Vonage CEO Alan Masarek on health by video: telemedicine skyrockets 20X


Will your next doctor visit be by webcam? If it’s in the next few weeks or months and COVID-19 is still raging, probably yes. Telemedicine is probably the only safe way to see a doctor right now.

Vonage is the communications giant that ignited the voice-over-IP revolution. It’s now a major player in video platforms: companies like Peloton use it to deliver their videos. Now with Coronavirus … Vonage is seeing a major inflection point.

Telemedicine has been around for a while … but now it’s exploding. In this edition of TechFirst with John Koetsier, I chat with Vonage CEO Alan Masarek.

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John Koetsier: Will your next doctor visit be by webcam?

Welcome to TechFirst with John Koetsier. Vonage is the communications giant that ignited the voice-over-IP revolution. It’s now a major player in video platforms. Companies like Peloton use it to deliver their videos. Now with Coronavirus, Vonage is seeing a major inflection point. Telemedicine has been around for a while, but now it’s exploding.

To chat about this, I’d like to bring in Vonage CEO, Alan Masarek. Welcome! 

Alan Masarek: Hey, John, thanks so much for having me. 

John Koetsier: It’s a real pleasure to have you here. And I’m starting every one of my interviews right now in this coronavirus era, COVID-19 era, just with something personal.   How are you doing? Where are you? Are you sheltering in place? What’s your life like and how have you been affected? 

Alan Masarek: I’m doing, actually, I’m doing fine. We’re fortunate, we live in Connecticut so I’ve got my family with me. There’s sort of a benefit for this for me and sort of selfishly, my granddaughter’s here, so it’s been wonderful from that perspective. But you know, we’ve got about 2,500 employees globally and spending quite a bit of time speaking to employees and people managers throughout, because my big concern is while I’m sitting there sort of hunkered down with my family and feeling very safe, and not feeling a great sense of anxiety, so many others are isolated.

And so we’re trying to be very sort of cognizant as a company, that to all our people managers to reach out to the teams who may not be as fortunate as me to be surrounded by family and may be isolated. So that’s the approach that we’re taking and it seems to be working well.

John Koetsier: You know it’s interesting you make that point, because I saw something on social just the other day, and that was people who are isolated, sheltering in place, and they’re single and they live alone. And that’s a different scenario than for you or for me. I mean, my wife is here, we have our two boys here in the house, and so there’s some socialization we can do in real life that others don’t have.

Alan Masarek: That’s exactly right. And again, people interpret this sort of stress, anxiety, and tension differently, whether that’s coronavirus or otherwise. People just personally sort of feel these things differently. So I think a lot from our employees’ perspective, there’s physical health and there’s emotional health. And so we’re trying to be really proactive about both. 

John Koetsier: Well, excellent. And let’s get into it. You sent me some very interesting data on telemedicine and like I said in the intro, it’s been around for a while. We’ve had it for a while, but we’ve absolutely seen an inflection point here and we’ve seen some off the charts growth. Can you talk about that a little bit? 

Alan Masarek: Yeah. So Vonage is a leader in cloud-based communications. Video as a modality of communications is a critical element of that. The video solutions that we provide are based around programmable video, which means that it is video that is program-induced solutions that we as businesses or consumers would interact with.

Telemedicine is the perfect example.

So, a doctor could remotely diagnose you through any sort of video link, but video lengths have to be compliant with the law called HIPAA compliance, and ours is. And it also has to be programmable into the broader solution, so the medical record system or the referral plan benefit formulary whatever, and so ours is built in, programmed into other solutions. And Vonage drives virtually all of the major telehealth providers throughout the world, and we’ve seen literally in the last month a 2000% increase in video usage in the telehealth vertical. 

John Koetsier: Wow. 2000% … I mean, have you seen anything like that ever before in your career?

Alan Masarek: No, not in such a short period of time. It is just this amazing spike and what’s interesting is we’ve been able to accommodate the increase in traffic because of the way the solution is architected. So we are a communications platform company across the modalities of communication, video, audio, messaging, IP messaging, email and the like.

And it’s a micro-services architected solution that’s run fully on the public cloud. So as you see one element spike, like we’re seeing with video, you have limitless scalability. And so that’s been very, very important to accommodate in virtually overnight fashion this massive increase in volume while maintaining very high quality video, very high security levels as well. So it’s been an interesting phenomenon right now. 

John Koetsier: That has been a recurring theme actually on a lot of companies. We’ve seen Microsoft Teams grow 8x. We’ve seen Zoom grow 20x, and our internet hasn’t crumbled.

We’ve stressed it out a little bit. Netflix has had to reduce some quality, others have done that, but it hasn’t crumbled. And so how we’ve architected the internet actually turns out to have been really, really good, really amazing for this need that we have right now. And cloud-based solutions in particular that can scale up capacity it’s turned out to be absolutely essential.

Now you have some significant clients on your solution using telemedicine, using video with some kind of amazing stats. Can you walk through a few of those?

Alan Masarek: Well yes, and so if you think about the major telehealth providers, so frequently people talk about Teladoc, or Docplanner, or Doctolib in Europe, or Babylon Health, and many, many others, even among the insurance  carriers as well.

Those are our customers and Vonage powers those telemedicine solutions, so they sit on top of our video infrastructure. And again, you’ve seen this massive spike in video but these communication solutions are driving other industries as well. So you see video driving not just telehealth, but think of it also in distance learning as an example. Huge increases in distance learning or all the remote delivery of services.

So again, we all need to consume healthcare, but we have to do it through some sort of video link. Or consume distance learning through some sort of video link, but go through vertical after vertical, and branchless banking, or insurance, or remote provision of other services, etc. So the video infrastructure is critically important to that. And Vonage is really a worldwide leader in this programmable video category.

Since inception we’ve done more than 50 billion minutes of video. 

John Koetsier: That’s significant, that’s significant. And I saw some data that one of your customers had brought on something like 130,000 new healthcare clients. So that might be a doctor’s office, or that might be a hospital, in the period of about a week or something like that.

So clearly people are jumping on this right away and you don’t want to go to the doctor’s office or emergency if you don’t have to because you’re likely to catch something. If you’re a doctor, you’re in a high risk group as well, because guess what? You’re most likely to be getting COVID-19 because you’re interfacing with potentially hundreds or thousands of people who are potentially sick with it. So it makes a lot of sense from that perspective as well.

One thing I wanted to ask about, there’s probably some things that work with telemedicine and there’s probably some things that don’t work. Can you talk a little bit about those scenarios? 

Alan Masarek: Well, again, telemedicine is the … well, let’s just think about this for a moment. Telemedicine has been a trend for quite some time. 

John Koetsier: Right. 

Alan Masarek: My view is with COVID you’re going to create a permanent paradigm shift where the volume of telemedicine that was increasing at some slope, and now obviously with COVID has gone on sort of turbo boost, that when COVID is behind us, telemedicine will … is now become sort of such a major part of the provision of medical services it’s not going to revert back to the old way.

I think that slope may not be as steep as it is right at this moment, but that slope is going to remain very steep because it’s the perfect way to triage healthcare. So rather than waiting for a hospital admission, an ER admission, or even just going to your local physician, an opportunity for someone to see you immediately and assess what’s going on with you as a patient, is critically important, and I think you’re going to see more of that.

We expect actually that the actual codes, the codes that doctors bill for referred to as the ICD-9 codes the actual diagnostic codes, that we think that insurance carriers will increasingly pay for more of those codes. Meaning that you’re going to see medical care provided over video more and more, simply because it’s more efficient and doctors can bill for it.

John Koetsier: That makes a ton of sense, and it actually solves a lot of problems as well in the future, not related to a pandemic, but related to access to health care, related to rural areas with fewer doctors, related to the cost of healthcare as well, and how much a doctor can physically do, and what his or her overhead costs are for operating a clinic as well.

Alan Masarek: Right.

John Koetsier: So that’s really, really interesting. One of the things that I was wondering about. So I went to my doctor. I go to my doctor very infrequently, I’m a horrible patient, so maybe once every two years or something like that. I happen to live in Canada. I’m in Vancouver so healthcare is “free,” so that’s not an impediment, it’s just I don’t have much need. But I went in, and I happen to use a smartwatch, right, and so I have a ton of health data on that and activity data, other things like that.

And I was wondering, you know, ‘Hey, would you be interested in seeing that?’ He says, ‘No, I have way too much data as it is right now!’ And so I was wondering about as we enter this era of increased amounts of healthcare delivered via technological means, do you see that kind of data coming in? And whether it’s episodic, or whether it’s sort of ambient, or whether it’s being used to diagnose, do you see more of that type of data coming in?

Alan Masarek: Well, I absolutely do see more data coming in through data capture devices. Your smartwatch is a data capture device of your blood pressure, your pulse, what have you. I think what’s so interesting about programmable communication, and in particular in this discussion in video, is you have to be able to capture that metadata.

John Koetsier: Yes. 

Alan Masarek: You and I could have, you could be a doctor and me a patient, and we could go through a simple video conference and you can look and see, and you know I can tell you how I’m feeling, and tell you I can take my temperature, and tell it to you and things like that, but no metadata is being captured in that scenario.

John Koetsier: Yes.

Alan Masarek: So the key issue about programmable solutions, in this example, programmable video, is that the metadata is captured from it. Whether it’s from a smartwatch or just the fact that as we’re having a conversation the doctor is real time into the medical record system.

It’s not having to sort of swivel chair away and record what he just observed into the medical record system. So this notion about metadata is critical and it applies not just into the telemedicine vertical, but many others as well. 

John Koetsier: And I can foresee a time, I think, where that stream of data and the programmable nature of it, understanding that data without even a doctor looking at it, but you have a healthcare system or a smart system that’s looking at that data and sees a spike in something, whatever it might be, and warns a doctor or warns you, and a doctor and says, ‘Hey, get this checked out.’ That would be something interesting. That’s sort of like an ambient healthcare provider or something like that. 

Alan Masarek: Well, I think those types of solutions you’re seeing more and more. From privacy perspective, people have to affirmatively report their results to the physician in a compliant setting. And again, it’s so important that these programmable communication solutions, it’s expressed as a few lines of API code that’s then programmed into Doctolib, or Docplanner, or Babylon Health, or Teladoc, etc, etc.

Those are all controllable, but it’s not going to happen passively. You can gather the data passively but it has to be affirmative from the patient’s perspective in order to release it. So, because the privacy concerns are critically important, particularly in healthcare. 

John Koetsier: Yeah. Yeah, I agree with that. I wanted to talk a little bit about trends, and we had an existing ongoing trend of telemedicine increasing. You’ve said we’ve hit an inflection point where it’s massively grown right now, and you’ve said that you think that trend is long lived. Are there structural challenges in the healthcare system in the US, around the world, to that really becoming part of the norm? 

Alan Masarek: Well, I think it is the virtual provision of services, healthcare or otherwise, will increasingly become part of the norm as a result of this COVID shock to the system. As I mentioned before, you’ve already seen prior to COVID, telemedicine growing quickly, increasing in adoption as people just become more familiar with it. Remote education has been a trend for many years now but you’re going to see a more permanent shift because of the virtualization.

So if you go a step up from what Vonage provides as a cloud communication provider, now we’ve been talking about video and principally around telehealth, but we cover all the modalities. So we connect or communicate via video, audio, messaging, SMS, email, etc.

So the point is, is that in a world where we are virtualizing and today we’re forced to be remote, you’re home, I’m home, in that world you’re going to see through these communication tools. It enables whether you would need to be officing anywhere, or your agents need to be anywhere, you also even need for business continuity. 

Think about it from that view, if in your local government, if you have a problem and you pick up the phone today and everybody’s sheltering at home and you call, is there anybody there to answer the phone? So the old premise-based solutions where the agents or the employees were in the office, today they can’t be in the office.

So these cloud communication tools that we provide enable virtual work whether it’s officing anywhere, or the agents anywhere, or medicine anywhere, or remote service anywhere. It’s all about business continuity at the end of the day, and also you know it’s healthcare continuity. But if a business cannot handle things unless people are sitting at their desks in the office then they won’t have business continuity in the midst of any sort of natural disaster, whether that’s a pandemic or something else. And so what we’re finding is a sea change which is happening everywhere in, again, these needing these cloud-based communication tools in order to enable all that remote delivery of service or the remote work or what have you.

That’s what’s happening and it’s interesting, it’s been a very significant sort of turbocharging of the business because it’s what people need to have that is sort of, you know, that need is just laid bare in this environment around COVID.

John Koetsier: It really has been laid bare. And it’s funny, I haven’t heard the term ‘officing’ before. It’s now entering my vocabulary, thank you very much. You talked about business continuity. Ultimately what we’re needing to be in the business of is civilization continuity because we have real huge challenges here.

We need to shelter in place, we need to slow the, flatten the curve. We need to do all those things, but guess what? Everybody needs to eat. People need jobs. People need to work. People need to provide for themselves and their families and other things like that. So, kind of a nice segue, maybe let’s talk about the macro view here for a little bit and how you see the economy and how you see a recovery happening, if at all.

Alan Masarek: Well, look, I think that it’s a scary time but all of us globally are going to get through this. And it’s impacting different areas of the world at sort of different rates.

So, you know Vonage is a very global company and we have nine offices in Asia PAC. And so clearly earlier in Q1 is when you saw the worst of it from a COVID perspective. And we’re coming through it, and you know our communication tools are built in everywhere and it’s just, you know, you can’t name a consumer or business application that Vonage’s communication tools are not built in. So we get a very early view of how the world of business is coming back and I will tell you that you’re seeing it come back in that area.

And so I’m very confident that while we’re all doing the right things here in North America, in sheltering in place and managing all or doing all the social distancing we need to do to flatten the curve, that we’re going to come through this quickly. Obviously there’s been a lot of economic dislocation. It’s gonna take some time to recover from that, but we are going to recover.

And I think as a people, I think we’re going to recover even stronger and be, you know, sort of the wisdom of the experience that we’ve been through is not going to be lost on people and I think you’ll see it’ll leave behind, it’ll change us, but I think we’re better from it. And you look at all sorts of major events that we as a people and regardless of country have been through, we’ve always emerged stronger from the experience. I think the same will happen here.

John Koetsier: Interesting, interesting. And well said. And we’ve heard a lot recently as well about the people who lived through the Great Depression and how that changed them, and how the things that affected them there changed what they did, how they thought of things, how they worked, how they lived their lives, how they raised their kids, and I can’t help but think that we’re going to have something similar there.

Well, thank you so much for being on TechFirst with me. 

Alan Masarek: My pleasure. Thanks so much. 

John Koetsier: Thank you for joining me on TechFirst. My name is John Koetsier as you know. I appreciate you being along for the ride. Whatever platform you’re watching on, please like, subscribe, share, comment, all of the above. If you’re on the podcast later on and you like this, please rate it, review it. That would be a massive help. Thank you so much. Until next time, this is John Koetsier.