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The other side of removing transportation as a barrier to care is have the doctors come to you. We've started using Heal (http://heal.com http://heal.com) rece

The other side of removing transportation as a barrier to care is have the doctors come to you. We've started using Heal (http://heal.com http://heal.com) recently when the whole family was sick with the flu and it was great. Doctor and assistant come to your home within a 2 hour window. Cost is same copay you incur at a doctor's office. We used it several times and doctors were great. Seems like a no-brainer to not force sick folk to travel and spread germs. Only downside really was that you don't usually see the same doctor twice although I believe you can request by name.

homero 9y ago
How do you deal with patients keeping the doctor there for an hour? Drives taking an hour in between? It's nice and I'd love it, but I can't see how it's feasible against an office where they can see 6 patients an hour. Great pricing however. Is it really $99 total? That's cheaper than driving and a copay.
- callumprentice 9y ago
  In my experiences, they're in and out pretty quickly. I didn't feel rushed but certainly not the mellow chit-chat I've experienced in the past when I visit my regular doctor where I used to live. My cost is $20 per visit for the copay - I guess they bill the insurance company in the same way as if you'd gone into the practice.
- dragonwriter 9y ago
  > Is it really $99 total? $99 is the cost with no insurance; with insurance they bill and you pay your normal copay. $99 is probably less than their average reimbursement. > That's cheaper than driving and a copay. If you have really high cost of driving, have poor insurance, or are comparing it to average urgent care copays instead of primary/specialist office visits (IIRC, copays for primary average around $25 and specialist around $40; $60-75 seems improbably high transport cost for most people to drive to a doctor, even with non-free parking), sure. But unless appointment availability is really high, it's going to be higher latency, on average, than urgent care, and in any case it seems necessarily to be less well equipped than most urgent care facilities (meaning you are more likely to need to go somewhere else and be seen after your visit when using it as an urgent care.)
  - jnbiche 9y ago
    Note that $25 is nowhere hear the average for Americans' copay for primary healthcare visit. You've just got really excellent insurance and are assuming everyone else does as well. We've got average insurance in our state, and copay is around $60.
    - dragonwriter 9y ago
      > Note that $25 is nowhere hear the average for Americans' copay for primary healthcare visit. $24 primary, $37 specialist, though that was published last year so it may have crept up a bit (it's been trending slowly upward.) [0] > You've just got really excellent insurance $25 is more than my primary care copay. I know I have excellent insurance; I also don't assume everyone else's is like mine. OTOH, you apparently have really crappy insurance and are assuming everyone else does. [0] http://time.com/money/4044394/average-health-deductible-premium/ http://time.com/money/4044394/average-health-deductible-prem...
      - tkxxx7 9y ago
        > Once workers have surpassed their deductibles, they pay an average $24 copay for a primary care office visit, $37 for a specialty care office visit, Note that, as stated in the article you linked, the percentage of plans with deductibles has gone up significantly (67%). So your average is really a veiled figure - many people won't come close to spending as much as their deductible on healthcare in a year to ever actually pay those prices.
desireco42 9y ago
I have trouble understanding how doctors can make money with Heal? For me it is great, $99 and I have nice doctor show up when I don't feel well and diagnose and prescribe treatment. I don't understand how they can make money with this.
- ABCLAW 9y ago
  Doctor isn't paying overhead for an office, plus they get paid more than the co-pay by your insurance.
  - samfisher83 9y ago
    An average gp makes about 170k with tax benefits etc its probably closer to 200k. Assuming they get 3weeks of vacations that 102 dollars/hour. I don't see how 99 dollars per visit makes economic sense.
    - newfoundglory 9y ago
      How many hours a week do they work? How many of those are overhead hours that Heal takes care of for them? How many of them are average? What other costs of running a clinic are there?
- empath75 9y ago
  I’m wondering if a lot of them aren’t working part time while doing something else? Like I can see it being really appealing for a doctor with young kids at home that don’t want to work long hours.
notatoad 9y ago
That sounds like a good plan if you have good insurance, but it doesn't sound like a sustainable way to improve health care service to a wider population. Doctors are a scarce resource, and having the doctor drive around to each patient's house is not a very good use of their time. At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care.
- kfriede 9y ago
  Cost could be minimized if the particular doctor does not have to pay for a facility. I can't even begin to imagine what the cost per sq/ft of a generic doctor's office is, given all the regulation and equipment requirements. Having them mobile may remove a significant cost (though probably won't come close to the added opportunity-cost you mentioned).
  - SiempreViernes 9y ago
    I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available; making the entire contents of a clinic mobile is surely more costly and complicated than paying rent.
    - bobthepanda 9y ago
      Test kits are mobile, vaccines and bloodwork are mobile, basic diagnostic equipment is mobile. Most people do not need the vast majority of things a clinic contains; nothing you couldn't solve with a small refrigerable unit in a vehicle. That being said, the downsides of travel time are so negative it's hard to see how they could be overcome.
    - dragonwriter 9y ago
      > I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available Compared to an urgent care facility, they pretty clearly have to be doing that.
ErrantX 9y ago
Its kinda sad to see this sort of service. Home visits are a key part of healthcare, but it doesnt scale and is potentially harmful. Especially when you realise that most people dont really need to see a doctor. Flu is a great example (not judging you, I have no idea how bad it was!) where most people could self care. Much better is phone doctors & good websites; the NHS have invested heavily in this. You can self-care for many minor things based on online guides, and are then directed to a phone GP for triaging if you need further help. (example online guide; https://www.nhs.uk/conditions/flu/ https://www.nhs.uk/conditions/flu/ what I like about it is that it gives you clear exoectations about self care and when you should feel better, plus clear (and varied) escalation paths for worsened symptoms)
- toomuchtodo 9y ago
  Most healthcare startups in the US are treating symptoms of the problem (poorly) instead of the underlying issue (a fundamental failure of the healthcare system).
- callumprentice 9y ago
  I was in bed for 3 weeks with real flu - not a runny nose or even a nasty cold. Plus, we just moved to a new neighborhood and finding a (good) primary care doctor you can visit is all but impossible - they're all full and not taking any new patients. The Heal service was an immense win for our family's situation.
- briandear 9y ago
  The NHS does that because there’s already a massive problem with too high demand and too little supply. Making health care “free” distorts incentives — so they have to come up with clever ways to implement barriers to care: waiting lists, attempts at convincing people of self care, etc. Does that NHS website provide a prescription to Tamiflu as well? Does the website know our medical history? If people paid directly for visits, there’s a built in incentive to reserve doctor visits for when they are actually necessary, rather than the British system of “free” (provided you can jump through enough hoops to actually earn an appointment.) Using the NHS as a model of “good” health care is laughable. What’s “good” about the NHS is that it’s “free.” It isn’t actually good when it comes to access to care or advanced treatments. Compare cancer death rates of the UK vs the US, for example. The French system where you actually have to pay some money for appointments is far better — you don’t have to wait weeks to visit a GP: I can get pediatrician appointments generally same day. That is literally impossible in the UK. I also am not getting referred to a “website” to solve my kids’ illnesses — I am not an idiot, I know how to google. I am not going to waste my time going to a doctor unless I actually feel that the doctor can provide some value. Want to better allocate a scarce resource? Make people pay a price that reflects the available supply instead of making it “free” but with convoluted access models.
SkyPuncher 9y ago
There's definitely a need for it. I'm working for a startup, called Carol Health[0], that's trying to do a similar thing but with nurses instead of doctors. There's a huge need for in-home care, especially in the aging population. For able bodied humans, going to the doctor's office is a pain but not a particular challenge. For aging, disabled, or mobility-limited individuals, it can be nearly impossible for them to get to a doctors office. Not to mention, an office is full of nasty things that can harm immuno-challenged individuals more than the office visit can benefit. Telemedicine is a really good start, but there are huge limitations without being able to actually interact with a patient. As more of these types of services popup, it's going to be incredibly beneficial for aging and homebound or almost homebound individuals. It really exciting to see a whole gamut of services, like Shipt and ClickList, popup. Hopefully in 10 years, aging in place will be more common until the point that individuals actually require frequent assistance or medical attention. [0] https://www.carolhealth.com https://www.carolhealth.com
indescions_2018 9y ago
We are nearing crisis mode regarding long term home health for the elderly here in US. Cost per visit for even non-nursing, personal care workers can easily exceed $100. Medicare coverage eligibility is subject to political risk. It's a significant tax on working families. And with 30-40M families requiring such workers. It's trivial to see how there may never be sufficient labor market supply. But a subscription service model for those that can afford the highest quality home care for the elderly. Represents a phenomenal startup growth opportunity.
terrantech 9y ago
We've had home-visit GPs in Australia for a few years now. There's multiple to choose from, and they're all covered by Medicare (so it's "free" to use). It's super handy for us, having 2 people in our family with illnesses that require regular doctor visits (once or twice a month on average). If it's night time and we need the GP, we don't have to worry about waking up the baby, loading up the kids and nappy bags and everything we need into the car, etc. We only go and visit our actual family GP if we need prescriptions renewed, or we want to talk to him about a bigger issue or general questions. Eg stuff that isn't urgent, so we don't waste the home-visit GP's time. Then again, the home-visit GPs have told us multiple times that they're happy to come out no matter how small the issue, and they prioritise/triage calls so you're never keeping a more urgent case waiting.
zouhair 9y ago
This is a horrible and expensive healthcare system for any society.

homero 9y ago

How do you deal with patients keeping the doctor there for an hour? Drives taking an hour in between? It's nice and I'd love it, but I can't see how it's feasible against an office where they can see 6 patients an hour. Great pricing however. Is it really $99 total? That's cheaper than driving and a copay.

callumprentice 9y ago
In my experiences, they're in and out pretty quickly. I didn't feel rushed but certainly not the mellow chit-chat I've experienced in the past when I visit my regular doctor where I used to live. My cost is $20 per visit for the copay - I guess they bill the insurance company in the same way as if you'd gone into the practice.
dragonwriter 9y ago
> Is it really $99 total? $99 is the cost with no insurance; with insurance they bill and you pay your normal copay. $99 is probably less than their average reimbursement. > That's cheaper than driving and a copay. If you have really high cost of driving, have poor insurance, or are comparing it to average urgent care copays instead of primary/specialist office visits (IIRC, copays for primary average around $25 and specialist around $40; $60-75 seems improbably high transport cost for most people to drive to a doctor, even with non-free parking), sure. But unless appointment availability is really high, it's going to be higher latency, on average, than urgent care, and in any case it seems necessarily to be less well equipped than most urgent care facilities (meaning you are more likely to need to go somewhere else and be seen after your visit when using it as an urgent care.)
- jnbiche 9y ago
  Note that $25 is nowhere hear the average for Americans' copay for primary healthcare visit. You've just got really excellent insurance and are assuming everyone else does as well. We've got average insurance in our state, and copay is around $60.
  - dragonwriter 9y ago
    > Note that $25 is nowhere hear the average for Americans' copay for primary healthcare visit. $24 primary, $37 specialist, though that was published last year so it may have crept up a bit (it's been trending slowly upward.) [0] > You've just got really excellent insurance $25 is more than my primary care copay. I know I have excellent insurance; I also don't assume everyone else's is like mine. OTOH, you apparently have really crappy insurance and are assuming everyone else does. [0] http://time.com/money/4044394/average-health-deductible-premium/ http://time.com/money/4044394/average-health-deductible-prem...
    - tkxxx7 9y ago
      > Once workers have surpassed their deductibles, they pay an average $24 copay for a primary care office visit, $37 for a specialty care office visit, Note that, as stated in the article you linked, the percentage of plans with deductibles has gone up significantly (67%). So your average is really a veiled figure - many people won't come close to spending as much as their deductible on healthcare in a year to ever actually pay those prices.

desireco42 9y ago

I have trouble understanding how doctors can make money with Heal? For me it is great, $99 and I have nice doctor show up when I don't feel well and diagnose and prescribe treatment. I don't understand how they can make money with this.

ABCLAW 9y ago
Doctor isn't paying overhead for an office, plus they get paid more than the co-pay by your insurance.
- samfisher83 9y ago
  An average gp makes about 170k with tax benefits etc its probably closer to 200k. Assuming they get 3weeks of vacations that 102 dollars/hour. I don't see how 99 dollars per visit makes economic sense.
  - newfoundglory 9y ago
    How many hours a week do they work? How many of those are overhead hours that Heal takes care of for them? How many of them are average? What other costs of running a clinic are there?
empath75 9y ago
I’m wondering if a lot of them aren’t working part time while doing something else? Like I can see it being really appealing for a doctor with young kids at home that don’t want to work long hours.

notatoad 9y ago

That sounds like a good plan if you have good insurance, but it doesn't sound like a sustainable way to improve health care service to a wider population. Doctors are a scarce resource, and having the doctor drive around to each patient's house is not a very good use of their time. At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care.

kfriede 9y ago
Cost could be minimized if the particular doctor does not have to pay for a facility. I can't even begin to imagine what the cost per sq/ft of a generic doctor's office is, given all the regulation and equipment requirements. Having them mobile may remove a significant cost (though probably won't come close to the added opportunity-cost you mentioned).
- SiempreViernes 9y ago
  I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available; making the entire contents of a clinic mobile is surely more costly and complicated than paying rent.
  - bobthepanda 9y ago
    Test kits are mobile, vaccines and bloodwork are mobile, basic diagnostic equipment is mobile. Most people do not need the vast majority of things a clinic contains; nothing you couldn't solve with a small refrigerable unit in a vehicle. That being said, the downsides of travel time are so negative it's hard to see how they could be overcome.
  - dragonwriter 9y ago
    > I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available Compared to an urgent care facility, they pretty clearly have to be doing that.

ErrantX 9y ago

Its kinda sad to see this sort of service. Home visits are a key part of healthcare, but it doesnt scale and is potentially harmful. Especially when you realise that most people dont really need to see a doctor. Flu is a great example (not judging you, I have no idea how bad it was!) where most people could self care. Much better is phone doctors & good websites; the NHS have invested heavily in this. You can self-care for many minor things based on online guides, and are then directed to a phone GP for triaging if you need further help. (example online guide; https://www.nhs.uk/conditions/flu/ https://www.nhs.uk/conditions/flu/ what I like about it is that it gives you clear exoectations about self care and when you should feel better, plus clear (and varied) escalation paths for worsened symptoms)

toomuchtodo 9y ago
Most healthcare startups in the US are treating symptoms of the problem (poorly) instead of the underlying issue (a fundamental failure of the healthcare system).
callumprentice 9y ago
I was in bed for 3 weeks with real flu - not a runny nose or even a nasty cold. Plus, we just moved to a new neighborhood and finding a (good) primary care doctor you can visit is all but impossible - they're all full and not taking any new patients. The Heal service was an immense win for our family's situation.
briandear 9y ago
The NHS does that because there’s already a massive problem with too high demand and too little supply. Making health care “free” distorts incentives — so they have to come up with clever ways to implement barriers to care: waiting lists, attempts at convincing people of self care, etc. Does that NHS website provide a prescription to Tamiflu as well? Does the website know our medical history? If people paid directly for visits, there’s a built in incentive to reserve doctor visits for when they are actually necessary, rather than the British system of “free” (provided you can jump through enough hoops to actually earn an appointment.) Using the NHS as a model of “good” health care is laughable. What’s “good” about the NHS is that it’s “free.” It isn’t actually good when it comes to access to care or advanced treatments. Compare cancer death rates of the UK vs the US, for example. The French system where you actually have to pay some money for appointments is far better — you don’t have to wait weeks to visit a GP: I can get pediatrician appointments generally same day. That is literally impossible in the UK. I also am not getting referred to a “website” to solve my kids’ illnesses — I am not an idiot, I know how to google. I am not going to waste my time going to a doctor unless I actually feel that the doctor can provide some value. Want to better allocate a scarce resource? Make people pay a price that reflects the available supply instead of making it “free” but with convoluted access models.

SkyPuncher 9y ago

There's definitely a need for it. I'm working for a startup, called Carol Health[0], that's trying to do a similar thing but with nurses instead of doctors. There's a huge need for in-home care, especially in the aging population. For able bodied humans, going to the doctor's office is a pain but not a particular challenge. For aging, disabled, or mobility-limited individuals, it can be nearly impossible for them to get to a doctors office. Not to mention, an office is full of nasty things that can harm immuno-challenged individuals more than the office visit can benefit. Telemedicine is a really good start, but there are huge limitations without being able to actually interact with a patient. As more of these types of services popup, it's going to be incredibly beneficial for aging and homebound or almost homebound individuals. It really exciting to see a whole gamut of services, like Shipt and ClickList, popup. Hopefully in 10 years, aging in place will be more common until the point that individuals actually require frequent assistance or medical attention. [0] https://www.carolhealth.com https://www.carolhealth.com

indescions_2018 9y ago

We are nearing crisis mode regarding long term home health for the elderly here in US. Cost per visit for even non-nursing, personal care workers can easily exceed $100. Medicare coverage eligibility is subject to political risk. It's a significant tax on working families. And with 30-40M families requiring such workers. It's trivial to see how there may never be sufficient labor market supply. But a subscription service model for those that can afford the highest quality home care for the elderly. Represents a phenomenal startup growth opportunity.

terrantech 9y ago

We've had home-visit GPs in Australia for a few years now. There's multiple to choose from, and they're all covered by Medicare (so it's "free" to use). It's super handy for us, having 2 people in our family with illnesses that require regular doctor visits (once or twice a month on average). If it's night time and we need the GP, we don't have to worry about waking up the baby, loading up the kids and nappy bags and everything we need into the car, etc. We only go and visit our actual family GP if we need prescriptions renewed, or we want to talk to him about a bigger issue or general questions. Eg stuff that isn't urgent, so we don't waste the home-visit GP's time. Then again, the home-visit GPs have told us multiple times that they're happy to come out no matter how small the issue, and they prioritise/triage calls so you're never keeping a more urgent case waiting.

zouhair 9y ago

This is a horrible and expensive healthcare system for any society.