Rebuilding Our Healthcare Ecosystem One Wave at a Time

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Pandemic reveals need for future planning post-COVID.

Over the past several months, our healthcare system has been tested in ways no one could have ever imagined. With some of the best healthcare in the world, we did not expect this level of devastation to take place here. “This could never happen in America,” many of us thought. We were wrong.

As a nation, COVID-19 has shaken us to our core, leaving powerful ripple effects of much suffering. Amid the series of waves, however – shock, adaptation, and uncertainty – has also come waves of enlightenment, which will serve to upend healthcare as we knew it before.

Wave 1: Urgent care visits

At the onset of the pandemic we saw a rush of patients seeking telehealth for urgent care. Most early patients were what we call the ‘worried well’ – presenting with low to moderate symptoms, but highly concerned of being infected. With infection rates growing, traditional doctors’ offices closed, and patients instructed to self-quarantine and maintain social distance, telehealth quickly became a lifeline for access to care while adhering to the new realities of COVID-19. It was only a matter of days after the first cases of COVID-19 were identified in the U.S. that there was a dramatic spike in urgent care telehealth demand.

As difficult as it may be to envision a post-coronavirus world, the pandemic will end. When it does, the physical points addressing urgent care needs will resume operation and the wave of telehealth-based urgent care will subside to near “normal” levels. Despite urgent-care telehealth demand going down, that first wave was arguably the most impactful, as it opened the floodgates and gave patients and providers alike a taste for what telehealth could offer, wiping within a matter of days many of the historical headwinds related to telehealth – awareness, trust, safety, quality and access.

Wave 2: Chronic and routine patient care

As the demand for virtual urgent care normalizes, a new wave of telehealth is emerging – patients connecting with their own doctors for their routine care needs, from dermatology and mental health to diabetes and cancer care. Over the past month, the demand for this type of telehealth has in fact outpaced the demand for urgent care. Specifically, at Amwell, these scheduled visits, between patients and their established clinicians, now account for nearly 60% of total visit volume, up from roughly 25% three months ago.

Unlike the urgent care wave, however, we do not expect telehealth utilization for this type of care to revert to the previous normal. In fact, quite the opposite; this type of telehealth care is likely to persist in even greater droves following the pandemic. That’s at least in part due to the fact that seniors and patients with chronic conditions – those who typically need the most care – are also the most at risk for the most severe health effects of COVID-19, and alas, will be among the last to reemerge from social distancing measures.

The good news is that, thanks to the water moved during Wave 1, more patients have experienced telehealth and more providers are offering virtual care to their patients for a growing variety of care scenarios. The more widely telehealth is used for different use cases, the more patients and providers will adapt to using it post-pandemic.

Wave 3: Primary care reimagined through a rebalancing of physical and digital services

Today many primary care offices are beginning to face a new reality: start using telehealth or lose business. Unfortunately, the pandemic has placed an even greater financial and operational strain on primary care settings, and many providers are realizing that what has traditionally worked in healthcare is no longer going to cut it. As a result of COVID-19, however, we’re seeing more and more delivery systems, and payers, realize that a new physical-digital balance can shift load away from high-cost facilities and redistribute care in a sustainable and responsible way.

What does this look like in practice? Imagine primary care encompassing much more than a yearly check-up and the occasional Rx. Imagine your local group practice hosting specialty providers, therapists or nutrition counselors, enabling a 360-degree healthcare experience without the need for constant referrals. Doctor’s offices are starting to see how they can use telehealth to add more clinical expertise and extend office hours by augmenting their physical staff with providers who join in over technology. Advancements in home biometrics and remote examination technologies are broadening the possibilities even further saving frail patients even that local bus ride. It’s a complete reimagining of how healthcare can play a greater role in our daily lives in a less cumbersome way.

Critically, in order to build upon, and not simply maintain, the progress we’ve made in the redistribution of healthcare, we must encourage policymakers to preserve and expand upon recent regulatory and reimbursement changes. Pointedly, it’s vital that telehealth become interchangeable with physical visits, at clinician discretion, so we as patients can experience the best it can offer.

These waves of change will ultimately serve our nation in helping us rebuild a better healthcare system – one that strikes a better balance between physical and digital services, giving consumers and providers more choice as to where and how healthcare is accessed. Ultimately, we will reemerge stronger, more connected and surrounded by a higher quality, less painful healthcare experience.


Roy Schoenberg is president and CEO of Amwell where, a decade ago, he introduced the technology that brokers on-demand telehealth visits between patients in need and available providers. Roy is the 2014 recipient of the American Telemedicine Association Industry award for leadership in the field of telemedicine. He is an avid author and speaker in the areas of healthcare technology and health IT policy. Roy serves on the board of the American Telemedicine Association, holds an MD from the Hebrew University and an MPH from Harvard. He is a sailor, scuba-diver and, between September and February, a devoted football fan.

1 Comment

  1. Prof Dr Dr Ernst Hanisch on

    “Some of the best health care system in the world”?
    I think looking at the mirror mirror study this statement is a kind of euphemism…

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