Amino

The service transaction between a patient and physician has always been looked at closely from a billing perspective. Relatively few attempts have been made to enhance the match-making aspect of it: like which physician is best suited for the given patient? Tweaking this may have cascading effects downstream in the service experience and actual outcome.

Years ago, Zocdoc impressed me with their simple solution in this space. It was making it easier to get an appointment with retail physician of your choice. It’s hard to scale the retail small/medium clinics, so they dabbled in employee wellness for a bit and finally settled its focus on hospitals and health system customers.

Amino focuses on figuring out the right physician first and then help with cost-estimation and scheduling. It claims to have analyzed a trove of insurance claims data to figure out the attributes of past interactions of care providers. Using the information that patient’s type in to Amino website (health problem, insurance, zip code, etc.) it can align it with the best physician profile in its database.

The approach has merits since most patients are inherently biased (“my sister says this doctor is great”), lazy (“I’ve always gone to this nearby clinic”) or arbitrary (“I just googled it”, “His name was on the first page of my insurance directory”) in the way they select physicians. Having a good partner in healthcare can make a difference. My curiosity is about their business model – who pays for this ultimately? For now, Amino has enough runway to not worry about it ($20M in three rounds so far).

PS: Kyruus does similar stuff, but for enterprise.

 

ConsultingMD

One the joys of working in an opaque system is that there are endless opportunities for curators. “Handpicked“, “Invite-only“, “Top 0.x%” slogans carry emotional value because the perennially ill-informed consumer is guaranteed to be frustrated with the complexity and impersonal nature of the given opaque system. The national prize for opaque system has been consistently won by healthcare ever since Medicare was signed into law in 1965. And after a few decades of helter-skelter with managed care acronyms, the age of healthcare service curators has arrived it seems. Thanks to the ubiquity of internet and communication infrastructure that connects everyone, there are a number of startups looking at how to match the demand for medical opinion with an …ahem… ‘hand-picked’ supply of experts.

ConsultingMD made news recently with it’s $10M series A round. They are in the very legitimate second-opinion niche of healthcare startups. There is a clear need for facilitating a marketplace between patient and doctors. But as I read more about what they do, two issues surfaced.

First is price. ConsultingMD’s opinions are priced at $3750 a pop for individuals. For an industry with a culture of third-party payment, that is huge! Which means that sadly, their usage will skew to high net worth individuals who already have a lot of healthcare options at their disposal. <soapbox>Which brings me to the philosophical argument of how should we solve the ‘second opinions’ need in healthcare? I think it’s by giving patients *all* their data back in an understandable way and make them informed consumers. Not by giving expensive access to an elite club of medical experts. If we do the former, the right options will automatically become popular (because of good outcomes), and hence easily discoverable. Just like it happens in retail.</soapbox>. I’m sure a significant part of that hefty sum goes towards collecting the myriad medical records on behalf of the patient and putting them in one digital place (silo alert). That manual aggregation service is probably a real value… I made the same point about MotherKnows previously.

Second  is the referrals part of ConsultingMD. The website says $200 per referral for an individual. Wait…What?? The patient pays the lead generation service to connect to doctors? That doesn’t make sense to me. Referrals are a visceral  process in the care ecosystem, part of the intrinsic flow that physicians generate as part of care continuity. I find the notion of patient-requesting-paid-referrals-directly (without a Primary doc in loop) as the wrong type of consumerism. Par8o has a better approach to referrals. We need Patient Centered Medical Home based solutions, where primary care team guides care.

However, both the issues fade away when one considered ConsultingMD as an added benefit from an employer to it’s workforce. That’s where the sweet spot is. Employers (good ones, at least) try to elbow each other out in providing fantastic benefits around health. So ConsultingMD services are meant to be sold to employers. That’s how the current system works anyways. You prevail by getting someone else to pay.

There is competition for ConsultingMD, of course. Second opinion companies (like BestDoctors, 2nd.MD, WorldCare), academic medical centers (like Johns Hopkins, Cleveland Clinic)  and even generic expert-request sites (like JustAnswer) are in the fray. Not to mention the free, yelp-like review sites (like Vitals) that have existed for a long time. So while I’m excited at the continuous movement in Healthcare IT startups, the central thrust of it still feels a bit misguided. Its like the big silicon valley echo chamber sucks in the few glitzy healthcare ideas that it inherently likes/understands; while ignoring the ugly hairy ones that roam outside praying for salvation.

Mar 2017 Update: ConsultingMD changed name to GrandRounds.com and has since then raised about $106M dollars. Let the good times roll!

ScanAvert

In the last few years, bar code scanning with smartphones has become much more robust and dependable functionality. Predictably enough, it’s main application has been in real-time comparison shopping and product information area, giving rise to new services like RedLaser (recently acquired by eBay).

ScanAvert is an interesting paid application of the same functionality. It allows users to scan the usual UPC barcode information on their supermarket items and cross-check the ingredients with their health profile. Consumers register and create their profile with facts like allergies, prescriptions, diagnoses, dietary needs, etc. ScanAvert uses data provided by Gladson (a major CPG product images and information provider) to do real-time checks on the ingredients of the item to detect incompatibilities. Now I know the usual critique would be that why wouldn’t the consumer just read the ingredient list or package label? And the counter would be that an average consumer may not find the information easily readable or understandable.

Those and other evident arguments aside, the service has obvious value for people with serious dietary issues (think gluten allergy, Celiac, Diabetes, Obesity, Prescription drug interactions). But I’m more excited about another aspect of the service- ScanAvert users can specify custom limits on a labels nutritional box values (calories, carbs, fat…) and get instant recommendation. To me, that is pretty useful for the rest of the population that doesn’t deal with any significant dietary restrictions. In fact, most of us end up buying food items without paying much attention to what it means nutritionally. Even those few that give a thought to the nutritional box items, the mental calculation done is only at a high level (“100 Cal drink…sounds low….I’ll try that”) and inconsistent (how many times have you checked the fat vs. saturated fat numbers?). I doubt most of the ‘normal’ population even knows what is their actual average dietary intake in terms of calories, fat, proteins, etc.

So if someone can setup a profile that puts a limit on the daily fat/protein/cal intake and have a real-time summary report given to them while they were grocery shopping, that would be an darn useful service, I think. Seems like currently ScanAvert can also suggest alternatives (if it detects incompatibility) and send alerts about scanned items that have been recalled. That makes the service even more useful.

It’s intriguing to think about expanding this service into a space where it can potentially be the long-term dietary record for an individual. Suppose one could combine that with a personal activity monitor like FitBit.  That would make a great ‘wellness solution’ for an individual to record, analyze, set goals and then get guidance on two important aspects:

  1. Energy input (your food intake)
  2. Energy output (your daily activity)

I also found some other apps that help manage food allergies (FoodContentAlerts, iCanEat/iEatOut), although they don’t have bar code scanning ability. This space just keeps getting more interesting every day.

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Vitals

VitalsLogoVitals is a physician search and rating destination. The fact that we need such tools is indisputable, although there are a plethora of sites that claim to have this ability now (DrScore, RateMDs, HealthcareReviews, HealthGrades, DoctorScorecard to name a few) . Which is part of the reason why none of them is successful enough to be the ultimate source of such information. Board certification, address, affiliations, publications, education etc. are all public information anyway (albeit in obscure hard-to-find databases that are generally out of scope for a normal patient). Its the subjective rating and candid feedback from actual patients that is hard to find. The fact that there are multiple places claiming to be the repository of such ratings is not helping the situation.

Ranting aside, I like the user-friendliness of this site- very easy to navigate and see relevant information. They also do a good job of digging up public information from various sources and aggregate it all in a as-comprehensive-as-possible profile. Was also impressed by the fact that they have a healthy growth in traffic (now more than half a million unique’s every month, according to Compete).

Given the fact that potential users perhaps value ratings/recommendations/comments from other patients most, the biggest issue with all such sites is how to validate such information. In my search for multiple doctors, user ratings were almost non-existent. But even if they were as abundant as on Amazon, how does one establish their authenticity? I was able to submit ratings on one doctor without submitting any proof that I was ever treated by him (in full disclosure, the rating didn’t show up right away so its not that simple apparently. For example, their FAQ page says you can only rate your doctor once a month). Not sure about their revenue model either, since its free for users. Regardless, this is a good site to bookmark, just for getting all the public information about your doctor in one place.

Heal Deal

HealDealLogoWhile we wait for President Obama’s public plan, the 46 million uninsured Americans need some options. Healdeal aims to bring the free market model to healthcare as one of them. The goal is to provide a marketplace for self-pay (uninsured) individuals to connect and transact with providers registered on the website.

There is scope for such services, for sure. There are significant number of people who need care that falls outside the realm of what insurance covers. Second opinions, cosmetic procedures, international travelers are some categories that come to mind. But as always, business model remains the Achilles heel. If you are operating a platform that matches supply with demand, its more straightforward to make money in commercial domains, much like eBay or eLance. But healthcare is different ballgame. Privacy, outcomes, benchmarking, feedback, transparency are some of the confounding issues that need to be taken care of.

Currently HealDeal is a social venture, with no subscription or advertisement model evident. Hopefully they have deep pockets or influential allies to keep themselves above water. It’d be interesting to have it as an app on Google Health though, especially if they can strike partnerships with other related, pro-self-pay businesses like Myca.

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