Cleveland Clinic, American Well Aim to 'Rapidly Deploy and Scale' Specialty Virtual Care

'The Clinic' is a joint venture company designed to expand direct patient access to specialists who will work in concert with local providers and hospitals.

With an announcement this morning at the 2019 Cleveland Clinic Medical Innovation Summit, telehealth just took a leap forward in scale. Cleveland Clinic and Boston-based American Well have formed a joint venture partnership to launch a new company, The Clinic, which will explore new ways to deliver specialty care directly to patients through virtual visits, a move that leaders at these organizations say will "democratize" access to specialists for patients around the globe.

"A place like Cleveland Clinic is [currently] available to the lucky few," Ido Schoenberg, MD, chairman and CEO of American Well says. "It offers relatively high-end care that is not always affordable to everybody. The Clinic's mission is to democratize that level of care to make sure that many more people—who normally could not have access to this caliber of clinical innovation, thinking, and practices—will be able to do that using the infrastructure of American Well and the genius of the people at Cleveland Clinic."

"We firmly believe that this digital platform enables unprecedented access to the depth of expertise that Cleveland Clinic is known for," says William Morris, MD, executive medical director, Cleveland Clinic Innovations.

Both executives note that the venture is in the early stage of collaboration. Providing patients direct access to clinical specialists through virtual care is limited due to issues such as reimbursement, lack of technological connectivity for specialists to quickly and efficiently access patient's records, and licensure across state lines. While telehealth is widely offered for urgent care, no other entity has been able to overcome these challenges to create a large-scale virtual care solution for specialists.

The Clinic will create models and products to address these issues and is already engaged with other partners to assist with these endeavors. Schoenberg says they are not prepared to release details about these relationships until a later date.

'Decanting Intellectual Capital' to Bring Providers to Patients
 

While Cleveland Clinic is seeking to expand its virtual care market share, another novel aspect of this venture is that The Clinic is not seeking to bring patients into the Cleveland Clinic system for treatment and services. Its specialists will offer consultative services and work in concert with a patient's own physicians and local hospitals.

"This is not a ploy to fill office visits and fill the building," says Morris. "It's the other way around: How do we decant our intellectual capital and bring the provider to you … especially for patients who are not in close proximity to Cleveland Clinic? The Clinic is a way for us to rapidly deploy and scale our digital services in a non–brick-and-mortar fashion."

Schoenberg further explains, "The idea is not to necessarily sell the time of doctors in Cleveland Clinic to others. The idea is much more profound: It's a way to take workflows, best practices, and algorithms, and make them available to a large audience to improve outcomes."

Creating a Payment Model That Introduces Value and Affordability
 

The Clinic is working on a payment model that will "introduce value and affordability into the system—not just another widget," says Morris. All options are on the table, he says, but the focus is on providing demonstrated value to the patient, self-insured employers, and payers.

"We have the technology," he says, "and I've got the docs. I can turn it on tomorrow. What we really need to do is capture that value and come up with the payment model."

Schoenberg points out that The Clinic is launching at a time when momentum is gaining for virtual care. [See related story: How Intermountain Lowers Costs Through Virtual Care]

Although Schoenberg  says only about 8% of Americans currently use telehealth, acceptance is growing. While reimbursement has been a barrier, he says, "CMS is opening its gates beginning in 2020 to seriously reimburse for telehealth." 

Licensure Hurdles for Specialists Have Been Addressed
 

Morris says that specialists in 40 Cleveland Clinic departments already perform virtual care consultative services for patients within the system and by offering second opinions to patients outside the system. Because practitioners are consulting with, rather than diagnosing or treating patients across state lines or national borders, they adhere to appropriate regulations. For any services that require credentialing, such as acute visits or telestroke services, "we follow the letter of the law," says Morris.

Organizations Made a 'Significant' Investment
 

While declining to cite its specific dollar amount dedicated to the joint venture, Schoenberg characterized the investment by both organizations into The Clinic as "significant." In a written statement to HealthLeaders, American Well says, "Each parent organization is equally committed to The Clinic. In addition to the financial assurance, both companies have dedicated top leaders from their respective teams to foster, nurture, and grow the venture." Morris says a national search will be conducted for The Clinic's CEO.

'How Does One Plus One Equal Five?"
 

Cleveland Clinic and American Well have collaborated since 2014 to deliver non-emergency and specialty care via telehealth through Cleveland Clinic Express Care Online. The health system has experienced a rapid increase in the use of virtual visits to deliver patient care. In 2018 alone, the number of annual virtual visits grew 68%. In a news release, Cleveland Clinic says that telehealth is a key part of its growth strategy to double the number of patients served in the next five years when it expects that 50% of its outpatient visits will be conducted virtually. Morris reiterates that the concept of The Clinic is to only provide specialist consultations virtually; care and treatment will be provided by each patient's local physician or hospital.

The health system is aware of a pent-up demand for access to its specialists and subspecialists, Morris says. The idea for The Clinic emerged from ongoing discussions between leaders of the two organizations who said, "Imagine if we didn't just have a vendor-client relationship, but a true partnership where we could leverage the intellectual capital, the experience, the trust in Cleveland Clinics and how we deliver healthcare plus a tech-enabled service platform like American Well," recalls Morris. "How does one plus one equal five?"

The discussions did not begin by addressing terms of business, says Morris. The focus was on the  cultural fit between the organizations and a shared vision to eliminate the physician barriers to health to  "democratize access to care," he says. "That's how we scale. It's not how many servers you have or how many physicians you can see. It's around whether you both share the same North star."

Schoenberg characterizes Cleveland Clinic as a pioneer and that collaborations between health systems and outside entities, such as American Well, may accelerate innovation in healthcare. The Clinic, he says, goes beyond telehealth by addressing a greater need related to healthcare delivery. Cleveland Clinic "may be the first organization that is … not only talking about the vision but committing, in every way, serious resources to grow their impact and to make their expertise available to many more people," he says.

"The path to the future is by creating connectivity," Schoenberg continues. "No one has the magic wand. It's all about rethinking the redistribution of healthcare services in a new democratic modality."