House calls have always been the gold standard for healthcare delivery in its most idealized form. Unfortunately, they are also the most expensive. Indeed, today most home healthcare visits are done by an emergency medical technician (EMT) under the direst of circumstances. But there is a better way to deliver personalized, high-quality healthcare at scale, and companies like Sherpaa are making it happen.
In this week's Fast Forward, PCMag Editor-in-Chief Dan Costa spoke with Sherpaa CEO and founder Dr. Jay Parkinsonn about Sherpaa's unique business model. One thing that isn't completely clear in the interview is that Sherpaa doctors all work in the same room, a kind of medical call center, and often kick diagnoses off one another to improve results. According to Parkinson, this kind of setup is better for patients and doctors and leads to materially better outcomes.
We spoke in PC Magazine Labs in New York City. Watch our interview in the video and check out the full transcript below.
Dan Costa: Before we get into the future, before we get into what Sherpaa does and what makes it such a unique institution, I think it's important to revisit the past a little bit and talk about how you first started off in the medical industry and what you started doing differently that you then took into all these business ventures.
Jay Parkinson: Yes, sure. June 29, 2007 the iPhone came out and my last day of residency was June 30, so the very next day. I saw that so many people were just communicating differently. I was their doctor friend. My friends would send me emails, photos and tell me their story, what's going on and I was their connector. I would solve things for them and I was just like, 'this is happening so frequently there's got to be something here. It's got to be a business or something.'
You started it informally, you rolled it into your practice and it was as simple as using the smartphone and Google Calendar to manage your practice.
Yes. It was interesting. People would go to my site, click on 'make an appointment,' that would bring up my Google Calendar. You could choose a time, tell me your symptoms and your address and that would send an alert to my new iPhone. I do a house call and we'd follow up on email and you'd pay me via PayPal. It cost about $1,500 to get started, my overhead was about 5 percent. I got so much press it was like an immediate practice available to me. It was very cool.
It was a great story, and there were multiple accounts. Actually, if you type in 'doctor of the future,' your name still comes up...so you've got a pretty good search SEO optimization on that term.
I didn't do that on purpose.
It happened. Now it's a couple years down the line, it's not just you. You've found a way to scale this approach and scale it with Sherpaa. Explain how Sherpaa works.
Sherpaa is best described as just primary care in the cloud. It's a membership-based practice where we contract with other companies or individuals. Your doctor is now available to you, your same doctor, over and over, is now available to you 24/7 within our app. It's all about asynchronous email-like messaging within the app. You don't have to schedule time, you just communicate as you go throughout your day.
It's really just a new way to communicate and problem solve. We order tests, we'll send you to the lab, we'll send you to get an x-ray. We follow up with you, we check in with you and basically what that means is the vast majority of primary care can be delivered online without actually having to go see anybody.
[To Audience:] If you have questions, are you are watching this live you can ask them in the comments section. We'll endeavor to answer them live. If you're listening to this as a rebroadcast, you can still ask questions in the comments section but don't expect live responses. That's not the way the Internet works. I'm sure our first question is going to be how much does the service cost on a monthly basis?
Right now it's $40 a month. It's unlimited care. It's 24/7. Whenever you think about how much an urgent care visit costs, which is $300, it's less than two urgent care center visits a year.
That's the thing. Most American consumers of healthcare have no idea what a visit costs, what a phone call costs, what their doctor's time costs or what the insurance companies are paying. Let's use a test case here. Let's assume I didn't take my contacts out at night, and I woke up and I've got an itchy eye and I think that I've got pink eye. I wake up in bed, I open up the Sherpaa app and I start communicating with Sherpaa. Follow us through. What happens after that?
Right. You fire up the app, you tell us your story. It's typically about a paragraph or so. Our doctors then read that and we fire off a series of questions to you. We've built these protocols for taking a good, accurate history over the last five years and we ask a bunch of questions. You respond to them, we get those answers back, we might ask a few more questions. If we need to do labs we'll send you to the lab.
If we need tests, we'll get those tests. It's an ongoing communication stream between you and me. We get your problem solved as quickly as we can.
Something routine like pink eye you know that there's probably going to be a prescription.
Yeah.
You can phone that in and just have it waiting?
That's so old school. No man. We do it in the app. We e-prescribe through the app. You get the alert that hey, there's a new medication that wants to be prescribed to you. You either choose I accept this medication or I deny this medication. If you accept the medication, it shows all the pharmacies around you, you choose your pharmacy, that fires off the prescription.
What's the scale of Sherpaa right now? This started way back in the day, it wasn't called Sherpaa. It was just you helping your friends. Now how many doctors do you have, how many customers do you have.
We're in about 42 states. The practice, each doctor can handle about 3,500 folks. We have about 10 doctors right now.
That seems like a lot.
It's pretty interesting. Because we're so efficient, it's asynchronous. It's not the sort of in-person communications, we can juggle a lot of balls and we can handle a lot of things at the same time. Typical doctor practices are about 1,800 to 2,000 people, we're at about 3,500. It's just because it's so freaking efficient.
I'm going to come back to that asynchronous thing, but we've got a question from the audience.
Audience: Do you use a chat bot for handling any inquiries?
No, we don't use any chat bots. It's our app. Our app is really focused on, the main functionality is just asynchronous messaging with our doctors.
It's real people on either side?
Yes.
Can you envision a future where it will be at least some portions of it automated with a chat bot? Maybe those first couple questions to put you in a certain bucket?
We've thought about that. It's pretty interesting. The first thing you do is choose 'hey I'm sick' or 'I'm hurt' or something like that. It's really valuable for us to have your own words and your own story. We get that and then we fire off those questions, and those questions are very...checklist-driven. I'm a little hesitant to have a bot identify what's going on and go down a rabbit hole.
Another question from the audience.
Audience: Do you have specialists or are these general practitioners?
Right now the doctors that work for us are both internal medicine doctors and psychologists. Our backend is like a CRM for specialists that we work with. Urgent care centers, radiology centers, ERs that sort of thing. Those are shareable objects within cases. If I want you to see a neurologist that specializes in headaches in LA, we just start typing that search term and our system presents the doctor that you should see that takes your insurance that's closest to you that specializes in what you need.
That's actually a really great example, a CRM system for medicine and for doctors. It really is about managing the patient relationship. There's great software for doing that. It this something you built on your own? Did you use any other outside tools to help cobble together?
No, we built everything from the ground up. It's healthcare. We got to have everything buttoned up.
So you can be compliant. I'm sure we're going to get a question about that. I want to go back to this idea of asynchrony. The first bloom of telemedicine, everybody thought there would be doctors talking with patients via video, via Skype calls and there's some of that out there. You've embraced the opportunity of text communication as being really, really valuable. Can you just explain your thoughts on text versus video and the values of each.
You combine Facebook Messenger, Gmail, and there's something like 80 billion messages sent a day. Meanwhile Skype has about 2 to 3 million synchronous video calls a day. The consumer has spoken. I think we've spoken. That's how everybody communicates nowadays. Introducing synchronous scheduling, it's so inefficient. That's just the bottom line, it's so inefficient.
Real-time communication isn't what it's about. The information can move faster if you do it asynchronously and the doctor can do research. It may take 10 minutes to get back.
Exactly. That's what our doctors love about it. You can't expect a doctor to know everything. Whenever you're presenting with something that's a little bit weird, they can go and brush up on what's going on. Same thing goes for the patient. The other day we had a patient who created a case on Friday, we sent the questions off, she didn't get back to us until Monday, but she prefaced with saying I spent the whole weekend thinking about these. That in and of itself is amazing because if you go to the doctor you're thinking on your feet. You're embarrassed, you're cold, you've been waiting forever, it's terrible communication.
The whole idea of waiting rooms, whether you're waiting in the waiting room, whether you're waiting in the office and the doctor's only got a limited amount of time. All those waiting steps get removed and you just get the advice and the information that you need.
Absolutely. It's better on both sides, I swear. The doctors love it, the patients love it. It's a better world.
A better world and a cheaper world. When you think of Sherpaa do you see it as primarily an added convenience to the customer? Better quality healthcare or just a cheaper way to take care of more people?
You can't separate those. It's a service and it's been designed with convenience and cost in mind. The most expensive thing in healthcare is the doctor's pen. When you go see them they order a bunch of tests, they don't even discuss with you the costs. Costs are baked into Sherpaa's platform so that we know ahead of time, for the most part, what you should be paying.
Are most people using it? I know for a while you were only available to businesses, now you're available directly to consumers. What's the mix?
I'm really excited about the direct-to-consumer thing. We launched that about three months ago and that's really the dream. It's give everybody access to doctors that just get today's world. It's still growing, it's brand spanking new. What is interesting is the age skews a little higher compared to the B2B line. On average for the direct-to-consumer it's 39/40 but 34 for the B2B.
Possibly because older people are going to use the services more, they can afford more, a concierge service on top of their insurance.
I don't look at this so much as concierge service, that typically means $5,000 a year. This is really about just convenience. It's cheaper than going to traditional doctors. If you go to the ER, if you go to the urgent care center, which is what most people are doing.
Automating healthcare, I know people are going to be concerned that we're going to get to a point where we don't have doctors at all. That we're diagnosed with a tool like Watson that has access to massive troves of diagnostic databases and patterns and can identify that in your case, given your genetic history, this is what's wrong. Do you see that happening or do you think there still needs to be that human factor?
If you look at any AI academic research they say that augmenting the human brain with AI is the way to go.
Working in partnership.
Yeah, working in partnership. We're already doing some of that stuff. You really just need to let doctors say, they can take an accurate history but then if you present to them, hey did you think about this, as well? That makes a lot of sense to me.
Question from the audience
Audience: Just to clarify, where is your service available and is there any expansion planned? It's probably faster to say where it's not available.
That's true. The service is available in 42 states. That's mostly due to some telemedicine laws and we really want to stay clear of those. For the most part, those 42 states are 95 percent of America's population.
When I travel in Europe and I talk about the future in technology databases and tracking, there are lots of privacy concerns. Here in the US, there tend to be fewer privacy concerns, but you still notice that people are concerned about the privacy of their relationship with their doctor. How have you overcome that and made people feel more comfortable with it?
Just being HIPAA-compliant is important obviously. Following just best practices, that's the most you can do nowadays. Then you can just build trust with the consumer and just say hey here's what we are, here's what we stand for. Really, it's just following best practices. There's nothing really deeper than that.
Is HIPAA enough? Are there any laws and regulations that need to be imposed to give people more control over their personal information or you think the way the laws are now is okay?
I think if you're a responsible company you go way above what HIPAA requires. I mean that's just what we stand for.
Talk to me about the future of Sherpaa. Do you just want to cover more people, get more people in the program? How do you see the service evolving over time?
I think it's definitely more and more people, obviously. Really what I'm interested in is how can we take the doctor outside of every single interaction and really use them as this big thinker, the one that sets the plan in motion. Doctors aren't the best at executing plans, they're really good at designing plans. What I think is most valuable is if you can take the doctor out of that equation, so that they're just making those big decisions, you can decrease costs and increase quality.
One of the examples you've used is that the doctor shouldn't be thought of as the CEO of your personal health. It's like you're the CEO and the doctor is the consultant. You're only going to see them once or twice a year, they're going to get you back on track but then it's going to be on you to execute. It seems to me the Sherpaa app is that thing you can check everyday and work with everyday but it's not expecting the doctor to solve all your problems.
Yes, that's definitely true. It's pretty nice because whenever a doctor presents a plan to you that's how it's presented in the case. Here's step one, step two, step three, that sort of thing. It is something that people can use. We're not really try to solve the problem of day-to-day use. It's really a how can you check in with us for preventive issues every quarter or something like that. Healthcare has always suffered from usability issues. We really want to be this thing that's not too invasive but just ridiculously helpful when you need us.
For more, check out Dan's interview with John Keefe, a data journalist for WNYC.