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.

 

InQuicker

In the standard healthcare IT media landscape, increasingly all I find are the ruinous signs of bloated, overcomplicated conventional healthcare IT systems struggling to do everything that they claim to do. Alongside that increasingly infertile landscape are green shoots of some startups doing few things, and doing them right.

I’ve harped in the past on scheduling being a ripe area for disruption, perhaps something that we will see being ‘done right’ very soon. Zocdoc is forging ahead, turbo-charged by humungous funding and legendary backers. But it only handles non-emergent situations where both patient and provider have the luxury to find a mutually convenient time.

Nashville, TN based InQuicker takes that value proposition to a new level. Besides facilitating non-urgent outpatient scheduling, it allows patients to ‘hold their place’ online in the urgent care or ER waiting room queues. That way patients with non-life threatening medical conditions can stay at home till it’s their turn to be seen. ER and Urgent Care Centers avoid overcrowding and patient frustration. The operational benefits of having a smooth flow in such round-the-clock care delivery centers is huge from a staffing, customer satisfaction and overall efficiency perspective. Which is why InQuicker has a growing list of participating facilities that underwrite this free service for patients. The conspicuous absence of a mobile InQuicker app is a bit odd though. This is a perfect context for mobile solution.

Enabling just-in-time operational strategy for emergency care operations… it’s a small but important piece of the overall process of delivering healthcare in a efficient and cost-effective manner. If you expect the incumbent EHR, EDI, HIE vendors or payers to get to this, don’t hold your breath. Pragmatic innovation like this will happen faster at the periphery of the perceived center of healthcare IT. InQuicker was founded in 2006, and has never raised a single dollar of venture capital. Their 2012 revenues are expected to be around $4. That, is a sign of a real business.

The need has not gone unnoticed by others. ERExpress, ERTexting are already there as direct competition. iTriage (now a part of Aetna) takes an almost similar approach with their ER wait times and check-in features.  ZocDoc may very well get into it with relative ease. Regardless of the competition, InQuicker is a great example of what laser-sharp focus can do in a nascent, over-regulated industry. Look out for such small and significant success stories in other healthcare IT sub-niches like clinical analytics, consent management, diagnostic decision support, care collaboration, transition of care, PHRs etc.

Simplee

Consumer tools that help deal with healthcare system complexity are unquestionably needed. A recent niche has focused on dealing with healthcare bills.

Simplee helps it’s users track medical expenses in an friendly online dashboard. The aggregated data and management tools can help manage health care costs and perhaps be used for finding the right medical plan and services for an individual or family. The service can also be used to pay medical bills since it has an integrated payment platform.

Obvious comparisons can (and have) been made to personal finance management websites like Mint. No surprises there since managing health and wealth are equally daunting tasks, riddled with complicated verbiage and stressful decision-making for most. The need is obvious and there is competition (CakeHealth, HealthExpense and Quicken Health for example). Payer coverage is key ground to cover quickly- I couldn’t find my insurer in Simplee, for example.

Regardless, the real utility of a service like this is in its integration with existing channels that push healthcare billing information to patient. A white-labeled Simplee would be fantastic for Payers so they can evolve the annoying EOB letters sent to patients. PHR or Patient Portals (whether provided by the insurer or provider’s EHR) would be another channel for using Simplee’s service to explain the bills. Without channels partnerships like these, I’m less optimistic about Simplee’s uptake in the real world. Another perplexing topic is business model. Providing free management tools can only get a user base, and to monetize that Simplee will need to add more services – perhaps become a shopping engine for health services, provide comparisons and ratings, etc. That can’t be a viable option for short-term since building a value proposition like that would need significant traction in a given healthcare market.

As a patient do I want a new, independent, smaller company to access, analyze and archive my healthcare bills? How comfortable am I want to give them my credit card info? The answer would probably be no for a significant part of conventional patient population, unless this useful ‘billing translation service’ was embedded in my usual interaction channel with the healthcare system. I’m looking forward to the partnerships that Simplee can muster going forward.

 

Medify

Scientific and medical research has seen explosive growth in the past few decades. Since 1996, the United States National Library of Medicine (NLM) has maintained PubMed, a free portal providing access to references and abstracts on life sciences and biomedical topics. PubMed now has over 21 million citations going back to 1966, and continues to add a staggering amount (about 500,000 new records) each year. The chart below was adapted from a recently published journal article about PubMed.

Article by Zhiyong Lu

Today, clinical professionals have tools (like Ovid, ScienceDirect, UpToDate, Trip) that help answer complex questions and are connected to validated knowledge bases derived off of sources like PubMed. But how does a patient, with no access or expertise in the domain find and leverage this information? Medify tries to solve that.

The value proposition of Medify is not easy to describe. In fact, the ‘What is Medify‘ description on the site was banal enough to be dismissed, just like most other online social health startup marketing. They do a better (albeit prolix) job on the ‘How it works‘ page. Medify will appeal to the well-informed patients who are not afraid to sift through piles of academic articles burdened with medical jargon to understand and manage their own disease. Medify gives them a dashboard of existing literature – with it they can monitor things like which treatments are gaining traction in the provider community, which institutions are on the forefront of relevant research, etc. Affiliated web 2.0 functionality like faceted search, social sharing, tracking, annotating are bundled in to make it more personal.

Under the hood, it is smartly leveraging what public knowledge bases are already out there. The citation and abstract are free from PubMed. Interstitial phrases and terms in the content are further linked to sources like Wikipedia and MeSH. Brief outcomes or summaries are synthetically constructed from the article text.

Medify is not alone. There are other sites that try to help patients navigate the vast sea of research literature. PubMed’s parent NLM runs MedLinePlus,  UpToDate has a patient-oriented version, and niche startups like MyDailyApple, PatientsLikeMe are also tackling this to some extent.

In 2001 Brian Haynes, MD, PhD wrote an article describing the landscape of such ‘pre-appraised’ resources through a hierarchical structure that had four layers (called “4S” Model):

  • Original ‘Studies’ (what PubMed provides) at the base
  • ‘Syntheses’ (systematic reviews sources like The Chochrane Library) of evidence just above that
  • ‘Synopses’ (like EBM, EBN Online) of studies and syntheses next up, and
  • the most evolved evidence-based information ‘Decision Support Systems’ at the top.

He later expanded the model to 2 more layers (read about the “6S” paper here), but the basic argument remained same – Information seekers should begin looking at the highest level resource available for the problem that prompted their search. That is a good framework to understand why services like Medify are needed.

The skeptics would argue that offerings like Medify will do little more than empower hypochondriacs. But I believe that well-served health information only makes outcomes better. The lag time between published research being implemented in real-world medical practice can be in the order of decades. As consumers, we are entrusted to make choices about other important topics like money, and the market provides personal finance tools/services to help. Same can apply to healthcare, without diminishing the role of experts.

Alliance Health

There have been plenty of success stories of online networks that help aggregate individuals with a common interest in a health condition. PatientsLikeMe, MedHelp, DailyStrength, Sermo to name some. So it was only a matter of time before we saw a network of networks. Something that went beyond a online community with singular focus.

Alliance Health offers services to create health-related social networks. So it’s like Ning (Marc Andreessen‘s online platform for custom social networks) for healthcare, except that users can’t self-service and start a health-related network on Alliance Health.

They currently operate separate networks on over 40 physical and mental health issues (see screenshot below). Each community offers the standard fare expected in a online social networking site- discussion forums, videos, posts, reviews, etc. The star performer in their portfolio is DiabeticConnect, which is reportedly the largest diabetic community online with around a million unique visitors monthly.

If you look at the top most active social networking websites today, there are hardly any entries related to health (DXY.cn, DailyStrength, CaringBridge are the only ones). Yet health information is one of the most commonly sought-after content online. So there is definitely scope and need for leveraging social features of internet for health. Doing so on a combined platform increases viability, since the mainstay of revenue for social networking is still advertising. Cumulative audience across all networks is a better sell to potential advertisers.

I have high hopes for Alliance Health. Once the user base is there (like in DiabeticConnect), there are significant revenue opportunities in data analytics and mining. Beyond niche topic-based networks, I think they can extend services to private organizations like large care delivery organizations, insurers to create white-label social networks.

Enhanced by Zemanta