HOUSE CALL APPS CREATE COMPETITION AND OPPORTUNITY FOR URGENT CARE CENTERS
C
all it coming full circle. House calls are roaring back to life, but in an incarnation that’s light years away from the buggy-driving physician with a black bag by his side. Just as taxicabs are being supplanted by Uber, urgent care centers run the risk of being displaced by the likes of Heal, Pager, and PediaQ – mobile apps that deliver medical care to a consumer’s doorstep. Urgent care’s patient-centered, retail-inspired model was a disruptor to the healthcare delivery system. House call apps leverage technology to take healthcare access and customer service to the next level, catering to those who can’t or choose not to make the trip to the neighborhood urgent care center. The renaissance of the house call is innovative, but sometimes the inspiration behind innovation is intensely personal. A year ago, Dr. Renee Dua and Nick Desai, her serial entrepreneur husband, were at loose ends when they couldn’t readily access pediatric care for their infant. After spending what they felt was an unnecessary day in the emergency room, the couple had a light bulb moment. “We knew there had to be an affordable way to bring a doctor to your door,” Dua says. Without Dua’s knowledge, Desai and a friend developed Heal, an app that enables patients to arrange for house calls to their homes, offices, or wherever they might be. “It was so simple and sophisticated,” says Dua. The duo found an angel investor within the first six weeks, launched Heal in Los Angeles in February 2015, and expanded to San Francisco two months later. “We’ve had 100 percent growth month after month,” Dua says.
Apples and Oranges
The growing demand for house calls at the touch of a fingertip is qualitatively and quantitatively different when compared to a century ago – or even a decade ago. In 1930, 40 percent of doctors’ visits were house calls. By the mid 20th century, that plummeted to 10 percent. By 1980, house calls accounted for only 0.6 percent of all doctors’ visits. That trend started to reverse after 1988, the year that Medicare home healthcare reimbursements were restructured. Since then, house calls have been on the rise. The American Academy of Home Care Medicine (AAHCM), which has tracked Medicare-reimbursed house calls for the past decade, notes a strong upward trajectory, from 1.5 million house calls in 1995 to 2.6 million in 2014. Toby Hervey, vice president of expansion for Pager, says that Medicare-reimbursement statistics of geriatric and homebound
patients don’t tell the on-demand house call story. “Those are not relevant to the sore throats and acute episodic conditions that we are treating,” he says. Indeed, Pager doesn’t typically see geriatric or palliative patients. “While there are lots of use cases for our technology among groups that are doing care for geriatric patients, we’re focused on improving care delivery that’s akin to an urgent care or retail clinic,” he says. Heal’s Dua says that the elderly and those with special needs utilize Heal’s services, but that the patient pool is much broader. “I thought it would be housewives and moms with multiple children,” she says. It turns out that having a doctor on demand appeals to a range of patients, including those who don’t have time to leave their workplace, “or the man who doesn’t want to go to the doctor because he doesn’t think there’s a need,” she says.
Getting Patients on Board
Dua says that the biggest hurdle faced by house call apps is shifting the healthcare paradigm in the patient’s mind. “It’s strange for people to think that you can get a great doctor in your house,” she says. “Patients have to begin thinking, ‘Wait a minute. I don’t have to leave to get taken care of.’” Hervey acknowledges that using technology to manage healthcare is a new frontier for most people. “There’s an undercurrent of being an early adopter” among Pager’s patient population, he says. Beyond serving early adopters, Pager attracts four primary demographics. One segment consists of parents who call at night when their children have conditions typically seen in an urgent care setting, such as ear infections, conjunctivitis, and fevers. “Then there are the 20- or 30-something busy urban professionals who are treated for upper respiratory infections and UTIs,” Hervey says. “Busy executives who are a little older and trying to get on top of their health” also want to save time and appreciate the convenience of a house call. Finally, Pager serves travelers who find that they’re ill in an unfamiliar city and don’t have access to their primary care physicians. Heal provides more than urgent care. “We’re absolutely set up to do primary care,” Dua says. It’s not uncommon for a patient to schedule a follow-up appointment and ask the physician to administer flu shots to the patient’s kids. “Thirty percent of our patients are re-users,” says Dua. “The patient recognizes that house calls are far more convenient and far more affordable.” While Heal and other house call apps screen out medical emergencies, if an emergency does arise during the course of a visit, UrgentCareMagazine.com
Nov. 2015
13