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.

 

Amion

AmionLogo Amion stands for the question every physician asks at one point or other in their residency – “Am I on?”. As I’ve pointed out before, scheduling is one of the prime candidates for being done externalized – done right by a handful of players, and utilized by everyone else.

Unlike the recent upstarts though, Amion has been around for 15 years. You can read the full story here. And unlike vanity metrics thrown around by other start-ups, Amion probably is used by over 100,000 users, as the company claims. They have products aimed at three user categories -residents, attendings, and organizations. Individuals can schedule their blocks, clinics, shifts synchronized with their personal calendars on external services (like Google Calendar or iCloud). Nuances like shift swaps , didactic pairings are probably what makes it highly relevant product for physician scheduling. Organizations probably value features like the vacation request management, policy-based rules checks, vacation/duty-hour reports, managing last-minute coverage changes etc. Plus there are some logical overlays likes auto-scheduler and template-based scheduling. Last year, Amion announced that they were launching a mobile app in partnership with Doximity. It does make sense that Amion user profiles be powered by Doximity, but the tone of press release seems to suggest more intimacy (scope of which I can’t understand).

For those who dismiss scheduling as a calendering feature, not a product by itself, think again. Here is the rough categories of solutions aimed at the scheduling puzzle in healthcare:

Chances of consolidation? Sure. But more likely are acquisitions by incumbent EHR technology players. Either way, it’s fascinating to see the breed of solutions as evidence for the inherent complexity of delivering timely, coordinated care.

AmionFlow_Sheet

 

November 2013 Update: Stuart Karon from Amion was kind enough to reach out and explain the Doximity-Amion relationship. Seems like it started with Doximity pulling schedule data for it’s users from Amion. They ended up spinning that part off into an independent app (for Amion). That way Amion got a professional mobile app with minimal investment and Doximity got a channel for getting new users onto the network. Symbiotic…

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!

Lightning Bolt

LightningBoltLogoScheduling is starting to become a great example when I talk to others about what is wrong with the current mainstream healthcare IT market. In short, the mainstream vendors are trying to do everything, and ending up with sub-optimal solutions across the board. Luckily for them, most clients are either unaware or choose to overlook the grotesque in the IT solutions presented. Which is why, I think the future is niche. Focused solutions that do a fantastic job at a subset of the myriad jumble called healthcare will be the next generation. Scheduling, is one such focus.

Some good examples already exist, albeit with slight variations on how/what they approach in healthcare scheduling. MyHealthDirect, ZocDoc, Zeel, YourNurseIsOn, InQuicker come to mind. Add Lightning Bolt to the lineup (the complete list is here). Founded in 2002 by a scientist working on scheduling supercomputer tasks, Lightning Bolt provides medical staff scheduling solutions to create, manage, request, report and communicate staff schedules.

I’ve not used their solutions, so unable to do a deep examination. But two things stood out for me. First, they position tailored solutions to certain clinical domains like radiology, hospitalist, etc. That is  nice, because I do believe that the challenges and complexities of scheduling in one clinical domain (like anesthesiology) may be different enough from another (say, something like Emergency Medicine) to warrant a different user experience. The underlying technical platform can of course be common. Second, I like the subscription-based pricing model. It’s common in the SaaS world, but most healthcare IT vendor ecosystem is still mired in license mentality.

LightningBoltApp

It’s encouraging to see more entrants in the scheduling arena. What worries me is that niche solutions need to find enough scale to be viable long-term. Like it or not, the checks in enterprise healthcare IT are still written to stolid incumbents. Partly because these incumbents continuously claim to be a one-stop-shop (simpler for the client CIO, CFO)… which brings me to the point I started this post with (that they try to do a lot, and end up sucking at most of it).

So how does a new entrant, which does a singular-but-key workflow, find it’s place in the established ecosystem? I wish I knew. Regardless, an upstart like this will surely claim the crown for healthcare scheduling one day.

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.