The direct to consumer (DTC) model is changing the way we get our goods and services across everything from makeup to meal kits.
And it is upending healthcare too, perhaps most visibly in pharmaceuticals, where we can get our meds mailed, on autopilot.
But drill a bit deeper and DTC can shift some of the dynamics in how we treat and even diagnose some of the most persistent personal problems — cosmetic ones and even some debilitating conditions.
To that end, startup Thirty Madison’s niche focal points — for now — include Keeps, which focuses on hair loss; Cove, which helps treat migraines and, upon launch last year in September, Evens, an acid reflux treatment plan.
In an interview with Karen Webster, Steven Gutentag, co-founder of the firm, said that personalized and ongoing treatment could be fashioned for people suffering from chronic conditions — connecting them to medical experts and medications via remote, digital conduits.
The firm traces its genesis to hair loss treatments (and with Gutentag’s issues with the same). But as he told Webster, “very quickly as I went through that problem, what I realized that it wasn’t an issue with hair. It was a broader access issue: How we access specialists and how we get high-level quality of care ... to manage health care issues that are chronic in nature on an ongoing basis.”
With a nod toward the overall journey, from end to end, he said keeping several healthcare offerings (and eyeing new ones) across the platform involves creating personalized treatment. And personalized treatment comes not just through subscriptions that deliver low-cost pharmaceuticals (like Minoxidil) to patients but also access via telehealth visits across a range of doctors (interaction with doctors also can be done across online chats).
Thirty Madison, he said, offers the “tools, content and continued access to that same physician, all wrapped in a brand and experience.”
The Infrastructure Needs
Of course, tackling chronic conditions — even one at a time — across digital direct to consumer (DTC) efforts requires getting some technological infrastructure in place.
That technology heavy lifting mandated building a platform and back-office operations that tied Thirty Madison to telemedicine and pharmaceutical manufacturers to offer content including education and to dispense and deliver medication to consumers’ doors.
That road to buildout shone a spotlight on just how fragmented a process healthcare can be. In the case of a migraine, according to Gutentag, there might be a visit to urgent care, primary care, a specialist and a visit to a pharmacist — and the challenge of keeping track of it all.
“You’re coordinating across five or six ‘pillars’ that are not speaking to each other,” Gutentag noted.
The telehealth part of the equation involves working with leading healthcare experts as Thirty Madison develops a framework, clinical guidelines and questions that would mimic an in-person visit — accessible by end consumers 24/7 across “asynchronous video” where videos can help doctors craft treatment plans.
In one example of telehealth, through the video exchange, doctors can request that patients record themselves working through a set of movements or tasks — across a 15- to 20-minute interaction and consult.
“The physician now can look at the full set of information, the full consult and the videos all together,” said Gutentag. “They can ask to follow up questions if they need to. This is never a chatbot — it’s a licensed physician on the other side of the conversation.”
That level of interaction can help craft effective treatment plans where, according to Gutentag, “our average patient has nine or more migraines a month.” There are about 40 million individuals who suffer from migraines, he said, but only a few hundred physicians are specializing in that field — most of them in urgent care settings.
Most sufferers have never been able to have specialized visits, he said. As a result, roughly 70 percent of Thirty Madison’s migraine sufferers see a reduction in severity, and half of those with nine or more migraines a month see incidence number cut in half after just a few months of treatment.
Patients, he said, can develop and maintain a continuous, beneficial relationship with their healthcare providers.
The Payment Aspect And The Road Ahead
The company last month received a $47 million funding round that included participation from Johnson & Johnson.
So far, Thirty Madison’s model means that patients pay for care on their own, but he said the firm because it works directly with pharma and healthcare companies, has been able to deliver care at affordable pricing.
“But especially as we move into more complex issues, there may be cases where it’s actually going to be cheaper if you use your insurance,” he told Webster. “So we want to work and enable that for patients so that whether it’s self-pay or your insurance.” Through the next several months, a key Thirty Madison focus will be to integrate more tightly with the healthcare system at large, including payers and pharmacy benefit managers (PBMs).
Looking ahead, he said that Thirty Madison would continue to target chronic conditions that impact large patient populations.
“For chronic issues, where adherence to a protocol and engagement with your physician actually monitoring and measuring progress is really crucial,” he said. “You don’t have to see a doctor, live, to have that kind of care.”