Emerging Applications for Telemedicine: Q&A with Clay Whitehead, CO-CEO and Founder, PresenceLearning

Recent Joint Commission requirement changes and tighter standards for stroke centers are creating partnership opportunities for telemedicine companies.  Alix Oliver, Director at Oxeon, had a chance to catch-up with Clay Whitehead, Co-CEO & Co-Founder of PresenceLearning, an Oxeon client and investment, a technology company that connects speech, behavioral and occupational therapists with patients in need. Telemedicine isn't new. In fact, physicians started experimenting with telephonic dissemination of diagnoses and treatment in the late 19th century. Nonetheless, the topic finds its way into the popular press regularly, as government and private payers expand coverage and providers find new and innovative ways to leverage telemedicine technologies in attempts to reduce costs, increase patient access, and improve outcomes.

Earlier this year, UnitedHealth announced plans to cover telemedicine services for 20 million members by January 2016 (Aetna and Cigna have offered some telemedicine coverage since 2011 and 2013, respectively). Just this month, Mercy Health in Saint Louis unveiled the nation's first-ever virtual care center to house over 75 telemedicine programs and 300 clinicians and support staff. The $54m facility will enable Mercy to monitor nearly 4,000 chronically ill patients across five states, in addition to other services.

Medicare Part B, which covers diagnostic and preventative services and supplies, currently includes coverage for "certain" videoconferencing services for beneficiaries in "some rural areas." Yet as the aging baby-boomer population's need for home-based care and monitoring increases, many predict/speculate that the federal behemoth will expand coverage for videoconferencing [coverage. Medicaid reimbursement for telehealth is broadly determined at the state level, but in September of this year Washington joined 10 other states in recognizing telemedicine as an "allowable mode" for delivering speech-language, occupational, and other therapies from qualified practitioners in school settings.

One of Oxeon's newest (and most awesome, in my opinion) clients, PresenceLearning is a San Francisco-based technology company that specializes in linking speech therapists with patients in need. With plans to add services in behavioral and occupational therapies, Presence is uniquely positioned to partner with schools, school districts, and now health systems, as Medicaid expands reimbursement policies.

I had the chance to catch-up with PresenceLearning Co-CEO and Co-Founder Clay Whitehead on the changing telemedicine landscape and the amazing work they're doing to enable students across the country to broaden their impact and push virtual care to its fullest potential.

Why did you and Jack decide to build PresenceLearning and the platform?

When I was in first grade, I was diagnosed with learning disabilities, ADHD, and dyslexia. Overcoming those challenges and turning it around was a huge part of my childhood, but I was lucky. I was gifted and had great family support. My co-founder Jack grew up with a cousin on the autism spectrum who is non-verbal.  We both knew the huge impact that complex mental, behavioral, and physical conditions can have on children throughout their lives, and wanted to leverage both our own experiences and our passion for technology to help others at a massive scale.

So, we developed a telemedicine marketplace for mental and behavioral health professionals,speech therapists, occupational therapists and other professionals to connect with patients from our enterprise customers, and a platform that allows them to deliver high quality services remotely. We have a full telemedicine solution that encompasses everything from the softer aspects of service to all the things that technology is great at, like workflow automation, billing, scheduling, and progress tracking.

We started PresenceLearning to give all kids a chance, and we're well on our way to doing that, having seen some fantastic growth. Now that we have five years of experience in providing high quality services at scale -- we're currently delivering over 3,000 sessions per day -- we are excited to expand our mission to helping everyone, and not just children, unlock their potential through telemedicine.

How have you been so successful in selling in the education market?

The number one reason we've been successful is the positive impact that we have on the lives of the children we serve. Every year, there are kids who abandon plans to commit suicide, say their first words ever to their parents, or leave their own house for the first time in years because of the care our clinicians deliver. It's things big and small, from the way that our patients are beating the national outcome averages to the way that many of them are now happy and excited about attending therapy for the first time. So, as families and institutions struggle with a massive national shortage of care professionals, we are increasingly being seen as a new, key part of our enterprise client's continuum of care.

But, obviously, a lot goes into creating that impact and getting those results at scale. We are maniacally focused on attracting and retaining only the best clinicians. In fact, we only have a 5% acceptance rate for clinicians. Beyond that, we think deeply about how we recruit, how we help foster professional development, and how we use data to continually improve.

From a technology standpoint, we break down each part of the experience of every one of our stakeholders -- patients and their caregivers, payers, and any supporting professionals -- and take a design-centered approach to developing elegant patient- and clinician-centric solutions. That approach shows up in our games, therapy tools, progress tracking, and other platform components, and it reflects our passion in bringing the best of Silicon Valley -- our home -- to the world of health care.

What are the most notable trends you’ve observed in telehealth since launching the company?

Attitudes have changed dramatically. As recently as 2013, when we brought up telemedicine with potential partners, they asked us what it was and openly wondered why their peers might use it. Now, not only is there an awareness of telemedicine as a category, but people generally understand the benefits. I think that this increased acceptance is a part of a cultural shift. We have all come to expect high-quality, high-convenience services with almost instant access in so many parts of our lives thanks to Uber, Instacart, and other services. In addition, video has truly become ubiquitous now that everyone has a smart phone in their pocket. Patients and decision makers feel comfortable with telemedicine now, and they both want and need it. It's easy to forget that this wasn't the case just a few short years ago.

Can you talk about your work with hospitals and stroke centers?

We have developed an incredible expertise in delivering online care, conducting over 3,000 sessions per day. That experience allows us to see a lot of new opportunities and to ensure that we have high-quality implementations with partners.

As a result of this track-record, we are increasingly being invited into stroke centers to perform speech therapy evaluations, among other services. Timely speech therapy evaluations are a critical, evidence-based part of treating every stroke patient, as swallowing issues can cause serious complications and even death. In addition, tightening Joint Commission requirements and stroke centers raising their own standards are increasingly driving adoption of telemedicine in this area.

We've seen a great deal of excitement from our partners, once they realize our scale and capabilities, to expand into other services and other settings, including outpatient.

Can you tell me about the new platform and the features and functionality you’ll be introducing?

Since our mission is to help everyone unlock their full potential through telemedicine, we focus our development efforts on three things. First, we focus on increasing access, and so, in our latest release, we halved our bandwidth and CPU requirements and redesigned our whole experience to be native on tablets. This means that the cost and infrastructure barriers to using our services are now next to negligible. Second, we focus on greater patient and clinician engagement. We now have a much more streamlined interface, better tools, and more engaging therapy content. Last, we focus on efficiency, so we also revamped our whole backend infrastructure, including scheduling, clinician matching and more, to equip us to provide ever larger numbers of patients at the the high standard of care demanded of us every day.

Can you talk a bit about your and Jack’s vision for PresenceLearning?

Our vision has always been the same: a global marketplace, paired with a best-in-class platform for the delivery of services, that ensures that everyone has access to the care they need when they need it. For us, that vision means that we will continually be entering new clinical areas and working with new populations. We've proven this model, starting out by providing just one service to schools, expanding to five, and now working with hospitals and stroke centers. We're excited to see this vision coming to life. We know that there is no shortage of hard work ahead, but wake up every day excited to make even more progress towards this vision.

Bibliography:

http://www.k12.wa.us/BulletinsMemos/Memos2015/M051-15.pdf

http://jama.jamanetwork.com/article.aspx?articleid=2411266

http://www.stltoday.com/business/local/mercy-debuts-new-million-virtual-care-center/article_8acce931-0b29-50a6-af77-113fa8cdb4f1.html

https://www.medicare.gov/coverage/telehealth.html

https://www.oxeonpartners.com/2014/06/25/argument-virtual-physical-care/

http://www.wired.com/2015/04/the-ux-of-telemedicine/

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Telemedicine.html

http://m.stltoday.com/business/local/mercy-debuts-new-million-virtual-care-center/article_8acce931-0b29-50a6-af77-113fa8cdb4f1.html?mobile_touch=true

http://www.who.int/goe/publications/goe_telemedicine_2010.pdf

http://www.npr.org/sections/health-shots/2015/09/30/444236446/telemedicine-expands-though-financial-prospects-still-uncertain

http://webreprints.djreprints.com/3654351084695.html

http://www.researchgate.net/profile/Simonetta_Scalvini/publication/7831264_Telemedicine_a_new_frontier_for_effective_healthcare_services/links/09e4150e84997924b6000000.pdf

http://presencelearning.com/press-release/washington-joins-10-other-states-in-adding-medicaid-reimbursement-for-schools-using-live-online-therapy-services/