Sesame Membership Model Brings ‘Radically Normal Healthcare’ to Millions of US Consumers

Online telehealth is growing by leaps as the pandemic drags on, but these services can often feel urgent and impermanent compared to the close in-person relationships patients like to form with primary care physicians and specialists.

If Amazon were to take it on, it would almost certainly opt for a choice-rich marketplace model where people can browse nearby doctors, consult with them via video and then follow up with in-person visit if needed, ideally finding a great new local doctor to see to their care.

This kind of model is very much on the mind of David Goldhill, founder and CEO of Sesame. Surveying a healthcare system plagued by outdated, outmoded treatment and payment methods, he founded Sesame in 2018 — and in 2020, launched it as a direct-to-consumer (D2C) online marketplace.

Now, the company is introducing a membership program to help customers save on medical care, whether they have health insurance or not. It’s the latest innovation from a company obsessed with making the cost of healthcare more manageable.

Members don’t have to pay to join Sesame’s membership, and they can get started with a valid email address to receive a baseline tier of benefits — $5 prescriptions, access to customer service concierges, a portal for appointments and prescriptions, and exclusive access to special deals and promotional pricing. For $7 per month, customers can upgrade to Sesame Plus and gain additional benefits. The company estimates that Sesame Plus users will save more than $200 annually while having access to convenient, high-quality care.

“When I think about how you better control not just the cost of care but also the quality of care and the ability of customers to access it, it’s all about allowing innovation to occur, because there are lots of doctors out there who would like to practice medicine in a different way than what the straight-jacket insurance requires,” Goldhill told PYMNTS’ Karen Webster in a recent conversation.

During the height of the COVID-19 pandemic in 2020, telehealth moved from the periphery of care to mainstream status. And rather than putting doctors at a distance, Goldhill believes that the shift is improving patient choice.

“Video visits are now becoming an important first point of contact in almost any healthcare journey,” he said. “Even seeing a specialist, where before you would think hands-on was necessary, a first visit is often by video. That tends to work better for both patient and doctor.”

And it’s where the connected economy is meeting healthcare’s digital shift.

As PYMNTS found in The Healthcare Payment Experience Report, a Rectangle Health collaboration, “Simplifying healthcare access by limiting the barriers to positive consumer experiences will help to preserve patients’ 94% satisfaction rate with in-person interactions and increase patient engagement over time.”

Get the study: The Healthcare Payment Experience Report

Personalizing Online Healthcare

Sesame’s membership model is well-attuned to an era when subscription commerce is touching nearly every other aspect of American life.

In a statement, Goldhill said the platform has seen “hundreds of thousands of Americans — many without insurance — save as much as 70% on their medical care over the past year. For those that join our membership program, the savings and accessibility will be even greater.”

That kind of thinking permeates Sesame, which has in effect turned finding a doctor into something akin to shopping on a marketplace site like Amazon.

“We’re a marketplace in internet terms, which means that suppliers — in our case, doctors, medical institutions, clinics and group practices — list services that are available and patients can come and buy. All of our services are listed at a fixed price. They’re all prepaid by the patient, and they’re often just extraordinary values,” Goldhill said.

Unlike most online marketplaces, buying care on Sesame may well take the patient to a doctor’s office. And given the current rebound in doctor’s office visits, Goldhill said, many platform users are benefiting from the service.

Sesame is not a pure-play telemed service “where you get whatever provider happens to be available at that moment,” he explained. “You literally pick … this doctor or this nurse. Most people pick somebody who is geographically close to them,” which drives office visits for practices and ensures greater satisfaction from the patient/consumer who is engaging with the service.

Asked if the new business model had member acquisition potential, the simple answer is “yes” — but it’s happening in a more organic way as the patient/consumer explores their needs.

“The core interest [Sesame now sees] from the consumer, the patient, is that we now have a communications channel where we can understand what medical services you’re looking for and can alert you when there are specials or discounts or prices that work,” said Goldhill.

For example, when a member is looking for a certain specialist at a certain price, the Sesame platform sends an alert that the opportunity is available. As Goldhill said, “a meaningful part of our initial customers are people who are paying a lot out of pocket for healthcare” — and such patients are effectively direct pay healthcare consumers. The platform allows users to shop for deals, which is not possible with traditional insurance.

“We are just so aware of how many people are disenfranchised by this current health care system. Sesame’s commitment is to create value for consumers,” he added.

See also: Sesame CEO: Direct Payments Inject Innovation Into Healthcare

Helping Physicians Operate Better

Sesame is a two-sided marketplace that allows physicians to prescribe to members. But Goldhill sees the company as authentically disruptive in the cost and delivery of care.

For physicians and practices, the platform offers practices a way to acquire new patients in a time of rebuilding, as well as competitive advantages for running their business in a post-pandemic world.

“I think increasingly, what’s true of the doctor-and-other-provider world is that narrow networks, the enormous cost of health insurance for an independent practice, and the collections and credit issues around new patients mean that Sesame can serve an important economic role in building and maintaining the practice,” Goldhill told Webster.

With practices reporting that 30 to 40 cents of each insurance reimbursement dollar goes to general and administrative costs, platform effects could have a substantial impact. Word is getting around, Goldhill said.

“We have a huge number of inbound inquiries from physicians every week,” he noted. Sesame is even allowing physicians to list services and pricing without supplying names on a trial basis. “For those who might’ve been reluctant to have an attractive price out there, they can just describe the service in detail and give a location, but not have to put the name of the practice on yet. That’s proven very, very popular, and a way for us to rapidly accelerate.”

Goldhill said there are currently over 15,000 total listings of physicians and other providers on Sesame, as well as national lab and pharmacy coverage. “It’s a pretty full-scope map already.”

See also: Sesame Launches Direct-to-Consumer Healthcare Marketplace