Supreme Courtroom blocks Biden Covid vaccine mandate for companies, permits health-care employee rule

The Supreme Court on Thursday blocked the Biden administration from enforcing its comprehensive vaccination or testing requirements for large private companies, but allowed a vaccination mandate for medical facilities that accept Medicare or Medicaid payments.

The verdicts came three days after the Occupational Safety and Health Administration’s emergency measures for companies went into effect.

The mandate required workers in companies with 100 or more employees to be vaccinated or present a negative Covid test weekly to enter the workplace. Also, unvaccinated workers were required to wear masks when working indoors.

“Although Congress has undeniably granted OSHA authority to regulate occupational hazards, it has not conferred that agency authority to regulate public health more broadly,” the court wrote in an unsigned opinion.

“Requiring the vaccination of 84 million Americans selected solely because they work for employers with more than 100 employees certainly falls into the latter category,” the court wrote.

A protester holds a “Freedoms & Mandates Don’t Mix” sign in front of the US Supreme Court Friday, January 7, 2022 while discussing two federal vaccination measures in Washington, DC, United States.

Al Drago | Bloomberg | Getty Images

Liberal Justices Stephen Breyer, Sonia Sotomayor and Elena Kagan disagreed, writing that the majority had usurped power from Congress, the President and OSHA without legal basis.

“With the pandemic still raging, this court is telling the agency charged with protecting worker safety that it may not do so in all required workplaces,” they said in dissent.

“As sickness and death continue to rise, this court is telling the Authority that it cannot respond as effectively as possible. Without a legal basis, the court usurps a decision that rightfully belongs to others. It undermines the capacity of appropriate federal officials to act well within their authority to protect American workers from serious danger,” they wrote.

President Joe Biden said in a statement the Supreme Court chose to block requirements that are life-saving for workers. Biden called on states and companies to increase and voluntarily implement vaccination requirements to protect workers, customers and the broader community.

“The Court has ruled that my administration cannot use the powers granted to it by Congress to require this action, but that does not prevent me from using my voice as President to advocate for employers to do the right thing, to protect the health and economy of Americans,” Biden said.

Labor Secretary Marty Walsh called the court’s decision a major setback to the health and safety of workers and vowed OSHA would use its existing authority to ensure companies protect workers. The American Medical Association, one of the largest medical associations in the country, said it was “deeply disappointed”.

“In the face of an ever-evolving COVID-19 pandemic that poses a grave threat to the health of our nation, the Supreme Court today halted one of the most powerful tools in the fight against further transmission and death from this aggressive virus,” the AMA said said President Gerald Harmon.

In a separate ruling released at the same time on the government’s vaccination rules for healthcare workers, a 5-4 majority sided with the Biden administration.

“We agree with the government that the [Health and Human Services] The secretary’s rule falls within the powers conferred on him by Congress,” said the majority, writing that the rule “fits very well with the language of the statute”.

“Finally, ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: First, do no harm,” says the majority opinion.

Justices Clarence Thomas, Samuel Alito, Neil Gorsuch and Amy Coney Barrett, four of the six Conservatives on the nine-seat bench, disagreed.

“I don’t think the federal government is likely to show that Congress authorized the unprecedented move to force over 10,000,000 healthcare workers to be vaccinated under threat of dismissal,” Alito wrote in his dissent.

Biden said in a statement that making vaccinations compulsory for healthcare workers will save the lives of patients, doctors and nurses. “We will enforce it,” the president said of the mandate.

OSHA, which oversees workplace safety for the Department of Labor, granted the business mandate under its emergency powers established by Congress. OSHA can cut short the normal rulemaking process, which can take years, when the Secretary of Labor determines that a new occupational safety standard is needed to protect workers from a serious hazard.

CNBC Policy

Read more about CNBC’s political coverage:

The court’s decision to overturn the business mandate comes as the pandemic rages across the United States and the highly contagious Omicron variant is sparking an unprecedented surge in new infections. The US is reporting an average of 786,000 new infections daily, a pandemic record and a 37% increase from last week, according to CNBC analysis of data from Johns Hopkins University.

Hospital admissions have also reached a pandemic peak, according to federal data dating back to the summer of 2020. According to a seven-day average of Department of Health and Human Services data, 149,000 Americans are in US hospitals with Covid, a 27% increase. last week.

The vaccination or testing rules have faced a number of lawsuits from 27 states involving Republican attorneys general or governors, private companies, religious groups and national business organizations such as the National Retail Federation, the American Trucking Associations and the National Federation of Independent Business.

The NRF issued a statement calling the Supreme Court ruling a “victory” and calling on the Biden administration to “reject this unlawful mandate and instead work with employers, workers and public health professionals on practical ways to increase immunization rates and contain it.” the spread of the virus in 2022.”

The mandates were the most extensive use of power by the federal government to protect workers from Covid since the pandemic began. Taken together, the Biden administration estimated that the rules for businesses and healthcare workers would apply to about 100 million Americans.

But both rules were in flux long before the Supreme Court adopted them. The OSHA rules were blocked by a conservative federal appeals court in November, then Reinstated weeks later by another court.

The White House at the time urged companies to follow public safety requirements even if they were not enforced.

Some companies have done this, others have introduced their own rules. A number of large employers, including Citigroup, Nike and Columbia Sportswear, have announced plans to lay off unvaccinated workers in recent days.

— CNBC’s Christina Wilkie contributed to this report.

Famend investor Kevin Ryan thinks the massive cash is in healthcare – TechCrunch

Kevin Ryan has become very wealthy by being in the right place at the right time – including the online advertising network DoubleClick, which he joined as the twelfth employee and eventually headed as CEO (it was later acquired twice) – as well as co-founding numerous companies , including software company MongoDB, which is currently valued at around $ 30 billion as a publicly traded company. (Ryan still owns “at least half of my shares” in the company, he says.)

The other day we spoke to Ryan about his biggest and newest bet on health technology. As we reported earlier, his investment firm AlleyCorp is stalling $ 100 million mostly of Ryan’s own capital into creating and funding outfits in space – on top of the roughly 20 related bets the outfit has already made. We wondered how he got so involved when his previous projects had almost nothing to do with each other. You can hear this conversation here or view excerpts below.

TC: To someone who is not careful, your extreme focus on health technology comes as a surprise. What sparked your initial interest?

KR: One of the things I always do from the AlleyCorp perspective is to think about what 5 to 10 year trends we want to bet on. Some areas can be overcrowded and you think there is no chance, everything is already taken care of. And sometimes you think there is a great opportunity. And so, two or three years ago, I felt like there were huge opportunities in both New York and healthcare in general because there are so many aspects of the healthcare system that are just not working well. It’s incredibly expensive, the electronic records aren’t great, it’s super inefficient. Most of us are very frustrated with this whole health system, which means opportunity.

TC: You mostly oversee your own capital here. Why not borrow billions of dollars to invest, which you, as a proven entrepreneur and investor, could probably do in this current market?

KR: Partly because the area of ​​the ecosystem in which I like to play and in which I feel most comfortable and know best is still in its early stages. So, do I want to invest in a $ 3 billion company and hope it hits $ 10 billion? I don’t really play there. I want to be in the early stages where it’s riskiest and that just requires less capital. By the way, we are not tied up with capital, otherwise we would not bring all these other things to the market [including incubating a number companies inside AlleyCorp like Nomad Health, which raised a $63 million round earlier this year, and Pearl Health, which closed an $18 million round in September].

When we start a new business, we have to bring in $ 1.5 million to $ 2 million to get a business off the ground and then we raise money [from] outside and when we have to raise a lot of money, we collect a lot of money and keep investing, we try to limit our investment in a single company to around $ 10 million. But no, there are many options. And here I want to play.

TC: And this model works even in a world where we are now seeing $ 100 million seed rounds?

KR: The changed environment only helps us. Take pearl health. We have invested $ 1.5 million in this company and are starting with a large equity position. It depends on the company, but we’ll probably have 30-60% somewhere between our partners because the management team has a lot and sometimes there are co-founders on it, so it’s a great position.

Then a company like Andreessen Horowitz comes with a high valuation, a big step up – and we put another $ 3 million or $ 4 million into that round – but we decide who comes in. And by the way, if there is a round at, I don’t know, $ 400 million, then we’re probably going to stop investing. That’s what happens to seed capital. Other big buys will come, we will be watered down, and that’s not a problem. Our money is most effective when we think we can make 10 times our money.

TC: So you are not interested in participating in the later stages.

KR: No. I’ve invested every now and then. We just put a ton of money into Nomad, and Nomad is valued at around $ 250 million. But I think it’s a $ 2 billion company that can be started, so I still feel good about it [our bigger investment], but it’s probably the last round we’ll invest in. There are other people out there who play the role of investing money who think they will get 2 or 3 times the return on it, which is fantastic for their fund. You are much later; they’ll just be inside [a company] for five years. We want to put our money in, be in it for nine years and earn 100 times our money,

TC: Many of your contemporaries are beginning to step out of the venture capital industry, or at least out of their companies. I was wondering how you feel about it. Do you have a right hand at AlleyCorp? What if you decide to step down at some point?

KR: First of all, I don’t think that’s going to happen anytime soon. But you know it’s Brenton [Fargnoli], Conduct health efforts; it’s wendy [Tsu] who works in the non-medical field. And then I guess that in a year we will have two or three more partners and that I would be practically the managing partner of the company. But I’m fine for another 10 years.

Ought to sufferers generate income by promoting their healthcare knowledge?

Emergency room overcrowding occurs when the demand for critical emergency care exceeds supply and poses a serious threat to safe patient care.

here Dr. Colin Dewar, Specialist in emergency medicine at University Hospitals Sussex NHS Trust, breaks down the main causes along with possible solutions.

What are the top causes of emergency room overcrowding (ED)?
Each emergency room is unique and crowding is a complex problem, but there is a helpful framework to categorize the three overarching causes of crowding.

First, as the population increases, so does the number of visitors to the ED. This rush has also been fueled by public health campaigns that focus on time-sensitive conditions such as heart attacks. In the UK, we have also seen a significant increase in ED visits after COVID. Input causes for ED crowing are therefore largely socio-economic.

There are then causes of crowding that are found once a patient has entered the emergency room. Bottlenecks arise from the fact that plants are often not equipped for the increased demand due to insufficient staffing or spatial arrangement. Many other factors can reduce patient flow resulting in overcrowding, e.g. other patients.

Finally, a reduced output of the ED can lead to overfill; this is more commonly referred to as the “exit block”. A shortage of inpatient beds in relation to demand can lead to a longer stay of the admitted patients in the emergency room. The exit block is often seen as the main contributing factor. Because of this, ED crowing is a hospital-wide problem and this must be taken into account when attempting to resolve it.

How does this affect patient care?
Overcrowding in the emergency room is the greatest threat to safe patient care in acute situations in industrialized countries. It affects patient care in terms of the quality of care they receive and this naturally affects patient outcomes.

ED crowing has been shown to be associated with higher staff workloads, delayed patient assessment, higher treatment costs, more frequent discharges of patients with high-risk clinical characteristics, poor infection prevention and control measures, and lower patient satisfaction, all of which are also associated with the likelihood of increasing reduce the patient’s compliance with their follow-up care plan.

This leads to lower patient outcomes, particularly in the form of high readmission rates, extended hospital stays, increased work stoppages, a higher frequency of medication errors and adverse events, and increased morbidity and mortality.

It is demoralizing for employees because they cannot provide the level of care they want when emergency rooms are constantly operated with needs that exceed both physical and human resources and capacities.

How has the pandemic affected this problem?
During the pandemic, attempts were made to keep patients out of the hospital whenever possible. This lowered admission rates for ED, but as the world normalized a bit there has been a significant spike in UK ED participation in the post-pandemic period and the challenge has come again.

The overcrowding has been compounded by the need to give patients adequate space to ensure safe care in the context of the pandemic.

It has shown the need for solutions that can be implemented in the short to medium term, as demand will only continue to increase, as it has in the last 20 years. And the main pressures that ED faces is the need for ED leaders to be actively involved in developing solutions to crowding. Emergency room corridors crowded with patients on carts and chairs should not be an accepted part of 21st century healthcare.

Where, if at all, is this problem currently being technically addressed?
While the implications for patient care are well known, previous solutions have been patchy and inconsistent.
In terms of technology, tools that allow superficial measurements of crowding to aid decision-making are such as: NEDOCS and ICMED For example, scores are available to emergency medicine executives, although their limitations and inadequacies are widely recognized.

Otherwise, the initiatives tend to focus on improving access to primary care and general practitioners as well as on alternative care models. All of them have their shortcomings. The Royal College of Emergency Medicine has consistently argued that the proportion of patients with poor visual acuity (who could be treated in alternative health care facilities) does not exceed 15% clinics or the increasing access to these clinics is likely to be limited.

Britain has also introduced goals such as all ED patients must be treated within 4 hours. This has increased the resources available for emergency doctors, but has not been able to keep up with the increasing demand from year to year.

Overall, this is an area where technological innovations need to be explored.

Can artificial intelligence and machine learning (AI / ML) help solve the problem?
I believe that only large data sets with AI / ML technology applied will be able to unlock the proactive modeling needed to tackle the overcrowding problem. KI / ML offers the promise of transforming the provision of acute services from the current reactive system to a proactive model.

To do this, we need a testable predictive tool for both emergency room needs and inpatient admission. This would be the first step in building a system that optimizes the resources available to meet the expected pressures, with a consequent reduction in ED crowding and the damage it causes.
Such a solution would transform care in emergency rooms and go a long way in ensuring safe and timely patient care while minimizing clinician burnout.

What role will technology play in this area in the future?
In the future, I see the advent of really advanced digital health technologies will also play a role in providing extremely rich, previously inaccessible information about patients’ physiological health (vital signs, etc.) in real time, as well as their exact location in the hospital. This could one day also supply ML-driven crowding models with this type of data, which could permanently change our understanding of what constitutes high-quality hospital care management.

ED crowding is therefore an issue in the healthcare landscape where the urgent need for change meets enormous potential for innovation. Therefore, now is the time to form an international consortium to capitalize on this convergence.

You work with electronRx, what are you doing in this area?
ElectronRx is a deep tech startup based in Cambridge, United Kingdom. They have an expert team of interdisciplinary scientists and engineers who develop a range of novel technologies to revolutionize patient engagement and support clinical decision-making, and take a consistently data-driven approach to the way we deliver health care and treatment of diseases to improve, to change.

With electronRx we are building an international consortium of emergency medicine executives who all work together passionately to overcome the long-standing, internationally recognized obstacle to high-quality patient care, ED crowding.

Our project aims to use their AI / ML skills to extract the value that lies dormant in a plethora of previously inaccessible healthcare insights across the hospital. Our goal is to create a holistic, AI-driven solution that delivers actionable insights with measurable results to fight ED crowing once and for all.

Amazon health-care menace? Teladoc CEO says it is ‘overrated’

The Amazon Pharmacy home screen on a smartphone arranged in the Brooklyn Borough of New York, U.S., on Tuesday, Nov. 17, 2020.

Gabby Jones | Bloomberg | Getty Images

Ask a sports star before a game whether their team is going to win and they’re likely to say yes with confidence. And then cue the headlines that will sensationalize the hubris. But would you expect an athlete to say — would you want them to think — they’re about to lose?

The heads of companies sometimes talk about the competition in a similar way, and they shouldn’t be in the CEO hot seat without confidence in their company’s ability to win.

Take Teladoc Health CEO Jason Gorevic, recently asked at the CNBC Healthy Returns Summit about the threat Amazon poses in health care.

“Based on the fact that it has one enterprise client of 385 employees, it is overrated,” Gorevic said, answering a question about Amazon Care, the retail and tech giant’s app-based primary care entry in Teladoc’s market, which signed up its first client, Peloton-owned fitness equipment company Precor, in May.

Should the Teladoc CEO be more worried? Even after Amazon’s deal with Berkshire Hathaway and J.P. Morgan to take on the status quo with its health care joint effort, Haven, fell apart, the merchandising giant still has a big market to exploit.

Amazon Care is expected to expand to its own employees in all 50 states this summer. It has been adding workers faster than any company in history, more than 500,000 in 2020. It also has had a deal with employer health provider Crossover Health for in-person employee health clinics that continues to expand across states with a goal of putting these clinics within a few miles of all Amazon employees, especially in light of the attention its workplace injury rates have received.

J.P. Morgan is moving on and deeper into health care after Haven, recently announcing it will move ahead with its own effort to invest in new health-care ideas, to be offered among its 165,000 employees and families.

Virtual health here to stay

As society has moved rapidly from the awareness phase of virtual care to the expectation phase, those expectations have increased, and Teladoc has added services like mental health treatment as part of what Gorevic tells CNBC is the future “unified experience” with patients.

“Virtual care is not a stay at home phenomenon,” Gorevic said. “The utilization we are seeing across multiple conditions all indicate it is here to stay.”

He cited first quarter 2021 results during which visit volume was up 69% year over year in spite of the fact that seasonal flu-related visits were down 90%.

Nevertheless, Teladoc shares have cratered, down from a peak earlier this year above $290 to roughly half that level, ending trading last week slightly above $146. But Gorevic says investors are missing the bigger picture, and overlooking improving numbers. The biggest quarterly number he cites: revenue per member, per month, which in Q1 2021 was $2.25, versus 87 cents a year ago.

Others cite the rapid M&A taking place in Teladoc’s market as reason to worry.

Walmart acquired MeMD in May; two other telemedicine competitors, Doctor on Demand and Grand Rounds, recently merged.

“Everyone feels like they have to have a press release that says something about telehealth to be relevant,” Gorevic told CNBC Healthy Returns. “I’m not surprised by any of these moves.”

“This pandemic has thrown the whole market into motion. As we looked at the market, we said we needed to be bold, and we see where it’s going,” the Teladoc CEO said, citing its $18 billion acquisition of chronic disease management company Livongo, which is focused on diabetes, and its expanding mental health services.

Gorevic says health-care consumers are overwhelmed by health-care websites and apps and want a unified experience, and the company is seeing that in multi-product bookings, which in 2020 represented two-thirds of bookings.

Amazon and the fear of disruption

Amazon’s ability to upend, or at least send waves of terror, through the health care industry has already been seen in the launch of its online pharmacy, which led to shares of Goodrx dropping from over $52 to roughly $33 after the announcement last October.

Wall Street analysts who cover Teladoc see Amazon’s presence as significant, yet not all agree it is an acute threat to Teladoc currently.

“Leery of Amazon’s initiatives here,” wrote Sean Wieland, managing director and a senior research analyst focusing on health-care information technology and health-care services at Piper Sandler, in response to an email.

“Even Amazon would have to get the enterprise market on board one employer at a time, as it’s a highly fragmented market and that would take years. Also, it’s a significant lift to go from offering urgent care visits on demand to whole person health care.”

More from CNBC’s Healthy Returns

Charles Rhyee, managing director and senior research analyst covering health-care technology and distribution at Cowen & Co., said Goodrx is a good example of how Amazon can disrupt health care, and it would be a mistake to ignore Amazon’s potential. But he thinks the threat in pharmacy is more direct than in telehealth.

“It’s is a mature market. There are tons of pharmacies out there and it is not a growth sector. In the truest sense, more of zero sum game,” Rhyee said, and that is something Amazon can afford to win at the expense of CVS or Goodrx.

Telehealth visits still a fraction of the market

Telehealth is still a nascent field and that may play to Teladoc’s favor in the years ahead.

“We are all talking about it because of Covid forcing everyone to seek virtual care, but if you think about how many visits Teladoc will do this year, it’s 12 million to 13 million visits,” Rhyee said.

That compares to a U.S. market in which there are one billion visits or more, annually, including mental health care.

Whether a Teladoc or American Well is growing in the telemedicine market, Rhyee says that amounts to about 2% to 3% of visits, a small fraction of what can be virtualized and an indicator that the market is going to expand.

“I’m not concerned,” Rhyee said. “Where Teladoc sits is not what Amazon is doing. It’s not just basic video visits to speak to a doctor for a minor thing. It is increasingly in multiple specialities and second opinions and Livongo. You can argue right now very few, if any, have that broad capabilities, and that’s why Doctor on Demand is merging with Grand Rounds.”

He looks at Amazon in basic care and pharmacy in a similar way to his analysis of Walmart’s health care after its acquisition of MeMD. “They want to provide some basic connectivity and prescriptions that can be dispensed at Walmart.”  

Why Teladoc shares have been volatile

Stocks move up and down in discrete periods of time, and that doesn’t always correspond to the longer-term trend. That’s part of the challenge for investors with Teladoc right now, trying to figure out what its growth looks like post-Covid.

Membership growth guidance for this year may not be as strong as some investors wanted coming out of Covid, and app tracking firms have shown slowing momentum in daily usage. Yet people using Teladoc less now than April of last year does not mean they are using it less than they were in 2019. And last year was unusual.

“We don’t know what virtual will look like in the end,” Rhyee said. 

The Cowen analyst has a $240 price target on the stock and says at $140 it is trading at roughly 8 times forward revenue, which is up from where it traded before Covid, but that was when “people didn’t believe it was a real business.”

Rhyee says he will worry more about Amazon if it starts stringing together acquisitions in health care, including in the chronic condition management space. “That would tell me they are much more serious about it,” he said.

As long as Amazon Care is one enterprise client and its own employees, the Teladoc outlook will be based elsewhere.

The idea of competition between Teladoc and Amazon may be missing the real threat Amazon poses in health care, according to David Grossman, research manager director at Stifel. That includes disrupting the legacy providers in insurance and pharmacy benefits managers.

Teladoc is disrupting traditional providers by creating a virtual 24/7 network on demand that can offer a potentially lower-cost alternative. Those traditional providers now forced to offer telemedicine are more of a near-term threat to Teladoc, in Grossman’s view, as they evolve from starting telehealth “literally overnight” to incorporating virtual care as a permanent feature of their care delivery models.

“Virtual care is now table stakes for providers, while 15 months ago it was barely on the radar screen,” he said.

Setting up appointments online and having telehealth as an option may be one of the features Amazon offers, but that is a shortsighted way to view what Amazon is after in the health care system.

Amazon is saying we take over everything. It’s not lets go after Teladoc. That’s incidental.

David Gross, Stifel analyst

Grossman, who is concerned about Teladoc’s ability to grow revenue and margins, says Gorevic is a smart guy building a reasonable model. Now they can pitch health plans on using a provider network they have created at lower cost for employers, if employees agree to access services virtually as a first stop. That disintermediates the traditional provider network, but he does not see Amazon stopping there or even thinking in those terms specifically.

“Amazon is saying we take over everything,” Grossman said, looking at traditional health care market that is flawed in delivery and pricing and adds little value. “It’s not lets go after Teladoc. That’s incidental.”

Taking cost out of the system is what Amazon already has proven to be great at, squeezing out players that don’t offer value and shouldn’t be there. “I’m rooting for them in that sense,” the Stifel analyst said.

But whether it is Amazon’s or Walmart’s efforts that are emerging in health care, the models to watch do not exclude Teladoc. “There is no indication we should write it off,” Grossman said.

Teladoc shares are down for a lot of reasons, starting with the market rotation out of growth names and the market acknowledging that traditional providers are ramping up their own telemedicine products.

“Everyone points to Amazon, and let’s be fair, it was a high multiple stock and the market is getting out of the stay at home trade and pricing how high can utilization translate into pricing” Grossman said. He added that Teladoc has struggled to convince the street of its pricing power. “They have been opaque.”

The company is growing monthly revenue per member, as Gorevic noted, but the Stifel analyst was quick to point out the recent Q1 growth relied on the acquisition of Livongo. Livongo is the largest provider of virtual chronic care and that is top of mind for employers, but Teladoc has a lot of work left to do to prove demand for it is a secular driver of its business growth.

Behavioral health, meanwhile, is the fastest- growing incremental service but there is only so much that can be delivered on an automated basis, so it becomes a staffing platform to match supply and demand and help sole mental health practice proprietors fill their book of business like an Uber or Lyft.

While the 8 times revenue the company is trading at might seem less than rich, double-digit revenue multiple companies tend to be in sectors like software, where scalability comes fast and at high margins. Teladoc’s subscription-heavy sales model means a majority of revenue is fixed while the costs remain variable.

“Their claim all along has been as utilization goes up it’s good for them, but there is no pricing algorithm around that. We don’t know how to calculate that,” Grossman said.

Companies like Teladoc and American Well can grow members, and grow utilization among members, but how either of those growth measures factor into pricing power remains unpredictable. Utilization can go up, but revenue not match it. And that contributes to investor concerns about its scalability.

“It is factually correct they can get more per member with more services and there are lots of opportunities, but lots of competition for each module and booking,” Grossman said. The company’s scale and visibility give it an advantage, “but lots remains uncertain,” he said.

Gorevic told CNBC this is not a pandemic story. “Something else is going on here. People are reaching out for other things.”

Mental health, dermatology, and chronic conditions including diabetes, and health issues linked to it such as weight loss. “Not one and done things, and that’s why I am convinced,” the Teladoc CEO said.

Building the virtual primary care model and convincing payers and employers that it is most cost-effective to choose this option, and agree to have members enter the health system virtually as the first step, is the bigger opportunity to drive higher revenue per member, Grossman said, and longer-term it is the more sustainable way to disrupt the traditional provider network.

In that sense, Teladoc is taking market share just like Amazon would, and they can grow for a longer period of time. That may be a discrete disruption in health care that becomes permanent. The biggest disruption in health care, though, is not about telemedicine.

“All roads lead into the payers,” Grossman said. “That’s where the level of satisfaction is low and the control they have is high.”

Stay connected with Healthy Returns

For a front row seat at CNBC Events, you can hear directly from the visionary executives, innovators, leaders and influencers taking the stage in “The Keynote Podcast.” Listen now, however you get your podcasts.

For more exclusive insights from our reporters and speakers, sign up for our Healthy Returns newsletter to get the latest delivered straight to your inbox weekly.