David Williams: One of the issues in health care delivery is that physicians and other caregivers don’t necessarily coordinate or communicate with one another in the care of a given patient. There are some approaches like the medical home that are supposed to address that to some degree. Some people expect that health IT is going to do it. I noticed that in one of your promotional videos there is somebody with a Sharpie drawing arrows among the different caregivers. How do you think about the coordination of care and communication among caregivers as part of the Hello Health platform?
Jay Parkinson: What connects caregivers today is literally paper and telephone. There is absolutely no possibility of efficient communication happening between caregivers when only 20% of doctors use computers. So the problem is the manner in which we communicate nowadays within the health care industry and the tools that simply just aren’t available to doctors and patients and people on the doctor’s team. So what we’re creating is a platform for communication that enables these people to be all on the same page. For those members of patients’ team, they can all see what’s going on with that patient. It’s absurd that it’s 2009 and you can’t do that today. The real problem is the stranglehold that the legacy health IT companies have on the health care industry. They’re not willing to innovate and if they are, they surely don’t like that we change a system from Windows 95 to something that looks more like Facebook. So I don’t believe that health IT is going to be the solution with the current health IT plans.
David: Think about Hello Health and having different caregivers on the network. In an ideal world everyone I’m seeing for care and for prevention should be able to communicate, but in reality, probably in the early stages there might only be one –or if I’m lucky two– people that are on there. Would there be a way for caregivers to communicate with their colleagues who are outside of the Hello Health system or does it really require being a part of it?
Jay: We have a couple of solutions to that. One is dealing with PDF and faxes that come in. That becomes a part of the patient’s profile. Within the next six months there are going to be various levels of profiles for doctors and the health professionals. They can simply create a profile and use it for e-mail communication, but also have access to their patients’ records. Right now, because primary care doctors are so busy seeing 35 or 40 patients a day they simply don’t have time to write the reason why a patient has been referred. So a specialist often gets patients in their office, looks at this chicken scratch and wonders ‘What is the question you want me to answer?’ That’s a problem that needs to be solved. If the doctor referring the patient can essentially create another doctor’s profile for them, then the other doctor simply has to log in and claim that profile and submit their credentials to us so that we know they’re a doctor and they can have access to that patient’s information.
These are challenges and something that’s not going to be solved easily. I don’t think this even solves the majority of doctors’ problems. I think there’s a solid core group of doctors –probably about 20%– who really do their jobs well and are frustrated that they can’t get into today’s infrastructure. I think we’re catering more towards that group of doctors who really want to solve this problem versus solving every problem for every doctor.
David: What happens if there is a patient who uses Hello Health along with their providers and then they end up having to go into the hospital? Once that happens are they just sort of back in the traditional system?
Jay: Yes, of course. Absolutely. I’d love to create technology that solves poverty and everything else, but you know you can’t do that so we’re focusing on the problem and the need of the normal people 90% of the time. Then after that we’ll do our best and gradually expand our tools and research for that infrastructure, but right now we have to focus on solving the easier problems before you tackle the hard ones.
David: We started off the call by talking about the different ways that you could interact with patients in your practice including home visits and office visits and IM’s and phone calls and potentially video chat and other sorts of things. In an optimal world, what do you think the split would be for those sort of media? Are things like video chats something that’s cool to show, but that don’t have that much impact? What would you expect? I’m sure it varies by patient.
Jay: Well, no. On a population level I think it totally mimics the way people use the Internet today. The Pew Internet in American Life projects found amazing data about how people use the Internet in America. People use e-mail all the time. That is an ingrained behavior on the Internet followed by IM and a distant third is video. People aren’t comfortable at all using video with strangers. You do it with the husband or wife or the kids, grandma and grandpa so they can see the kids, but if consumers wanted to chat with people they barely know or strangers, Apple would have embraced it in their customer service years ago, but obviously that’s not the case. It’s very much a text driven e-mail driven style of communication that people are already used to.
David: What’s the connection, if any, between what you’re doing with Hello Health and the patient centered medical home? Is that a concept that makes sense to you and are there synergies with what you’re doing?
Jay: Yeah. We’re creating a platform that enables health care providers to be on the same page, definitely. However, I don’t believe in the patient centered medical home with the doctor being the organizer and main communicator and project manager. Doctors just don’t do that. We’re not trained in that. We’re not trained to change our behavior. We’re only trained to dispense medication and use a scalpel. We’re definitely not trained to lead a team of people who can take care of a population of patients. I don’t think that’s the way the current physician as the primary focus of the organization will work at all. However, if your physician was one of the tools that a specially trained project manager for a population of people could use, I think it could work extremely well.
David: What’s the business model for Hello Health? What’s the way to make money and how do you make it successful? Is it something that needs to have local scale? In other words, do you need lots of caregivers and providers in one geographic area or is it something that can be spread all around?
Jay: The good thing is that doctor practices have grown out. The doctor hangs their shingle and patients walk by and word of mouth gets out that this doctor’s office is open and you recommend that person to your family and friends. So in terms of local scale you can start off with one doctor and if that doctor has an inherent network of colleagues that they already use for referrals, there are often like minded individuals who would buy into a nice, streamlined way of delivering health care. So we’re definitely leveraging the inherent nature of physicians that are already in existence.
The business model of Hello Health is again another one of freedom for doctors. There are a few settings within the doctor’s profile, such as how much do you charge per month for patients to be a member of your practice? They can range from zero dollars to fifty thousand dollars. And do you bill by the hour or do you bill by the visit? So the doctor enters: “I bill $150 an hour.” That’s probably not going to work in rural Maine. They might bill $80 an hour there. But you have to pay doctors by the hour because otherwise they will continue to do the widgets that they sell that makes them the most money. If your doctor charged $50 for a video visit and $100 for an office visit, they certainly are not going to do a video visit with you if they can make much more in the office. So the business model is complete freedom for doctors, so it’s totally up to them how much they charge. We just take certain fractions of each transaction. That’s where we are now, but I think this will evolve.
David: You mentioned earlier that it was a mistake for people to equate having insurance with having access to health care. I wonder what you think about the emphasis of the health care reform bills that are being considered now. There certainly is an emphasis on getting people covered by insurance and enforcing certain rules on insurers and so on. That seems to be the focus, rather than on access to care or delivery of care. I’m just curious about your perspective on health care reform.
Jay: Oh jeeze. That’s a loaded topic, but I’ve been blogging about it for months. The best resource for that is my blog, but I personally don’t believe that anything top down works, especially when it’s trying to restructure one fifth of the country’s economy. So I’m very, very hesitant to think that anything can work except disruptive innovation. I think that just like Clayton Christiansen talks about in his amazing new book called the Innovators Prescription, the business model of health care needs to be disrupted. We need to change it from health care providers getting paid for sickness instead getting paid for wellness. That’s not going to come from the top down. I think there’s going to be seeds of change from the collective community of like-minded new business models, new technologies that stand together to deliver health care at literally half the cost of what it is.
We know that Canada and the UK can deliver health care at half the cost. We have a bunch of smart people in the United States. What the government should be doing is fostering these disruptive innovations and experimenting significantly with significant amounts of money. The United States military spends $80 billion a year on R&D to develop better ways to kill people. We only spend $30 billion through the NIH and CDC on R&D on basic science for health care. I think that we should get that $80 billion like the military to just literally invest in disruptive, innovative health care companies.
David: I’ve been speaking today with Dr. Jay Parkinson. He is co-founder of Hello Health and he is Chief Concept Officer of Myca. Jay, thanks very much for your time.
Jay: Of course. Thank you for having me. It’s been great.August 17, 2009