Larry Jones: Telemedicine’s Next Wave Belongs to the Programmers

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According to Larry Jones, CEO and founder of Telacare, telemedicine is in need of a backend overhaul.  A computer programmer by training, Jones wants to fundamentally rethink the software backbone for how digital health gets delivered.
As told to Logan Plaster

Telacare has about 30 employees and utilizes a network of about 750 providers, with an additional 1500 available if we need them. We cover every state where telemedicine is permitted, plus Puerto Rico.

We approach telemedicine differently. In my opinion, telemedicine is nothing but technology. I mean, the whole term tele is referring to technology of some sort. I think the key points to remember with telehealth today: if you don’t have a strong technology base, you’re not going to be able to deliver to your clients.

On Entering the Telemedicine Market
I had brushed by a company that was offering Telemedicine. I got to see what they were doing and how they were doing it. And there was just such a huge issue with the way it was being delivered and utilized. There were actually no biometrics. There were no units. There were no measurements. One of my curiosities was: How do you tell if I have a fever? How do you tell if I’ve got respiratory issues? There was no answer to that question. No offense, I could be faking it.

Once I got a chance to see what was under the hood of their car, I sat down and talked to the telemedicine company about what they needed to change. Once they decided it was something they weren’t ready to do yet, it just made me say: You know what? This is a great service. You don’t want to do it then I’m going to go do it.

The first thing I did before I even entered the telemedicine arena was actually go start working with biometric units and seeing about the connectivity and what could we use and what could we not use for a case setting inside a business.

On Telacare’s current biometrics offerings
We currently have whole sit-down kiosks in pharmacies. We also have wall-mounted units, which are about 10.5 inches deep and about 2.5 feet wide with locked doors for the biometric units, which connect to a flat screen and a drop-down board. We came out with those years ago.

On gathering biometrics at home
We’re actually kind of excited about this. We’re coming out with something this year, fourth quarter, which is going to enable the patients at home to plug a home kit into their computer for consultations with us. Home has always been an expensive venture for telemedicine companies because you would have to get the mom or the dad or somebody to actually purchase the kit. But I think if you could get a low-cost enough kit, you’re still going to get into some of these homes.

On competing in a crowded telemedicine market
First off, we have zero venture capital. We don’t have to answer to a board. We don’t have to answer to people who aren’t familiar with telemedicine and just gave us money. So, we can still think outside the box. We are a free-thinking telehealth company. If something’s new, something’s inventive or something’s going to push the envelope in the telehealth arena, we can get up the next morning and start building it. If I’m a Teladoc or an MDLive, those innovations can easily get stuck on the drawing board. What we see is these bigger telemedicine companies seem to be copying each other. MDLive bought Breakthrough. Now the former CEO of Breakthrough is the head of psych for Teladoc. To me, if they’re going to keep copying each other, they’re not going to advance. We don’t care what they do. Telacare only cares about what’s the newest, the greatest and the hottest thing in telehealth. Teladoc just acquired HealthiestYou for $125 million, but they were only earning ten million a year and their app was built on third party APIs – there was nothing proprietary.

Also, what you’re going to find is that the Teladocs and American Wells and the MDLives are 90 percent made up of insurers and large Medicaid/Medicare companies and probably only ten percent general businesses. I, on the other hand, have no Medicaid/Medicare business or any insurance companies. I’m 100 percent made up of small to medium size businesses and consumers.

On Telacare’s market differentiators
Our strength over the competition is in utilization. We have 40 percent utilization. Compare that to some of the biggest players in the market, who are hitting around four percent utilization (rough estimate).

On Telacare’s pricing structure
The big telemedicine players in the market have been competing on who could sell their services the lowest. Those guys were in the market saying: Well, I’ll do it for a quarter less. What they’re finding out now – thanks to Teledoc’s public data – is that this pricing structure might not be such a good idea.

When we sold telemedicine, we said: Look, flat out, we have a minimum. Our minimum is five dollars. And people said: Oh, well, gosh, I can get it from Teladoc for two. And my response was: Get it. And in six months let’s see what your utilization is. That’s what people did and that’s why they started coming back. Because they said: Look, you’re right. It’s not worth it. At two bucks if nobody uses it, I’m throwing two dollars out the window. I might as well pay three more and guarantee utilization.

On scaling up
Our current user base is in the seven figures, but everyone wants to be larger. My focus has never been on how many lives we can get, and “I’ve got more than you.” My thought process has always been: Am I doing it better than the other guys? Am I doing it right? And am I getting the results for my customers?

So in terms of scalability, yes, I would love to have ten million, 15 million, 20 million members; providing that I can still deliver the same great utilization and service that I do now. If I can’t, then no, I don’t want it. Because then all I’m doing is becoming another one of those giants who’s saying: Look at me, I’ve got all these big numbers but I’m still making no money and I’m not producing the service or the solution that I’m promising these people.

If my customer wants something tomorrow, I’ll build it. I guarantee it’s going to take many board meetings and discussions and roundtables before the big guys even get to the same spot to start building something. I’ll wake up tomorrow and tell my guys: Build the damn thing now. And we’ll build it. I’m still hungry and even after seven years haven’t lost that thought.

So I guess it just depends. Can I continue to do what I’m doing? I think yes. I think we can scale larger. And I think we can continue to deliver. We are profitable. We’re proud of that. We don’t have any venture capital. I’m absolutely proud of that. We took on no debt. And for a telehealth company to be profitable, that means I have to be charging something and doing something correct.

On having a CEO with a tech background
I don’t think it matters if you went to Harvard or Chico State University. I think the determination, the drive, your vision is what matters. What makes me different? I don’t have to do what you say. I have to do what my members say. And if my members say that they want it to be easier to sign up on the back-end, that’s what we’ll do. When we built our systems, we made it so that it was a single sign-on, so that people didn’t have to worry about checking a box or looking in the spam folder or anything. It’s simple things like that that I have the ability to take further than the other guys. Customers need the KISS method. And as a tech guy, I can look at the KISS method and immediately see that we have a problem. We are constantly evolving. We’re constantly changing. And I don’t think I sleep much because I’m always sitting there thinking: What can I do to make mine better or easier or more appealing? Because every day I have to go out and compete.

Put your company in the hands of an actual developer and let them have free creative reign. What you’re going to see is them continuously coming out with new products, new systems. Because a developer does not know how to sit still and they also sure don’t know how to let stuff get stagnant. They’re always trying to improve upon something that they have built. That’s just the mentality we have.

On the challenges of having a software developer at the helm
We’re stubborn. We would take longer sometimes because it’s never really done for us. Think about Steve Jobs, who took forever to come out with the Macintosh. That he wouldn’t go to market with it and he kept spending more money was one of the reasons he was let go. And of course what did they do later? They brought him back because they couldn’t make it work.

Having a developer at the helm did pose a problem, but as a developer, you know when it’s ready and you know when it’s not. It’s not all about being first to market.

On Telacare’s client base
My smallest client has five employees. Two of the biggest telemedicine providers had told them they were too small, that they couldn’t help them. They called us and I said: I don’t care if you have one employee. I’m happy to help you. At the end of the day, I don’t think people realize that two plus two does become four.

On Telacare’s end game
I’m not going anywhere, I can tell you that. I sure as hell ain’t selling. I’m not hurting for money. I’m a happy guy. I got my wife and my three kids. And I enjoy getting up every day and doing what I’m doing. So, it really doesn’t matter what they want to offer me.


Logan has created, edited and designed healthcare publications since 2005. After redesigning and managing Emergency Physicians Monthly, he founded Emergency Physicians International in 2010, and then launched Telemedicine Magazine in 2015 where he served as writer/editor until 2018. Logan is the co-founder of The mHealth Toolbox, a project that brings practicing physicians into the conversation about innovative medical technology. Logan also served as the Director of Communications for The IFEM Foundation, the leading non-profit supporting global emergency care development.

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