Seven Key Insights Every Virtual Care Exec Needs to Know

Wheel CEO & Co-founder, Michelle Davey, sat down in her home office last week to remotely connect with Bradley Tusk, podcast host as well as Co-founder and Managing Partner of Tusk Venture Partners.

Michelle and Bradley chatted in-depth about a variety of topics, including the state of healthcare during this pandemic, and her vision to bridge the gap between healthcare and patients by focusing on the clinician. They also discussed the fact that this is the first time the CDC has ever made a recommendation of an integrated care strategy that includes telemedicine, and what it takes to get a telehealth company off the ground.

Michelle is in a unique position to see trends that are difficult to see across so many verticals, by virtue of the exposure Wheel has had to a wide range of clients exploring virtual care-- from DTC telehealth companies to big box retail brands, from tech giants to payor groups, and from hospital systems to consumer lab testing brands.

Here are 7 key insights she shares with Bradley that every virtual care executive needs to understand to get moving and achieve success:

Seven Key Insights on Virtual Care

  1. Telehealth is like banking--10 years ago, we called it mobile banking. Now, 98% of banking transactions actually happen on a smartphone. It’s just banking. In the very, very near future telemedicine will be referred to as just “healthcare.”

  2. The shift everyone is starting to make is to position telehealth as the “front door of care.” At least 98% of all healthcare matters can be triaged through telemedicine-- COVID and beyond.

  3. Until now, most people viewed telehealth as a way to manage cold and flu, and maybe some low acuity areas. But now, smart companies aiming to get ahead of the curve are now pairing up with digital health partners to move into higher acuity and chronic condition management. The potential opportunities for remote patient monitoring, lab testing, and diagnostics through telemedicine is incredible today.

  4. It's important to remember that in telemedicine, a good outcome isn't always a prescription. Sometimes it's care navigation to say, "You know what? You actually do need to go in to see a primary care clinician in a clinic." Or during this COVID-19 pandemic, "Yes, you do need to go to the hospital for this."

  5. The number one problem that companies will face when scaling a virtual care offering is finding great clinicians, training them, utilizing them in the most efficient way possible.

  6. Many companies have had virtual care somewhere on their business roadmaps, maybe two or three years down the road. Maybe they’ve been exploring multiple vendors for several years. Or maybe they even have an existing vendor that's not able to keep up with their growing demand. But now there’s no more excuse-- you have to move faster now.

  7. Organizations looking to add virtual care to their offering are starting to realize the fundamentals that they must have in place-- operationally speaking-- to get moving and achieve success: : 1) regulations and compliance best practices, 2) optimal treatment areas to serve their patient population, 3) polished clinical guidelines and protocols, and 4) a high-quality network that can flex up or down as patient demand inevitably shifts.

To listen to the podcast interview, check it out here on Firewall with Bradley Tusk.

Full transcript of their fascinating discussion below:

How do we prepare clinicians for the digital health industry?

Bradley Tusk (00:06):

All right, great. Welcome to another episode of Firewall. As usual, I'm your host, Bradley Tusk. Joining me today, now for the second day in a row after some technical problems kicked us off yesterday, is Michelle Davey, the Co-Founder and CEO of Wheel. Michelle, thanks so much for joining us.

Michelle Davey (00:23):

Yeah, thanks for having me.

Bradley Tusk (00:24):

So I should first disclose that we are a lead investor in Wheel. Jordan [Nof] is on Michelle's board as an observer or is he on the board itself?

Michelle Davey (00:35):

He's an observer.

Bradley Tusk (00:36):

Yeah, that's what I figured. But he acts like he's chairman. That's basically all of my interaction with him on everything.

Bradley Tusk (00:45):

But Wheel is one of THE companies at the moment because they are really at the heart of telemedicine right now in the US, and given the coronavirus, this is clearly the way a lot of treatment is now taking place. So Michelle, take us through real fast, your career and how did you end up in telemedicine? You kind of look like the genius right now, but what got you to this point?

Michelle Davey (01:10):

Yeah. So my professional career has actually been rooted in recruiting and operations from companies like Medtronic and Favor [00:01:17], all the way to Google. But stepping further back into my personal life, I actually grew up in a rural part of Texas and went undiagnosed with an autoimmune condition for over 15 years because we only had one family medicine doctor in our town, and unfortunately, he hadn't had experience with my type of autoimmune condition. So I've interacted with the healthcare system early and often throughout my life, and it's made me super passionate about access to care.

Michelle Davey (01:51):

But stepping back into my professional career, I've had a mix of both healthcare and tech. And then when I found telehealth, it was when both my personal and professional goals really aligned. And so I joined a telemedicine company where I was the head of operations and global talent, and saw this problem head on… so tried to build a provider network, quickly realized that it's not as easy as just hiring people, that there is a lot of regulation and rules, but also about finding these clinicians and training them properly.

Michelle Davey (02:27):

So after several months of trying to accomplish this inside of a telehealth company, me and my co-founder, who was my general counsel at the time, started asking around the industry how other people were solving this. We heard repeatedly that finding great clinicians and training them and utilizing them was the number one problem that these telehealth companies were having when it came to scale, so we left together and started Enzyme in January of 2018.

Bradley Tusk (03:02):

Yeah, and so when you started it, I mean clearly it was like this supposition of, "Hey, here's a solution to a problem that most people don't even know actually exists because they're not even aware of telemedicine in the first place." What did it take to both ...

Bradley Tusk (03:17):

Look, we invested I guess in the latter half of the seed round, but early on we were pre-seed, what did it take to convince investors that this was an idea whose time had come? And then what did it take to even convince telehealth companies to want to work with you, or were they just super excited and immediately signed up?

Michelle Davey (03:36):

Yeah, I think the interesting part was it was a big enough problem that within a couple weeks of us being launched, and I say launched with air quotes because we were pretty much just a slide deck and a dream and pitching people, these companies. We had one of the largest telemedicine companies actually sign up for our services within two weeks of being launched. So we really started to see the momentum in this space and how big of a problem accessing these clinicians really was.

Michelle Davey (04:13):

And then when we started actually fundraising, we were fundraising with a different approach. So when we first started, we were building this two-sided market, I call it the for telehealth, where we were essentially just matching clinicians and telehealth companies and stepping out of the picture. But when we started fundraising for new capital, we were telling this story that was very different than that. We were saying just that match was one, the pinnacle of finding the clinical talent was the pinnacle of the problem. But it was all the operational lift that it took to manage the regulations, and manage that workforce, and deploy them rapidly, and train them, and all of those things. That quickly became a bigger story, about building that infrastructure for the digital health industry to scale. So we've been able to grab some really great investors, like Tusk, to help us continue to build that out.

Bradley Tusk (05:13):

So right now, when a telehealth company, like Roman, works with you guys, and if I just violated some sort of privacy, we'll take that out, what does it actually look like? So what are they doing? What are you doing? What do they need you specifically to figure out for them?

Michelle Davey (05:31):

Yeah, so we work with the telehealth companies in a lot of different ways. So really where we step in, is we're a completely white-labeled network. So we plug in using our technology to their telemedicine platform and then they have access to our entire network, which is expansive across the entire US, and what it enables them to do is scale into all 50 states, or have additional coverage, or try new treatment areas, we do across 40 different treatment areas today. And really, it enables these companies to access clinicians who are the highest quality clinicians and already trained in telehealth and web-side manner pretty much at the drop of a hat.

Bradley Tusk (06:23):

So what do you think the medical industry as a whole thinks about telemedicine, and do you think its views are materially different than the rest of the world?

Michelle Davey (06:34):

Yeah, so I think, I mean in the wake of COVID, I think there's been a huge spotlight on the industry, and it's really started to bring to light the power of telemedicine. I think before that, stepping back, was most people viewed it as a way to do cold and flu and maybe some low acuity areas. Even for clinicians, it wasn't really legitimized. People saw this as clinicians just came to virtual care and telemedicine because they couldn't get a job elsewhere. But over the last couple of years, that's been changing. More companies coming out, like Ro, and a number of companies that are focusing not just on urgent care but other parts of healthcare and the higher acuity areas.

Michelle Davey (07:24):

And then I think what we're seeing in wake of COVID, is really, it's the first time the CDC has ever made a recommendation of a treatment for a public health crisis, recommending an integrated care strategy that includes telemedicine. But it really puts telemedicine at the forefront. So I think COVID has actually legitimized virtual care, not only for the industry, but really for the clinicians as well, as a viable option for their career path.

Bradley Tusk (07:58):

So COVID aside, if we tried to have, I know this is an oxymoron, but the most efficient, cost effective healthcare system possible, what role would telemedicine play, and what percentage of current care that's treated in person could be treated virtually instead?

Michelle Davey (08:19):

Yeah, so I like to use the analogy that telehealth is like mobile banking 10 years ago. So 10 years ago, we called it mobile banking. Now, 98% of banking transactions actually happen on a smartphone. So telehealth is really that future of healthcare and we're realizing that now, but it's really the front door of care. So we say about 98% of all healthcare matters can at least be triaged through telemedicine. So it's important to remember that telemedicine, a good outcome isn't just a prescription. Sometimes it's care navigation to say, "You know what? You actually do need to go in to see the primary care." Or in this aspect, COVID, "Yes, you do need to go see somebody in the hospital for this."

Michelle Davey (09:12):

One of the things that's really important is that funnel of people coming in and helping them find and access the right level of care at a low cost, and then pairing up with other types of digital health areas like remote patient monitoring and lab testing and diagnostics. We can really actually start treating patients at home for chronic conditions and some of the larger acuity areas.

Bradley Tusk (09:42):

And so with COVID, especially now, obviously people are vastly and quickly more aware of what virtual care has to offer, but where do you think this whole crisis ...

Bradley Tusk (09:54):

We're recording this on March 31, you've been in the middle of this and trying to provide your clients and companies with the ability to offer care for at least a month now, how's it looking from your perspective? Where is it heading? When do we peak? Does it come back? What are your thoughts around this whole thing?

Michelle Davey (10:16):

For COVID specifically?

Bradley Tusk (10:18):


Michelle Davey (10:18):

Yeah. So it's been a wild ride over the last couple of months, and I say that digital health has actually innovated quicker in the last couple of months than it has in the last 10 years combined. We're seeing that innovation in real time. We're seeing some challenges as well, where companies are trying to step in and fix things in the private market and the public market to try and optimize that.

Michelle Davey (10:48):

Unfortunately, a lot of where this will go is unknown and uncertain. But the important part to remember and why telemedicine is here, is really to also navigate through what's myth and also what's factual, and what clinicians are being trained, and what actually is the virus and what isn't. But I think with a lot of uncertainty in this, I don't think that we're seeing the light at the end of the tunnel yet. I think we've seen demand pick up, we've seen the virus spread without a lot of contact with other people, but I think we're going to continue to see this virus, but also many other illnesses pop up, and telemedicine being the way to combat that in the future as well.

Bradley Tusk (11:51):

Right now, are you guys hearing from all kinds of providers who normally weren't offering virtual care and now realize that they want to or need to? And when a random hospital or health organization calls, how do they get started?

Michelle Davey (12:07):

Yeah. So yes, definitely. I think most people have had virtual care somewhere on their business roadmaps, maybe three years down the road, or it was something that they've been looking at multiple vendors for several years, or maybe they even have a current vendor that's not being able to keep up with the current demand and the increase in demand. And so for them to get started with us, one of the things that is really important to us, from our side, is we actually do a clinical and a regulatory review of all of our partners. That ensures the safety of our clinicians. Our clinicians are on the front lines of care, not only in the hospitals, but also in virtual care, and their licensure and their livelihood is at risk as well when it comes to virtual care.

Michelle Davey (12:59):

So we ensure that the partners that we're with working with are the highest cream of the crop, and they're up to snuff as far as regulations, cyber liability, and then also the clinical guidelines and protocols, to ensure the safety of not only clinicians but the patients that they're actually interacting with as well. So we start that clinical review and once that's passed, we work with them to get stood up and enable our providers to start working with them as fast as possible.

Bradley Tusk (13:35):

So you are a group practice of some kind, a small hospital, whatever it is, and you realize that virtual care is now a reality. Let's say they haven't really thought about it before. What are the first ... If they're listening to this podcast, what are the first steps they take to start moving into this?

Michelle Davey (13:54):

Yeah, I think the very first part of it is actually the regulatory world, so understanding what your state by state regulations are. And for anybody listening to this, they can always reach out to Wheel or look on our blog. We post a lot of this information upfront so that you can figure out how to navigate it. But once you start to look at the regulatory field and how you can get involved, it's really about starting to figure out how you're going to operationalize this. And coming to a company like Wheel, we can help you do that and walk through that.

Michelle Davey (14:36):

A lot of what our job is in the early days, is educating telehealth providers, or healthcare companies, or adding virtual care, or just a company that's looking at adding telemedicine, virtual care, and educating them on these steps. So first regulations, then the second part is thinking about the treatment areas and what they're going to offer to their patient population, and the clinical guidelines and protocols around that. Wheel can help every step of the way. We do a lot of that upfront work with our clients and providers, so we can ensure the safety of patients and clinicians combined.

Bradley Tusk (15:16):

And let's say you work in government, you're listening to this, and a lot of our listeners are people in politics, and you're saying, "Okay, clearly I want to try to make virtual care easier," what are some steps that you think federal government or states could take to make all of this a lot more efficient and feasible?

Michelle Davey (15:36):

Well, I'm not a regulatory lawyer, so I can't go super deep on this. I do think that there's a couple of federal and state stuff that we can do. I think one of the things that, in the wake of COVID, a lot of the conversation has been about licensure. So stepping back from a regulatory perspective, the most important part, from the clinician's side, is that they have to be licensed where the patient currently is.

Michelle Davey (16:09):

So you can imagine if a provider is licensed in Texas because that's where they practice and they've always practiced, enabling them to work maybe in Oklahoma or Louisiana virtually, would also expand the access to care for other patients. So that's probably the one area we've seen in wake of COVID-19, is some of the state by states issuing emergency licensure ruling saying, "Okay, if you're practicing in Texas, you can also file to practice in Florida," for instance.

Michelle Davey (16:47):

So some of those changes I think will help move the industry forward. We'll see how and if they stick after COVID. I think some of the other areas are the treatment areas. I think one of the areas that we've seen and the regulatory world has been circling around is the Ryan Haight Act. And so there's a lot of people that still have opioid addiction and telehealth and virtual care is a great way to help on the front lines of that fight as well. And so we're seeing a lot of those regulations lifted. So just thinking where telemedicine can get involved, it's really unblocking us at the state level, and then allowing these providers, who are clinicians, who are trained in these specialty areas, to really be able to treat patients on a whole different level.

Bradley Tusk (17:48):

Yeah, so we had the medical director of Boulder Care on last week, actually.

Michelle Davey (17:53):

Oh, great.

Bradley Tusk (17:53):

Yes. Obviously, we're investors in them as well.

Bradley Tusk (17:58):

So five years from now, where do you think the telemedicine industry is and where does Wheel fit into it?

Michelle Davey (18:08):

Yeah, so five years from now, I don't think it will be the telemedicine industry. I think it will be healthcare. As I mentioned, I think, I use that analogy of mobile banking because it's really not a separate part of healthcare. It is the future of healthcare, and we're starting to realize that future now. But in five years from now I think it will be healthcare and that's how we will interact with the system, at least on the front lines of it.

Michelle Davey (18:36):

And so where is Wheel going to be a part of that? Our goal is to be the clinician first, where we're enabling all different types of clinicians to practice virtual care. And then we also, one of the big points of what we do, is we train clinicians on virtual care and web-side manner. So that when they're up and going in telemedicine, you have somebody who's specialized in virtual care, so those nuances are already worked out by the time that they're interacting with a patient.

Bradley Tusk (19:16):

Do you think we're entering an age of pandemics or do you think this was a random one-off, where a lot of really weird things happened and a lot of poor decision-making followed by government? Or do you think that the way that we live now that is so interconnected, means that this is the beginning of some sort of regular cycle of this stuff?

Michelle Davey (19:37):

That's a good question. Yeah, ultimately I think just the way we are so interconnected and travel and some of those things, I do think there will be future pandemics. I hope because of what we've learned in this and what we're learning in real time, that we're able to combat them and not get to this point earlier.

Michelle Davey (20:04):

So I think some of the decision-making and the learnings that we've learned in this pandemic, while super unfortunate here, can be applied to future pandemics in the sense that we'll be ready for these pandemics that come down the line. I do think a lot of the effort that we've put into COVID and stopping the spread will be used on the front lines of pandemics of the future.

Bradley Tusk (20:35):

Let's assume that we are entering an age of more and more pandemics, do you think just by sort of applying learnings and new technology, we can sufficiently defeat it, or do you think it's going to require a level of shared sacrifice that people tend to not be comfortable making anymore? I'll just give you my concern. I'll stall so you can think while I talk.

Michelle Davey (21:00):


Bradley Tusk (21:00):

Which is… take climate, right?

Michelle Davey (21:03):

Mm-hmm (affirmative).

Bradley Tusk (21:04):

Vast majority of people agree that it's real, that it's a massive problem. They see the world, in some cases, literally burning up. And yet, even as we see that, we still buy a new refrigerator, and get in our car and drive to the mall, turn on the air conditioner, and do all these things that only exacerbate the problem. So we're able to understand the problem intellectually, but we're not willing to make sacrifices personally that would really change our ability to confront it.

Bradley Tusk (21:33):

Now, I'm not 100% sure what those sacrifices with pandemics would be, but if it requires our lives being less convenient, less easy, less autonomous - even though I'd like to think that we are invested enough in this crisis that we would make those my fear is that, like everything, we return to normal very quickly and then we just keep being vulnerable to the same things over and over again.

Michelle Davey (21:57):

Well, I think that's probably true at the individual level. I think yes, I mean, everybody being stuck inside and being quarantined, and having some of the freedoms that they normally have put on pause. I think at the individual level, it does bring, maybe really quickly they'll come back into their normal habits an-- not proper hand washing-- and who knows. A number of those things.

Michelle Davey (22:31):

But I think at the level of healthcare, at least in the US, and I think even the global healthcare economy, we'll learn from this. I think there'll be things that we do in preparation for future pandemics and we start paying attention and sharing more of that global healthcare data and information more so than we ever have. Whether or not it curbs another pandemic, I'm not sure. I'm not an expert in that area. But I do think it will at least bring those conversations to light for future pandemics.

Bradley Tusk (23:06):

Yep. And virtual care and the kind of technology you guys are all building makes it a lot more feasible and possible, right? Because it connects the medical community all over the world.

Michelle Davey (23:16):

Yeah, absolutely. I think one of the things is learning from other medical communities when a pandemic starts. And I think while this pandemic started in China and there was data coming out, it's also about connecting the US-based providers to other countries and helping them navigate that, and other clinicians maybe who are seeing something in Italy and the mutation there, also sharing that information back to US providers, so we can continue to fight this at a global level and not just country by country.

Bradley Tusk (23:54):

Yeah. All right, so we're going to end this on a optimistic note since [inaudible 00:23:59] across these pages is a little scary. So Michelle, thank you so much for joining us, and as things progress, would love to have you back on.