Jeff Wessler
We had an intern. She was doing other things, but one of the things she was doing was calling cardiology practices all across the country to find out how long it would take her to get an appointment for a specific set of issues. And the average was 40 days in many markets, which is, frankly, unacceptable for a disease state like heart disease, where you need care, you need treatment management diagnosis much, much sooner than that if you’re going to stay ahead of the course on this disease.
Narrator
That was Jeff Wessler explaining why he thinks cardiology and other specialty care services are the next frontier for telemedicine. Wessler is the founder and CEO of Heartbeat Health, a New York-based company that delivers virtual-first cardiology services to patients. The platform connects patients directly with a cardiologist, who then uses real-time data to help patients manage their conditions. And in this podcast with Oliver Wyman’s Ann Kaplan, Wessler details what specialty care providers need to do in order to catch up to primary care when it comes to utilizing telehealth.
Wessler was a 2022 recipient of Oliver Wyman’s Tom Main Health Innovation Mentorship, a program that pairs innovators with senior members of Oliver Wyman’s health and life Sciences practice to help them map out a strategy for their company. During the podcast, Wessler and Kaplan discussed the challenges of launching a startup
during a pandemic, and what the current economic climate means for entrepreneurs.
The Oliver Wyman Health Podcast is brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com. And now let’s pick things up with Wessler detailing his rationale for launching Heartbeat Health.
Jeff
Heartbeat really started out of work I was doing at the time as an academic cardiologist, mostly in the hospital, and in a very high acute care setting. And after years of work, training, and academic work and clinical work in that space, it became pretty clear to me that cardiology, as an example of a subspecialty, was really, for lack of a better word, locked behind a set of doors that was very difficult to access for people earlier in their care journey that really needed it. So we set out on this journey now a few years later to bring cardiology and the cardiovascular care model out to the forefront of care so that it was accessible for people who needed it the most, at the right time, much earlier in their disease journey.
Ann
The past two years have really seen a roller coaster of use of telehealth. How has Heartbeat been affected by that?
Jeff
It has been amazing to both be building a telehealth company a couple years before the pandemic, and then now a few years into it. And I think a couple key milestones. The first couple pf years were incredibly difficult to educate the world on how remote care could apply to specialty care, and how to really create a set of clinical use cases that could benefit from telemedicine, even though we felt very strongly that it could work, would work, and did work. Nobody was using telemedicine back in 2017, 2018.
Then the pandemic hits and all of a sudden everyone starts using telemedicine, but really just for the access issue, not necessarily as applied in a differential way to a different clinical sides or clinical spaces, but because that was the only option, telemedicine became the de facto type of care. Now the third milestone is that gold rush of telemedicine has worn off, and now everyone is, I think appropriately, reverting to, “Well, how should we use telemedicine?” Not just use it because we have to and because it’s the only option, but let’s find the nooks and the crannies in the healthcare space to actually make this model work better for the patients, better for the payers, better for the system at large.
Ann
What do you think the key areas are going to be that pop out? Besides, obviously, cardiology.
Jeff
Specialty care is going to arise as the real use case for telemedicine, and perhaps the best one. And the reason I think that is, is because there has emerged a lot of primary care, family medicine, general medicine access models that have been really successful at scaling out a better experience for getting your primary care. Specialty has not done the same thing. And as a result, access is a huge, huge problem.
This past summer at Heartbeat, we had an intern, she was doing other things, but one of the things she was doing was calling cardiology practices all across the country to find out how long it would take her to get an appointment for a specific set of issues. The average was 40 days in many markets, which is, frankly, unacceptable for a disease state like heart disease, where you need care, you need treatment management diagnosis much, much sooner than that if you’re going to stay ahead of the course on this disease. So I think specialty is the right fit for virtual first care where things can start sooner and then we can use that to launch the downstream follow-up care.
Ann
What kind of reception are you getting to that?
Jeff
It’s tough. We’re still in the phase of, telemedicine is bringing value at the urgent care level for immediate access issues, but we’ve not brought it to the chronic care management. We’ve not brought it to the risk landscape appropriately. That’s the challenge right now. And to me, what will drive that is really bringing an evidence base that makes tele specialty care unimpeachable from a standpoint of, does it bring an ROI, does it add clinical value, and will anyone pay for it?
Ann
How far out do you think we are from that?
Jeff
I think we’re at least two or three years from the stage of risk being really taken in the specialty model. We’ve started some of our first partial risk deals and contracts, which is really exciting, but it will take a long time to prove that those can be converted into full risk. And I think until you have your first full risk cardiovascular populations, then this will still be an add-on to the model that’s going to be pushed secondary to many of the others.
Ann
Would you term this as the biggest challenge you faced in scaling the company, or are there others that are on that list?
Jeff
There are quite a few on our list. I think the sales cycle length, and then the time to scale populations is much, much slower than any of us want, and much longer than any of us want. And we could be working on a population or a program for years before seeing our first patient in and first dollar of revenue, all of which is needed to really grow and sustain the business.
Ann
How has that been exacerbated by the past couple of months as we all stare down the threat of a possible recession?
Jeff
Yeah, I think there is a tendency when the economy is booming and venture capital money is booming to say, “Revenue at all costs, growth at all costs grow, grow, grow.” But we’ve now all seen that that should not be the headliner for any company that wants to really make it. And the headliner should be, “Let’s build a healthy business that is achieving good in the healthcare space clinical outcomes, good cost in unit economics, healthy margins, has a path to achieve profitability.”
We have pushed to have those conversations, hard conversations much, much sooner in our life cycle than we would have had the looming recession not occurred, where we might have waited until three more of rounds of funding before we get into the, is this a healthy business? Now we’re having those conversations every day.
Ann
I put myself in the viewpoint of a provider system. That’s a lot of different puzzle pieces to try to integrate. How are you guys tackling that part of the problem for your clients?
Jeff
Yeah, provider systems are hard, and health systems that have legacy everything do not like introducing new delivery models. We’ve taken somewhat of a “we’ll need to be an outsider disruptor” approach to that, and bring a new model directly to the population rather than going at the health system. But these things intertwine, and they enter the same path at some point on a patient’s journey, and so we have to interact with health systems.
What I believe is the direction that all of this is going is that the service providers will have a lot more opportunity if they’re able to develop nimble or more nimble operating models and business models that come with that. And that’s going to take somewhat of a departure from the health system that owns everything and insources everything to the provider groups that have the autonomy to do care the way they think is best for the patient. And then it’s going to be up for groups and solutions, point solutions, telehealth companies, specialty solutions to bring those directly to the provider groups who will subsequently get buy-in from their health system. So, long-winded and somewhat convoluted way to say that, I think the provider autonomy is coming back. I think it’s been gone for years, and as it comes back, their ability to choose what they want to do, how they want to do care, will come back into the financial mix.
Ann
That’s a provocative statement to make in terms of provider independence. Where do you think is driving that?
Jeff
I certainly think the provider landscape is going through a crisis right now, and so that’s not my observation, but the number of clinicians having burnout that are leaving their longtime jobs, looking for new opportunities, that’s a true epidemic in the provider space. And then you couple that with the financial struggles of the health system. I think we’re heading toward a pretty sharp drop-off in terms of viability of these systems to provide all the care.
When I meet and chat with cardiologists, which are the main provider groups that I interface with, it seems the writing on the wall is clear that they all have very, very strong opinions of how care should be done. These care models that they want to do exist, and they’re backed by evidence. What they don’t have is the sort of financial backing of their systems to do so. And that seems like an untenable situation that only ends with providers breaking off and grabbing their autonomy back.
Ann
Do you think that the payers will support that?
Jeff
I actually do see glimmers of hope there. I think there’s more payer provider innovation going on than I’ve seen in the last few years. And that comes from not just payers, I think partner to buying practices, which has been happening for a while, but payers realizing that the clinical relationships, the patient/provider relationships are some of the strongest for their members. And so that may be one of the strongest footholds that provider groups have on the payers bending to their ideas, concerns, and recommendations.
Ann
Jeff, maybe to get back a little bit to the principles for Heartbeat. Who are your major customers?
Jeff
We are, first and foremost, a service provider. We do cardiology services. As a result, we have two major channels that we sell that into. The first are your at-risk providers and payers. Anyone who’s taking financial risk on cardiovascular populations, we come in there and provide a suite of services for their members, whether it’s diagnostic services, telemedicine services. Anything that encompasses remote cardiology, that’s our landscape.
But the other customer and client that we increasingly have seen a lot of traction and growth with is the cardiac diagnostic company that is bringing a device or a diagnostic to market but wants to add that cardiology service suite to it to bring a full bundle of care to market.
Ann
And would something like that be the Apple Watch I’m thinking of buying for my father, or something similar?
Jeff
Yeah, exactly. So all of these devices that do EKGs or electrocardiograms on your wrist, or a patch that you wear to detect atrial fibrillation, these are really amazing technologies, but have mostly lived either fully on the consumer side, where an individual can purchase them and use them, but then has to choose to bring them to their clinician, and for the most part the clinicians don’t spend a ton of energy or time using them, or the devices live on the prescription side where a clinician will prescribe them and use them as part of a clinical care. A good example of that is the Zio patch, which is a prescribed arrhythmia detection device that someone will wear for two weeks, but it’s for the most part only prescribed by cardiologists or cardiovascular service providers.
Ann
And of those two channels and the various products, what are you most excited about?
Jeff
Bringing those together is where this is all going. We work on both sides. We interpret consumer EKG devices, and then we also interpret and prescribe the clinical grid devices. There’s a new program we’re bringing to market called Know Your Rhythm with iRhythm, that is a public company, and this program is basically looking for the early detection and then subsequent management for atrial fibrillation. It’s bringing a patch that you wear for a couple weeks, and it looks for AFib and other arrhythmias, directly to members at their home. And I think that merging of the device with the clinical services that prescribe it, interpret it, and do televisits — reporting back to primary care, the patient, and the payers — those are the bundles that are going to be the next wave of this device-integrated clinical care.
Ann
You play in an interesting space with other providers because on the one hand you’re a competitor in some ways, and on the other you’re a source of leverage. What kind of reception have you gotten?
Jeff
We have long answered the question of who are our competitors as the traditional health system or the traditional provider groups that are working with a given plan or a population. And I think for the time being, our model has been to play nice in the sandbox with them. The cardiology groups across the country are still doing amazing care, and they’re needed for any of the in-person or — I’ve started calling it terrestrial care — that happens. And yet our model is in many ways contradictory to theirs that says, “You shouldn’t go for an appointment, wait 40 days before your first appointment, then get a follow-up and seven different types of tests just to get your initial diagnosis.”
We can do a lot of that remotely with virtual care and remote diagnostics. We’re finding that balance. Eventually and ultimately, our goal is to let the use case win the day and say, for this phenotype of patient, they should get a virtual first model for this, they should get the terrestrial model, but let’s let the clinical pathways actually guide what type of care you should get, and not have it be at the whim of your payer or your benefits plan.
Ann
Is there a space in there for the patient to choose?
Jeff
Great question. And yes. Right now, I think the patients are choosing more and more, and in many cases, their hands are being forced to say, “The patient actually has a say in this,” and as long as either the benefits plan allows for it or there’s a direct-to-consumer approach for it, then we’re receptive to that and have to be.
Ann
What about those patients that are complex and need multiple specialists? How do you plug into those complex care models?
Jeff
If I say that primary care, urgent care was phase one of telemedicine, I think phase two, and probably right now the strongest use case, is specialty care. I think complex care is still a ways away. We’ve done some pilots with multi-specialty complex care models. They’re very tricky to navigate and they’re tricky to organize. The good news is that they are sort of equivalent to the hot-spotting model of saying identification of these patients and then dropping a parachute of resources on them is really what they need. Whether that happens virtually, in person, or a hybrid, they just need that care done. So I think that’s the phase we’re at. I don’t think we’re yet able to discriminate and say a virtual model alone is equipped to handle them.
Ann
How far out do you think we are from it?
Jeff
I’ll put that one at five to seven years.
Ann
Can you make this personal for us, with a patient example? How would someone use Heartbeat Health? Why would they choose it? How would they experience it?
Jeff
One of the issues with the specialty model is in many ways it’s hard to personalize. Not everybody’s been to a specialist, or is dealing with advanced care, so it’s hard to know what this looks like. I’ll give you an example. This now happens all the time with our atrial fibrillation program. So atrial fibrillation is a disease of the rhythm and conduction system of the heart where an abnormal rhythm takes over the normal sinus heart rhythm and causes two major issues. The first is the heart can go way too fast, and that can cause people to get heart failure and downstream complications that lead them to be hospitalized, and then the second is that it causes the top chambers of the heart to fibrillate, which causes clots to build up, which can break off and cause strokes.
Obviously both huge issues, but strokes are one of the most devastating conditions a patient can be faced with. We now are looking for atrial fibrillation on many, many patients, but had a member, a patient that we got a call on who was wearing one of the Zio patches that we prescribed, who was having a huge burden of new atrial fibrillation that was being captured, that prompted Heartbeat to interpret that and say, “We need to do a televisit with this patient.” Turns out they were actively getting symptomatic, likely about to head to the hospital, where they would be put on a bunch of medications, have about 10 different tests done, if not worse, that they started by having an event that was devastating for them. So instead, we were able to get them on a new set of rate control medicines to essentially keep their heart rate back in the slow range, put them on a blood thinner to prevent the stroke and to reduce the risk of stroke, and then get them checked in to make sure they had all of the advanced testing that they needed remotely out of the hospital. So not only did this patient get diagnosed with atrial fibrillation at the perfect time before they had an event, and before it was too late, but it was tremendously cost saving. And then the experience, this was a life-changing experience for this person who now is totally checked into their cardiology world and has completely reengaged with their care.
Ann
What lessons would you share with potential new founders who are looking to start businesses in the next year or two?
Jeff
Yeah, and I think about this all the time. I think we bring a lot of the first couple years of learnings to what we’re doing now. And time and time again, I come back to let the evidence drive what you’re building. So set up experiments in hypothesis testing to see if what you’re doing works, evaluate it, use those metrics in the outcomes that you track to improve your model, and then throw away that what doesn’t work, keep what does work and do it again and again and again, until you have an evidence-based clinical model that’s driving your business.
Ann
OK, thank you.
Jeff
Thanks. Yeah.
Narrator
The Oliver Wyman Health Podcast is brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.
This transcript has been edited for clarity.
