Michelle Davey, Wheel, on building the new virtual care stack

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In this episode, we interviewed Michelle Davey, the Co-Founder and CEO of Wheel. Wheel is working behind the scenes to build many of the telemedicine services you’re familiar with. Its online platform matches doctors with patients and also enables any company to stand up a virtual care practice. Wheel makes it simple for companies to build virtual care services under their brand by pairing technology with a nationwide clinician network. Wheel also provides clinicians with the best place to work in virtual care. By helping more companies and clinicians get started in virtual care, Wheel is helping patients get connected to the best care for their health needs. Today, Wheel works with companies of all sizes including publicly-traded digital health innovators, big tech companies, laboratories, retailers, and pharmaceutical and medical device companies. Wheel has raised $66 million from Lightspeed Ventures, CRV, Silverton Partners, Tusk Venture Partners, J.P. Morgan, and Future Shape.

Growing up in a rural area with limited medical resources, Michelle became focused on improving patient access to care. Her career took on a journey through healthcare, tech, marketplaces and virtual care. After recognizing the need for a new workforce configuration in healthcare, she co-founded Wheel with Griffin Mulcahey in January of 2018, after working together in the telehealth industry and realizing no one was looking out for those at the center of the healthcare engine: the clinicians on the front lines. Wheel became the industry’s first model for delivering high-quality virtual care at scale by empowering clinicians and providing new efficiencies for healthcare companies. Michelle is a thought leader focused on the urgent need for reinventing healthcare delivery models, clinician empowerment, and the future of work in healthcare.

In this episode, we discussed:

• Michelle’s childhood journey through the healthcare system: going undiagnosed with an autoimmune condition while living in a rural area, a personal experience which ties into her professional interests today around virtual care expansion and clinician hiring/retention
• Why telehealth isn’t just a buzzword, where telehealth giants have fallen short in pushing more recent innovation in virtual care, and why clinicians believe Wheel’s clinician-centric business is different than other telemedicine platforms
• Wheel’s platform business, why clinicians prefer working with Wheel, its decision to enter new specialties, and how the company manages liability and quality across all of its provider-virtual care company interactions
• How to manage a remote-first workplace during a global pandemic, the devastating Texas winter storms, and through plans to double the company’s workforce in the next few months

Start — 8:00: Michelle’s background

• Michelle’s childhood journey through the healthcare system: Michelle enjoyed growing up in a rural community about an hour outside of Austin, but the location was not great for access to healthcare. She was sick from an early age with multiple symptoms that required dozens of doctor visits, usually ending in an antibiotics prescription or dehydration diagnosis. Over time, the repeated lack of answers about the root cause of her illness frustrated Michelle. She learned the painful reality of the healthcare experience as a patient at a young age, and continued living it for 15 years before she was finally diagnosed with an autoimmune condition. Healthcare access is usually defined with two strokes: geographic and socioeconomic, but for Michelle, the third leg of the stool that inspired Wheel is finding the right clinician via the right medium at the right time, in real-time.
• Michelle’s background in tech and healthcare recruiting and operations and the genesis of Wheel: Michelle started her career in healthcare, working in recruiting at companies like Medtronic and large medical device manufacturers. After three years, she swore off healthcare, believing it was too broken and slow to be fixed or interesting. She transitioned to tech recruiting at Google, which was faster-paced and taught Michelle the importance of building great teams. Afterwards, she joined a small food delivery startup as employee number eight, and helped the company rapidly scale their delivery worker network into 18 states. This was Michelle’s first exposure to the gig economy back when “the future of work” was a burgeoning sector. Michelle fell in love with the idea with this new way of work — that people could earn extra income or gain flexibility and maintain more control over their schedules. This all culminated in Michelle’s final role prior to Wheel at a telemedicine startup in 2016 — her first foray into healthcare since she swore it off. Michelle was the Head of Global Talent and Shared Services, and led the company’s effort to build a nationwide provider network. While Michelle had hired thousands of people into wide-ranging roles from engineering to operations, she was humbled by the complexities of hiring in healthcare, from state licensure requirements to scope of practice laws. This led to a lightbulb moment between Michelle and her colleague (now Wheel co-founder and General Counsel) Griffin that there ought to be a different way to more efficiently scale up virtual care onboarding and operations to serve underserved areas like where she grew up, while bringing the future of work to clinicians. This idea was the genesis of Wheel.
• On being between coasts, as a female founder: People thought Michelle was crazy in 2018 to build outside of what was then-considered technology hubs (NYC, SF). Even within Texas, Austin is not known for healthcare. Now, Michelle likes to think she is proving people wrong. Austin stands out not only because Michelle spent her childhood and most of her adult life in the area, but for two other reasons. First, unlike in the Bay, she feels that Wheel puts a greater emphasis on building a scalable, sustainable, and healthy business, not one that just needs to ingest capital. Second, Austin is a place where employees can put their heads down and work without getting distracted by trends happening on each coast. They also were able to source from diverse industries to round out their leadership team and bring novel perspectives into healthcare. For example, Wheel’s CFO and COO come from the rideshare economy, and their perspectives are integrated into how we think about healthcare today. As for being a woman, Michelle feels that women are still finding their voice in healthcare. While she feels the industry — even in just the last 18 months — has made strides, not only at startups but also incumbents (e.g., Karen Lynch at CVS/Aetna, Roz Brewer at Walgreens Boots Alliance) who have women CEOs at the helm. While this is encouraging, there is more work to do.

“We could go [to SF] to meet with our clients, and we did pre-pandemic often to hear the heartbeat. But when we returned to Austin, this was ultimately the place where the team could put our heads down and execute the Wheel vision without ‘trendy’ distractions. Building in Austin was challenging at first — you couldn’t look around and find healthcare executives around you. But it also challenged us to find talent with non-traditional backgrounds, such as myself.”

8:00–19:00: The telemedicine landscape

“When I say broken system, I mean a model in traditional healthcare in which one clinician works for one hospital group or one community center and just serves the patient population around them. While they have a great impact into that direct community, this 1:1 model doesn’t scale. In the early days of telemedicine, we were just bringing that system online. Each company was hiring its own provider network in a siloed approach, just increasing the shortage of clinicians over time.”

• Why it’s so difficult to create a nationwide provider network: In Michelle’s mind, there are three main reasons for the high barrier to entry on a scaled virtual care platform. First, we have a massive clinician shortage of 2.3 million clinicians needed over the next five years, but 50% of existing providers already say they are burnt out. Pile on a global pandemic, and now you see lagging burnout effects, with one in five clinicians saying they expect to leave healthcare post-pandemic, exacerbating the shortage. And, clinicians don’t have many readily available free hours, especially when they are working in person. The industry can’t simply replicate this broken system and bring it online, which is what early telemedicine did. The second issue is that healthcare is highly regulated, with good reason. Healthcare isn’t the rideshare industry — patient lives are at stake — so regulatory intent is to protect the patient. However, regulations make it harder and more cumbersome to scale up a virtual care business. A clinician has to be licensed in the state in which a patient actually lives.

“Imagine a provider licensed in Texas, because that’s where their practices are. Then they come on to a virtual care platform, but they have a Texas license — so they can just see patients who are in Texas at that moment. How does that scale? You now have to have at least 50 clinicians in every single state, every single hour, every day, but have to load balance these clinicians against demand in real time. Maybe there is more demand in Georgia, but you overstaffed in NYC because that’s where the patients were yesterday. You can’t easily ship those providers to ‘pick up’ that patient demand. Ultimately, you have to create this massive provider network, which is an expensive overhead option for companies. If patients have to wait hours to get care, why wouldn’t they go to the urgent care or Minute Clinic around the corner?”

• On whether virtual care is too hyped up: Before the pandemic, a “good” virtual care outcome typically was a prescription. Or, if you saw a provider in person, you might end your care journey with discussions online via patient portal with your provider. The pandemic forced mass adoption of telemedicine, and shifted the patient journey to begin with virtual care as patients were trying to get to the right clinician. Thus, care navigation became the standard for a “good” outcome for virtual care. What changed [in the pandemic] is that most care now starts online and then — only if needed — does the patient experience a physical interaction, whether labs are sent into the home, or the provider does a home visit, or the patient needs to go into an office for that visit. So, Michelle believes that while certain types of virtual visits have plateaued, in other verticals — like in mental health — people are getting better access to care online. She also believes that there is seasonality in healthcare, and we’re seeing lower rates of certain illnesses in summer months (e.g., flu, cold), favoring more preventative care which can be done virtually. Michelle recently wrote more about her predictions for virtual care in 2021.

“We [at Wheel] hear it all the time — we are a clinician-centered company. We do not actually have a patient front door. So we spend all of our time and resources thinking about the clinical infrastructure and clinician experience inside the next generation of healthcare. That excites clinicians.”

• On the elephants in the room — Amwell and Teladoc — and why clinicians like working with Wheel: Recently, Michelle provided commentary on the Amwell’s CEO’s take on Amazon’s foray into primary care (“I would just say welcome to the swamp. It’s much more complicated than you think.”). Michelle credits early telehealth companies like Amwell and Teladoc with thinking about increasing patient access in an innovative way, and certainly created a category. However, the “welcome to the swamp” notion effectively supports more barriers to entry in a segment that still needs innovation. Michelle believes this statement implies the way healthcare exists today is broken and cannot be competed in, creating siloes rather than breaking ground for other infrastructure and connective companies that can enable better care. We’re seeing more M&A activity in virtual care than ever before (e.g., Cigna-MDLive, Dr. On Demand-Grand Rounds). Incumbents are looking at other startups and seeing them as competitors for the first time. As for why clinicians like working with Wheel, Michelle believes it comes down to them wanting to be part of the next innovative generation of healthcare. Wheel is also a firmly clinician-centric company. Michelle and the Wheel team hear time and time again from clinicians that it’s refreshing Wheel cares about the clinician voice and experience, working closely with clinicians to inform everything from product development to new training on “webside manner” and virtual care practices. Wheel hears the best and most feedback around its high level of support for clinicians, and how Wheel provides a different level of service than what clinicians have ever experienced before.

“Imagine if you’re a clinician walking into virtual care today. You have so many options to choose from. You can work at three different virtual care companies and manage your own schedule, and credential separately across all of them. Or, you could work with Wheel. We set you up with one platform to manage one credential, one schedule, while working across many virtual care companies seeing different patient populations to increase your impact in healthcare. All that, while still earning and having the flexibility to support your family and still see your family.”

19:00–30:00: Wheel

Editor’s note: Wheel’s business by the numbers: Wheel has delivered half a million patient visits to-date (including a 50 percent spike in patient consults in Q4 2020). Wheel’s clinician network includes thousands of clinicians with a 90% clinician retention rate. 70 percent of Wheel clinicians work in brick-and-mortar settings. 70 percent of Wheel clinicians are parents and/or caregivers, and 2/3 of Wheel clinicians are the sole income providers for their household. Wheel supports over 100 primary care treatment areas.

• Investing in clinicians — what webside manner training does Wheel provide?: Michelle believes that investing in clinicians is one of the most direct ways to improve the health of our country (she also wrote about this thesis recently). Burnout rates are skyrocketing, with 50% of providers saying they’re burned out. That impacts patient care. Even five years ago, clinicians had never received any type of training on how to provide patient care online, whether in residency or in medical schools. Then we saw some innovative residency programs start integrating these skills into their training over the last three years. This training is essential — for example, without ever having to touch a patient, clinicians must learn ways of getting information from patients about their symptoms, understand how they are managing their condition, etc. While we don’t want to remove all clinicians from an in-person environment for good reasons (ultimately some care will need to be facilitated in-person), we need to build infrastructure that allows these clinicians to have a hybrid work style.

“If 50% of physicians are saying they’re already burnt out, imagine what it’s like on your very worst day of your job. You’re stressed, your communication level to your team might be poor, and you have a ton of administrative burden placed on you. Then, you have to interact with patients all day — imagine how that stress and exhaustion impacts the patient-provider relationship. I’ve been to the doctor’s office where the doctor must click through 16 screens and ask me the same questions the nurse just asked me just to get through the EMR. I’m a firm believer that improving the clinician experience is the way to increase patient outcomes.”

• Wheel’s product offerings: Wheel supports many different types of businesses, each with their own virtual care program and service offering, and thus has a unique product spread. Wheel has a white-labeled virtual care platform that allows virtual care companies to build asynchronous, synchronous, scheduled synchronous, and chat-based telehealth services. For a given company, it may be important in different treatment areas for a chat to follow a synchronous visit, or to have a scheduled synchronous visit for recurring visits with the same therapist. Wheel is continuing to add modalities that help different patient populations in ways that traditional video visits might fall short.
• Why don’t partner businesses just build these functionalities in-house?: In the early days of digital health, many companies believed they should build end-to-end virtual care services in-house because that’s how it had always been done. In going to market successfully, Wheel has found that there’s a better way to outsource this work — why wouldn’t a virtual care company partner with Wheel, whose sole focus is to concentrate on the clinical infrastructure and clinician services that support virtual care, so that the company can focus on the patient’s journey and care? Wheel’s platform allows its partner companies to deliver better care to their patients, but in a more cost-efficient way.

“Scaling a nationwide network requires massive sitting overhead costs. These ultimately get passed onto the patient. Wheel’s cost model is that partners pay per use, so that every single time a patient and clinician meet, you pay for that time together — so you no longer have large sitting overhead. At Wheel, our goal is not to increase patient costs, but in fact reduce overall overhead by centralizing the clinical and regulatory infrastructure needed for virtual care, so that savings get passed onto the patient.

• On clinician liability and quality assurance: Wheel enables clinicians to see patients through multiple different companies that may have different care models, which begs the question how Wheel addresses clinical liability for services provided by providers to its customer businesses. Many clinicians skeptical of virtual care have experienced or learned of horror stories in which virtual care mishaps (not the fault of the clinician) can impact the clinicians’ own licenses and livelihoods. From the beginning, Wheel has been committed to ensuring this is not a concern for clinicians. Michelle’s cofounder is a health regulatory lawyer. They both kickstarted Wheel’s two vetting processes for businesses that use Wheel to power their virtual care companies. Each partner company goes through a regulatory check and a clinical check. With a regulatory check, before Wheel even begins working with a partner, it ensures that the company is compliant with major health regulatory laws (e.g., no active state or federal investigations against them) and vets their care model. For virtual care companies that don’t have the infrastructure to stay compliant over time, Wheel’s built-in regulatory features help companies grow their businesses into new verticals while complying with healthcare regulations. In return, these checks help protect clinicians, their licenses, and their livelihoods. Then, Wheel goes one step further in providing malpractice for each patient consult that is performed on the Wheel platform. Finally, Wheel has an entire behind-the-scenes team that helps partners and clinicians both understand important regulatory and legislative changes in real-time so that companies can avoid their own regulatory risks as they scale.
• On entering new specialties: When Wheel started in 2018, the predominant use case for telemedicine was in urgent-care and low-acuity visits. What the Wheel team started to notice during the pandemic was the need for more virtual-enabled longitudinal or specialty-level care. Patients who were previously using telehealth for urgent care or birth control prescription renewal now wanted to now utilize telehealth for primary care and chronic care management. Since Wheel is a two-sided platform for both clinicians and virtual care companies, it has direct visibility into supply and demand constraints and trends for virtual care. Wheel recently entered behavioral health to aid not only businesses whose core focus was on mental health, but also companies in other verticals (e.g., urgent care, primary care) that wanted to expand their services into mental health access. In an urgent care model, patients might have come in for a cold or a flu, but also had depression. Under the status quo, clinicians would just refer that patient out to see a specialist for mental health. Now, if patients mark that they are interested in seeing a clinician for both (as an example) birth control prescription and anxiety, then that patient can see both of those clinicians online rather than being turned away for having multiple care needs. Wheel is also building the supporting infrastructure around what constitutes a “good” outcome from virtual care, e.g., getting labs drawn. Michelle is a big believer that in the next five years, we’ll drop “virtual” and call all healthcare digitally-enabled.

“Our platform plays behind the scenes for virtual care companies ranging from small startups to large enterprises and incumbents. So, from our perspective, we get to see what growth plans are in the market — which allows us to spot trends much more quickly than an individual player on either side.”

30:00 — End: Personal Leadership Growth

• On hiring and adaptability in a remote-first workplace: Just after Wheel’s Series A raise in January 2020, the company was 15 people. Since then, they’ve exploded to upwards of 100 people, and are planning to double that figure in the coming months — most of them remotely all over the US. They also were forced to adapt to remote work during the Texas winter storms in 2021, which left many teammates without wifi, heat or running water. On the front-end of hiring, Wheel ensures cultural fit through values-based interviews, in which candidates have to establish experience with each of Wheel’s five company values. On the back-end of onboarding and retention, Wheel had to think differently about onboarding new employees, from teaching them about the business to learning about the healthcare industry at large. Wheel’s core business as a virtual platform lent itself well here — the company has created a customer-employee feedback loop by pulling a lot of onboarding and training for its clinician stakeholders for its employees, and vice versa.
• On the recent Series B, announced in May 2021: Wheel has many ambitious goals for how to continue building clinical infrastructure around the company and rebuild a foundation for virtual care companies to scale on top of Wheel’s platform. Wheel will be focused on building new types of clinicians (specialties, licensure, etc.) online to virtual care for the first time ever. They’re also excited to double down on their technology and continue to build new care models, treatment areas, and underlying infrastructure required to get a patient the right clinician for their care needs in real time. Lastly, Michelle believes 2020 represents a large acceleration for the entire healthcare industry, but 2021 represents building a longer-term, tech-enabled virtual care vision. Wheel is hiring!