Technology

Bringing back the house call: Apps in some big cities let you summon a doctor

Jessica Orkin, a physician for Heal, made a house call to check on Nicky Drobnick’s baby, Charlotte. Heal started in Los Angeles and has added service in Orange County and San Francisco.
Jessica Orkin, a physician for Heal, made a house call to check on Nicky Drobnick’s baby, Charlotte. Heal started in Los Angeles and has added service in Orange County and San Francisco. Heal

If you’re old enough, childhood memories include being able to get your family doctor to come to your house — even if pizza delivery didn’t exist yet in your town.

Now, thanks to a new batch of smartphone apps, people under the weather in and around Los Angeles, San Francisco and New York can summon a doctor, sometimes faster than they can get a double pepperoni with extra cheese.

Similar to Uber’s ability to send for a ride, the apps Heal, Pager and FirstLine Medical let prospective patients, in return for a credit card number and some information on their medical issue, order a house call. The physicians come prepared for any minor ailments, much like those treated at urgent care clinics, but they also can handle some ER chores such as stitching up nasty cuts and, given the increased portability of today’s technology, perform sophisticated testing.

The services favor flat fees, paid up front — Heal charges $99 for a visit, Pager $50 for a first visit and $200 after, FirstLine $199 for most basic calls. They don’t take insurance, though some are working on adding that, but they do provide records that can be filed with an insurer and shared with a patient’s family doctor, if there is one.

Those services launched this year or last and have attracted millions in startup capital and made thousands of house calls. And as they add cities, they could eventually make their way to Kansas City and other midsize metro areas.

Heal got started in Los Angeles and nearby Orange County early this year after a particularly long and frustrating night at a hospital.

Renee Dua’s son was sick, and she was advised to take him to an emergency room. She’s a doctor, a kidney specialist, but says, “I don’t practice medicine on my son.” So she took her little boy to the hospital and waited. And waited. Eight hours later, the diagnosis came: just a bad cold.

“I told my husband, ‘There’s got to be a better way to do this,’” Dua said in a recent interview. “We’re lucky. But what about people who can’t afford to leave their jobs for hours?”

Her husband, Nick Desai, a serial entrepreneur, knew how to assemble investors, and Dua recruited fellow physicians interested in mixing some unhurried, one-on-one care into their practices.

“The idea behind Heal is twofold: to provide access to high-quality, convenient, affordable health care,” she said, “and to give physicians a better, more personal way to provide some of that care.”

A second round of venture capital has come in — backers include singer Lionel Richie, Qualcomm executive Paul Jacobs and former Los Angeles Dodgers co-ower Jamie McCourt — and Heal expanded to San Francisco in April. Dua and Desai would like to add 15 more cities, though Dua isn’t saying which those might be.

The house call apps are a logical extension of the already extensive use of telemedicine, for rural and homebound populations and also by similar new apps and services. Doctor on Demand, based in San Francisco, is supported by Google and Phil McGraw, TV’s “Dr. Phil.” It followed Teladoc and MDLIve into telemedicine.

And in one niche, the Spruce app lets patients get dermatology advice and treatment after sending in a photo and description of a skin problem.

But they don’t offer home visits, as Heal, Pager and FirstLine Medical do.

Pager, which started in New York and recently made the jump to San Francisco, starts with an online “visit” to determine whether a house call is needed, and what equipment the doctor should bring in that case. Ailments treated without an in-person visit are just $25.

And when members of the Pager team say they want to be the Uber for doctors, they know what they’re talking about. One founder, Oscar Salazar, was also on Uber’s initial team, and he helped start Pager when two other entrepreneurs brought him the idea.

Andrew Chomer, Pager’s head of marketing, said, “We’re interested in providing the right type of care for individuals. Pager provides the personal touch when needed but adds the layer of efficiency telemedicine can bring in many cases.”

Chomer said since Pager’s late-November launch, its 20 physicians had made thousands of house calls in New York, and now five doctors are on board in San Francisco.

San Francisco is where FirstLine Medical launched, and CEO Bryan O’Connell says the service has seven physicians in its group and is adding 10 more to meet rapidly growing demand.

FirstLine is already gearing up to operate in Boston and sizing up Phoenix as a possible third location, said O’Connell, so Midwestern metro areas such as Kansas City also could be house call app markets eventually.

“The need for good health care at transparent prices is universal, so I don’t think our services have to be exclusively in big cities,” said O’Connell, a venture capitalist from Ireland with experience on the business side of the United Kingdom’s National Health Service.

House calls and their benefits, of course, are nothing new. But they went from 40 percent of doctor visits in 1930 to 10 percent in 1950 and, with the rise of specialized medicine, just 1 percent in 1980. Now, the increase in technology, along with some changes in Medicare reimbursement and Affordable Care Act efforts to reduce costs, are helping them come back.

One company in the vanguard of house call apps was Medicast, started in 2013 by brothers Sam and Nafis Zebarjadi. They spent time in Kansas City at Sprint’s Mobile Health Accelerator developing their company and now have offices in Mountain View, Calif.

But Medicast gave up on its direct-to-consumer model, which operated in California and Florida, in part because consumers had trouble trusting a new-name startup. Instead, Medicast is partnering with large hospital networks interested in its software and services, starting with a house call app for Providence Health & Services in the Seattle area.

Such a partnership would be another way on-demand house calls might come to the Kansas City area. Cerner Corp. and other big health-care players in the area — St. Luke’s Health System, University of Kansas Hospital, North Kansas City Hospital, HCA — say they don’t have house call app plans in the works, but they’re the type of partner Medicast is courting.

Other related home-care services have sprung up, too. In the Denver area, “house call ambulances” are equipped to provide acute care when they arrive at someone’s home, often saving a much more expensive trip back to an emergency room and a hospital stay.

And in Chicago, Go2Nurse Inc. co-founder Meg Kubiak, a registered nurse, had the idea of an app to summon nurses, because “from time immemorial, the majority of health care has come from nurses,” said Ed Ben-Alec, who created the software for Go2Nurse.com.

But the company soon realized it would be better to use its technology and nurse network to provide regular care for chronic conditions and follow-up care for surgery or trauma patients.

That keeps business and nurses’ workloads more regular and takes advantage of changes in Medicare reimbursement to help with home care. Patients, whose lack of mobility often makes a trip to the doctor an ordeal, get regular care at home. And whoever’s paying the bill — government program, private insurer, patient, or a combination — can pay a little more for home care but possibly a lot less in the long run by avoiding emergency-room trips, or complications and relapses that require another hospital stay.

The Kansas City area was almost Go2Nurse’s second location, Ben-Alec said. But severe cutbacks a few months ago at the Kansas Bioscience Authority, which was considering helping finance a Go2Nurse operation in Johnson County, scuttled that possibility.

“We were literally driving along the Mississippi River, set to head west across Missouri,” Ben-Alec said, “when we got the phone call” canceling a meeting with authority officials.

But if the economics of more widespread house calls work out elsewhere — whether by startup app, hospital network outreach or efficiently managed quick response — they could spread across the country eventually.

As Dua, the doctor behind Heal, put it, “We provide convenient, high-quality, personal care in the privacy of your home.” If you’re a Heal patient, she said, her staff members go the extra mile. For a small extra fee, they’ll even deliver prescriptions.

But for that double pepperoni, you’re on your own.

Greg Hack also can be reached at 816-234-4439. Twitter: @GregHack.

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