Prospective patients too sick or busy to visit a physician can now choose from several Uber-like apps that make use of new technology to bring doctors, physician assistants (PAs), and nurses into their homes, hotels, and workplaces with a few taps on a smartphone.
Home services like these can also help provide patients who use the emergency department or urgent care facilities for conditions such as ear and sinus infections with continuity of care from clinicians or within health systems that have ongoing access to their health records. And the services are so convenient that a clinician is usually knocking at the patient’s door in less than 90 minutes.
“Our mission is to make it easy to see your doctor,” said Renée Dua, MD, a nephrologist and cofounder of Heal, a Santa Monica, Calif.-based house call healthcare service. She and her husband, Nick Desai, started the company after spending many frustrating hours in an emergency room seeking answers about their sick child. It occurred to them that it would have been much easier on their family if a pediatrician had been able to come to their home.
In November 2015, Desai and Dr. Dua debuted Heal for just that purpose. Today, patients who live within their service areas in California can call for one of Heal’s 75 physicians to come to their home to suture a cut, evaluate a stomach virus, perform a physical, and/or administer a flu shot. While most of these physicians are full-time Heal employees, the company also works with a small percentage of contract physicians who fill in the gaps as the startup grows. At a cost of less than $100 a visit, the fees for patients differ vastly from concierge medicine, which typically operates on a retainer model, with annual fees of $5,000 per person to bring a physician to a home.
Recently, Dr. Dua helped a patient go through his medications. It turned out he was on two blood pressure medicines of the same class—unnecessary and potentially dangerous. Dr. Dua believes medicine reconciliation is an important part of a physician’s job, and the task is much easier to perform in a person’s home, where the medicine cabinet is just a few steps away, than to rely on patients bringing their medications to a clinic appointment.
Continuity of Care
Similar home visit services are popping up in various parts of the country. Pager, which serves parts of New York, Florida, and Texas, was co-founded by one of the team members who created Uber. Swedish Express Care at Home serves the Seattle area, and their affiliate Providence Express Care at Home serves parts of California.
Sam Zebarjadi, director of business development at the Providence Health System, said their Express Care offers a suite of services that includes freestanding retail clinics as well as those partnered with Walgreens, both lighter versions of urgent care that focus on non-emergent but somewhat acute conditions, such as strep throat and urinary tract infections; traditional telemedicine, in which a clinician is videoconferenced into the home; and Express Care at Home, which utilizes house call technology built on the Medicast platform, the startup created by Zebarjadi and acquired by the Providence Health System, along with Zebarjadi’s team.
Zebarjadi said that his service allows patients to benefit from a continuity of care within the Providence Health System. “Before, if you wanted your doctor to have access to your medical records, you would have to go to a Providence doctor’s office or Providence Emergency Room. Now, our providers have access to your medical records within any of our Express Care offerings, whether it’s in one of our retail clinics, through telemedicine, or through our home visit service,” he said.
Providence Express Care at Home clinicians see many otolaryngologic issues, including sore throats, strep, stuffy noses, congestion, laryngitis, and pharyngitis. After an initial diagnosis is made, they may end up referring a patient to a specialist, channeling the patient into a clinic for a follow-up visit. “Once you’re on a treatment plan, if it’s a chronic issue, we want to get you in to see a specialist,” Zebarjadi said.
Dr. Dua said often a patient with a cold will go to urgent care and get a referral to an otolaryngologist. “We want to utilize [the specialist’s] time correctly. If you have a stuffy nose, you don’t need to see an otolaryngologist. But if you have hearing loss, you do,” she added.
Express Care at Home is planning to offer otolaryngology consultations via telemedicine in the near future but, for now, the company is concentrating on the model of sending a nurse practitioner out on the call and bringing in the specialist as needed. The company is currently working with other healthcare systems to help license technology in their respective geographies.
Renée Bacher is a freelance medical writer based in New Jersey.