“There’s got to be a better way.” That single phrase has started plenty of innovative companies when uttered by frustrated entrepreneurs who find themselves running headlong into something that should be easy but isn’t.
Nick Desai, co-founder and CEO of medical disruptor Heal, found himself uttering that phrase as he was driving home from a seven-hour emergency room visit with his baby son some years ago.
The next day, he began to sketch out the early concept of the business before he and his wife decided to dive in and start building it.
“What we found was that entering the healthcare space was like peeling an onion,” Desai said. “We learned how broken and how bad things can be for people.”
What he also learned is that he and his wife had gotten off relatively easy. They could control their schedules to get to the doctor’s office whenever necessary because he was CEO of a tech company and she was a doctor. (His wife, Dr. Renee Dua, is now Heal’s chief medical officer.)
And when the couple got hit with a $1,900 bill for the emergency room visit, the cost wasn’t much of an issue for them. But the more they dug, the more they learned how many people’s credit scores get destroyed over medical bills they could have paid but didn’t know how to.
The pair also saw how many people aren’t taking medications they’ve been prescribed because no one has explained how to take them. And the couple discovered how many people are simply avoiding medical treatment because they’re scared of the bill.
Desai said the things he and his wife found were “illuminating and inspired us about what we could do, [while] at the same disheartening … about the status of the problem as massive.”
They decided that healthcare needed a new idea — sort of. Actually, what they decided it needed was an old idea — house calls — reborn with digital tools to offer a better, more effective solution for patients and providers.
Is There a Doctor in the House? There Should Be
Until the 20th century, the most common way Americans received healthcare was for the doctor to come to the patient as opposed to the other way around. Even when World War II began, roughly 40 percent of all U.S. doctor-patient interactions took place in the patient’s home.
But by the 1980s, the practice had virtually disappeared. Less than 1 percent of all medical visits were house calls.
And yet, Desai said that from the perspective of providing care, a house call is more cost-effective than running an office and correlates with better patient outcomes.
It’s also more realistic given that a quarter of the U.S. population faces demographic, economic or medical difficulties getting to a doctor’s office.
“A house call is the only place where a doctor can see you firsthand and see your social determinants of health — all of the lifestyle things like smoking, diet and alcohol,” Desai said. “They can see issues with the medications and the food insecurities and begin to truly assess what a care plan looks like for this patient.”
It’s a solution that he said works better for everyone involved. For example, Desai said patients don’t have any reason to delay or avoid care.
They log in online, enter their insurance information (24 insurance companies and Medicaid are all currently onboard) and get a co-pay amount that they pay up front. That’s the end of their involvement with the transaction.
Heal handles all the insurance billing on the back end and the patient never sees a bill. Two hours later, a physician comes to their door.
Desai said doctors enjoy a better experience with the platform as well because Heal takes all the back-end business administration off of the person’s plate. Instead, the company pays doctors salaries, and the physicians focus on the thing they actually went to medical school to do: practice medicine. And doctors do that with only eight to 10 patients a day, which means they have the time to more carefully evaluate each client’s full needs.
Desai said that’s better than today, where “you have a sore throat and go to the doctor who is in a hurry and looks at the throat and says, ‘That’s not strep, so you are fine.’ But the doctor also misses the lump in your armpit, and that sore throat is a symptom of cancer that they didn’t have time to spot.”
Unfortunately, the doctor only discovers the cancer six visits later after it has spread, making it harder to cure, more difficult for the patient and far more expensive for the insurance company. Avoiding that is why Heal has managed to sign on so many insurers — and the federal government — and monetize the savings that they offer.
An Ounce Of Prevention
While we all know the old adage “an ounce of prevention is worth a pound of cure,” in no place is it more forcefully illustrated that in medicine.
Desai said half of all prescriptions picked up and paid for by patients currently go unused. Meanwhile, 85 million Americans who are currently classified as pre-diabetic could see their health futures drastically improved with good lifestyle choices.
Ultimately, Desai said, fixing problems like that is much cheaper than doing late-stage, heroic medical interventions that become necessary when patients ignore their problems until they need life-saving emergency treatment or hospital admission.
“These things get found and taken care of in house calls … and they lead to early diagnosis and detection,” he said. “People lead happier, healthier lives, and the healthcare system saves money. And we monetize that value, [which] is how we make money.”
Why Insurers Signed On
It turns out one of the great benefits of offering up an old idea with new technology is that insurers already have billing codes for house calls. By contrast, carriers have had to invent new codes for pure-play telemedicine.
But Heal found that all it takes to get insurers on board is showing them how much more efficient it is to turn potential ER visits into house calls. After all, few consumers will choose a $2,000 seven-hour ER trip over a $50 home visit.
Heal has also raised millions in capital from backers that include famed musician Lionel Richie as well as Robert Johnson, founder of Black Entertainment Television (BET).
Add it all up and Desai said he sees the company’s model as a win-win for everyone.
“Healthcare systems and patients save money, and [our] doctors get to focus on delivering good care in a way that is profitable for us and makes a system that is sick in a lot of ways healthier,” he said.
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