Most people think going to the doctor costs a $25 co-pay. But then a few weeks later, you’ll get a bill for the rest of the cost of the visit. So, a PCP visit is typically $175, an urgent care visit is $350, and an ER visit is $2,000.

Sherpaa is like having your own primary care doctor. You get unlimited visits with us and it costs less than an urgent care center visit. Next time you think you need a doctor or an urgent care center, give Sherpaa a try. We’re pretty awesome:

https://sherpaa.com

This morning, Sherpaa launched an entirely new offering for small and medium-sized businesses.

#1: Companies can now pay for Sherpaa based on actual usage. This means each time an employee creates a medical case within Sherpaa’s app, companies are charged a flat fee. No matter how complex and long a case goes or how simple it is, it’s a flat fee. Prior to this, we were charging companies a per employee per month fee and this led to all kinds of headaches. Companies had to trust us that their employees would use Sherpaa. Then we had to spend all kinds of time and effort justifying our value. A flat rate per case eliminates this dilemma. Paying for Sherpaa based on actual usage de-risks the company. Companies can simply sign up and see what happens!

#2: It now takes less than a minute for a company to sign up for Sherpaa. You can do so here. Prior to this, selling Sherpaa was a complicated sales process. We found that companies, especially small companies, were interested in Sherpaa, yet we were not working with companies smaller than 100. Now, any company can sign up and get started implementing Sherpaa within their company in 5 minutes.

A Sherpaa case costs a company $150. Compare this to the average cost of care in traditional settings:

  • PCP visit: $175
  • Urgent Care: $350
  • ER visit: $2,000

When employees don’t have an access point before they get in-person care, they’re on their own trying to get their problems solved. This often results in piecemeal, expensive, paid for out of their own pocket care from urgent care centers, ERs, and random doctors. When employees have accessible doctors who can nip an issue in the bud before they spend on in-person care or direct their in-person care to exactly who and what they need, they spend their money wisely. Seventy percent of all cases created by your employees are diagnosed and treated without in-person care. Out of 100 cases diagnosed and treated by our doctors without an in-person referral, each $150 Sherpaa case prevents:

  • 35 PCP visits at $175 each
  • 50 urgent care visits at $350 each
  • 15 ER visits at $2,000 each

Just considering those 15 Sherpaa visits that prevent 15 ER visits, for a $2,250 investment, you’re saving those employees $30,000. That is an unprecedented gift questionably more valuable than unlimited coffee in the office.

Here’s what this means for your company:

Based on Sherpaa’s 5 years of data, 50% of employees will use Sherpaa as their PCPs and they will create, on average, 2.5 cases per year. So, here is what you can expect per month:

10 employees = ~$150 per month
50 employees = $750 per month
100 employees = ~$1,500 per month

What does “Can I use my health insurance for x?” actually mean?

To “use” your insurance to most people means “will my insurance cover this in-full?” Here are the conditions that must be met for your health insurance to cover things in full:

  • You must have spent your entire deductible
  • You have a plan without co-pays (very, very rare)
  • You have a plan without co-insurance (increasingly rare)
  • The expense happened during a routine annual physical and was a recommended screening test for your age/gender/risk factors (thanks Obama!)
  • Certain forms of contraceptives (thanks Obama!)

The real questions are:

  • What will it cost me to see a doctor or visit an urgent care center or ER?
  • What will it cost me to get tests?
  • What will it cost me to get procedures?

The answer to these 3 questions is, before you’ve spent your entire deductible, you are responsible for paying for the entire cost of these things.

So, now the question becomes “will my health insurance cover this in-full after I’ve spent my deductible?”

The increasingly likely answer is no. In decades past, when we as adults were introduced to the concept of health insurance, insurance used to cover all visits. Then they started introducing co-pays (to visit the doctor, you have to pay $25 at the time of the visit). Then they introduced co-insurance (your health insurance pays, say 80%, of the bill and then you pay the rest after you’ve met your deductible). The real reason people are confused about this is because deductibles, co-pays, and co-insurance are relatively new concepts that were introduced gradually over time. As you can see, these are measures to offload costs from health insurance companies and employers onto you. The days of insurance fronting the costs of all things are over.

To clear things up, until you’ve spent your entire deductible, co-pays and co-insurance do not yet apply. After you’ve spent your entire deductible, you start sharing the cost through co-pays and co-insurance.

So, before you’ve spent your deductible, the smartest thing to do is to be a super savvy healthcare consumer. If you have to spend $4,000 out of your own pocket before insurance even kicks in, it’s important to spend that money wisely in partnership with a doctor who’s looking out for your spend. And that’s what we do at Sherpaa.

An Employer’s Guide: Comparing Sherpaa with One Medical

What is Sherpaa and what is One Medical?

One Medical is a traditional brick and mortar primary care practice located primarily in San Francisco and NYC that offers online scheduling and same or next day appointments. There’s a significant membership fee for individuals ($149 per year) or companies (~$40,000 for 250 employees) to join and each visit then costs employees market prices for a traditional primary care visit. Their main sources of revenue are a membership fee to individuals or companies plus traditional reimbursements from insurance companies. The more visits they do, the more revenue they generate from your employees.

Sherpaa is an online medical practice powered by our full-time physicians who diagnose and treat 70% of primary care issues virtually and, for the rest, personally arrange care with local specialists or facilities. It is traditional, relationship-based primary care, just online and available 24/7 from anywhere. Our mission is to prevent the unnecessary 70% of traditional office visits, like those that happen at One Medical, to make healthcare convenient and less expensive. There’s no membership fee to join Sherpaa and our only source of revenue is a per employee per month fee only for the employees that regularly use Sherpaa. That fee covers the cost of primary care for those employees and prevents unnecessary claims.

How much does One Medical charge employers per year?

For a company of 250, it costs the employer ~$40,000 in annual fees. For a company of 150 employees, it costs ~$24,000.

What does $40,000 a year get an employer with Sherpaa?

Roughly 275 primary care visits with Sherpaa’s doctors at no cost to employees. This is enough to cover 2 visits for the 60% of employees who use Sherpaa as their primary care doctors. These 275 online primary care visits prevent ~$68,000 in costs for primary care, urgent care, and ER visits.

What does One Medical’s $40,000 a year fees get an employer?

The ability for employees to walk through One Medical’s door. It does not cover the cost of doctor visits and their add-ons. Employees must pay their own medical bills.

Should One Medical pay companies for lead generation? Yes.

One Medical has deals with brokerages and HR platforms like Sequoia and Justworks that give One Medical away for free to employees of companies that use those services. One Medical pays those companies for patient lead generation. An employer is no different. One Medical should be paying employers for their employees’ healthcare dollars. A company has employees who spend money on healthcare. One Medical wants their money. It’s old-fashioned lead generation.

How much will your employees spend on traditional healthcare per year?

50% of employees spend $0 to $100

40% of employees spend $100 to $5000 or less

10% of employees spend more than $5,000 a year

Half of employees will not need a doctor in a given year. And half of your employees will use a reasonable amount of healthcare. But do they already have a primary care doctor? And are they willing to switch their care to One Medical’s doctors?

Say you have a company of 250 employees. In reality, 10-20% of them will use One Medical.

What does a $40,000 One Medical membership fee cover?

These are from the actual line items in a One Medical $40,000 proposal for a 250 person company.

#1: One Medical Membership for each eligible employee

One Medical charges employers an $11-$13 PEPM fee for all eligible employees, whether or not they use it. Companies can choose to include dependents age 14 and over. If 20% of employees use One Medical (this number is probably quite realistic), this costs you $800 per employee per year and the employee pays for each visit out of their own pocket. Compare this to the often waived $149 fee each employee would have paid if they signed up as an individual.

If x% of employees use One Medical, this is the membership cost to employers per user:

10% = $1600

20% = $800

30% = $533

40% = $400

50% = $320

60% = $266

70% = $228

80% = $200

90% = $178

100% = $160

#2: Access to high-touch primary care

Annual membership fees simply pay for access or an affiliation, not care. But in-person office care is where One Medical does a good job. It’s a well-designed traditional doctor office that offers online scheduling and same or next day appointments. That’s surely an upgrade to traditional primary care. ZocDoc also offers same and next day appointments with primary care doctors at no cost to you or your employees. One Medical also bills like a traditional doctor’s office. The more diagnoses they make, the more tests they do, the more your employees pay them. When doctors charge you more for doing more, your doctor’s economic interests are competing against yours.

#3: 24/7/365 Telehealth

This service is powered via phone or video by non-doctors for limited, simple conditions for 24/7 real-time nurseline-like care. One Medical does not charge your employees for each use of this service.

#4: Access to all offices nationally

One Medical is operating in 6 cities: 26 offices in the San Francisco area, 9 offices in NYC, 2 offices in Boston, 3 offices in LA, 3 offices in Chicago, 4 in Phoenix, and 6 in DC. If employees who use One Medical regularly travel to these cities and need medical care during normal operating hours, this could be valuable if they are within a convenient distance from one of their practices in another city. But for those remote employees who don’t live or work near a One Medical practice, One Medical is irrelevant to them.

#5: Access to Women’s Health Services

These are services provided by a family practitioner or physician assistant. They are not gynecologists nor obstetricians so they will not offer services for pregnancies. Most working-age women already have a gynecologist.

#6: Travel Health Consultation

This service costs an employee $50 plus the few hundred dollars for the cost of a limited range of vaccines. Anyone can enter their itinerary here and the CDC will offer recommended vaccines to be administered in any doctor’s office.

#7: Patient Financial Navigation

There are no details to be found on any of One Medical’s materials that describe this service.

#8: Open Enrollment Communication and Support

This is an opportunity for One Medical to explain their services and attempt to drive engagement and employee revenue toward One Medical. This isn’t really a benefit to be included in an employer’s annual fees.

#9: Rise Nutritional Coaching

Rise is an app One Medical acquired that anyone can download. Your employees will need to pay a $15 to $90 a month, non-insurance reimburseable in-app purchase to use in-app nutritionist services.

And for an extra cost:

  • Annual on-site flu vaccination program ($18 per employee per year. Others can also visit your office to administer flu vaccines)
  • Annual on-site biometric screening ($60 per employee per year)
  • 11 On site care days per year: ($25,000 per year)
  • Virtual-only telehealth care (an additional cost to the employer and available by request…see above for a description of their telehealth service)
  • Building an on-site center: Custom pricing

What is not included in your One Medical fees?

  • Free 24/7 physician care for your employees that prevents 70% of in-office primary care, urgent care, and ER visits from happening.
  • Real-time insights from a dashboard an employer can log into that shows how many employees were using One Medical services with anonymous details about actual usage. You should know at all times the value you’re getting from your investment.

How does Sherpaa add value to employers and employees?

All fees paid to Sherpaa covers the cost of our full-time, dedicated doctors’ care and expertise so it costs employees nothing to get primary care. Sixty to 70% of employees use Sherpaa each year and we prevent 70% of in-person primary care, urgent care, and ER visits your employees would have previously had to pay for out of their own pocket. And employers get a real-time dashboard to see how many of their employees are currently using Sherpaa, how many cases were created, and what types of cases.

9 Reasons to Choose Sherpaa over One Medical

You pay for each and every One Medical visit out of your own pocket and there’s no way to know how much you’ll be billed. It’s traditional healthcare.

Sherpaa is a flat rate for unlimited care. We keep things simple and transparent. When other doctors charge you more for doing more, their economic interests are competing against yours. One Medical, and other traditional doctors, bill you more for doing more.

Sherpaa believes accessibility is a doctor’s ethical duty. You, nor your employer, should pay a meaningless access fee to doctors and then pay for each visit. The money you pay doctors should be for their time and expertise. See how much employers pay for One Medical here.

Sherpaa turns multiple visits into one. When you need more than primary care expertise, Sherpaa doesn’t make you come in to then refer you to what you actually need. We get your story via our app, understand your needs without an appointment, and then personally arrange specialist or urgent care for you. That way, Sherpaa skips the traditional primary care visit and sends you directly to the specialist with the expertise needed to solve your problem.

When you’re sick or hurt you shouldn’t have to go visit a doctor unless absolutely necessary. Sherpaa diagnoses and treats the majority of primary care without in-person visits. One Medical overwhelmingly requires in-person office visits, with occasional virtual care handled by doctor assistants. One Medical restricts their telehealth service to a few “common” things to drive more office visits, and, therefore, more revenue from you.

Sherpaa can be your primary care doctors for life. You don’t have to live or work near our physical office. When you move neighborhoods, change jobs, switch insurance, or travel, you should have the same doctors.

Sherpaa uses full-time, dedicated doctors, not nurse practitioners or physician assistants. When your health is on the line, do you want extensive physician expertise or a “physician extender” employed to cut costs? 

Sherpaa will not send you medical bills that cause confusion and waste your time. One Medical traditionally bills you with the same line items full of medical codes and things that look like bills but say “this is not a bill.” In fact, One Medical online reviews suggest billing disputes are a primary complaint.

Sherpaa is an independent, mission-driven, self-funded company. One Medical’s last two rounds of funding came from a hedge fund and a private equity firm. Support Sherpaa. Or support Wall Street.

Yesterday, one of Sherpaa’s members reached out and asked if we could help them find a health insurance plan. We said, “have you seen Stride Health? Go there and let them do that for you. They nail it.” The patient’s response was a simple “Wow! Thank you.” Over the last 5 years, there’s been an onslaught of new digital health companies, some good, some bad, and some absolutely great. Healthcare is one big complicated, messy process. It wasn’t designed around real, everyday people’s needs. While it’s gotten more complex, digital health companies have been working passionately on real solutions to transform healthcare and the patient experience.

My company, Sherpaa, tries to solve one real problem for our members: delivering the right care to each patient as accurately, easily, and affordably as possible. Sherpaa is “primary care in the cloud.” But we view ourselves as not only doctors but curators and partners in making our patients lives easier and healthcare more affordable for them. When members communicate with Sherpaa’s doctors, they get diagnosed and treated and/or guidance through online and local services available to them. We’re effectively a funnel that can point our members to a curated set of services that make healthcare easier, less confusing, and more affordable for them. From Sherpaa’s and the patient’s perspective, there are so many other steps involved in healthcare. Things like:

  • Choosing health insurance (Stride)
  • Purchasing health insurance
  • Understanding how to use your health insurance
  • Analyzing your healthcare spending
  • Ensuring medical bills are accurate (Remedy)
  • Financing large medical expenses
  • Understanding costs of care (Healthcare Bluebook and ClearHealthCosts, FairHealth or NewChoiceHealth)
  • Getting an FSA or HSA
  • Finding a PCP (ZocDoc, Amino)
  • Finding the most appropriate and effective specialist (ProPublica, Amino)
  • Treating chronic medical issues
  • Treating mental health issues (Lantern)
  • Planning a predictable procedure
  • Getting a second opinion (GrandRounds)
  • Getting in-person acute care (Concentra, CityMD)
  • Getting care at home (Honor)
  • Procuring medication at the lowest cost (GoodRx)
  • Receiving daily medications consistently and reliably (Pillpack)
  • Getting a lab test and results (STDCheck.com)
  • Getting an imaging test and results
  • Learning about your health conditions (SmartPatients)
  • Learning about your medication (Iodine)
  • Learning about the value of procedures
  • Learning about actions/therapies you can do at home to improve your health
  • Daily health coaching (Vida)

While Sherpaa is a healthcare service and communications and problem-solving platform between doctors and patients, we can’t solve every problem. Best-in-class, forward-thinking digital health companies, like the ones linked to above, must band together to offer a seamless solution that solves real problems that real patients have on a regular basis. And when you effectively solve a real need, people see value and businesses flourish. Most digital health companies have chosen one problem to solve. But that problem is just one of over 20 complicated problems that real patients have. We can’t leave it up to the patients to find these services. It’s too confusing and it’s too hard for them to vet the services. We must identify one another, treat each other as partners, and effectively solve these problems together. We shouldn’t be acting in silos. We should be partnering, using and recommending each other’s services, and coming together to define and design the optimal healthcare experience that puts the patient first. Luckily, we have a built-in test market…our own employees. Between all of us, we have thousands of engaged, super passionate employees, who are patients themselves, working hard to make healthcare great.

If this resonates with you, send me an email or tweet at me. From there, we can start the process of getting us all together and delivering an elegant experience as one comprehensive solution that solves real problems for real people.

Ideal criteria for inclusion:

  • The service must be accessible to consumers directly
  • The service must have elegant design at its core
  • The service must be scalable across America
  • The service must deliver a delightful experience
  • The company must have a mission to put the patient first
  • The company wants to collaborate for the good of the patient

Who should pay for primary care?

Today’s primary care is a series of one night stands from fractured silos of random providers. There’s a 22 day wait to see an experienced primary care doctor in NYC, but the future looks more like Boston’s 45 day wait. So folks turned to ERs because they were accessible. As insurance companies tried to get expensive ER overuse under control, this led to the rise of urgent care centers that were just as accessible but a bit less expensive. As every business executive knows, the more inefficient, the more expensive. Letting insurance companies pay for primary care created today’s sad state of primary care. But an accessible primary care system is the backbone of efficiency and, therefore, affordability.

So who could pay for primary care?

  • Insurance companies. See above.
  • Individuals/employees.
  • Employers.

Employers should pay for primary care. Here’s why.

Health insurance is a benefit meant to protect employees from financial ruin when an expensive medical issue arises. However, health insurance paying for day-to-day care, often makes employees lives harder. They’re confused by what may or may not be covered. They’re frustrated with wait times for appointments. As employers offload more of the monthly premiums to employees, they’re increasingly paying for care out of their own pocket. They hope their conditions improve on their own so they delay care until things get worse and more expensive. Meanwhile, their ability to be a good worker suffers.

Up until now, employers had no way to easily pay for scalable primary care across their workforce.

Companies have offices and remote employees scattered all over America, but healthcare systems are local. Signing deals with the best healthcare systems in each city and state is untenable. Some companies have invested in brick and mortar primary care on corporate campuses. This is fine for those employees on those campuses but irrelevant to other offices and remote employees. Also, companies shouldn’t be in the healthcare delivery business.

How much should primary care cost?

$150 per problem. Easy and crystal clear. Problems can be simple, moderate, or complex. A simple problem is a UTI treatment that takes a few minutes. A moderate problem is tweaking asthma medications throughout a person’s springtime flareup. A complex problem is arranging and organizing a team of local doctors to perform surgery on a cancer case that’s ongoing for 6 months. There will be lots of simple problems, less moderate problems, and even less complex problems. No matter what, each problem should cost the same $150 and, over the course of a year, they average out.

Why $150? Let’s look at the competition. It’s $49 for a 10 minute Doctor on Demand video visit for the very simple things like pink eye, $200 for a typical PCP visit, $300 for a typical urgent care visit, and $1,233 for a typical ER visit. Averaging all of these out in a population of normal users and each case is ~$150.

Leaving it up to insurance companies to attempt to manage your employees’ care is markedly contributing to your 12% or 20% annual cost increases.

How can new models of primary care be delivered much cheaper than traditional primary care?

Seventy percent of primary care can be delivered virtually without the cost of in-person visits the overhead from managing brick and mortar clinics. Last year, more than half of Kaiser’s patient visits were done virtually. While this is wonderful for the 7 million folks in California who have Kaiser insurance, what about the other 323 million Americans?

Primary care should be accessible anytime from anywhere, consistently acquired from the same service, and affordable. That’s where Sherpaa comes in. Sherpaa is an online primary care practice available anytime and anywhere. It’s primary care in the cloud available to all of your employees, whether on campus or remote. We charge $150 a case, no matter how simple or complex and ongoing that case is. And we make your employees happier, healthier, and more productive.