Nick Desai and Renee Dua, founders, Heal

Remember when doctors made house calls? Most people don’t—that golden age of unhurried, one-to-one medical care has receded into the realm of nostalgia. In 1930, around 40% of physician encounters in the US happened this way, but by 1980 house calls had all but ceased.

Today, at a time when we can summon anything on a smartphone—a car, a Pad Thai, a hair stylist—shouldn’t we also be able to have doctors come to us? The health startup and technology platform Heal has gone a long way toward making house calls a reality again. Having raised over $52 million in funding, Heal is now expanding from California into Florida, Texas, New York and Pennsylvania.

Heal is the creation of husband-and-wife team of Dr. Renee Dua and Nick Desai. The company leverages Desai’s background in technology entrepreneurship and Dua’s internal medicine training to make the case that, yes, house calls are not only possible, but necessary, in 21^st century medicine. Below, we discuss how Heal fits into the future of healthcare, and how its approach relates to lifestyle in general.

How does Heal fit into the broader landscape of healthcare today?

NICK DESAI: Healthcare is a $3 trillion industry, and it’s broken—I don’t have to convince you of that. But there are some fundamental root causes for this that affect the consumer.

The first issue is that doctors are spread too thin between too many patients. Primary care doctors today have to see more than 40 patients a day to make a living—they see the first 28 to pay for rent and overhead, the next four to pay for their office staff and billing, and then they will actually make money on the last eight patients. That’s not just frustrating to the patients; it’s frustrating to the doctors, as well, because doctors are meant to heal.

We let doctors be doctors. We use technology to cut away all that bureaucracy and let them focus on patient care. Our billing is completely seamless, transparent, integrated and automated—and we don’t have doctor’s offices that pay rent. By doing all this, we reduce the operating costs by 65%. This means the doctor can make a great income compared to what they would make in a conventional practice, by seeing 12 to 15 patients per day instead of 40. Instead of 7 minutes, they can spend an average of 30 minutes with each patient.

For patients, the obvious value of Heal is I don’t have to go to the doctor’s office. And when I’m sick or my kids are sick, a doctor will come to me: it’s on demand, our doctors come within two hours, and we’re open 8 a.m. to 8 p.m., seven days a week, 365 days a year. We accept insurance, so it doesn’t cost me more than going to the doctor’s office.

So, primary care is being delivered in the home. How does this change the way doctors practice medicine?

DESAI: Conventional primary care can be an unpleasant experience. Patients don’t have pricing experience and don’t know if this or that service is covered. Then, they sit in the doctor’s office for five to seven minutes, and the doctor is staring into a computer screen and they’re intimidated. They forget their questions.

With Heal, the appointment takes place in the patient’s house. Now, the patient is relaxed; they didn’t just sit in 30 minutes of traffic. Instead of patients forgetting what medications they take, the doctors can see the pill bottle. Doctors don’t have to ask if they’re smoking or if there are pets, because they see the pets, and know whether they’re smoking. Doctors assess those lifestyle factors, medication compliance factors, stress, anxiety, food, diet—all of which is critical to a proper diagnosis.

Also, because the patient is at home, they don’t have a motivation to run out and get tests done. The doctor can say “you don’t need this test, you don’t need this medicine. Here’s what you actually need.” They’re not sending people with a sprained ankle to get an MRI and see an orthopedic surgeon; 90% of the time they’re saying to keep weight off of it for a couple days and put on a hot pack or a cold pack.

We return doctors to what they love doing, which is practicing great medicine. It’s relationship-oriented, long-term, non-transactional care that looks at a holistic view of the entire patient. For patients, we’re delivering not just the convenience of a doctor in their house, but also better medicine, better outcomes, lower medication, lower costs, and less time spent.

It’s interesting that you’re talking about lifestyle factors, because we’ve seen that more brands in the lifestyle industries are moving into the health and wellness space. Does that resonate with what you’re talking about in healthcare?

DESAI: If you walk into someone’s house, you see where they live, how they live, who they live with, what smells are in their house, and what stuff is in their house. Is there a liquor cabinet? These kinds of details can give you tremendous insight into that person’s lifestyle.

People want to be advised about treatments or curative strategies that are more appropriate to their lifestyle. Do you want to take a more natural approach that’s dependent on you eating better and more exercise, or do you just want to pop the pills?

For doctors, talking to the patient and understanding what’s happening in their homes and in their personal lives can help them prescribe a much more personal, lifestyle-oriented brand of treatment.

Renee, you’re a practicing physician. Is this how you practice medicine yourself?

RENEE DUA: I’m a practicing kidney specialist, and I haven’t given up my regular practice—but I also do house calls every week. When you’re at a patient’s house, it’s very intimate. Not every patient is comfortable with that, and not every doctor is comfortable with that. But we want to reduce some of that friction and have the experience be very comforting. When we come, you should already start to feel better, knowing there’s a doctor there.

I’ll give you an example. I go on house calls every week, and about a week ago I went to see a woman who was on amoxicillin. When that didn’t work, she was on a Z-Pak [another antibiotic]. When I examined her, I said “What are we doing? We’re giving you diarrhea—you don’t need all these antibiotics; you need someone to tell you this is a virus. You need to understand how antibiotics work. You need to understand that there are bacteria in your body that protect you, and we’re killing them. You need a day of tea, toast, honey, a humidifier.”

From having that conversation with her, it became a longer visit. She’s also on thyroid medication, and she doesn’t know why—she hasn’t had her thyroid checked in ages. So, we drew her blood while we were there. We made sure she’s organizing her mammogram—we did all this, and she called me for a cough. I’m just giving you one story. But if she goes on to keep taking a thyroid medicine she doesn’t need, that’s dangerous. It’s wasteful, and it’s not good medicine.

Consumers have recently become accustomed to being able to summon any service at the touch of a button on their smartphone. Is Heal an extension of the “on-demand” business models we’ve seen elsewhere?

DUA: To some extent, it’s like having a concierge doctor. But I want to stay very true to my mission of getting people access to care. You don’t have to be rich to use Heal and that’s very important to me.

DESAI: Heal is fundamentally different from the on-demand and gig-economy companies. I think some of those companies are revolutionary, but a lot of them are having trouble because as the economy improves, people don’t want gigs. They want full-time jobs.

Our doctors are full-time employees. They’re not paid on a per visit basis. They are salaried, employed doctors who are making this their career choice because it’s a better way to practice medicine. A lot of these gig-economy companies came out of 2008, when people didn’t have work and were willing to do anything for money. But in the case of primary care, there’s an ongoing shortage of doctors. How do we motivate doctors to return to practicing excellent quality care?

I’m trying to imagine the logistics of how this works—are the doctors driving themselves between appointments?

NICK DESAI: They travel with a medical assistant, who drives them. They go in what is called “Heal mobiles,” which are Heal-branded Priuses with all the medical equipment in the car. The medical assistant also draws blood and so on, so the doctor can spend more time interacting with the patient.

If you’re a big pharmaceutical company, or if you’re otherwise invested in the existing system, how should you respond to a company like Heal? You often counsel people to avoid unnecessary medication, so is that a threat? Or is this an opportunity to shift their business model or partner with a company like Heal?

It’s an incredible opportunity. Yes, there are times we tell people not to take unnecessary antibiotics. But antibiotics are generic drugs, and not very lucrative. The issue is with patient non-compliance. For people who are not finishing their medication—cancer medication, HIV medication, hypertension medication, whatever it is—we’re actually the first line of defense. We close that last mile to say “Hey, you actually need to take these medications.”

On top of which, pharmaceutical companies are looking to understand much more about the patients and their lifestyles. As pharmaceutical companies and medicine overall get more precise, a huge part of precision is knowing the patient, having a trusting relationship and knowing the home environment, right? And often, it’s just “Hey, we’re prescribing this medication to this person; we have instructions to take it with it”—but they don’t know how to read or don’t read English. We help close that loop.

How you see healthcare changing in the next several years? What trends are you seeing across the sector?

NICK DESAI: I think precision medicine is a trend—much more advanced, accurate diagnosis. One of the innovations I’m not sanguine on, though, is the idea of AI doctors taking the place of the real thing. Except in some very rare cases where a computer can go through 9,000 different possibilities faster than a human can, I don’t see it happening any time soon.

RENEE DUA: We will always have doctors, but it’s about that human connection. Sometimes I’ll go in for a cough and it’ll be about depression, right? I went in to do a physical exam in the Bay Area and we talked about infertility—a painful conversation, but important.

Medicine is changing. When I was in med school, we got new information every few years. Now, you get new information every 30 days, and diseases are being eliminated. Cancer, you know—my kids may never know it. It’s an exciting time to be a doctor.

For more on the future of health and wellbeing, download our latest trend report, The Well Economy.

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Nick Desai and Renee Dua, founders, Heal

Apr 28, 2017

We're delivering not just the convenience of a doctor in their house, but also better medicine.

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