It’s an experience that almost every American adult can relate to: the holiday trip to an emergency room with an injured or sick child that becomes a half-day experience.
It’s usually prompted by a just serious enough medical emergency that doesn’t quite require an ambulance, but does require a higher order of care than the typical urgent care clinic – and something that can’t wait for normal office hours the next day.
The problem, Nick Desai, co-founder and CEO at Heal, told Karen Webster in this week’s edition of Matchmakers, is that it is only when one gets to the emergency room that they discover the care may not be “immediate” – and the definition of “qualified” care may be stretched.
It was a lesson that he and his wife learned the hard way when their 7-month-old required an emergency room visit during a holiday weekend a few years ago. Desai and his wife spent seven hours in a waiting room, only to be eventually matched with a resident who didn’t know how to use an infant-sized blood-pressure cuff.
It was, Desai told Webster, a discouraging experience.
While most American adults can tell some version of that story, Desai and his wife were not the average pair of angry and exhausted parents. Nick Desai is a serial tech entrepreneur, and his wife, Renee, is a doctor.
“We looked at each other and observed how broken the system is and decided to put our heads together and solve this trillion-dollar problem,” Desai told Webster.
Heal, the firm they founded, is the solution they came up with: a platform that enables a patient to dial up a doctor on demand, to arrive at their front door within two hours.
It’s a house call, albeit digitally souped-up for the mobile age.
How It Works
While doctors on demand may sound a bit like Uber for medicine, the critical difference is that the doctors on the Heal platform are not contractors, but employees – extremely well-vetted employees, according to Desai.
“We get to be very selective,” he said of the hiring process led by his wife Renee, who is also the firm’s chief medical officer. “Only one in 14 doctors who apply are selected to work with Heal, and we put them through a vetting and credentialing process that is over and above what any insurance company is going to require.”
What all their doctors have in common, he noted, is that they are tired of working in a system that forces them to see 30 patients a day and spend “700 hours a year filling out paperwork."
That goes with the territory, Desai told Webster, since most primary care doctors and pediatricians are part of large groups whose professional experience is more like “being a shift worker” than a doctor.
The first phase of design for Heal was trying to create a better situation for those who love practicing medicine and helping patients, but not the environment that most large practices offer.
“You can’t fix medicine for patients without fixing it for doctors first,” Desai emphasized. “You have to make them better equipped, happier doctors. So we are offering them a competitive wage to see 14 patients a day instead of 30 – and actually have the time to really see a patient in context.”
Offering that better deal is financially feasible, he noted, because 65 percent of primary care revenues are actually flowing to the back-office functions and administrative costs that doctors especially hate interacting with. Heal’s idea was to “rewrite the back office entirely, from booking to billing – and automating all of that with software, so that doctors can be doctors.”
Over the tens of thousands of patients, they’ve reduced the costs of bureaucracy, meaning they can pay their doctors competitively while offering a patient load that is half the size of the daily average.
It’s a service for all people who want it, not just for wealthy people who can afford it. Heal accepts all the major forms of insurance in the markets in which they operate, which today is 70 percent of California, Washington, D.C. and Northern Virginia.
Patients with insurance scan their insurance cards and are charged the same co-pay as an office visit with any other doctor. Patients without insurance, or with an insurance program that isn’t accepted by the platform, can pay a flat $99 fee per visit.
From a Cold to Cholesterol
Desai said that Heal’s goal is not to be a patient’s urgent care on wheels, even though that may be how the relationship starts. Instead, the company strives to become every person’s family doctor. And that happens 55 percent of the time, because to experience it once, Desai noted, is to realize there is a better way to get medical services.
“It takes two hours to get a doctor, they come to your home so you don’t have to be exposed to other germs in an ER, and it costs the same – or in many cases less – than going to an emergency room or urgent care center,” Desai said. “That can be a pretty life-changing experience, and we find that very few people walk away from it and say, 'nah, you know I really want to go back to a doctor’s office when I feel sick again, as opposed to the doctor coming to my couch.”
And while that outcome is more convenient for a patient, it also turns out that it is often healthier for them as well. Because medicine, he noted, often works better in context – and a patient in an office complaining of a symptom often isn’t enough context to communicate what a doctor needs to know to form a diagnosis.
Being in a customer’s house, on the other hand, gives a doctor all kinds of information about the patient's environment – and, in turn, gives doctors an early jump on diagnosing conditions before they become serious enough to require extensive intervention.
Moreover, talking to a doctor during that emergency visit for a cold or fever can also be a chance for the doctor to prompt the patient to schedule a routine physical, or check their blood pressure or cholesterol.
Which means those patients are more likely to catch small issues before they become big issues.
About 70 percent of people with hypertension in the U.S. don’t know they have it, Desai noted, and the risk of heart attack and stroke from hypertension can be reduced 30 percent if someone begins a simple blood pressure control regimen.
But, he said, the vast majority of Americans don’t go to the doctor as often as they should, and so they often don't notice any symptoms of hypertension until they have the heart attack or stroke.
When the patient is prompted to take more regular care of their health, he noted, they are more likely to continue to book regular appointments, which is key to igniting the platform.
“Doctors are an expensive asset to sit around, and they don’t actually want to sit around, but because of how they encounter patients, that often isn’t an issue,” Desai told Webster.
Desai provided an example of a family that calls a Heal pediatrician to their home for a feverish child who cannot get into the pediatrician’s office. The Heal doctor will come and deal with the immediate issue, and then ask if the child has had her well visits scheduled. The parents might prefer to stay with their pediatrician, and that is fine – but over half the time, Heal’s first-time users become recurring users.
Once the doctor has those wellness visits booked, they can turn to other members of the household. Does the sick child have brothers and sisters? And the parents might choose to bring a Heal PCP to the house once they realize they are getting all the services of primary care delivered to their doorstep for no additional cost.
“We are seeing doctors in communities booking 70 percent of their business ahead of time by serving a geographically dense core of patients and families and really filling the gap in care, and making sure that all the recommended visits are actually attended," Desai said.
There is some risk for overuse, but it is rare. Mostly, Desai noted, the services save families money – and make doctors' lives a lot easier – just by making the matching and contact process that much easier.
And while both groups are being better served, the platform is maintaining the right booking density it needs to pay the doctors and also make money. The key is for that density to become a more predictable function over time, because consumers are using more routine medical services and potentially fewer emergency services that require spontaneous logistical organizing.
The goal, according to Desai, is for Heal to be in all 25 major metros, decisions that will largely rely on local partnerships with managed care providers, with additional consideration given to demand and doctor density.
Part of the $20 million they have recently raised will go toward that, while the rest will go toward leveling up the medical and data technology used by doctors on the platform – so they are better able to offer more accurate diagnosis on the go.
As for the future of primary care for consumers? Webster wondered if Desai thought that the future of the service would end up looking a lot like the past, mostly dominated by house calls.
Predictions are hard to make, particularly around timing. But he thinks the way consumers are getting primary care today is expensive, inconvenient and inefficient. And doctors, Desai noted, don't really benefit in that system, which means it's a good bet that it's time for that system to change.
The full effect of those changes may not be fully understood for a while, as technology will certainly advance – but the change is unmistakably coming.
“If 10 years ago, I had told you retail was going to fully reset and all these brands were going to disappear, you wouldn’t have believed me," Desai said. "But other innovations just blew past the worst part of that experience. I think we are going to see something similar happen in medicine, and I think Heal wants to be part of leading that change to something better that is accessible to all patients.”