I’ve been thinking a lot about the collapse of healthcare recently and what it’s going to look like. So I’ve been talking to a lot of people about it. Both people in and outside the industry. Here’s what I’ve concluded: The collapse is currently happening. It’s more severe than anyone thinks. And it’s starting with the middle/upper class entrepreneurs and gig workers. Think about these … Continue reading Healthcare is collapsing. Now. And it’s worse than people think.
I recently read a nice piece about why CareMore Health and Iora and One Medical and all the other groups out there trying to reinvent office-based primary care haven’t “become the new normal.” CareMore was founded in the 90’s and has now ~130,000 patients and has changed hands multiple times most recently selling for $800M to Anthem. Iora has raised ~$225M and I haven’t been … Continue reading Why haven’t new models of primary care become mainstream already?
Sherpaa is one of those things where, once you experience a primarily online relationship with your own doctor, it’s hard to imagine going back to the old-fashioned “you can only talk to me during an increasingly expensive exam room visit.” I talk a ton about how amazing Sherpaa is and why you should be primarily communicating and problem-solving with your own personal doctor online, but … Continue reading What can’t Virtual Primary Care do?
With the Apple Watch’s new Fall Detection capability, you can quickly see how technology can update the old “I’ve fallen and I can’t get up!” concept. Or maybe it’s not a fall, it’s a heart attack or low blood sugar from your diabetes, or a kidnapping, or a hostage situation or a sexual assault. The Watch can’t detect any of those situations, but you need … Continue reading Set up your iPhone to easily message your friends or family if you’re in trouble
The scope of conversations in a primary care setting is massive. There are ~1,500 conditions primary care physicians typically diagnose and manage, but you’ve always got to be aware of and on the lookout for the other 10,000 or so conditions that are diagnosed and managed by specialists. To put it another way, PCPs manage the common, less complex conditions and specialists manage the more … Continue reading Artificial Intelligence in Primary Care
The easiest way to understand the costs of primary care is to simply consider the most expensive part of delivering primary care— the salaries and benefits of physicians, NPs/PAs, nurses, and staff. To keep things simple, we’ll ignore the other costs like facilities and operations. For this exercise, we’ll consider a 10,000 patient primary care practice and we’ll compare three kinds of practices: A traditional … Continue reading Comparing the operational costs of traditional primary care, Direct Primary Care, and Virtual Primary Care
I’ve been a startup guy for 11 years this month. And over the years, I’ve heard cries of “show me the evidence!” and “that’ll never work!” on an almost daily basis. They come from randos in comments on LinkedIn, doctors in comments on WSJ articles, or potential employer customers looking for something to help them mitigate their increasing healthcare costs. It goes something like this: … Continue reading How to deal with evidence and skepticism in healthcare startups
Yesterday, I wrote about the advantages of asynchronous communication and problem solving from the perspective of the patient. But what about for doctors? Does it make their practice easier or harder? Are they better doctors or worse? What can asynchronous doctors do that their traditional counterparts cannot? After 7 years of practicing exclusively asynchronously, our doctors believe practicing asynchronously is far safer, more efficient, and … Continue reading The advantages of asynchronous medicine: the doctor perspective
First, let’s define “asynchronous” as “not real-time conversations.” Instead of oral conversations, it’s messaging you respond to when you have the time. Of course, jumping on a call or video is always an option when necessary. But we all know how many emails we send vs. how few out-of-the-blue calls we make in a given day. Traditional healthcare has always been a real-time oral conversation … Continue reading Why the doctor-patient relationship should move primarily online: the patient perspective.
Most people without medical training drastically overestimate the sensitivity and specificity of the traditional physical exam as a means of diagnosis. In reality, for the vast majority of medical conditions, it is one minor data point that leads to a diagnosis. In fact, many, if not most, conditions have almost zero physical findings. Of course, some things are diagnosed exclusively by physical exam. But those … Continue reading The physical exam is a surprisingly uncommon critical piece in determining a diagnosis.