When Josh DeTillio became CEO of Access TeleCare roughly nine months ago, he wasn't stepping into unfamiliar territory. He'd been on the other side of the equation years before.

It was 2008, and DeTillio was COO of a community hospital in Miami. The facility lacked full specialist coverage and wanted to establish a primary stroke center, but had only one neurologist on staff. Around that time, a company called Specialist On Call, which would eventually become Access TeleCare, was just beginning to demonstrate what telehealth could do inside hospital walls. DeTillio brought them in.

"We were able to keep all of those neurology patients, open up our primary stroke center, and we saved a bunch of lives," DeTillio recalled. "For neurology patients and stroke patients, time is brain. Every second that the patient has a blockage, they're losing over a million neurons. We were able to keep those patients local, take care of them, and then they had better outcomes and were able to return to their normal lives and their families."

That experience shaped how he saw the potential of the platform when the CEO opportunity came around. As a hospital CEO himself for years before joining Access TeleCare, he understood what it meant to have specialist gaps, and what it cost, financially and clinically, to keep shipping patients out.

Today, Access TeleCare is the largest and oldest acute specialty telemedicine company in the country, operating across all 50 states and making specialty care accessible to more than 200 million Americans. The company offers eight service lines, a level of breadth that is rare in an industry where most telehealth companies specialize in one or two areas. Those service lines include neurology, behavioral health, cardiology, infectious disease, pulmonary critical care, nephrology, hospitalist services, and maternal-fetal medicine.

The company's founding story, and the clinical vision of founder Chris Gallagher, MD, was the subject of a StartUp Health feature last year. What's emerging now, under DeTillio's leadership, is a deepening of the enterprise strategy and a clear-eyed push toward what the next five years could look like.

One of the notable trends DeTillio has observed since taking the helm is a shift in how larger health systems are thinking about telehealth. What used to be a facility-by-facility, specialty-by-specialty decision is increasingly becoming a system-level one.

"What we see is a lot more bundling of services, more corporate-level decision making," he says. "It can really reduce the number of transfers for the health system, reduce costs, and increase admissions because they're retaining more."

The impact for individual hospitals, especially those operating with thin margins, is significant. DeTillio describes case studies where hospitals deeply in the red brought on telehealth across multiple service lines and were able to turn their financial situations around entirely.

The stakes extend beyond balance sheets. With more than 750 hospitals currently at risk of closing nationally, according to recent reporting, community hospitals are facing an existential moment. And because these hospitals are often the largest employers in their towns, the ripple effects of a closure go well beyond healthcare.

"When these community hospitals close, they're often the biggest employers in these towns," DeTillio notes. "Keeping them open is really vital, and telehealth has proved to be a big opportunity when it comes to those."

Another factor driving demand is the ongoing and well-documented physician shortage. Specialists are increasingly concentrating in larger urban centers, and even when physicians are available, the expectation of continuous on-call coverage is creating burnout and staffing gaps across the board.

DeTillio emphasizes that Access TeleCare functions not as a replacement for a hospital's existing medical staff, but as an extension of it. The company's clinicians are licensed in the relevant state, credentialed within the hospital's medical staff structure, and document directly in the hospital's EMR. For hospital administrators still navigating internal skepticism about virtual care, that integration matters.

"The typical pushback has really been from medical staff worried about telehealth and not being a physical presence there," he says. "But what we've seen in twenty years is that the medical staff, once we're in there, they love our clinicians. They love having the backup. It truly is a partnership."

On artificial intelligence, DeTillio is measured, which reflects a broader maturity in the field. He acknowledges the sector-wide trend of companies leaning aggressively into AI and then course-correcting, and describes Access TeleCare's approach as deliberate.

The company currently has three major AI initiatives in flight, with goals around increasing efficiency, lowering costs, and improving the speed and accuracy of clinical triage. The aim is to get the right clinician to the right patient faster, particularly as the volume of consults continues to grow.

"It's amazing what AI can do," he says. "We're at a point where we've implemented a number of things, and there are several more in flight."

Looking out five years, DeTillio sees a meaningful shift in how hospitals are configured. The model he describes, one where a facility handles straightforward acute and emergency care locally while relying on a robust set of virtual specialists for the full spectrum of medical complexity, is already working in practice. He calls it, with some reservation about the buzzword quality of the phrase, the "virtual hospital."

"Hospitals can afford telehealth and have the services local," he says. "For your straightforward, more medicine and emergency-type situations, having specialists available via telehealth is a great solution. We've seen hospitals do exceptionally well and continue to thrive with this model."

The challenge, as he sees it, is education. Many hospitals that could benefit haven't yet understood what's possible, or haven't seen the case studies that demonstrate the financial and clinical return.

For health system leaders considering whether this approach is right for their facilities, DeTillio's answer is direct: those barriers have largely been overcome by two decades of deployment. The results speak for themselves.

"Almost every situation, once hospitals move to a telehealth situation, they never go back."

StartUp Health community member Josh DeTillio and the team at Access TeleCare are advancing the Access to Care Health Moonshot. Learn more at accesstelecare.com or connect with Josh on LinkedIn. To learn more about joining the StartUp Health community, visit startuphealth.com.