Case Study: How an Israeli Company Launched a Transformational Telehealth Solution in the United States
Introduction
Antidote Health is an Israeli company offering affordable telehealth services for U.S. residents. Their vision is to create a transformational shift in the American healthcare system.
In March 2020, the company began working on a platform that would be the foundation of its services, with the goal of eventually offering a full Health Maintenance Organization (HMO) to its customers.
Background
Israel has a straightforward governmental system in which all residents pay a portion of their income toward healthcare and are members of one of four HMOs.
The Israeli HMOs cover all medical needs for an average cost of $3,000 per member per year, with a result of one of the highest life expectancies in the world.
The Antidote Health team realized that “straightforward” isn’t the norm for people trying to navigate the complex American health system. Their company is striving to create a solution that makes healthcare more accessible and affordable for U.S. residents, regardless of insurance.
Antidote Health turned to Nixon Gwilt Law to help them get on the path to fulfilling their mission by building and launching a fully-compliant telehealth solution offering services throughout the country.
We spoke with Maya Krieger Kolevsohn, Chief Legal Officer for Antidote Health, about the company’s recent experience entering the U.S. healthcare market.
The Challenge of Delivering Telehealth in 50 Different Regulatory Zones
Like many tech-enabled services companies, Antidote Health started with the technological foundation of their solution—but they quickly realized building the platform and its ability to support clinical services would be simple compared to tackling the legal and compliance requirements of the U.S. healthcare system.
Krieger Kolevsohn explains, “When you start reading, you see that things are much more complicated in the United States. You have federal and (different) state laws, and you need to know if you need the FDA or not, and there’s a thing called a PC, and we didn’t know exactly what that was. We realized we really needed local advice and counsel.”
“It was obvious from the beginning that we would need local (U.S.) advice, but we didn't realize that we'd need it from day two!”
— Antidote Health Chief Legal Officer Maya Krieger Kolevsohn
Why Antidote Health Chose Nixon Gwilt Law
The Antidote Health team interviewed several different law firms in the U.S. and chose to work with Nixon Gwilt Law for a number of reasons.
Krieger Kolevsohn sought out a law firm that:
Possesses overall healthcare experience—not just telemedicine experience;
Works extensively with international companies who are grappling with the complexity of entering the U.S. healthcare market; and
Understands that when you’re running a startup, you’re working with your investors’ money.
“At the time, as an early stage startup, naturally we did not have endless sources to spend on legal services and fees,’” Krieger Kolevsohn shares. “You must begin working step by step, and understand that you cannot have everything set up at once. This is something that must be understood by the outside counsel as well, and Nixon Gwilt has both the experience and the understanding of this limitation.”
What Happened During the Engagement
As someone who has worked with various legal advisors, Krieger Kolevsohn noticed that many lawyers tend not to take a stand on issues. But instead of offering “wishy-washy” advice and never taking a side, Nixon Gwilt Law offered clear opinions with structured, logical advice on precisely what to do—and what not to do—and explained the risk involved with each decision.
Krieger Kolevsohn says Nixon Gwilt Law’s expertise in telehealth and virtual care management was an invaluable asset in helping them set up the company’s telehealth solution in the U.S.
“I can read 20 pages of the law on my own,” she says. “But it's a matter of experience in the field and knowing what the companies are doing in practice.” [Nixon Gwilt Law] was able to say ‘This is what it says in the law, and this is what companies do in practice. This is what we think should be done or can be done, and these are the risks. These are your options.’”
“Our first significant experience was during the first meeting, on a Friday at 5 p.m., when we explained our needs and that they were urgent (the PC structure). Rebecca just said, “OK, let’s do it,” and started verbally structuring the next steps. This conversation came after a discussion with a “top tier” firm that took the wind out of our wings with a negative approach.”
— Antidote Health Chief Legal Officer Maya Krieger Kolevsohn
NGL’s support included:
Building a multi-jurisdictional telehealth corporate and contractual infrastructure throughout 50 states + DC;
Crafting the terms and disclaimers to present to patients and providers;
Support for hiring key team members; and
Providing guidance related to the scope of practice, delivery of clinical services in a remote environment, and how and when to engage other professionals (e.g., insurance, valuation, tax and accounting, data privacy and security, etc.).
Krieger Kolevsohn adds, “When you're building a business, you have to be practical. You need a roadmap, you need instructions—especially when you are a “foreigner” and naturally, you're not knowledgeable about these specific laws.”
The Results
“When we started, we were one Israeli company with an American subsidiary,” Krieger Kolevsohn says. “Now we’ve built a whole management services organization (MSO) structure, domestic PCs, foreign entities, etc.”
She credits Nixon Gwilt Law with guiding Antidote Health through the process of building a new and innovative company in the U.S.
The company now has a clear roadmap for how to continue to expand their brand in an efficient and legally compliant way.
“What can we do today that we couldn’t do then? Everything. It's very obvious to see the contribution of Nixon Gwilt Law, when you see a business that started with NGL from day one, from scratch, and to see what we have achieved as of today.”
— Antidote Health Chief Legal Officer Maya Krieger Kolevsohn
What’s Next for Antidote Health
The Antidote Health team now feels confident about their ability to expand and advance toward their broader mission.
“The telemedicine platform is basically one step into being able to provide health plans and apply for HMO licenses. That's where we're going. in order to accomplish our vision of healthcare for all. We want to disrupt the cost of medical care in the United States while providing holistic and quality care to our customers.”
Of course, there are a host of regulatory constraints, so it won’t be an easy road—but Antidote Health is committed to changing the U.S. healthcare market. Within the next 2 years, the company would like to launch its HMO in a few states and be able to provide high-quality healthcare for people who can’t currently access or afford it.
Advice to International Healthcare Innovators Entering the US Market
When we asked Krieger Kolevsohn what advice she has for other international healthcare innovators, she said, “Usually, it starts with explaining the complexity of the law in the United States. I think a lot of companies outside the U.S. don't understand the complexity. They hear about HIPAA, or the FDA, and they ask their own local advisors what they need, and that’s it. They don’t realize that it’s much more complex. This lack of knowledge is very unhealthy when it comes to entrepreneurship. Don’t hold back your dreams, add knowledge.”
She advises healthcare innovators outside the United States to explore at the very first stage what they need in order to move forward from U.S. service providers.
“You may not need everything right now. Each company is its own business. But I tell people to at least get initial advice about where they stand in their business and what's relevant to them—and the best way of doing that is to get local American advice.”
— Antidote Health Chief Legal Officer Maya Krieger Kolevsohn
About Antidote Health
Antidote Health, a leading telehealth company, believes healthcare is a fundamental human right. Their services democratize access, delivering care for individuals or the whole family for a single price.
Antidote Health works with individuals, businesses of any size, and non-profits. Their goal is to ensure that everyone can have affordable, high-quality acute, primary and chronic care services, 24/7/365. For more information visit: www.antidotehealth.com
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