When last year’s flu vaccine turned out to be ineffective 80 percent of the time, it did not necessarily have to turn into a flu pandemic. The good news about living in 2018, Doctor on Demand CEO Hill Ferguson told Karen Webster, is that the flu can be treated in the first 48 hours of infection. Where the vaccine failed, the anti-viral drugs should have succeeded — but they didn’t.
The problem was that, for the average American patient, 48 hours is much too short of a turnaround time to get in to see a doctor. That meant some people were not getting treatment at all. Worse still, according to Ferguson, and more common were the patients who waited a few days until they felt really sick before going to an ER or urgent care center.
“What we learned last season very acutely was that people should not be out in public with viruses spreading them,” he said. “We actually had ERs and urgent care doctors telling people, ‘Please do not come in. Use a telemedicine service,’ just so they could avoid more contamination.”
Telemedicine services like Doctor on Demand — which now operates in 50 states — connect patients with physicians, psychiatrists and mental health workers entirely across digital channels. Instead of going to the doctor’s office, the doctor's office comes to one’s screen of choice.
Founded in 2012, the telemedicine startup was once a pay-out-of-pocket-only service (insurance didn’t cover those televisits), operating in a few states and simply trying to move out its concept. Today, the platform is launching a nationwide telehealth initiative with Walmart to help put more customers in front of digitally delivered doctors, covered by many insurance plans, with thousands of board-certified physicians ready to treat both urgent and mental healthcare needs.
It’s been a challenging, interesting and educational journey, Ferguson noted, one that is about to begin a new chapter now that the company is pairing up with the nation’s largest retailer. However, it's a journey guided by a single idea, the same idea that has launched many innovative health startups.
“How do we build a better customer experience — where we could shorten wait times, offer high technical capability and make sure people are working with great doctors?” he said.
Pulling In Both Sides Of The Platform
The average doctor on the platform, Ferguson noted, is not a “kid” fresh out of med school. The earliest adopters were 15-year-plus veterans who were looking to pioneer their way into a better way of practicing medicine. Decades in traditional healthcare in the U.S. had left them burned out.
“They jumped on the boat early as zealots for using technology as a visionary way to provide the future of healthcare,” he explained.
The goal for telemedicine, he said, should be to let doctors to do the thing they want to do: treat their patients. The goal for a telemedicine platform is to manage all the things doctors don’t want to do, like billing, payments, insurance or the other administrative parts of medicine.
Doctors aren’t trained to run small businesses (SMBs), and that is often what is demanded in the traditional private practice model, which is expensive and margin-draining for physicians. As the model has expanded and evolved, Doctor on Demand has become increasingly attractive to established clinicians looking to have greater control of their schedules.
“About two-thirds of the doctors on the platform are women — and many of them are moms who are looking for career flexibility so they can treat patients without having to be out of their home 12 hours a day,” Ferguson said, noting that doctors on the platform are allowed to set their own hours.
Working moms, he added, are also crucial to attracting patients to the platform. They are famously time-pressed and don’t typically have time to schedule medical appointments weeks in advance for the middle of a workday, after the workday or really at any time at all. However, Doctor on Demand appointments can happen anywhere, and the average wait time is about five minutes long (though it can be longer if one is waiting on a specific physician).
“That’s a timeline that works for working moms, who really are the chief medical officers [CMOs] of their households in most cases,” he said. “And the goal is to give them something that makes seeking medical care an experience [that is] very much like ordering up an Uber.”
As their family’s CMO, they refer their children the next time they get sick when the pediatrician’s office is closed — or they send their spouse, who otherwise wouldn't see a doctor for a medical condition less serious than Anthrax poisoning or a compound fracture. The doctors see patients in all walks of life, Ferguson noted, but a working mom is often the first link in the chain that brings many other patients on board.
In that context, Doctor on Demand’s new partnership with Walmart makes a lot of sense. After all, where better to attract one’s core customer group of working mothers than one of their natural commerce habitats?
Working With Walmart
Walmart and Doctor on Demand have been working together for some time. Initially, Ferguson noted, the company worked with the nation’s largest retailer to provide services for Walmart employees. From there, the two firms worked jointly on a pilot that put — what Ferguson described as — virtual exam rooms in 22 Walmart locations. Those customized locations were designed to help physicians with the detection of issues like diabetes and hypertension, and wired to let the Walmart wellness team “spring into action” with the appropriate prescription or medical equipment.
Through those collaborations, the two began working with health and hygiene product maker RB on the current rollout, which will allow customers who purchase certain RB products from Walmart locations (Mucinex, Delsym, Airborne or Digestive Advantage) to log in for a free consultation with a Doctor on Demand physician.
“So, if a customer tries the medicine, and it doesn’t work or they still have questions, they now have free access to talking with a doctor about their issue,” Ferguson said, noting that the promotion would run exclusively with Walmart online or in-store for the next few months.
The move is one of many that Walmart has made in the last year or so, including a big partnership with TSYS to combat patient non-compliance, a new over-the-counter (OTC) medication deal with Anthem and rumors that the retailer may purchase health insurance provider Humana.
“At Walmart, we are committed to the health and well-being of our consumers," said Annie Walker, Walmart’s VP of OTC Merchandising. "We believe that this collaboration will be a tremendous step forward in improving access to healthcare, during a time when people face challenges to getting the right treatment at the right time."
As of today, Ferguson noted, Doctor on Demand cannot take Medicare or Medicaid payments — and won’t be able to until the Centers for Medicare and Medicaid Services (CMS) change their rules to allow telemedicine to be a reimbursable expense.
Those rule changes, he said, are coming. There are all kinds of proposals to allow telemedicine to combat the opioid epidemic, provide senior care or help with the management of chronic health conditions. Those rule changes are going to take time, and require a lot of educational effort.
However, as the company has seen in the private markets, firms come around. Two years ago, he noted, insurance companies were among its biggest barriers to entry. Now, they make up 85 percent of the payments for the Doctor on Demand platform.
“Insurance companies are now happy to reimburse us for what we do because we have clinical data that proves we are on par with brick-and-mortar, if not better, and we can make our offering a literal fraction of the cost,” Ferguson said. “We are replacing a $250 or $300 office visit with a $50 visit, or a $1,500 emergency room visit. It’s a better value,” one he believes the market needs.
Today, he explained, there is a physician gap of about 35,000 doctors. By 2030, the estimates put that figure at about 100,000. Healthcare, he added, is sick — and it's not reasonable to believe that patients already waiting to see a doctor for 18 days are going to be OK with that number doubling or tripling. Moreover, as the economy is changing and more workers are self-employed through gig work, there needs to be affordable out-of-pocket alternatives, and telemedicine offers that.
The challenge going forward, Ferguson said, is both bringing new physicians and patients into the telemedicine fold and building out the offers. For Doctor on Demand, that will mean a bigger focus on chronic and long-term care offerings on the platform, and creating better programs for managing things like high cholesterol or diabetes.
“We started in urgent care and we have spent the last two years building out our mental health services,” Ferguson said. “And we are looking now [at] the broader range of medical services [that telemedicine is] technologically ready to handle, because it is clear that this is something the healthcare market very much needs.”