From the patient side, the many unpleasant points in the modern distribution of primary care in the U.S. are readily apparent. Appointments take a long time to book (two weeks on average), doctor visits are short and rather impersonal, and the assignment of a physician is very much a luck of the local draw – the experience and expertise a patient gets is pretty well limited by the geographical area.
And the net result of that unpleasant system is pretty predictable, as SteadyMD co-founder and COO Yarone Goren told Karen Webster for this week’s edition of The Matchmaker. The majority of patients, even those with insurance coverage, avoid seeing a doctor if there is any chance at all they can “gut it out on their own.” When things get really bad or unmanageable, he noted, people go to urgent care centers to get antibiotics or a referral for the x-ray they need.
It’s a bad model, Goren noted – and it has measurably bad consequences for patients: 50 percent of those prescribed for chronic diseases don’t take their medication properly, 30 percent of doctor’s office visits are no-shows and roughly 40 percent of the U.S. mortality rate each year (around 900,000 deaths) are attributed to “preventable causes.”
“But what I didn’t see until I started forming this business with my co-founder, Guy Friedman, was how miserable this also is on the primary care physician side of things,” Goren told Webster.
These doctors, he noted, typically have patient loads that stretch to the 2,500 mark – and they need to see about 20-30 patients per day in about 10-minute increments to earn a “good living,” since they are by and large billing insurance companies at $70 a pop. Even with payment for those long, packed and highly stressful hours, primary care doctors often remain under the shadow of several hundred thousand dollars’ worth of medical school debt until they are in their 40s or 50s.
“This is really a system tailor-made to make everyone involved, the doctors and the patients, miserable,” Goren noted.
And so SteadyMD decided to throw an online platform concept at the problem, to see if they couldn’t boost the experience on both sides.
SteadyMD: Concierge Service, Middle-Class Budget
In the early drawing board days of the firm, the founders knew there was already an alternative to the rather industrial feel of today’s primary care marketplace: the wondrous world of concierge care.
Patients are happy and doctors are happy. These doctors only serve 400 to 600 patients in their practice, and offer a much more intimate and focused primary care relationship, seeing only five to 10 patients a day.
It’s a great model, Goren noted, with one major issue: It is utterly inaccessible to the majority of American healthcare consumers. Because for that level of concierge service, consumers can expect to pay anywhere from $2,000 to $10,000 annually, which in itself is a roadblock. Moreover, he noted, those types of services only really exist in cities that have a large and affluent enough consumer base to keep them in operation. Even for consumers who have the money, the access just might not be there.
But in just the last decade, Goren pointed out, the web has evolved a lot in terms of the ability to rapidly and smoothly transmit video data in just the last decade – and that creates an opportunity for SteadyMD to mimic some of those concierge medical offerings with digital delivery.
“In our view, there is no substitute for in-person care, or a way to digitally replace the touch of an in-person doctor,” Goren told Webster. “We aren’t offering a replacement for that system. What we are offering is the ability to connect to and then form a relationship with a primary care physician.”
He likened it to being able to recruit a quarterback to “run all the plays” in one’s medical care, or like having “a doctor friend you can always reach out to.”
That reach out can be by text message or by video chat – both offered over a secure, HIPAA-compliant interface – and it offers patients the peace of mind that they have a doctor always on call to “listen to you, pay attention to your needs and help to best guide your care.”
Merely offering consumers a way to receive more managed and personalized primary care in general was a starting place, Goren told Webster, but the platform realized that as a matter of recruiting patients to a rather unorthodox method of providing medical care, they needed to offer more than the general.
Because, among the problems in today’s high-speed, highly generic primary care system, he noted, is the fact that in most cases, it is very hard to get a doctor who is attuned to one’s specific fitness needs.
Bodybuilders, Goren noted by way of an example, need doctors who don’t panic at the word “creatine” and who understand there are medically safe ways to do deadlifts. Doctors dealing with CrossFit enthusiasts need to understand that for practitioners, it represents an almost religious level of devotion – and that the entire medical journey needs to be oriented around that.
There are a lot of segments, Goren noted – and what they all have in common is a set of very specific fitness and healthcare needs that are simply hard to meet when shopping only from a local market.
“Those users can then come and sign up to be paired with a fellow athlete,” he said. “This is still a primary care doctor – we aren’t advertising sports specialists – but they are people who can now manage all of your care, and who understand and can share your passion for the activities you love, whether that’s running or CrossFit.”
Many of their users, he pointed out, have been brought in through the specialized channels in which they hang out – podcast advertising and the like – because the availability of specialized primary care is so lacking in the market.
In addition to expertise, patients also get a new and often more efficient way to manage their own care. Most users, Goren noted, will now start their journey with their SteadyMD doctor who knows their history, obtaining a personalized recommendation.
Sometimes it can be resolved at that level with a quick look, and other times they might send a prescription to a local pharmacy. Or, Goren explained, the doctor might determine that in-person care is needed, and would refer the patient to an urgent care center with more specific instructions – or, the doctor might refer and help their patient make an appointment with a local specialist.
“Having that doctor friend helps patients avoid interacting with an unpleasant system when they don’t have to – and helps them navigate it much better when they do,” Goren said.
Better for the Doctors
When users are given access to a doctor 24/7, Webster wondered how they will use that access.
In truth, Goren noted, they use it a lot – they often see their users texting their doctors nearly constantly.
“What’s hard to appreciate is how much better and more easily controlled that is for our doctors,” Goren pointed out. “Because they can have an ongoing conversation with their patients [over] time, which is vastly superior to rushing through 10-minute encounters all day.”
Doctors who work with the SteadyMD platform work from home, on their own schedule, with a patient load that is capped at around 600 – about half of what most of them are forced to accommodate in private practice.
“When you look at the doctors we attract,” Goren noted, “they are younger physicians who just don’t want to enter into this system where they can’t treat patients in the personal way they went into medicine [to use].”
Not all of the doctors on the platform are full-time as of yet, as SteadyMD is still building to scale – but those that are, Goren said, are paid well, earning $200,000 a year and more. That is better than the $190,000 most will make in average, when seeing lots of patients in person all day, every day.
And that is all funded with the $79 to $99 per month that users pay to be on the platform. There are no hidden payment relationships with insurance companies downstream.
“I think everyone at this point wants a better healthcare experience, particularly at the PCP level – and I think within the confines of the system we have, we can do a lot to really improve everyone’s experience by finding a newer, better way to leverage telemedicine,” says Goren.