Executive Summary

American well was founded in 2006 by two brothers, Ido and Roy Schoenenberg. These two
cofounders and co-CEOs had a vision to connect physicians and patients using the Internet and
telephony in hopes of facilitating patient care and office visit wait times. The companys mission
is to transform healthcare delivery through technology and improve accessibility to quality
healthcare by removing traditional barriers to the healthcare delivery infrastructure such as
distance, mobility, and time constraints. American Well set out to revolutionize medicine
transforming certain no acute visits into telemedicine visits through its proprietary web-based
software technology that affords the physician and patient a secure way to communicate at any
time. This affords patients and healthcare providers to connect via live visits through video,
secure text chat, and telephony. American Well set out to fulfill this core mission across the
country and around the world.
Ido was the chairman and was in charge of business strategy. Roy was the president and was in
charge of product development and operations. Both founders served us co-CEOs. Using Internet
technologies and telephony they hope to obfuscate the physical location and to connect patients
and physicians instantaneously. They saw the physical location and ability to schedule an
appointment as a constraint providing healthcare.
Ido and Roy Schoenenberg initially marketed this idea to major health insurance companies like
Blue Cross and Blue Sheild in the United States and the initial was well received.

The Schoenbergs
Ido was trained as a physician in Israel and in following that he met his wife Phyllis and they
cofounded a healthcare software company called iMDsoft that had an impact upon the
management of the critically ill patient by integrating quote expert systems that helped digitally
monitor these patients and facilitated quote decision-making, reduced errors, and improved the
financial performance in the most sick patients and freed up time for the clinicians to focus
on the patient and less on data tabulation. Phyllis stayed on and help grow iMDsoft to become a
major player in acute healthcare information systems.
Following this Ido cofounded a different electronic health management system, called CareKey,
with his brother Roy was also a physician and had obtained a Masters of public health from
Harvard University. He had written a scientific paper during his research fellowship which
talked about an online system to keep track of patient personal health records (PHRs). The
brothers hoped that CareKey would serve as a platform allowing the direct interaction between
patients and health insurance companies by providing Internet-based PHRs with interaction
between patient and staff members of their health care plan. This management model was
thought to be preventative earlier detection, saving healthcare dollars. In 2006, THE
Schoenbergs sold the company and it was renamed CareAdvance.

Do you agree with the founders assessment regarding the potential of online care to
revolutionize healthcare?
American Wells mission, as mentioned, was to transform healthcare delivery through
technology and improve accessibility to quality healthcare by removing traditional barriers to the
healthcare delivery infrastructure such as distance, mobility, and time constraints. American
Well set out to revolutionize medicine transforming certain no acute visits into telemedicine
visits through its proprietary web-based software technology that affords the physician and
patient a secure way to communicate at any time. This affords patients and healthcare providers
to connect via live visits through video, secure text chat, and telephony. Traditional medicine
requires a patient-physician interaction whereby there is initially an in person visit called a
consultation. The physician will discuss with the patient their needs or the inciting chief
complaint. A thorough in depth history of the patient is verbally taken or retrieve from past
medical records. The information obtained includes the complaint or illness, the history of the
present illness and a complete past medical history, past surgical history, allergies, medications,
social history family history and various other details about the patient [1]. This interview or
examination also includes a physical examination and review of any pertinent testing that had
been performed including looking at such things as x-rays, CT scans or laboratory testing. From
this information the physician can use various algorithms learned in the study of medicine and
apply them to generate a diffential diagnosis and address the chief complaint or presenting
illness. From this information the physician evaluates and then manages the patients complaint
or illness by formulating their recommendations. This information is generally shared, with the
patients consent, with other physicians including the patients primary care physician.

As medicine moves closer to an Electronic Medical Record (EMR) most healthcare facilities are
able to share information electronically but there are certain barriers which include the ability to
gain patient consent to abide by HIPPA law and protect medical information and ability of
different systems or facilities to communicate even if the use the same software. The majority of
health care records is communicated by letter or document and studies are generally downloaded
to portable devices such as CDs.
As we can see from what has been outlined thus far, most information is transportable or
obtainable via an online database. However telephony still does not transmit the emotions that
we can comprehend with a one-on-one in person encounter. Moreover, practicing medicine at a
distance negates the tactile encounter that a physician is able to perceive by touch and the ability
to show empathy and to reinforce the plan and to truly grasp patient commitment.

Is online care a substitute for a complement traditional medical care?

We are not convinced that this platform of medicine using online encounters will ever substitute
for a human encounter but we do agree that it will complement these encounters by making them
more efficient, save time, direct patient care timely and it has the potential to defray costs. We
have some reservations for the uninsured patients in urban setting using this platform because as
it stands now they can receive their healthcare from emergency room service and the healthcare
facilities. As it stands today these facilities are obligated to see these patients regardless of
ability to pay.

What barriers to adoption do you foresee?

The concept of diffusion was first studied by the French sociologist Gabriel Tarde in late 19th
century [3]. In the book Diffusion of Innovations, Rogers suggests a total of five categories of
adopters in order to standardize the usage of adopter categories in diffusion research. The
adoption of an innovation follows an S curve when plotted over a length of time [2,4].

The first stage [Figure 2,3] of diffusion of innovation is termed knowledge and stands for when
the individual is first exposed to an innovation, but lacks information about the innovation.
During this stage the individual has not yet been inspired to find out more information about the
innovation. The second stage of diffusion of innovation is termed persuasion and this is where
the individual is interested in the innovation and actively seeks related information/details. The
central stage in diffusion of innovation is decision and the individual takes the concept of the
change and weighs the advantages/disadvantages of using the innovation and decides whether to
adopt or reject the innovation. Due to the individualistic nature of this stage, Rogers notes that it
is the most difficult stage on which to acquire empirical evidence. The next stage in diffusion of
innovation is termed implementation the individual employs the innovation to a varying degree
depending on the situation. During this stage the individual also determines the usefulness of the
innovation and may search for further information about it. The last stage in diffusion of
innovation is called confirmation and the individual finalizes his/her decision to continue using
the innovation. This stage is both intrapersonal and interpersonal, confirmation the group has
made the right decision. [2,3,4]

We could expect the diffusion of innovations with American Well to implement according to
Rogers [Figure 4]. With successive groups of consumers adopting the new technology (shown in
blue), its market share (yellow) will eventually reach the saturation level. In mathematics, the
yellow curve is known as the logistic function. The curve is broken into sections of adopters.
Innovators accounting for an early part of the market share at 2.5%, early adopters taking a
healthier portion of the market share at 13.5% and then the early majority and late majority each
taking a larger portion of the market share at 34% each. Of course laggards or stragglers would
take up the tail end of innovation and adoption.

What value does online care create to patients, physicians and health insurers?
A value proposition is a business or marketing statement that summarizes why a consumer
should buy a product or use a service. This statement should convince a potential consumer that
one particular product or service will add more value or better solve a problem than other similar
offerings [5]. "Strategy is based on a differentiated customer value proposition. Satisfying
customers is the source of sustainable value creation."[6] In terms of the value proposition
canvas [Figure 5] we can create a canvas and divide them into customers (patients) and product
(Online Care). Each portion of the canvas has certain characteristics that need to be met to be
successful and to be additive and not deleterious. The company providing the online healthcare
product is American well and their ideal customer is direct to the consumer (DTC).
The Patient
The consumer or client in this value proposition is the patient and with the online healthcare
product put forth by American well, they will have certain wants, fears and needs. In terms of

their fears, the patient will always be concerned about costs and in this case the scalability of
such an online product which for the most part should be nil. The most important fear that the
consumer will have when entrusting patient healthcare records (PHR) to someone that they
havent met will be the security of the system and the ability of the system to maintain privacy
and abide by HIPPA compliance. In fact the patient will want or demand security and privacy of
their PHR. We foresee that patients will want to make sure that such a product will be easy to
access and usable. Again the needs of the client or patient will be to maintain security of their
PHR, they will demand easy access and immediate access and for such a product to meet the
clients expectations there will have to be no way time as experienced in an outpatient setting.
Online Care
On the other side of the canvas is Online Care or the online healthcare product. In terms of the
value proposition and interjecting a new way of providing healthcare they certainly have certain
benefits features and experience in this endeavor. In terms of their benefits that they will be able
to maintain privacy and security by their past proven track record with previous companies such
as CareKey and iMDsoft. There product features will sure efficiency, instantaneous connection
with no way time and will be mandated by the government that they maintain HIPAA
compliance. Their experience speaks for itself. The founders are to brilliant entrepreneurial
physicians who have a proven track record in PHR with at least two successful companies:
CareKey and iMDsoft.
Health Insurers
For will be interested in maintaining or increasing their market share which has predicted should
increase in the online healthcare industry. As shown in the article there would be cost savings to

the client insured as well as to the insurance company. As important as increasing revenue and
decreasing costs will be the maintenance of the PHR and the portability of that information from
facility to facility and the interaction between positions.

Should American well pursue any of the next generation options or exclusively focus on its
core platform and core target market?
Growth of a company or industry is always depend upon timing. American Well enjoy the
advantage of being the first mover and their ambitions were to go nationwide and to continue to
add health insurance companies to the startup company. It is clear from the article that they had
for their ambitions to just providing an online health encounter, there are very much interested in
adding an important portion of conveyance of the healthcare record between physicians using a
new application called, Team Edition. We guess in this analysis would need to weigh the risks
versus the benefits to both the next generation options versus firm establishment of their core
platform and establishment in the market. We would be concerned that if they moved forward
with these next generation options such as Team Edition, would provide a distraction to their
attention to firmly establishing a monumental shift in healthcare. On the other hand, the next
generation options are complementary to their initial competencies and would add value to
American Well, Online Health Care. We believe that continued concentration on their initial
product and ensuring its competitive advantage, knowing full well others will enter the market is
paramount and that rollout of their new add on should proceed slowly but with full knowledge of
being first in the market is important. If American well does not remain strong then the success
of Team Edition is diminished.