Healthy Consumers And The Future Of The Patient-Physician Relationship

Editor's note: Michelle Snyder is executive in residence at InterWest Partners focusing on the transformative role that mobile, social, and data can play in the healthcare industry. You can follow her on Twitter.

It's hard not to read an article about the healthcare system these days without some reference to the demise of the patient-physician relationship and the risk this poses to us as individuals and the collective health of our nation. Unfortunately this is old news.

For many people it's either been gone for awhile or it never existed. And longing for "the good old days" is, in many cases, the wrong goal to be working toward. What most people want is to get better in the fastest, most convenient way when they are sick and not have to think about their health when they are well. Physicians and other healthcare providers are an important piece in the puzzle, but having a "relationship" does not necessarily guarantee getting what you really want or need.

It's time to start a new conversation. Let's stop lamenting the end of Marcus Welby and instead get excited about the opportunities to reinvent healthcare delivery, as well as the technology, people, and services needed to be successful. This article examines some of the most interesting opportunities within the digital health space for healthy consumers. Though it's not an exhaustive list, it provides a framework that begins to look at new healthcare models that can meet their needs.

Not to be confused with the Quantified Self movement (which is a separate topic of discussion), the healthy consumer is your average healthy "Jane" who engages with the healthcare system infrequently, and, when she does, seeks convenience, service, and value. Though Jane and others like her are not likely to make the biggest impact on healthcare-system costs compared with addressing the problems of chronically ill patients, I find this population exciting from an investor and entrepreneurial perspective. They are likely to pay for convenience and are open to new models of care that may or may not include a "relationship" with a provider.

Remote Diagnosis And Treatment

Thanks to the X Prize and Qualcomm's $10 million, we may have a Tricorder in the not-too-distant future. In the meantime, however, it has been exciting to see companies making consumer convenience a cornerstone of their value propositions by helping them avoid a physician visit or getting faster access to care. Though widespread telehealth adoption has been slow due to reimbursement and credentialing issues, dermatology is emerging as a breakthrough area, as it lends itself well to algorithms and mobile technology advances. In addition, access to dermatologists is particularly challenging given the relatively small clinician population (only 12,000 dermatologists in the U.S.) and growing interest among many of those specialists in focusing on self-pay cosmetic procedures.

Direct Dermatology is among the more interesting companies in this emerging space. Its focus is to improve access in rural areas (six-month waits for a dermatologist visit are not atypical) via its network of top dermatologists from Stanford and UCLA. Other newcomers, such as RockHealth graduate NoviMedicine, target specific markets — acne in this case.

Another area is home tests. It's been more than 35 years since women were liberated from having to see a physician for a pregnancy test. It's time for the next generation of home tests, and companies like QuickCheck Health are looking to make routine rapid diagnostic tests for flu, strep, and UTI available at the pharmacy or through insurers. Tests could provide an alternative to a physician visit (especially if the results are negative, which happens the majority of the time) and/or you would have the option to pay a small fee for an online consult if the results are positive.

Service-Oriented Primary Care

Maybe it's the marketing data geek in me but I get excited when I hear providers talk about their net promoter scores. We are finally moving to an era where providers are listening to their customers and are concerned with how many of them will "refer them to a friend." Several different care providers are changing the way people think about primary care. They range from insurance-based, technology-savvy practices, such as One Medical Group and monthly fee-based membership models like Qliance and MedLion to those that provide home visits, such as WhiteGlove. While the business models vary, these companies believe that you must put the consumer first and meet their needs in terms of convenience, access, and value.

While it's more prevention-focused, another interesting company to keep an eye on is Ella Health. Though the bar is low in this care sector (ask most women about their mammography experiences), Ella is starting to raise it by providing a more consumer-friendly, spa-like experience with better outcomes. I am still waiting, however, for the day when you don't have to get your body squished into a machine.

Search, Scheduling, And Referrals

If you are a healthy consumer, there is a good chance you don't have a close relationship with a primary care doctor, let alone a specialist. What you really need is information to help you pick the best provider based on what you value the most at that time – convenience, cost (low or high – some people equate price with quality), and/or quality (ranging from outcomes to a nice office setting).

One of the reasons ZocDoc has been successful is that it has tapped into the healthy consumer market and helped Gen Y, among others, have a more consumer friendly experience with the healthcare system. By allowing consumers to find highly reviewed MDs and scheduling appointments within 1-2 days, ZocDoc fulfills their desire to get what they want (an appointment), when they want it (now). Health In Reach is another interesting company in the space providing a Hipmunk-like experience. Consumers can select the degree to which features like bedside manner, office atmosphere, and discounts are important to them when looking for a provider.

While "Dr. Google" is used by all segments of the population, if you are a healthy patient, it's likely to be your first and possibly only stop (since most of your friends are healthy, too). And while I use Google as much as anyone, my friend Dr. Jordan Shlain from HealthLoop likes to say that "Dr. Google is an oncologist – most symptoms take you to a cancer diagnosis." We are not where we need to be with healthcare search, but we are starting to see companies attempting to create tools to make search more meaningful and actionable.

Meddik, a Blueprint Health company still in beta, is using a sophisticated analytics engine to find out what other people like you are searching for, what articles are most valuable, and identify other potential co-morbidities through search (e.g. back pain sufferers are searching on topics for gout, as well). Another early stage company, Pokitdok, seeks to use analytical modeling to identify the healthcare products and services that would be of interest to you based on your preferences and others like you.

Prevention For At-Risk Consumers

Unfortunately, millions of people at any given time are at risk for graduating into the episodic and perpetual patient segments. To make matters worse, these consumers are one of the toughest groups to influence, because they haven't had an event yet which fundamentally changes their lives.

Omada Health is an example where successful disease prevention, not just management, could have huge financial and societal benefits (there are over 42 million pre-diabetics in the U.S. alone). Omada and a handful of others represent a new generation of health IT companies incorporating behavioral science and human-centered design to create more fun and engaging consumer experiences that motivate at-risk people to care about their health.

While not as sexy as "social," many within the healthcare system are recognizing the power of text messaging to not only reach the greatest number of at-risk patients but also to change behavior. Results from Voxiva, HealthCrowd, and others in this space are showing the ability to positively impact a variety of measures from immunization rates and prenatal care to medication compliance.

The beauty of these models is that you can automate aspects of the patient/provider relationship via smart messaging systems — the best of these customizes the messaging based on how different people respond to different messages over time — with minimal involvement from a healthcare professional.

Disclosure: I do not have a direct relationship with any of the companies mentioned in this article except HealthLoop, where I serve as an advisory board member. Two of the companies listed, Meddik and NoviMedicine, are part of accelerator programs for which I serve as a program mentor/advisor (RockHealth, BluePrint Health).