Long before COVID-19, remote care addressed an obvious need. A patient with an episodic concern might wait days for an appointment, travel to a clinic, or use an emergency setting for something that could be assessed by phone or video. The communication technology existed. The harder problem was turning a connection into recognized care.
Teladoc and American Well, now Amwell, were both founded in the early 2000s. They confronted similar barriers: state licensure, clinician supply, reimbursement, patient trust, employer and health-plan distribution, and integration with existing health systems. But they did not build identical businesses.
Teladoc assembled a network that gave members on-demand access to clinicians. Employers and health plans became clients and distribution channels. Its contracts typically combined recurring per-member access fees with fees for completed visits. The model made availability a benefit that an institution could purchase for a population.
Amwell emphasized infrastructure that health plans and health systems could use to deliver digital care, often under their own relationships and brands. Its revenue included recurring platform subscriptions, usage-based clinical fees, and supporting services and hardware. Where Teladoc foregrounded access to a network, Amwell more visibly sold organizations the capability to put care online.
An emergency changes the adoption equation
COVID-19 did not create either company. It changed the cost of inaction. In-person encounters carried infection risk, patients still needed ongoing care, and regulators and payers temporarily reduced longstanding barriers. Amwell reported that average monthly visit volume in the second quarter of 2020 rose more than 300 percent compared with the average only three months earlier; active providers on its platform increased more than 400 percent.
The surge was powerful evidence that remote clinical encounters could work at far greater scale. It was not proof that every telehealth offering had a durable advantage. When emergency conditions eased, organizations again had to decide which encounters belonged online, how virtual care connected to longitudinal records and local providers, what consumers would continue using, and what buyers would continue funding.
The paired case helps separate three ideas that are often collapsed. A need can validate a channel. Institutional distribution can determine which companies reach users. Integration and economics determine whether adoption persists.
The companies’ later strategies, acquisitions, impairments, and performance should be assessed separately; a pandemic utilization spike does not adjudicate them. Nor should telehealth be judged only by whether video visits replace office visits. Remote care may become part of a hybrid system, valuable in some conditions and workflows but not others.
COVID-19 answered a narrow but important question: millions of patients and clinicians could use remote care when they had a compelling reason. The strategic question that followed was harder. Once the crisis stopped forcing adoption, which companies had built telehealth into the surrounding system rather than simply benefiting from attention to the channel?
Sources and further reading
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