@jayparkinson

56
Sherpaa moved to a beautiful new office in SoHo at Broadway and Prince a few weeks ago. The decor is coming along. We got a whole wall of vintage first aid kits via Etsy, one of Sherpaa’s clients. Lots of plants and a beautiful stretcher from the 60’s, you know, just in case. And on that coffee table is a vintage German knee from West German-knee! We’ve got 24 people now and we cover about 120 companies. So proud of our team. Sherpaa moved to a beautiful new office in SoHo at Broadway and Prince a few weeks ago. The decor is coming along. We got a whole wall of vintage first aid kits via Etsy, one of Sherpaa’s clients. Lots of plants and a beautiful stretcher from the 60’s, you know, just in case. And on that coffee table is a vintage German knee from West German-knee! We’ve got 24 people now and we cover about 120 companies. So proud of our team.

Sherpaa moved to a beautiful new office in SoHo at Broadway and Prince a few weeks ago. The decor is coming along. We got a whole wall of vintage first aid kits via Etsy, one of Sherpaa’s clients. Lots of plants and a beautiful stretcher from the 60’s, you know, just in case. And on that coffee table is a vintage German knee from West German-knee! We’ve got 24 people now and we cover about 120 companies. So proud of our team.

44
This is the only photo I can find of me during my pediatric residency. Seems we were so busy, we forgot to take photos.

This is the only photo I can find of me during my pediatric residency. Seems we were so busy, we forgot to take photos.

59
My watch is the only watch I’m excited about today. Call me a curmudgeon, but we look at too many screens and, already, get too many things vying for our attention. A wearable screen ready to distract us? Does that make us more present, or less? My iPhone has been my wearable since 2007. I wear it in my pocket. Do I really need another screen and another wearable?

My watch is the only watch I’m excited about today. Call me a curmudgeon, but we look at too many screens and, already, get too many things vying for our attention. A wearable screen ready to distract us? Does that make us more present, or less? My iPhone has been my wearable since 2007. I wear it in my pocket. Do I really need another screen and another wearable?

74
Sherpaa moved offices to a new space in SoHo. We’ve got about 25 people now. It feels good to grow.

Sherpaa moved offices to a new space in SoHo. We’ve got about 25 people now. It feels good to grow.

37

What is unique about how Sherpaa doctors practice medicine?

You can think of Sherpaa like a corporate medical practice in the cloud. When an employee health issue arises, employees launch the app, create a case, tell us their story, answer our questions, and see their plan. When an employee has a new message from our doctors, they get an email saying they have a new message and they should go to the app to read it. Ninety-eight percent of all communications our doctors have with our patients is done via asynchronous, private messaging within our app. The other 2% is via the phone. It’s essentially secure email within our app. Needless to say, this type of communication is one everyone in the working age population is far too familiar with.

First, let’s define how this is markedly different from the traditional way of practicing.

Sherpaa is online and asynchronous vs. real-time and in-person. Traditionally, communication between doctors and patients is done in real-time in an exam room with time spent on the case dictated to the patient by the doctor. Patients must think on their feet and answer questions upon command without the luxury of contemplating the question, or looking up terms they don’t understand. Although this is how it’s always been done, it’s highly ineffective and inefficient. Granted, there is some value in in-person body language. But that is relatively rare. The vast majority of patient-physician communication is matter of fact.

Sherpaa leverages checklists when taking a history vs. not. Although most doctors are average history takers, there is risk in not having a standardized process of taking a good history from the patient. When taking a history is unstructured and not part of a formalized, repeatable process, things can get missed or you can go down a rabbit hole. At Sherpaa, when a patient reaches out to us with a chief complaint of, say, abdominal pain, all of our patients are asked the same questions, depending on their gender. We’ve created a standardized way to take an accurate, complete history. For the top 200 chief complaints, we’ve created protocols to ask the right questions— questions that rule out the serious issues but also cover all bases and lead us to the right diagnosis. This ties back in to the issue of real-time and in-person. The only way to do this is with a checklist. Essentially, Sherpaa, at almost every point in the process from history taking to treatments, utilizes the concept of a checklist. A checklist is what enables 45,000 commercial planes to take off and land every day with years in between crashes. The same should be used in healthcare to effectively take a history and treat most appropriately.

Sherpaa doctors can take a time out. Just as patients need to sit back and think about the questions being asked them, doctors sometimes need to do this too. If doctors are in an exam room with a patient trying to ask the right questions and stumble upon a situation that either stumps them or is something they don’t have a ton of experience with, how do they, in real-time, educate themselves about the best way to diagnose and treat? Remember, doctors don’t and can’t know everything. Because Sherpaa is asynchronous, our doctors can also take a time-out and read up on the condition and/or how best to diagnose and treat it. It’s extremely valuable and safe.

Sherpaa leverages all diagnostic tools, including time. Doctors have tools to make an accurate diagnosis— asking the right questions, ordering the right blood or imaging tests, conducting a skillful physical exam, and, finally, leveraging the passing of time as a diagnostic test. For example, diseases often have a relatively predictable course. Doctors sometimes say, “well, I don’t know exactly what this is now, but if we wait 12 hours and see how things develop, we’ll have a much better idea.” The problem with this is how the healthcare system isn’t set up to leverage time as a diagnostic tool. A visit separated by 12 hours is double the cost. It’s an opportunity to bill twice, when it should be simply billed once. With Sherpaa, we always have a direct communication line to the patient at all times. As doctors, if we want, we can say to the patient, “we don’t know exactly what’s going on, but with your permission, we’re going to reach back out to you in 8 hours to check in and see how you’re doing.” And, then, 8 hours later, we send a check-in message to the patient to get an update. The passing of time is a wickedly powerful diagnostic tool that doctors who practice traditional medicine simply can’t employ. If you are discharged from the ER, good luck trying to reach that same doctor 8 hours later to give them an update on your condition. So Sherpaa doctors leverage time and they also have the luxury of ordering the right lab and/or imaging tests. Every day, we send people to Quest or LabCorp to get their blood drawn or to radiology centers to get imaging. Those results are then sent back into Sherpaa’s platform and our doctors diagnose and treat accordingly. Since our doctors never see a patient in-person, we can never do a physical exam. But that’s ok for 70% of our cases. One of the four rules of practicing Sherpaa is, “if you are in any way uncomfortable, get the patient seen in-person fast.” And that happens 30% of the time.

Sherpaa treats in an evidence-based way. In the same way we’ve built 200 protocols for taking an accurate history, we’ve also built about 200 treatment protocols based on the best available evidence. You would be highly surprised to know that 90% of everything a doctor does is essentially hearsay, folklore, wisdom, and faith. There is very little scientific evidence backing up the majority of what doctors do. So we’ve taken what little evidence there is in western medicine and created protocols around them. Essentially, safety checklists again. This standardizes care and allows us to understand its efficacy by tracking outcomes. Was this treatment plan effective? What was the outcome? With an always-on direct communication line with the patient, we have the luxury of gathering outcomes and understanding how effective our treatments are. Traditional doctors don’t. Once you’re out of their office, you’re gone and it’s on you to make another appointment to update them on your outcome. That’s wrong.

Sherpaa leverages data. Since 98% of what we do is online text communication, we have access to massive amounts of analyzable data from which we can learn. Because the rest of healthcare happens verbally in real-time, that is lost data that can never be used to study and improve best practices. Sherpaa is a vast medical practice full of usable data that can be used to help us get better and better. This allows us to understand “If the patient answered yes to this one question, the diagnosis of x is 90% likely. If the patient answers yes to these 5 questions, x diagnosis is 99% likely. If the patient is treated with this treatment plan for x diagnosis, there will be a 96% cure rate.” This data-driven practice of medicine simply can’t happen anywhere else in healthcare. It can only happen because we can analyze online communication and iterate on best practices.

We’re building something that happens nowhere else in healthcare. It’s quite astounding, unique, and powerful. Once you see it in action as a doctor or as a patient, you understand how revolutionary it truly is.

105
See that weird rash caused by a fitbit? That’s the only time a doctor will ever care about your fitbit. They’ll never care about the data generated from these devices, ever. Why?
Because ignorance is bliss. Imagine if a doctor’s typical panel of 2500 patients all had fitbits and were all generating data and sharing all that daily data with doctors. That’s a lot of data for a doctor to digest on a daily basis. Of course the doctor surely wouldn’t be responsible for all of that data. The doctor would only be responsible for the data that sets off some sort of trigger. Let’s say that there’s a miracle device with a miracle algorithm that flags 1% of users as atypical and something the doctor should be analyzing. That means a doctor would then be looking at data from 25 patients a day. Doctors typically see 25 patients a day in their practice, so now they are responsible for 25 more patients, analyzing their data, and then acting on the results. Meanwhile they’re not getting paid for this kind of management. Would this be a co-pay that patients pay? Could doctors open up cases for you that would then give them the freedom to take your co-pay whenever they want?
And what happens when they overlook a blip in someone’s data and don’t act on it? Are they negligent? Will they be sued for malpractice? Will you also be able to sue Apple or Fitbit because of a flawed algorithm that didn’t trigger alarms for life-threatening data it’s collecting about you? 
It’s the same issue with paper records. If you have your paper records and deliver an inch-thick of paper to your new doctor, it’s in the doctor’s best interest to refuse to take them. Because if they do take them, they are assuming responsibility for them and are then expected to know the information in that stack of papers. If they don’t take them, they can always claim ignorance. And, legally, ignorance is much better than negligence.
For doctors, it’s best to ignore these devices and this data. Too much data coming at you. And too many unknowns. With increasing data streams targeted at you and increasing risk of malpractice, it’s probably better to just keep your distance and call them “cute.”

See that weird rash caused by a fitbit? That’s the only time a doctor will ever care about your fitbit. They’ll never care about the data generated from these devices, ever. Why?

Because ignorance is bliss. Imagine if a doctor’s typical panel of 2500 patients all had fitbits and were all generating data and sharing all that daily data with doctors. That’s a lot of data for a doctor to digest on a daily basis. Of course the doctor surely wouldn’t be responsible for all of that data. The doctor would only be responsible for the data that sets off some sort of trigger. Let’s say that there’s a miracle device with a miracle algorithm that flags 1% of users as atypical and something the doctor should be analyzing. That means a doctor would then be looking at data from 25 patients a day. Doctors typically see 25 patients a day in their practice, so now they are responsible for 25 more patients, analyzing their data, and then acting on the results. Meanwhile they’re not getting paid for this kind of management. Would this be a co-pay that patients pay? Could doctors open up cases for you that would then give them the freedom to take your co-pay whenever they want?

And what happens when they overlook a blip in someone’s data and don’t act on it? Are they negligent? Will they be sued for malpractice? Will you also be able to sue Apple or Fitbit because of a flawed algorithm that didn’t trigger alarms for life-threatening data it’s collecting about you? 

It’s the same issue with paper records. If you have your paper records and deliver an inch-thick of paper to your new doctor, it’s in the doctor’s best interest to refuse to take them. Because if they do take them, they are assuming responsibility for them and are then expected to know the information in that stack of papers. If they don’t take them, they can always claim ignorance. And, legally, ignorance is much better than negligence.

For doctors, it’s best to ignore these devices and this data. Too much data coming at you. And too many unknowns. With increasing data streams targeted at you and increasing risk of malpractice, it’s probably better to just keep your distance and call them “cute.”

13

Are you a family practice or internal medicine doctor who wants to work at Sherpaa? Do you think healthcare is broken and you want to be on the team that’s fixing it? Are you ready for an exciting change? If so, please join us. 

What do Sherpaa physicians do all day? They talk with patients via our app or phone, order tests, diagnose, treat, coordinate care, and/or refer to the perfect specialist for the patient. In fact, 70% of the time, we actually diagnose and treat without referring for an in-person visit. You work out of the Sherpaa office in Soho and become part of our growing Sherpaa team. 

It’s creative, refreshingly different than a traditional doctor’s life, and it’s an opportunity to be part of something that works better than traditional, old-fashioned healthcare delivery. You’ll work alongside our tech team and help guide our app’s development as we continually focus on making healthcare delivery as effective and efficient as possible. You’ll become a part of our patients’ lives as you change their lives and health for the better.

It’s doctoring, and also working at one of the most forward-thinking healthcare startups around today. You’ll get a salary that’s more competitive than a traditional doctor, amazing benefits, and we, of course, cover your malpractice. Please send your resumé to jay@sherpaa.com. I’m looking forward to meeting you!

22

I’m been a bit silent lately. Sherpaa is moving to a much larger office in Soho on Friday and we’ve been quite busy. But here’s one of the many things we’ve been working on.

sherpaa:

Sherpaa has an internal team devoted exclusively to building and optimizing a group of specialists our full-time doctors here at Sherpaa refer to when you need to be seen in person. This only happens about 30% of the time, but when you need to be physically examined, our mission is to send you to the highest quality doctor where you’ll have the best experience. Essentially, out of the 880,000 doctors in America, we’re curating doctors so we can send you to the best doctors who will provide you with the best experience. These doctors are rare. We look for the upper echelon of exceptional— the probably less than 5% that meet our definition of a doctor we’d trust with our own lives. So how do we choose our specialists? And how do we define an exceptional doctor? 

Our candidates must meet the standards of a proprietary 30-point weighted system before they’re considered. Next, we look at credentials. Are they board-certified in their specialty? How prestigious was their education? What have they published and do they have a professorship? Are they members and/or leaders of professional organizations? Most of all, we prize clinicians, as we believe that the more time spent with patients, the better.

Credentials are only the beginning. Sherpaa next performs an exhaustive search of  a candidate’s online presence, of how a doctor presents herself and of how patients perceive her. We’re likely to refer to someone with great Yelp reviews, for instance, but that’s only one piece of the puzzle. We then investigate all available quality metrics. For example, we’ll consider outcome rates for procedure-based specialists or preventive care efforts for primary care doctors.

Part of our commitment to a great patient experience is ensuring that the medical treatment as well as financial obligations make sense. Our doctors take patients’ insurance nearly every time. We also ensure our doctors aren’t part of the sliver of doctors receiving a large amount of payouts from insurance companies. We want to avoid, at all costs, doctors who overbill insurance companies and patients.

If a prospective specialist passes this test, we move the conversation offline and into their practice. We choose physicians and practitioners with great personalities; who enjoy their profession and nurture their interests; whose offices are orderly and comforting; and who appreciate timeliness, kindness, and efficacy. 

Our system for assigning potential specialists a weighted score includes the following:

  • Their personal website must be high quality and value beauty and clarity
  • They take more than 5 major health insurance plans
  • Their practice size is less than 10 physicians
  • They graduated from a well-regarded American medical school
  • They have a professorship
  • They’ve published academic journal articles
  • They are members of their respective professional affiliation
  • They’ve been in practice between 5 and 15 years
  • Yelp must have above 4 stars and 20 yearly reviews
  • Healthgrades must have over 4 stars and over 10 yearly reviews
  • ZocDoc must have over 4 stars and over 20 yearly reviews
  • They speak English and Spanish
  • Their bedside manner is top notch
  • Their office is well designed, with exceptional staff, and minimal wait times
  • They are one of the top 10 specialties to which we refer

Our team is constantly researching new doctors, looking for the 5% of doctors that meet our criteria, adding them to our referral network, engaging with them on a regular basis, and ensuring the reviews our patients leave within Sherpaa sustain our decision to include them.

We’re curating doctors to add meaning to the list of 880,000 doctors in America we all have access to on the internet or on our health insurance company’s website. Massive lists are meaningless. We’re doing all the work for you so you have access to a curated group of specialists who meet our definition of an exceptional doctor.

17

Although there is a ton of activity in healthcare right now in terms of new apps, new health data companies, new ways to purchase health insurance, etc…there are very few companies tackling the most profound part of healthcare that’s broken and ripe for disruption— the delivery of healthcare. What does it mean to “go to the doctor?” When do you need to actually see a doctor in person vs. just talk with a doctor?”

Here at Sherpaa, we’re preventing 70% of office visits from happening at all. That is a fundamentally massive change. It’s true healthcare disruption, not incremental change. It’s not an efficiency increase of 5%. It’s an acknowledgement that 70% of doctor office visits simply don’t need to happen.

So, on June 12th, I’m delighted to be on a panel with two of my fellow healthcare delivery innovators:

  • Tom Lee, the CEO of One Medical Group
  • Jason Gorevic, the CEO of TelaDoc

Although Tom, Jason, and I are reimagining the future of healthcare delivery, there are fundamental differences in the strategy and philosophy of our companies. 

Needless to say, it’s going to be a spirited discussion tackling the real issues of healthcare. I’m excited. 

It’s free, located at Softbank’s space in Flatiron on June 12th and 6:30pm, and there will be food and booze. 

Space is limited. RSVP to Saundra (Saundra_parola@softbank.com) to secure your spot. 

124
My grandfather turned 94 two weeks ago. He’s been a wealth of influence in my life, but there’s one thing he’s regularly told me:
"If you sit down, you’ll never stand up."
He’s always been moving. He’s been the most active man I’ve ever known and his long life has been his reward. A new groundbreaking study just published in JAMA suggests that:

Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.
While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.
“For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people,” said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.
Countless epidemiological studies have found a strong correlation between physical activity in advanced age and a longer, healthier life. But such studies can’t prove that exercise improves older people’s health, only that healthy older people exercise.

My grandfather has always been ahead of the curve. It’s nice to see science proving his theories. It’s also interesting to note that the studies around such a logical concept are “surprisingly limited.” Actually, it’s not that surprising. In the medical world, if you can’t profit off the findings of a study, there probably isn’t good, well-funded, objective science around it. The question is interesting…who stands to profit off exercise and would they still publish the results if the findings found there was no effect?
Interesting…
 

My grandfather turned 94 two weeks ago. He’s been a wealth of influence in my life, but there’s one thing he’s regularly told me:

"If you sit down, you’ll never stand up."

He’s always been moving. He’s been the most active man I’ve ever known and his long life has been his reward. A new groundbreaking study just published in JAMA suggests that:

Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.

While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.

“For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people,” said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.

Countless epidemiological studies have found a strong correlation between physical activity in advanced age and a longer, healthier life. But such studies can’t prove that exercise improves older people’s health, only that healthy older people exercise.

My grandfather has always been ahead of the curve. It’s nice to see science proving his theories. It’s also interesting to note that the studies around such a logical concept are “surprisingly limited.” Actually, it’s not that surprising. In the medical world, if you can’t profit off the findings of a study, there probably isn’t good, well-funded, objective science around it. The question is interesting…who stands to profit off exercise and would they still publish the results if the findings found there was no effect?

Interesting…

 

10

We’re looking for a dedicated back end developer to help us improve healthcare with technology. Won’t you join us?

Who we need:

We are looking for a back end developer eager to join our small but ambitious development team and grow with us. With just two developers, we’ve built a product that is currently giving thousands of people better healthcare, but as we expand and set up shop outside of NYC, we have a lot more to build.

The core of our technology is a secure, rich, asynchronous messaging system connecting doctors and insurance specialists to our clients to solve their health and insurance problems. Our next challenge is to transition our existing system to a robust and scalable architecture capable of serving orders of magnitude more users, while building powerful new features that enable our doctors and insurance specialists to work more efficiently.

Elegance and ease of use is our priority, and we pride ourselves on bringing that to our clients.

Our next addition to the development team will need a good handle on:

  • Python

  • OO design

  • Security

  • Unix administration/server ops

  • Functional programming concepts

  • Databases (SQL and alternative)

  • Distributed systems

  • Web Architecture

Most importantly, we need a capable, skilled, and thoughtful engineer, who wants to solve large-scale problems, is confident and decisive enough to help us reach our goals, and can add your own experience and vision to our team.

Please send your resume along with a thoughtful cover letter to engineering@sherpaa.com

51

I’m obviously quite excited about this. Sherpaa started in February of 2012 with one client, tumblr. A little over two years later:

  • We take care of more than 100 companies
  • We’re 18 employees and hiring
  • Our monthly revenue covers our monthly burn
  • We’re now in California and in the process of expanding to 10 other major cities by the end of the year
  • We solve 70% of medical problems without referring you to see a doctor in person…think about that…that means 70% of doctor visits don’t need to happen
  • Our insurance experts recoup money on a daily basis for you from insurance companies and doctors’ billing mistakes
  • Employees absolutely love the service with 98% rating the experience as exceptional
  • Companies are offering this exceptionally-rated service and saving money 

Healthcare absolutely can be better and we’re proof. I’ve seen a lot of healthcare companies come and go and raise too much or too little money. My goal is to create a sustainable service that people absolutely need and love powered by an intelligent business and investment strategy based on a career of studying what works and what doesn’t in healthcare. In the beginning of my career, back in 2007, I often blogged about what’s wrong with healthcare. Around 2011, I decided to stop bitching, and start building something better. Sherpaa is a dream come true, enabled by a good idea and passionate investors who want to change a very important, yet broken, industry and fundamentally make it better. Without our investors’ passion and talents, Sherpaa would be nowhere. Along with the investors in our seed round (O’Reilly Alpha Tech Ventures, First Round Capital, and Collaborative Fund) who followed on in this Series A, Josh Guttman at Softbank led this investment along with David Karp, the CEO and founder of tumblr. I’m thrilled to have such a rock star group of investors enabling Sherpaa to grow bigger and better.

The WSJ article alludes to something I strongly believe. If you haven’t noticed, our investors are not healthcare investors. Their main focus is consumer technology. I’m a huge believer that change in healthcare cannot come from within the confines of traditional healthcare thinking. It must come from fresh-eyed partners and investors outside of the healthcare box who find healthcare way too frustrating and backwards. 

So cheers to the finest team of doctors, sales people, engineers, account experience directors, and insurance experts that power Sherpaa and make a better version of healthcare as awesome as it can be. Cheers to the companies who entrust us to make healthcare better for their company. And cheers to Phase Two of Sherpaa, making it bigger, better, and quickly coming to a city near you.