There is nothing worse than being sick–except, perhaps, having to go to the doctor when you’re sick. You know the drill: While tending to your drippy nose and hoping your scratchy voice is comprehensible, you call the clinic to schedule a doctor’s visit only to be put on hold for twenty minutes, then given an appointment for three weeks from now. As your fever rises, you decide to take matters into your own hands by dragging your weary self the emergency room, where you sit in the waiting room for hours before finally seeing someone who can help you. By the end of this ordeal, you’re pretty sure that visiting the doctor has made you even sicker than you were before.
If this story sounds familiar, it is because it is now the norm. Patients waste 1.2 billion hours each year in waiting rooms to see a doctor. A full 71% of emergency room visits in the United States should have been handled in primary care: this is a massive waste of resources, since an emergency visit costs around $580 more than a comparable visit to a doctor’s office, which adds up to $38 billion in unnecessary spending every year. But what’s a patient to do? Since it is often impossible to get a doctor’s appointment quickly enough, going to the emergency room seems like the only way to get immediate care or relief from pain.
The good news is that change is around the corner.
Doctors and entrepreneurs around the country are joining forces to try to make the miserable doctor’s visit a thing of the past. Meet, for instance, Thompson Aderinkomi. When Aderinkomi’s son was a year old, he got very sick and had to be taken to the clinic four times within a few weeks before eventually being diagnosed with pneumonia. Besides the time, effort, and worry, these visits ended up costing the family $7,500 out of pocket, on top of insurance premiums. Aderinkomi, a serial entrepreneur, kept thinking about all the pain points he had experienced in that process–the difficulty of scheduling a visit, the long waits, the high cost–and tinkered with new business models that would make going to the doctor less terrible. Two years later, in 2012, he founded a company called Retrace Health, essentially a doctor on-demand service. “Think of it as the Uber of health care,” he tells me.
The basic idea is that when you have a health problem, a nurse practitioner will be dispatched to your house immediately, any time of day, for $175. He or she will come fully equipped to do lab tests or X-rays if necessary. If you have a problem that might not necessarily require a healthcare professional to be physically present–say, for example, you are having an acne flare-up or you want to know why you get nauseous when you eat cheese–you can opt for a video consultation for $50. At this point, Retrace Health has launched in the Twin Cities area of Minnesota, staffed by a team of local nurse practitioners, and currently serves over 3,000 patients, though this number is growing fast, especially with companies that are beginning to sign on to have their employees use this service. As Aderinkomi irons out the kinks in this business model, he is hoping to go national.
The kinks, it turns out, are pretty darn complicated. If Uber has had considerable trouble navigating the complexities of the taxi industry, Aderinkomi is facing an even harder battle in his ambitious attempts to remake the health care system. Over the last couple of months, his main challenge has been working with the insurance companies to ensure that Retrace Health customers are covered by all their policies. With a lot of convincing and working through detailed legal jargon, he’s managed to get the major health insurers in Minnesota on board, but going national will require intense negotiations. He has also considered collaborating with hospitals and clinics, but he’s found that big, established health care providers are resistant to change.
“Companies in the health care industry have invested billions of dollars building brick and mortar facilities, as well as equipment and systems” Aderinkomi says. “Their goal is to make sure those facilities are used, which goes against our entire model, so our incentives are not always aligned.”
Despite the odds, Aderinkomi is taking a stab at changing the status quo and he’s dreaming big. “I imagine that one day, this will be the way that everybody receives primary care,” he tells me. “Hospitals will be reserved for inpatient care, including things like surgeries. It seems crazy to me that in the 21st century, when technology is so advanced, the simple act of trying to go to a doctor’s office is so inconvenient and expensive.”
He’s not alone in feeling like this. Other entrepreneurs are beginning to roll out similar in-home doctor’s visits. A 2013 startup called Pager launched to brings doctors to patients’ homes in New York City for $199 a visit, while Teladoc and MDLIVE offer immediate access to doctors via video chat.
For scrappy startups, going up against the health care system sometimes seems like an impossible task. But fortunately, other major players in the industry, such as McKesson, are pushing for change as well. The name “McKesson” may ring a bell because it is emblazoned on many medical supplies and equipment you encounter when you visit your doctor’s office; the company makes everything from syringes and medical gloves to the patient database and billing software found in health care facilities. With tentacles throughout the health care industry, McKesson needs to think strategically about how the industry will evolve over the next few years.
Matthew Zubiller, VP of strategy and business development at McKesson, believes that ideas at the heart of a startup like Retrace Health–providing care outside of a traditional clinic or hospital–will become mainstream soon. He points to CVS’s MinuteClinic model, which are walk-in clinics staffed by nurse practitioners and physicians assistants that can handle anything from minors wounds to coughs and colds. (Walgreen’s and Walmart have both launched similar clinics.) “There are two intertwined reasons that we’re seeing care delivered outside traditional clinics,” Zubiller tells me. “These new services focus on cost reduction and ease of use–concepts that are not traditionally associated with hospital systems.”
This newfound emphasis on cost reduction is partly an outcome of Obamacare, Zubiller argues. Now, more people have access to health insurance, but in many of the basic plans, premiums are low but co-pays are high, meaning that patients often have more up front and out of pocket costs. As a result, patients now care more about transparency in medical costs than ever before.
Companies are rushing in to help consumers make better decisions about where to spend their health care dollars. ClearCost Health, for instance, allows patients to compute exactly how much a particular visit or procedure will cost at nearby medical facilities so they can make the most cost-effective choice. McKesson has also developed a system called Clear Coverage that makes it easier for insurers to quickly authorize a procedure to reduce inappropriate administrative and medical costs. But money is not the only concern when it comes to making sound health care decisions: patients also want to find the best doctor for their needs and then be seen quickly. A startup called ZocDoc, has made this process easier. The platform is essentially Yelp and OpenTable rolled into one, but for health care: patients can check out reviews of doctors in their neighborhood, find openings in their schedules and then book an appointment directly from the app or webpage.
Change is already afoot. Instead of waiting weeks to see your doctor when you have a cold, you can now go to your local drugstore, see a nurse, pick up your medications and be home in an hour. However, changing the health care system in more widespread and fundamental ways is going to take much longer. “You have to be realistic when it comes to health care because it is a slow moving system,” McKesson’s Zubiller tells me. “It’s a huge industry that makes up 20% of our GDP as a nation and it is a multi-headed beast. Among the stakeholders, you’ve got employers, doctors, patients, pharmacists and hospitals, all of whom have different incentives and agendas.” He says that while in some industries, it is possible to roll out new products within months, health care companies need to give themselves a much longer lead time to penetrate the market: venture capitalists in the health care space typically wait at least 10 years before expecting to see a return on their investments.
So Retrace Health’s Aderinkomi might have to wait longer than he might like before health care is optimized to be both cost effective and convenient for patients. “I’m very optimistic and I can see change happening right now,” Zubiller says. “But it is going to take twenty years before we fully have the kind of health care environment that we’re hoping for.”
For some, that may sound like a bitter pill to swallow, but this winter remember: hope still springs eternal.
Correction: In an earlier version of this article, we mistakenly said that Retrace Health has doctors on staff. In fact, they currently have nurse practitioners.