 million tax filers claimed a medical expense deduction in tax
year 2015 according to IRS data and those filers deducted a total of $87 billion in
expenses. The senate bill repeals the Affordable Care Act’s indiv idual mandate
penalty which individuals without health insurance must pay unless they qualify
for an exemption. The house bill doesn’t change the mandate penalty. In tax
year 2015, 6.7 million people paid a penalty for not having health insurance,
those payments totaled $3.1 billion. And that’s my FactCheck for this week, I am
Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com , we will have FactCheck.org’s, Lori
Robertson, check it out for you, here on Conversations on Healthcare.

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Each week Conversations highlights a bright idea about how to make wellness a
part of our communities into everyday lives. When venture capitalist and Shark
Tank co - host Mark Cuban decides to sink a couple o f hundred thousand dollars
into your business idea, you are probably onto something and that is what
happened to Olivier Noel a medical student and a young geneticist when he
appeared on the popular ABC show. Noel learned that no matter how many
resources a clinical study has, it is still extremely difficult to get a large sample of
participants to join in studies. So he thought what if you could simplify the
process, eliminate the barriers to research participation and build up a rich DNA
database for fu ture research all at the same time and he created DNA Simple
because he wanted to make it well simple.

Noel: There is not really a formalized way for people to just participate in
research and provide samples remotely, so the idea was to create a databas e
where if you are anywhere in the states you could participate in a research study,
that could easily be done by providing a saliva sample.

Margaret Flinter: All the participants have to do is to take a simple swab of the
inside of the mouth, send it in and wait to see if your specific DNA is of interest to
researchers. The company will make their DNA and data available to
researchers studying specific diseases offering a much broader spectrum of
study participants and the study participants themselves receive an extra
something for choosing to participate.

Noel: So every time you participate, send a sample back to us, we send it to the
researchers and then send you 50 bucks to adjust [PH].

Roy and Ido Schoenberg – American Well

Margaret Flinter: DNA Simple has gotten a big boost from the Shark Tank win to
expand their DNA database to represent as broad, a demographic spectrum as
possible.

Noel: We want to be the place where you could automatically think of, if you are
thinking about study, and need a population that could go to when you are
thinking of a study and eliminate that worry of “oh I am not going to do this
because I may not be able to get the samples.”

Margaret Flinter: DNA Simple a better database linking researchers with a
broader array of participants to enhance lab resea rch by eliminating the barriers
to finding participants, now that’s a bright idea.

This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare broadcast from WESU at W esleyan University,
streaming live at wesufm.org and brought to you by the community health center.