Virtual Primary Care is 95% as effective as a traditional PCP at less than half the cost.

There are so few innovations in primary care. But it’s the entry point to all of your healthcare expenses. There have been three scalable primary care innovations:

  • Telehealth
  • Retail Health clinics (Walgreens, Minute Clinic, etc.)
  • Virtual Primary Care (Sherpaa)

These innovations need to be evaluated based on two questions:

  1. How capable are they at handling real world problems?
  2. How cost-effective are they?

Telehealth like Teladoc can only diagnose and treat ~30 simple, inexpensive things. Let’s call this pink eye telehealth. From a doctor’s perspective, here’s why video visits are so limited in scope. Each visit costs employees ~$49 and employers either nothing or some negligible amount like $1 PEPM.

Next are Walgreens Nurse Practitioner clinics that people call retail health. They diagnose and treat a slightly larger amount of conditions (~50) because they can examine you and do simple tests that can’t be done via a phone call or video. A nurse practitioner can diagnose more things via an in-person visit than a doctor can via a phone or video call. This makes sense. Essentially, this means a doctor is no better than a nurse diagnosing stupid simple things. Each visit typically costs $79.

Next is Virtual Primary Care (VPC), invented and pioneered by Sherpaa over 6 years ago. If you have a regular doctor who communicates with you via messaging, photos, health data, phone, and video, and can order tests and take ownership of your outcome from beginning to end, those doctors can handle ~1450 diagnoses. A month of this care costs $99 or $270 per patient per year.

Next is the traditional PCP. They can do a bit more than VPC because they can take care of the rare situations where regular physical exams are required for ongoing management of your situation (they can listen to your heartbeat and do an EKG if you have a heart rhythm disorder for example). But they charge, on average, $200 each time you visit them.

So biggest bank for your buck? By far, VPC. It’s 95% effective as traditional PCPs at less than half the cost.

Learn more about Virtual Primary Care.

How Virtual Primary Care Saves Time, Money, and Stress for Simple and Complex Situations

We recommend reaching out to Sherpaa (Virtual Primary Care) for anything that’s not an emergency. Sherpaa members create cases within Sherpaa’s app for things like “I’m sick” or “I’m hurt.” Within cases, you can send messages, attach photos, see test results, read specialist reports about an in-person visit, approve prescriptions and choose your pharmacy, and learn about your diagnoses. Cases can be simple to complex and last for minutes to months. Because this is a new concept, we’ll explain typical types of cases.

Simple Case: A UTI

You woke up with UTI symptoms. You launch the iPhone app, create a case, and describe your symptoms. Since you get these once a year, almost like clock work, you know what you’ve got. In your description, you also mention that you’ve never had a complicated UTI and always respond well to antibiotics. You submit your case, a few minutes later our doctors respond with a message and ask you a few more questions. You answer them almost immediately. Based on your responses, our doctors prescribe you an antibiotic within the app. You choose your pharmacy and pick up the antibiotics an hour later down the street. Three days later, you get a message from our doctors asking for an update. You report all is well!

Moderate Case: Pneumonia

Your cough started as a cold about three weeks ago. This morning you developed a fever and your cough seems to be worsening. You fire up Safari on your laptop, create a Sherpaa case, and describe your symptoms in about 2 paragraphs. You submit your case. Twelve minutes later, your Sherpaa doctor responds with 24 questions asking for more detail. You notice these are the kinds of questions a doctor would ask you in their office. You respond thoughtfully and a few minutes later you get a message from a Sherpaa doctor asking you to go to Chelsea Diagnostic Radiology a few neighborhoods away to get a chest x-ray. Your Sherpaa doctor orders the test from Sherpaa’s platform which sends the order to the radiology center. You go and get the test. About an hour after you got the test, you get a new message from Sherpaa. You fire up the iPhone app and see the radiologist has diagnosed a mild pneumonia in your left lung. Your Sherpaa doctor prescribes an antibiotic and explains other things you can do at home to help you feel better. You approve the prescription in your app, choose the pharmacy down the street, and an hour later you pick up the antibiotics. Twenty four hours later, your Sherpaa doctor asks for an update. You say your fever broke and your cough might be getting better. Two days later, your Sherpaa doctors asks for an update. You’re now feeling much better but you’re reminded to take the rest of your antibiotics. A week later, your Sherpaa doctor asks for an update. You’re back to normal.

Complex Case: A scary new lump

This morning, while you were showering, you felt a hard lump on your testicle. It didn’t hurt when you pressed on it and you’re terrified. You go to, log in, and create a Sherpaa case describing what you felt. Ten minutes later, you get a message and 26 questions to answer. You answer them and 3 minutes later you get a phone call from your Sherpaa doctor. She lets you know she’s worried and wants you to go to the local imaging center to get an ultrasound. She orders the test via Sherpaa’s platform, calls up the radiology center to speak to the radiologist to request an urgent test. An hour later, you’re getting the test. An hour later, you get a phone call from your Sherpaa doctor. They found something suspicious. You’re terrified but reassured when Dr. Gonnella says she’ll call you back in a few minutes. Meanwhile, Dr. Gonnella has texted the local urologist that offers bundled pricing for procedures asking him to squeeze you in this afternoon. He can, so you go to the visit. The next 48 hours seem like a whirlwind, but two days later you’re home after surgery. You get a call a day later and the surgeon says the pathology report confirms testicular cancer that had not spread anywhere else.

Complex Case: Moderate, persistent asthma

You’ve had asthma most of your life. You’ve wound up in the ER and admitted a few times over the years when it flares up in the spring. It’s April and you feel it coming on. You launch the iPhone app, create a case, and tell us how you’re feeling. A few minutes later, you get a message from your Sherpaa doctor with a series of questions. You respond to them and 20 minutes later, you get a prescription for some medications and a peak flow meter (an inexpensive device that measures the severity of your asthma). You choose your pharmacy down the street and an hour later you get an alert from Walgreens that everything’s ready to be picked up. An hour later, you get a message from your Sherpaa doctor asking about your peak flow along with a YouTube video describing how to properly use the peak flow meter. You report back with a number that’s not great. Your Sherpaa doctor sends an action plan to check your peak flows regularly and what do when the numbers aren’t ideal. Over the course of the next month, your Sherpaa doctor checks in every few days to see how you’re doing and adjusts your medication doses accordingly. A month later, your asthma is under control and you’re enjoying the spring flowers.

What is Virtual Primary Care?

Sherpaa invented and pioneered Virtual Primary Care over the last 7 years.

VPC is a new genre of primary care.  It’s “mobile-first healthcare.” It is an ongoing relationship you have with the same doctors, that offers cost-effective care conveniently delivered online via a secure, HIPAA-compliant mobile and web app.

VPC’s main mode of communication and problem solving is via messaging, photos, health data, phone, and video. This is compared to traditional PCPs who use appointments, office conversations, and per-visit medical bills to communicate and problem solve.

VPC doctors order tests, prescribe medication, and own your progress over time.

VPC doctors practice VPC full-time. VPC is not something they do on the side. They are 100% dedicated and focused.

VPC doctors can diagnose and manage ~95% of conditions a traditional PCP can manage. Because VPC doctors can order lab or imaging tests, communicate with you on an hourly basis (if needed), prescribe medication, and maintain a relationship with you over time, this offsets the value of an in-person physical exam. The vast majority of diagnoses are not made via a physical exam, but by taking a thorough history by asking the right targeted questions and ordering the right tests to confirm suspicions.

VPC is accessible 24/7/365 from anywhere in America. VPC is Netflix. Traditional PCPs are Blockbuster.

VPC is transparently-priced. It is billed on a per-episode of care or a flat rate for unlimited care (no matter which pricing model is chosen, VPC can be delivered for ~$270 per year per person).

VPC serves as both treatment and triage. By communicating online, instead of an office visit, VPC doctors can understand exactly who and what you need without having to see you in person first. 70% of cases are diagnosed and treated without an in-person visit and 30% are referred appropriately.

VPC is an always-on communication channel between you and your VPC doctor.Either can communicate with one another at any time. This means a VPC doctor can manage situations differently than traditional PCPs. VPC doctors can say “I have a feeling you’ve got x, but I’m going to check back in in 4 hours to see how you’re doing and we’ll take it from there.”

VPCs can diagnose and treat ~70% of primary care health conditions without referring for an in-person visit. This is on par with traditional PCPs who refer to specialists ~30% of the time, after they’ve charged for the visit.

VPC doctors do not do physical exams. When an in-person visit is required, a referral is made to a local urgent care center, specialist, retail clinic, or ER.

VPC doctors are cost-conscious. For the sake of your bank account, the technology VPC doctors use has cost information baked in at every decision point for the doctor. VPC doctors can steer you toward preferred surgical centers, medications, pharmacies, and testing centers.

VPC doctors can diagnose and treat ~1500 conditions while telehealth doctors can diagnose and treat ~30. Traditional telehealth is a 10 minute phone or video call with a random doctor who doesn’t know you, they can’t order tests, they can’t arrange complicated local care for you, and they can’t follow-up with you.

VPC doctors are markedly less expensive than traditional PCPs, but more expensive than telehealth. Traditional PCPs bill for every office visit and have brick and mortar overhead. Telehealth is essentially free because usage is low and the kind of conditions they treat don’t affect costs in a significant way.

VPC doctors are powered by a data-driven platform. It’s checklist and protocol-driven to make it safe, effective, and efficient.

VPC is Sherpaa.

A Person’s Entry Point into Healthcare

For nearly a century, people have assumed that primary care doctors were the gatekeepers to health care. As waits to see PCPs ballooned from getting a house call that day to 40-something day waits, PCPs have rightly lost their status. Because we’re an enterprising nation, urgent care centers, retail clinics, ZocDoc, and telehealth arose to fill the demand for accessible care. But all of them sacrificed continuity and relationships for immediacy. And our culture increasingly expects immediacy due to expectations created by other industries (uber). I think you can have both — immediacy and continuity — but only if you reimagine primary care as a service, not a PCP.

All of these new services are terrible entry points into healthcare.

Urgent care centers are typically independent entities loosely tethered to the local hospital networks. Retail clinics are literally Walgreens and CVS. ZocDoc connects you with PCPs (most likely new and less experienced PCPs) who need to pay ZocDoc to fill their practice. And telehealth is a bank of random doctors (again, a PCP with free time…Really? Who the hell are these people and why?) somewhere in your state who can talk with you for 10 minutes and once they realize they can’t diagnose and treat you (they can only diagnose ~30 stupid simple issues), you’re on your own again looking for another local entry point into healthcare.

As a consumer, you either have an untrusted, untethered entry point, or you have a trusted relationship.

As relationships have fallen by the wayside, consumers are on their own. Local hospital systems view primary care as the loss leader that’s incentivized to refer to higher revenue-generating specialist services. Primary care departments then get the shaft as hospitals don’t have the vision to reimagine primary care as a series of services that intelligently route people to exactly who and what they need. They’re still doubling down on the old-fashioned, increasingly inaccessible PCP.

Consumers literally have two choices

  • Wait weeks to spend money just to be told by a PCP that they probably need someone/something else
  • Go to an urgent care, retail clinic, or telehealth

Reimagining primary care is the secret to intelligent healthcare usage and, when consumers feel like they have services that actually serve their needs, they’ll be lifelong customers. But primary care won’t look like today’s primary care. It’ll be a whole new concept. It won’t feature the PCP as the central figure. It’ll be an immediately accessible online service that either treats online or routes intelligently.