COVID-19 created a revolution in telemedicine. Will it stick?

For years, it's looked as if telemedicine was set to take off, and now, it finally is. It just took the worst pandemic in a generation to get doctors to treat patients from home.

Gloria Lau, the co-founder and CEO of Alpha Medical, a telemedicine company for women, was one of the people thinking about telemedicine long before COVID-19 hit the U.S. She told Protocol that she sees one "silver lining" in the pandemic: It's helped reshape regulations around telemedicine at lightning speed. There's the U.S.' blanket waiver that now allows telemedicine providers to practice across state lines, and some states have instituted emergency regulations that require a payment parity between in-person visits and telemedicine calls.

And it's brought funding to the industry, Lau said, calling out the FCC's $200 million fund supporting public and nonprofit telehealth programs. "The entire industry has been given a lift, getting more people to understand what it is, getting more people to use it," Lau said.

Prior to jumping into the world of health tech, Lau had what she called "a very classic Silicon Valley background," getting a master's and a doctorate from Stanford, working in data science at LinkedIn and Google, and even working as a "part-time" VC at AV8 Ventures. But after dealing with a health care system that made it difficult, even in the Bay Area, to get treatment for her son, Lau began to look at how she could use her skills for the world of health. She founded Alpha with Chief Medical Officer Dr. Mary Jacobson, a longtime academic and OB/GYN. Their company aims to treat what Lau says are the 70% to 80% of ailments that don't really require someone to visit a doctor's office by using a network of doctors across the U.S. who can see patients when it suits them.

Protocol spoke with Lau about how the pandemic has put a spotlight on the telemedicine industry, how it's had to adapt rapidly, and how it's likely to look after the dust settles.

This interview has been edited and condensed for clarity.

Do you think that the new paradigm that COVID-19 is creating with telemedicine is something that will remain after life starts to return to normal, or will all these emergency regulations and actions get repealed?

That's something that we actually discuss quite a bit amongst the investor circles. There's two sides: One is the regulatory, one is consumer behavior. I think on the regulatory landscape, some of these regulations are going to stick. They make a lot of sense, and I don't think they're going to repeal them — I think the bulk of them are going to stay. I think that's the general thinking amongst legal counsel and investors, specifically for telemedicine practice across state lines and how long it takes to get your license — that kind of thing that's going to stick.

On the consumer behavior side, so many more people are using telemedicine. We're seeing a huge volume increase just like every other telemedicine company, but do we think they're going to stick around? Do we think that they're going to stick with the platform? It's like a guessing game right now with no data. My background is data science, so we try to make every decision as data-driven as possible, but this is so new.

We started seeing the [COVID-19] wave on March 2, so we have, like, all of one month of cohort data to tell. But I think personally that once you experience something like [Amazon's] Prime Now, it's really hard for you to go back to your normal way of living. Especially for conditions that are more private that you really don't want the judgment of a face-to-face doctor, having to visit the front desk and the pharmacist. So I think that behavior is going to stick.

How has your company been coping? Has coronavirus put a strain on things?

I think in telemedicine, we're uniquely suited for this particular challenge. Even before COVID-19, all of our clinical staff was remote. All of them work, some of them in different states, and they all practice in their own home, which is great protection. They don't have to risk their lives just to treat patients. And in terms of addressing the volume increase: We've been growing a lot, and we've doubled our number of clinicians, and we're increasing our clinical support staff. We recently hired registered nurses to help support and do everything we can on the recruiting front.

On the technology front: My background was in machine learning and data science, so we built in efficiency tools as much as possible to help the patients figure it out on their end. Like when you're going through the medical intake form online, let's say you suspect that you might have this issue, we code in all the intelligence possible to bounce you off if you're not right for a telemedicine treatment or you should go to urgent care right away. We don't want patients to waste time in the funnel. And every case that lands at our clinicians' hands, we are highly confident that we can treat them.

Do you think there will be a time in the near future where a majority of people in the U.S. will see telemedicine doctors as their first port of call for medical issues?

I'm definitely hopeful, but with a healthy dose of skepticism. I do think that telemedicine is a pretty tough story to sell. Let's be honest: It's not like buying a pair of shoes or a mattress online — those are very simple. In what we practice, we actually tell everybody, no, we're not ecommerce. That's not how we think about it. We're not wellness. We are your online primary care doctor, and for the more chronic conditions like asthma, we can also ship you the inhaler through our pharmacy partner (because there's literally no reason for you to go to the pharmacy, especially right now).

But I do think that from a consumer standpoint, it is a difficult concept to grok. And I think COVID-19's sort of silver lining is that the public is getting a huge education in ways to be creative. Like I can't see my primary care doctor right now, but I need that inhaler. I don't want to end up in the emergency room, what do I do?

I think it's a sort of nudge for consumers to be creative in how they can get treatment. But there's no wobbling around the fact that telemedicine is a pretty complicated concept. Utilization for the past 20-odd years has been really low. I do think that this particular moment is a boost to the entire sector. I'm hoping that [customers] will stay, and for sure with our demographic, which tends to be female and around 35 years old, this modality is the preferred way of communication after a first point of contact or a family doctor.

Fundamentally when you think about this, we're solving for health care access, and we just don't have enough supply of doctors. We have an increasing number of patients that we have to manage — so how do you bridge that gap as the technology is? I think the only way forward is with technology. Using technology, using asynchronous telemedicine, you can increase the utilization on the supply side a whole lot more than if I were to have you walk into a doctor's office supported by four medical assistants and paying for the rental space. So I think both from a cost standpoint and increasing access, it's a no-brainer.

Is there a certain type of doctor who would want to practice telemedicine over being in person?

Right now, obviously a lot of doctors are open to doing telemedicine, because you don't have to take that risk of seeing someone in person. I think what we were seeing before COVID-19, telemedicine is especially suited for a couple types of practitioners. One is practitioners who are looking to supplement their income and who want to practice flexible hours. Our patients go in, fill out their medical intake form, and within eight to 24 hours, our clinicians go back with a treatment plan. So, the clinician can practice in Hawaii at 2 a.m., and it doesn't matter. They're on their own schedule. So we're just fantastic.

And the other side of this, we do have clinicians who are not as mobile, who might have an accident or some issues in the past that means they can no longer practice as a surgeon or go in and see patients because of a physical disability or limitation. So this allows them to keep treating patients and really stick to their craft and continue to practice.

Where do you feel that the majority of the investment in health tech is going and do you think it's going — and where it should be going?

Before or after COVID-19? [Laughs] The chatter in Silicon Valley is now that the funding landscape has completely changed. It's closed. Everybody is advising all the portfolio companies to have runway into Q2 of next year, so around 18 months. As a startup founder, this is ridiculous because when most people raise money, your runway is 18 months. You're on this spectrum between zero to 18 months. Let's say you're at nine months and you're told that you should double your runway. How are you going to do that? Well, that's what we're hearing.

COVID-19 really is changing the investment landscape. It is going to be really difficult for my original training — AI, machine learning and data science — I think a lot of those [funds] go back to investments in essential business that people cannot absolutely live without during a financial downturn, during a recession.

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Are there areas where you think, from an investment perspective, that the health industry might actually get a better look in than it did before?

With COVID-19, I'm hopeful we're spending a little bit more time on fundamental science, on true expertise, on just like, basic science. I'm hopeful that we're spending more money in areas like biotech, vaccines and the entire supply chain that goes behind that.

Even at Alpha, we saw a huge spike in patient traffic even before COVID-19 was announced as a pandemic and our pharmacy partners started to go low on stock. Our pharmacy partners were being rationed. There was nothing — literally nothing — I can do for these patients. That whole supply chain, it's barely looked at in the investment world, it's really boring. How can I track it better? How can we procure more? Where is the inefficiency? Is it the manufacturer, the ingredients? I think a lot of that [supply chain] behind the biotech side of things will be looked at deeply, and hopefully more investment dollars goes into that.