Santa Monica-based healthcare startup Heal announced a $100 million investment and partnership with health insurance provider Humana, a move that will vastly extend the reach of their on-demand doctor service.
Humana hopes to use Heal's applications for its Medicare Advantage program, providing more in-home care to seniors. It will also bring the service to major metro areas including Chicago, Houston and Charlotte.
Heal's CEO Nick Desai, who is fond of saying that the traditional doctor's office is dead, said it will help his company grow nationally and develop more predictive tools to guide doctors with care.
"You want a headline?" Desai joked after making the joint announcement, "Heal wins $100 million to bring concierge care to all Americans."
"We want to expand, so we go nationwide," Desai said. "We like to think the real winners in this is the millions of Americans who get health care this way. "
Heal CEO Nick Desai and Chief Medical Officer Renee Dua are married.
Heal boasts 200,000 home visits since it launched five years ago and expects to see 250% revenue growth between this and next year. Started by Desai and his wife, a medical doctor, after waiting seven hours for their then one year old to see an emergency doctor, the company has been on fast growth trajectory as traditional insurers look to startups for new ways to deliver care. He wouldn't provide revenue, but said it was in the tens of millions of dollars.
Humana, with about 17 million members, will use the services for its government-subsidized Medicare Advantage program as it seeks to build on its 34% penetration — as of 2019 — in the market.
"Our goal is to make the healthcare experience easier, more personalized and caring for the people we serve," said Susan Diamond, Humana's segment president for home business, who is joining Heal's board. "We continue to see high levels of customer satisfaction and improved health outcomes when care is delivered in the home,"
Humana said the partnership will help it fulfill its mission of addressing the needs of the whole person by giving doctors greater insight into health with at-home visits. There, doctors can see the social factors that may be impacting patients' health, such as a steep staircase or exposure to environmental hazards like pollution.
Most doctors see 8 to 10 patients, much fewer than regular physicians who often see dozens of patients in a day. The model, he said, brings down emergency room visits and elevates preventive care, making it appealing to insurers.
It's also a throwback.
"In 1970, 50% of all primary health care in America was delivered by house calls. Today it's less than 10%," he said. "That went away with insurance and fee-for-service care, Medicare. We are bringing it back."
But unlike the 70s, Heal monitors blood pressure, blood sugar and other vitals remotely using cloud connected devices to provide insight into patient care.
Last fall, the company, which operates fully in seven states and Washington D.C., bought Doctors on Call in New York City. That allowed it to make an entrance into the nation's largest city that was also, at one time, its largest coronavirus hotspot.
To deal with the pandemic, Heal protocol was to schedule an initial telemedicine call before scheduling a house visit to make sure their doctors weren't going to be exposed to the coronavirus.
"You know today, you don't want to go to the doctor's office because of COVID, but tomorrow it will be something else," he said. "You will never want to go to the doctor's office. Why would ever go to the doctor if the doctor comes to your house?"
Heal investors include former Qualcomm CEO and Executive Chairman Paul Jacobs, who is the company's chairman of the board, IRA Capital, Fidelity ContraFund, Jim Breyer, singer Lionel Richie and former Florida Governor Jeb Bush.
**This story has been update to include an interview with Heal's CEO.
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Warehouse from Outer, Trucks From Clutter, Logistics From Well Health. How L.A. Startups Are Collaborating to Get Aid To Local Hospitals
Jiake Liu is the founder of a startup outdoor furniture company, but lately he feels like he's running a second company — one that's helping supply local hospitals with thousands of protective masks and, in the process, rallying Los Angeles' tech community.
Liu started SoCal Tech for Hospitals in early March with the goal of raising $60,000 to purchase 30,000 masks for hospitals facing shortages. He's now helped raise nearly $200,000, delivered 50,000 hospital-grade masks and is looking to up the ante with the region's vast tech community to do good beyond the pandemic.
Over the past months, he's enrolled some of the most well-known startups in town to pitch in for the logistical effort of distributing the masks. After the workday ends, Liu jumps on the phone with other founders to orchestrate the effort.
"We are really able to leverage everyone's expertise," he said. "It really is the spirit of entrepreneurship. You don't necessarily have the right answers. But you come to figure things out."
His own company, Outer, uses their warehouse to store palettes of masks he's helped procure. Trucks from on-demand storage company Clutter distribute the medical supplies. While, Well Health pitches in by gauging the needs at local hospitals. Others, like the head of the rental furniture company Fernish rally venture capital donations.
Early on Liu found that venture capital firms had already been bombarded with requests for donations, but his pitch was that this effort would benefit local hospitals and was different.
"We are really the only group that's like 'let's really reach the L.A. tech community,'" he said. "If you work in L.A. tech you should donate to us. It was a call to action."
It got attention. He's pulled in donations from some of the region's top firms including Wonder Ventures, GreyCroft, Upfront Ventures. He also pulled in donations from the online coupon cutter Honey Science Corp. and carpet seller Ruggable. dot.LA is also a contributor. In return, companies get a shout out on their website.
Among the hospitals that have received the masks are Adventist Health Glendale, Children's Hospital of Los Angeles, Dignity Health - California Hospital Medical Center, Pomona Valley Medical Center, St. Francis Medical Center, LA+USC Medical Center, Arrowhead Regional Medical Center, White Memorial Community Health Center, Harbor UCLA Medical Center and Olive View UCLA Medical Center.
Liu began the effort because a doctor couple he knew that worked at Cedars Sinai Medical Center were worried about the supply of masks, so he started a GoFundMe page.
"When I started, I just wanted to get masks for my friends, but as I started talking to folks and getting a sense of the desire to do good," he said.
Someone at the location data software company Factual saw the page and introduced Liu to the nonprofit the Count On Me Family Foundation, which is now handling the funds.
Liu's next goal is to hit $250,000 in donations, but he has a larger one. With non-profit LA-Tech.org recently joining the effort, he's looking at ways to keep the momentum going beyond the pandemic.
"Now that we have attention of the tech community, the question is can we diverge some of the energy that we captured to continue to do good?"
Editor's note: dot.LA is a contributor to the fund.
As the chief medical officer overseeing four Los Angeles County hospitals, Vincent Green is looking at some grim realities.
The emergency room doctor is running low on ventilators, the supply of personal protective equipment is dwindling and many on his medical staff are over 60 years old, making them a higher risk for dying should they contract the novel coronavirus.
"There are times when I wake up and I can't get back to sleep," said Green, an executive at El Segundo-based Pipeline Health, which owns the Memorial Hospital of Gardena, East Los Angeles Doctors Hospital, Coast Plaza Hospital and Community Hospital of Huntington Park along with two others in Dallas and Chicago. He keeps going over in his mind what he can do to help protect his staff from changing intubation procedures to procuring gowns before the expected surge of patients hits. "We're trying now to get prepared and ready so that when that crazy volume comes in, we're able to try to be as safe as possible for everybody."
Green isn't alone. Other tech savvy medical professionals are turning to telemedicine to save lives and companies that provide it have seen usage skyrocket.
A few weeks ago, Green made a decision to use the translation equipment provided by El Segundo-based Cloudbreak, an interpretation service which is now providing telemedicine, to help reduce face-to-face visits with patients and in turn save protective gear that might otherwise be used for visits with COVID-19 patients.
Tapping telemedicine is one way doctors, policymakers and administrators like Green hope they can preserve resources and keep staff safe. At least two health care workers in Los Angeles County have died due to the virus and 324 have tested positive. And medical staff around the country are scared as reports of sick nurses and doctors stack up and a shortage of protective equipment persists.
Green and others have begun to deploy technology from smartphones and computers to remote patient monitoring tools in an effort to limit COVID-19 exposure. Meanwhile, jittery patients are flocking to companies that offer remote services rather than risk going into an infected doctor's office. But, telehealth has its limits and doctors can't diagnose everything via a screen.
Cloudbreak's service lets patients talk to doctors from monitors that are carted into their rooms. Like many executives facing the pandemic, the head of Cloudbreak, Jamey Edwards, switched the company's focus as the virus began to ravage the country to one more relevant to the times: telemedicine. Now, demand is booming and he is looking at more services that can help doctors reach patients on their cellphones and beyond. Green has 16 of Cloudbreak's carts in his Los Angeles-based hospitals and ordered another 20 in anticipation of an onslaught of COVID-19 patients.
Jamey Edwards, CEO of Cloudbreak
It may sound like a small gesture, but the video conference could slow the burn of hospitals' protective equipment by 10% to 15%. Not only is the protective gear more difficult to acquire as demand jumps, but prices are rising just as hospitals and clinics like his are getting squeezed financially as they forgo elective surgeries and other treatments they rely on for revenue.
The standard N95 masks used by doctors previously cost less than $1, but are now being sold for six times the price in some cases.
"This provides another layer of safety to my elderly physician staff as well as just to the rank and file employees," Green said. "They are nervous and rightfully so, because they have never had to unnecessarily risk their own life while treating patients."
At the Gardena hospital, which has a large population of uninsured and nursing home residents, Green said he is looking to use it for COVID-19 patients in the ICU that might normally require consistent monitoring from nurses, saving medical staff from constantly going into check on them.
At Martin Luther King Jr. Community Hospital, Dr. Stanley Frencher who is the medical director of surgical outcomes and quality, says many of these carts will be used in tents outside the hospital to evaluate possible COVID-19 patients, and there will also be one in nearly every room inside the facility. The hospital now has 60 with another 80 on order and a goal of getting to about 160 in the coming weeks.
"You have all these different ways in which telemedicine can be leveraged to ultimately manage this short term need to physically distance ourselves from one another," he said. "In doing so, we will definitely be saving lives by using telemedicine."
Expansion of Telemedicine
To encourage telemedicine use and slow the trajectory of the fast-moving virus, President Donald Trump earlier this month waived restrictions allowing doctors to operate across state lines and relaxed HIPAA compliance allowing doctors to use their own phones to free up hospitals and doctors for COVID-19 patients. This week, the Federal Communication Commission unveiled a $200 million fund to boost telehealth services for hospitals.
Use of remote health services has been surging amid the pandemic.
Companies like Los Angeles-based Heal, a primary healthcare service offering home doctor visits from a network of physicians, has seen usage jump 640% over the past month as patients turn online instead of risking going to a doctor's office. The San Francisco-based Forward, a health care subscription service with clinics in Los Angeles, launched a COVID-19 screener. At GoodRx, which acquired HeyDoctor last year, telehealth visits have soared.
"We think this is going to be the new normal for 2020," said John Asalone, who heads telehealth at GoodRx. "People are not going to their primary care doctors right now, but as health issues are still happening (and) they still need their medication, they will either skip care or find it elsewhere."
The $5.6 billion telehealth market in the United States has struggled for years to take off with people reluctant to connect with doctors online, but recently more companies like e-commerce giant Amazon have looked to telehealth to offset the high cost of employee medical coverage. The pandemic has forced people with chronic conditions like diabetes to check in with their doctor online or by phone as clinics and hospitals across the country cancel routine visits and elective surgeries.
"This could almost ironically be the tipping point for telehealth," said Jay Goss, general partner at Pasadena-based venture capital firm Wavemaker Three-Sixty Health that has several telehealth companies in their portfolio. "The core thing these companies do is more valuable today than it was before the pandemic.
"There's a cultural willingness now to do something that for the longest time was just done in person," Goss said.
Limits of Remote Doctors
There's also a dire necessity, but it's an imperfect tool. Doctors can't administer important tests or touch patients. There's technical issues that can pop up. And then, even Cloudbreak's carts that are rolled into ICUs must be sanitized by a human.
Despite this, Alex Fredrick, an analyst at Pitchbook, expects the pandemic will force rapid adoption of telemedicine. He points to companies like InTouch Health, a Santa Barbara company acquired by New York-based Teladoc in January that was used to treat what is believed to be patient zero in Washington.
He expects to see more robots being used to administer services as the sector develops. But that isn't helping people now who cannot be tested remotely.
The $5.6 billion telehealth market in the United States has struggled for years to take off with people reluctant to connect with doctors online. Photo courtesy of Wikimedia Commons
Forward, the subscription health service, tries to bridge some of the gap with their remote tools to monitor patients. But even the clinics in Los Angeles had to set up two drive-thru locations in Glendale and Newport Beach this month in an attempt to prevent carriers of COVID-19 from entering their clinics. And doctors there say there is no substitute for hearing and touching a person up close.
"Sometimes when you are talking to a person over the phone, you think, 'gosh, I really need to listen to this person's lungs. I need to examine them'," said Keith DesRochers, a primary care physician at Forward's clinic in Century City. "People have switched in his world to thinking COVID yes or no 100 percent of the time, but people still get pneumonia, people still get asthma exacerbations, they still get the flu. We need to make sure that we aren't missing those things."
But coming into work is a frightening proposition these days.
"To be honest, primary care doctors aren't used to being fully on the frontlines and putting ourselves at risk," he said. "It's scary, we are all trying to do the best we can to take care of our patients."
***This story was updated April 8 at 1:46 p.m. to reflect the most recent rates of COVID-19 infections and deaths among health care workers as reported by L.A. County health officials.
Reach out to me on Twitter @racheluranga, where my DMs are open, email me at rachel(at)dot.la.
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