Amwell calls for 'all hands on deck' to manage telehealth surge

During the pandemic, providers have increasingly turned to telehealth services as a way of continuing their caregiving duties. Now, telehealth usage is undergoing another shift, according to Peter Antall, M.D., chief medical officer at Amwell.

While telehealth is leveling off for urgent care visits, the telehealth services provider is seeing a dramatic increase in behavioral health services. Compared to the same time last year, use of behavioral health services is up 100%, he said.

In this Q&A, Antall talks about the swift uptick in Amwell telehealth use, how the company managed the surge and why behavioral telehealth is now having a moment.

How have telehealth services shifted in the last few months?

Peter Antall

Peter Antall: Telehealth was gaining, growing and expanding up until this point. In our physician survey, only about 5% of providers across the country had adopted telehealth back in 2015, or were using it in any way. By 2019, that number was up to 22%. During COVID, providers needed to change drastically and change quickly. Providers' offices were closing or were restricted; patients were afraid to go into brick-and-mortar [offices]. One study from the Larry A. Green Center that has been surveying providers weekly during this period found in the primary care provider group [that] 85% have been using telehealth in some way, shape or form during COVID. The shift from visits happening in an office setting to visits happening electronically has been absolutely dramatic over these last three months.

Do you expect to see that level of telehealth adoption maintained post-COVID-19?

Antall: Some of that will [decrease] as offices open and people are a little less fearful about waiting in a waiting room. There will be a shift back and some of the old habits will come back with some doctors, but we expect that this is the real inflection point for provider adoption. We're seeing it and we expect to continue to see it. The increase in visits for our urgent care operations in our medical group have varied from 400% to, at certain times in certain states, as much as 1,000% increase. We've seen an incredible volume of patients coming in. Some of those patients are certainly coming in due to respiratory concerns or concerns about COVID, but another large group of patients in that increase is coming in for normal care because those patients needed somewhere to go.

Importantly, I think the other piece of data from our perspective is that the number of providers that are not in our medical group, so providers at hospital systems that have a version of our platform, has jumped even more dramatically. We're running at about [a] 4,000% increase in visits by non-Amwell providers happening on our platforms at this point relative to last year.

How has it been navigating such drastic increases in Amwell telehealth service use?

Antall: Four words -- all hands on deck. I mean that literally. We shifted folks who were in sales and other business-oriented roles into our operations team on the medical group side to help onboard providers. Our hosting team was installing new servers so rapidly, they ran out of the ability to obtain enough servers. We have some cloud-based services as well, we had to make a rapid transition to more of our hosting on AWS … We were running out of computers for all of the new employees that we brought into our organization. We couldn't get them. Our IT team was having to go onto eBay and other places like that just to get laptops for new employees. You can't prepare or drill for that. We certainly were prepared and drilled for a 100% increase or a 200% increase -- not a 4,000% increase.

Are you still seeing high levels of Amwell telehealth use?

I think we're happy to see care go back to some extent the way it was, but we really believe that this inflection point, this introduction to telehealth on an emergency basis to providers, is just what the industry needed.

Antall: In our medical group, particularly on the urgent care side, the dramatic increase was from mid-March to mid-April … but [now] we've seen a dramatic increase in behavioral health use. Both our therapy program and our psychiatry program are well over 100% above projected volumes for this time of year. It's pretty well-documented in the literature that after a natural disaster there tends to be a medical need immediately, and then a behavioral health need that lags by about three to four weeks. We've certainly seen that and that is still ongoing, in fact it's increasing.

How is Amwell preparing for life after COVID-19?

Antall: No. 1, I think our vision is that we are a technology provider. We don't believe we can build a medical group that can satisfy all the medical needs in America. Where we have clinical services, it's really intended to backstop the services of others when they don't have enough physicians to staff urgent care and do it on-demand and do it 24/7, we're there to help them with that. If they don't have enough psychiatrists in their network to meet demand, we can help increase the size of their network. … I think we're happy to see care go back to some extent the way it was, but we really believe that this inflection point, this introduction to telehealth on an emergency basis to providers, is just what the industry needed. Once providers try it, many of them see the value.