Jason Gorevic 0:03
It’s all about the patient experience and we do a lot of work in order to coach physicians on a website manner, not just a bedside manner, because there are differences.
Gary Bisbee 0:16
That was Jason Gorevic, CEO Teladoc Health speaking about Teladoc coaching its physicians to understand and act on the differences between a website manner and a bedside manner. I’m Gary Bisbee and this is Fireside Chat. Jason discussed why he first became interested in healthcare and how his background with health plans and working with providers was an excellent base for leading Teladoc Health. He thinks about Teladoc services as coordinating a bricks and clicks experience for the patient. He pointed to the future of healthcare moving to the home and estimates that COVID has accelerated patient and physician acceptance by up to three years. He outlined the importance of Teledoc’s capability to engage patients in the hospital or nursing home and then provide services across the continuum of care to the home. Let’s listen.
Jason Gorevic 1:05
The ability for a physician to use the InTouch technology to first deliver care to a patient who’s in a hospital bed or a skilled nursing facility, and then follow them using that same technology into the home is a tremendous opportunity. There is no question that that’s where healthcare is going.
Gary Bisbee 1:27
Jason is tracking telehealth innovation by hospitals and health systems, including expanding coverage to clinical specialties, pre-surgical workups, and post-discharge follow up visits.
Jason Gorevic 1:38
We’re seeing hospitals and health systems engage in use cases across the entire spectrum of clinical specialties ranging from oncology to cardiology to orthopedics and we’re seeing quite a bit of use right now in pre-surgical workups and post-discharge follow-up visits.
Gary Bisbee 2:03
I’m delighted to welcome Jason Gorevic to the microphone. Well, good afternoon, Jason, and welcome.
Jason Gorevic 2:12
Well, thanks, Gary. I’m happy to be here. Happy to join you on the podcast.
Gary Bisbee 2:16
Well, we’re pleased to have you at this microphone. Let’s start by getting to know you, Jason, and then we’ll turn to Teladoc and COVID. When did you first develop an interest in healthcare?
Jason Gorevic 2:26
Gary, I was a student at Penn during the first Clinton healthcare debate back in ’92 and that sparked an interest for me in healthcare. I had thought I might go into my family’s business, decided I didn’t want to go that route and I was considering my options. And I was fortunate enough to land in an on-campus recruiting meeting. They gave me the opportunity to enter healthcare. It was something I wanted to do because I want to know ultimately make an impact and not just have a satisfying and rewarding career.
Gary Bisbee 3:00
So you came up to Connecticut to work for Oxford? Was that your first posting?
Jason Gorevic 3:05
It was. Yes. Doesn’t everybody grow up dreaming of working for health insurance? You know, it was an interesting time, obviously, in the early 90’s and Oxford had a different approach to managed care on the East Coast, something that had been pioneered on the West Coast but was really making its way across the country. I was very fortunate, I have to say, I landed in a company that was thinking about things differently and provided me with just incredible executive access, responsibility, mentoring, and a lot of the people I worked with then and who were my mentors then, I continue to work with today and continue to be mentors and colleagues for me today.
Gary Bisbee 3:46
You followed up your time at Oxford with predecessor of Anthem and then Empire Blue Cross and provokes the question, as you were learning more and more about healthcare, what opinions did you form about healthcare working for these large insurance companies?
Jason Gorevic 4:02
I think when you work for a big health plan, there are drawbacks but there are also real advantages. I think you really understand how the economics of healthcare work. I think you get an appreciation for how healthcare is paid for and the dynamics that go between the employer, the consumer, the provider, and the incentives that move around among them. And so it gives you a little bit of a bird’s eye view and it doesn’t necessarily give you a real appreciation for what it is to be a healthcare provider. Some of the best health plan executives I know have spent time on the provider side. But you know, I also took some time off between those to do some more technology-oriented startups, earlier stage things outside of healthcare. It gave me an appreciation for market dynamics in a two-sided marketplace. It gave me an appreciation for the power of the internet and how you can connect to people. I like to say that I brought all of that together when I ultimately joined Teladoc.
Gary Bisbee 5:09
I noticed that while you were at Oxford you built and managed the telephone medical advice service and I wondered if that gave you a predecessor view of telehealth and Teledoc?
Jason Gorevic 5:21
It definitely did. Interesting, because at the early age of that, it started as a marketing-driven thing, something that was driven to drive better consumer satisfaction and loyalty at a time when health plans weren’t really doing those kinds of things. And we were on the leading edge, we were the first non-staff model HMO to deliver that kind of a service. And ultimately, as we started to build it, and I was really deeply involved in building the workflows and the screens that the nurses would use, and as we started to build it, we started to see the power of the data that we were getting and the ability to influence consumer behavior and really meet their healthcare needs in a different way. But there were limitations because you couldn’t diagnose and treat and so it was really limited to triage as opposed to treatment. And that gave me some of the insights about the power of it and the opportunity, but also some of the drawbacks of what a nurse advice line meant.
Gary Bisbee 6:21
So your background is fascinating, entrepreneur as well as an operator. How do you view yourself? As an entrepreneur or an operator or both?
Jason Gorevic 6:30
I guess the answer is both. I think any really good successful entrepreneur who can be successful at building and growing and scaling an organization has to be a strong operator. I guess it’s true that not every strong operator has to be a good entrepreneur. So I feel like it takes both at this stage and to be honest, I don’t think we would have gotten through some of the early stages if I weren’t an okay operator.
Gary Bisbee 6:58
I’m sure of that. Compared to leadership of large insurers, I know you did other entrepreneurial activities, but given compared to leadership and large insurers, what was the greatest learning curve in leading a high growth, high tech company like Teladoc?
Jason Gorevic 7:13
There were a lot of challenges along the way. I had really not dealt a lot with the regulatory side of the business. That had been other people’s responsibilities when I was in Health Plan. And so that was an eye-opener for me. I didn’t really expect to be in a situation where we were fighting the kind of regulatory battles that we were at an early stage in Teladoc’s existence. And it took some intestinal fortitude to get through those, but we were fortunate to be able to do that. And we stuck to our values, focused on doing what’s right.
Gary Bisbee 7:49
Thinking about you during your CEO career, what’s been the most rewarding thing about being a CEO to you, Jason?
Jason Gorevic 7:56
I think it’s all in the lives that you have the opportunity to impact. Between our team members, the members that we have, now over 50 million members and 10’s of millions more than that who have access to our platform, the providers, who we have the opportunity to really impact and enable to change in how they deliver care and really transform how they deliver care and give them an opportunity to expand their income as well as their scope. It’s very gratifying and, Gary, I think right now, it’s particularly gratifying as we have the opportunity to be part of the solution in what is a very, very challenging time.
Gary Bisbee 8:39
Well, on the flip side, what’s been the most challenging decision that you’ve had to make as a CEO.
Jason Gorevic 8:45
Kind of a well-told story, but we were in the middle of raising our Series B and we had a term sheet on the table, and we were in the middle of diligence when we got what essentially amounts to a cease and desist letter from Texas Medical Board. And after a lot of discussions and a lot of gut-wrenching decisions with our board, we made the decision to file suit against the Texas Medical Board. That was a pretty terrifying thing to do. It was the right thing to do, as I mentioned, but that was a very, very difficult decision and one that was almost life or death for the company.
Gary Bisbee 9:22
Well, that turned out well as you say it was the right call. Let’s now turn to Teladoc, with which most of us are generally familiar. Will you please describe Teladoc for us, Jason?
Jason Gorevic 9:33
Sure. Well, our role and our mission is to transform how people get health care, making it more convenient, higher quality, lower cost, and an experience that is friendly to the consumer and really uses technology to advance access to care. And we do that by providing consumers with the opportunity to connect virtually with their physicians or with our physicians and providing hospital systems, health systems, physician offices with a technology platform that enables them to do that with their patients or expand the scope of their practices to practice for our consumer efforts. And we do that all around the world. We provide products and services to health plans, to employers, to health systems, directly to consumers, both here in the US and globally.
Gary Bisbee 10:27
Well, congratulations on your earnings report yesterday, just terrific! Estimated revenues for 2020 will be close to a billion dollars. Do you remember what they were in 2009 when you joined Teladoc?
Jason Gorevic 10:40
I do! That year we did $4 million in revenue. I had the opportunity to go run another big health plan or go to this tiny little virtual care telehealth at the time company, and I decided to obviously come to Teladoc and it was only $4 million in revenue and I remember getting emails of condolences and concern from my friends in the industry.
Gary Bisbee 11:05
No condolence emails today, that’s for darn sure. Great run! I’m sure there were just many steps along the way. It’d be fun to talk to you when we have a bit more time about that, but what percentage of revenue comes from the US versus international at this point?
Jason Gorevic 11:22
We are about 85% give or take revenue from the US and about 15% outside the US. I continue to think the global market presents a tremendous opportunity. And, you know, we announced a couple of new deals both in the Nordic Region, as well as in Brazil, just in the last quarter, as well as expansion earlier than I would have expected, selling our new InTouch portfolio of products into Germany and India and the UK.
Gary Bisbee 11:51
So do you think the growth rate is going to be differential over let’s say the next five years between the US and international?
Jason Gorevic 12:00
I try hard not to parse apart the components of our growth rate too much. One of the benefits of our business is that it’s a diversified portfolio of customer channels. I don’t have to hit a home run every year in every one of the channels for us to be very, very successful. So that’s a luxury to have.
Gary Bisbee 12:20
Another question I think of interest to the listeners would be thinking about the B2B business, employers, health insurers, health systems. What’s the breakdown and revenue coming from those types of companies?
Jason Gorevic 12:33
That represents the largest portion of our business. It’s where we started, quite frankly. It has the biggest legacy book of business, as well as some of the acquisitions that we’ve made, were entirely focused on that area. But with the introduction of InTouch Health to our family of products, that adds quite a bit to our revenue and our product portfolio focused on hospitals and health systems. And we really believe that hospitals and health systems are making a significant move toward virtual care and doing it across their enterprise, across their specialties, both from facility-to-facility as well as facility into the home.
Gary Bisbee 13:16
Will the explosion in televisits handled by these large health systems change either the opportunity for Teledoc with the health systems or change the business relationship with the health systems?
Jason Gorevic 13:29
I think it has the opportunity to. I think there’s the opportunity for sort of a seamless bricks and clicks consumer experience. And in order to facilitate that, the health plans and the hospital systems need to work together and that’s one of the reasons for our strategy to be in all of those consumer channels focused on making sure that we’re delivering the right integrated technology so that the consumer can have a great experience regardless what front door they come in, and that we’re meeting the needs of each one of the key constituents in the market.
Gary Bisbee 14:09
Right, you’ve mentioned InTouch several times which has been a relatively recent acquisition. Can you describe InTouch for us and how that fits into Teladoc?
Jason Gorevic 14:18
Yeah, absolutely. So, InTouch has been the leader in providing hospitals and health systems with technology, historically, for high acuity situations like Telestroke, ICU, NICU where you need medical-grade technology that you know is going to be reliable because it can be a life and death situation. And they do that and really facilitate facility-to-facility communications where you can bring a highly trained and high-cost specialists from one facility virtually into another facility to deliver the care that’s necessary. They’ve expanded as hospitals and health systems opened up the view of where they can apply virtual care to come outside the four walls of the hospital, which is of course, where Teladoc Health has traditionally played, enabling hospitals and health systems to reach outside of the four walls into the community and to the bedside at home, not just the bedside, in the hospital. And so, if you look at us together, we really enable, with a single platform and a single interface for the physician, the ability to go from the hospital bed to the bedroom, regardless of where the consumer is and needs care, on a single platform. And that’s a very, very powerful offering and enables still with that medical-grade technology, the ability for a health system to purchase one solution for the full entirety of their virtual characters.
Gary Bisbee 15:54
Yeah, across the continuum. Well on to visits, 2020 visits are estimated to be well over 10 million. What were the number of visits back in 2009, Jason, when you joined Teladoc?
Jason Gorevic 16:08
We did about 18,000 visits the entire year of 2009. And today, on a busy day, we do that in about 12 hours.
Gary Bisbee 16:22
It’s been an amazing roughly 11 years that you’ve been there. What about the CBS partnership? I know you have one. I’m not all that familiar with the details?
Jason Gorevic 16:33
The CBS partnership. We have a partnership both with CBS on the store side, as well as with Aetna and great relationships on both sides of the business. Just like many pairs for Aetna, we provide virtual care services across multiple specialties, ranging from mental health to general medical dermatology services for their fully insured and self-insured populations. And on the CBS side, we power the CBS video visits that are embedded in the MinuteClinic app and consumer portal. And that is a great example of where we use both our physician network that we manage, as well as enabling their Nurse Practitioners on our platform to deliver care and it’s really seamless. And enables them to use their assets or their capacity when it’s available and use ours where and when it’s not and gives them tremendous flexibility, which is one of the things that we also bring to hospitals and health systems, the ability to choose who they want to deliver the care and technology platform we deploy for them.
Gary Bisbee 17:46
So what’s the process for Teladooc developing its treatment protocols? How do you go about doing that?
Jason Gorevic 17:53
We convene an expert panel and we have a Medical Advisory Board that oversees that and the expert panel reviews the literature and adapts the best practices and clinical guidelines from the literature to an environment where the consumer and the provider are not in the same place. And the goal is to say what is appropriate to be able to diagnose and to treat and where are the limitations where you need to be in person or you really do need a lab result in order to make a diagnosis. And we have our own proprietary set of those because nobody has really stepped back and said, well, if you can visualize the patient, can you get to diagnosis on this, but if you can’t visualize the patient, then what’s the limitation? And are you able to use this set of questions and symptomatology in order to get to a diagnosis and a treatment plan? Can you hear the patient’s cough and whether it’s congested or dry? Can you visualize the eye in order to figure out whether it’s pinkeye or something like that. And, for much more intense things, for example, we’re seeing now a much higher incidence of non-infectious disease consumers coming to us with things like back pain or hypertension and so we work hard to make sure that the medicine is grounded in the best practices from literature.
Gary Bisbee 19:25
That leads into this question about patient trust in a digital setting, which I think has become more obvious just over the last several months that patients are comfortable in a digital setting once they get used to it, but how do you think about developing patient trust in a digital setting, Jason?
Jason Gorevic 19:44
I think it’s all about the patient experience. And we do a lot of work in order to coach physicians on a website manner, not just a bedside manner, because there are differences and so we do tremendous customer sentiment research. We do that by reaching out directly to them. We also do that using AI tools to focus on consumer reaction, best practices when it comes to the clinical quality, but also the interaction between the physician and the patient. Because we know that there are certain behaviors, and there’s tone of voice that comes into play, sometimes it’s as simple as asking at the end of the visit whether the physician answered all their questions and was there anything else that they wanted to ask about, not just the primary symptom that they are interacting with the physician for. And so, we work very hard to do that and I’m so proud of the fact that while we’ve seen this massive spike in volume, actually our net promoter scores and member satisfaction scores have increased.
Gary Bisbee 20:54
How do you think going forward, you’ve obviously been a leader in digital visits and thinking about that, how do you see going forward, the future mix of digital and in-person visits?
Jason Gorevic 21:06
It’s a good question. I don’t know that I’m ready to give a prognostication. We estimate that about a third of ambulatory care visits can be done remotely. And Kinsey just came out with a study that estimated that $250 billion worth of us healthcare spending could be virtualized. Our own company, our employees experience about a 300% utilization rate, meaning visits overpopulation is about three times the visits that we have employees. So I don’t know if I can give you an exact answer but that should give you at least a few things to help triangulate what that looks like.
Gary Bisbee 21:51
We definitely think that the proportion of digital visits will grow over time. I think that’s clear. Thinking about higher acuity cases found in hospital at home, that sort of arrangement, how active will Teledoc be in playing in that space, Jason?
Jason Gorevic 22:09
I think we’ll be very active and I think InTouch is really a door into that opportunity. The ability for a physician to use the InTouch technology to first deliver care to a patient who is in a hospital bed or a skilled nursing facility, and then follow them using that same technology into the home is a tremendous opportunity. There’s no question that that’s where healthcare has gone.
Gary Bisbee 22:37
Well, let’s turn to the COVID crisis. As is frequently said, a crisis accelerates developing trends more than it creates new ones. But what impact has the COVID crisis had on Teladoc?
Jason Gorevic 22:49
I think you said it as well as anyone. It has accelerated what was already happening, probably by what I would estimate is about three years. So I would say we’ve taken a three-year warp speed journey in about four months, and it’s accelerated consumer awareness, consumer adoption, provider adoption, provider satisfaction, and engagement. And it’s also just massively accelerated the role that virtual care will play. It’s opened the door to things like virtual primary care that people were skeptical about even six months ago and now see as an eventuality.
Gary Bisbee 23:29
So as an international company operating, I believe, and roughly 175 countries. How did your unique global vantage point assist Teladoc in preparing for the surges in the various countries?
Jason Gorevic 23:42
Well, you’re right. We have a very large team in Barcelona. We have about 50 people on the ground in China. Our team in China was deeply engaged as early as the middle of January. So at the end of January, we were in contact with the WHO and the CDC, creating information and educational items for our clients, especially large multinational employers. And we were able to get, I would say, as prepared as possible for when it hit the US shores. I don’t think anybody anticipated that it would have the overnight spike that it did. But I feel really good about our early involvement and that early involvement here in the US gave a lot of information to the CDC to enable them to track the outbreak. Because we are a bit of a unique situation because we have a true single national platform. It gives us the ability to really get good data. So for example, it’s the same thing with the flu. That’s actually ahead of what the CDC gets when hospitals are reporting it to them because there’s just a new inevitable lag in that reporting, as opposed to us being able to see it real-time.
Gary Bisbee 25:05
One of the questions, of course, that everyone has, which is how much will the force demand for telehealth services caused by the COVID crisis tail off as a surge recedes? Do you have any sense of that at this point, Jason?
Jason Gorevic 25:19
I do because even now we’re seeing the states that have come back to where the COVID spread has been effectively suppressed, in the northeast, for example. And office visit volume is almost back to pre COVID levels, we still see levels of volumes that are roughly 40% bigger than what we saw before the COVID crisis hit. The rates of growth that are roughly double what we were seeing prior to COVID. And so there is no doubt in my mind that our new normal will be at a significantly higher visit volume utilization rate. And we’ve essentially taken the curve and shifted it up by quite a bit. And that goes along with that probably two to three-year acceleration.
Gary Bisbee 26:14
Right. Well as you think about the new normal for Teladoc, as you’re saying, do you have in mind innovative uses of telehealth that you either might be aware of or you think might be developed that will further increase demand for telehealth services?
Jason Gorevic 26:29
I think we’re seeing hospitals and health systems engage in use cases across the entire spectrum of clinical specialties ranging from oncology to cardiology to orthopedics. And we’re seeing quite a bit of use right now in pre-surgical workups and post-discharge follow-up visits where the patient doesn’t have to come into the facility for either one of those, and it drives better compliance, it drives better patient satisfaction, it’s just a better overall experience. And then, maybe the last thing I’d say here is we’re doing quite a bit of work on using artificial intelligence to improve healthcare delivery. So things like using the video feed to be able to measure temperature, to be able to measure heart rate, to be able to measure blood pressure, and the technology is there to be able to do that and I think that will open up the aperture of what can be done.
Gary Bisbee 27:36
Thinking about the major changes in health financing and delivery that are clearly going to be coming over the next several years, how do you think the increase in demand for telehealth will change the business models of large health systems and the large health plans?
Jason Gorevic 27:53
I am fortunate to sit on a number of CEO workgroups with healthcare CEOs and a lot of those are hospital system CEOs. And what I hear from them is they’re actively engaged in rethinking their business models and the care that they deliver and this physical space and real estate requirements that go along with it. The estimates I hear are somewhere between a quarter and a third of their visits they believe can be done virtually. And that just fundamentally creates different cost structures that are lower and may be able to reduce costs from the system, while simultaneously increasing margins for hospitals and health systems.
Gary Bisbee 28:36
How about large employers? How do you see them changing their view of health care with the advent of more telehealth?
Jason Gorevic 28:45
The large employers are embracing the full suite of our services. Large employers had already begun to really embrace the need for mental healthcare and there is no better delivery mechanism for mental health than virtual care. They are coming to us for Virtual Center of Excellence programs that enable more of their population who need the Center of Excellence to get access to one because there’s not the geographic barrier of having to get there. And then we’re seeing employers really interested in virtual primary care, especially for rural populations, remote workforces, so that they can get the care that they really need and turn it from a challenge to get care when someone’s sick into something that really delivers better preventive care and holistic care for the consumer.
Gary Bisbee 29:37
Jason, this has been a terrific interview. We really appreciate your time. I’ve got one other line of question if we could, and that is about leadership, which is always magnified in times of crisis. When you became aware of the Coronavirus crisis, what were your first thoughts?
Jason Gorevic 29:56
I’m not sure if it’s exactly when I became aware of it, but I will say, I came home one night and I realized that our volume had doubled. I had good insight into the fact that our technology platform was holding up, but we just didn’t have enough doctors on the platform activated in order to meet the demand. I came home and I was talking to my wife and I said, this is unbelievable. I was really concerned about people who were waiting longer than they should to get the care that they needed. And she looked at me and she said, you know, you’ve been working 11 years for this moment, you got this. And it was the seminal moment for the organization, for me personally. I’m so proud of the team for rallying in order to take some innovative approaches and take the bull by the horns and really step up to deliver what was necessary.
Gary Bisbee 30:46
I was proud as well of your wife who nailed it, for sure. What are the most important characteristics of a leader in a crisis do you think, Jason?
Jason Gorevic 30:55
I think leaders have to be decisive in times of crisis. I think they have to be communicative. I think they have to recognize that people are going through their own personal challenges at the same time that the company needs them to step up to the company’s challenges. And I think you have to be human and vulnerable. I think the era of the infallible leader on the rock who never shows any vulnerability is over. And I think acknowledging that you’re going through your own stuff, but demonstrating leadership and leading by example, is absolutely critical in a time of crisis.
Gary Bisbee 31:36
Final question. Has the COVID experience changed you as a leader or a family member?
Jason Gorevic 31:42
Well, I suppose as a family member, it has, spending more time than ever with my family. And I haven’t been back into the office since mid-March. And I really enjoy the fact that I get to eat dinner with my family most nights, although my two teenage kids might say that that’s overkill. As a leader, it’s, it’s probably made me more deliberate. We’ve had to engage in more structured communications efforts with our various teams within the organization. I’ve done a lot more skip level, like one-on-one discussions with people over video conference to be able to just understand what’s going on and how people are feeling. And that’s probably more deliberate than I’ve been in the past, rather than just letting it happen. But I think in this kind of environment, it’s absolutely essential.
Gary Bisbee 32:29
Jason, we appreciate your time. Terrific interview. We all look forward to following Teladoc’s progress.
Jason Gorevic 32:36
Well, thanks, Gary. I appreciate your having me on and I’d love to do it again sometime.
Gary Bisbee 32:40
This episode of Fireside Chat is produced by Strafire. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review Fireside Chat so we can continue to explore key issues with innovative and dynamic health care leaders. In addition to subscribing and rating, we have found that podcasts are known through word of mouth, and we appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capital in Washington DC, where we explore the intersection of healthcare politics, financing, and delivery. For additional perspectives on health policy and leadership, read my weekly blog Bisbee’s Brief. For questions and suggestions about Fireside Chat, contact me through our website, firesidechatpodcast.com or Gary@hmacademy.com. Thanks for listening.