We spoke to Parkinson recently to catch up on developments with Hello Health, learn what new ventures he's involved in, and discuss his ideas on how to effectively improve the healthcare system.
MDNG spoke with Jay Parkinson, MD, back in May 2008 about the inadequacy of physician quality ratings, his high-tech practice management start-up Hello Health (www.hellohealth.com), and the importance of centering medical practice around the wants and needs of the patient. We spoke to Parkinson recently to catch up on developments with Hello Health, learn what new ventures he’s involved in, and discuss his ideas on how to effectively improve the healthcare system.
When we last spoke you said, “Much of the downfall of healthcare is that it’s been taken out of the community and made very impersonal.” What steps have you, and Hello Health, taken to remedy this issue, and are you seeing a change?
I left Hello Health full-time about five months ago; basically, I got it started and turned it over to my co-founder, Nat Findlay, and he and the team that we built it with are executing that right now. I pop in every once in a while, but other than that, they’re building up the company. The entire goal was to essentially give doctors the freedom to practice as they wish, so everything was designed to be fully customizable for doctors. They could go in and choose whether they offer videos or IM services, as well as how much they charge—if they wanted to charge $50 a visit or $1,000 a visit, they could do that. Even more importantly, it was designed for the patient to have their own health profile with people who can help solve their medical problems.
Did you leave Hello Health to pursue other ventures?
Yes, I started another company called The Future Well (www.thefuturewell.com). It’s a really interesting company that’s just getting started. It is a company with three partners right now: myself and two others. [One is] Grant Harrison, a legend in the business world, because he built something called the Tesco Clubcard. Tesco is the second largest retailer in the world, behind Wal-Mart, and it’s based in the UK. We all go to Walgreen’s and we have our digitally tracked buying cards; he created that concept, and rolled it out in Tesco. I know the profit was about $300 million in the first year. He then thought that if you could engage loyalty in a retail space, you can engage consumer loyalty in a health space, and started Virgin Health Miles, which is a B2B company, part of the Virgin Richard Branson enterprises, but it rewards employees with Virgin mileage for good health behaviors. And then he left that and was the head of innovation at Humana. So, he and I found each other while I was working with Humana and just hit it off. Then Tim O’Reilly’s people hooked me up with Scott Switzer, who’s the third partner. He started a company called OpenX, which powers about 25% of the ads on the Internet. So, we take consumer loyalty and health innovation, and the creative doctor perspective, then add in some Open Source legendary data technology development, and that’s The Future Well.
We’re basically working with large brands, a few large companies, to sort of go for scale. Hello Health was a grassroots, ground-up revolution in the doctorpatient relationship, and now we’re working with large health players to help them create things that people love within the health space. For example, can we work with 180,000 people in New York to develop a healthcare system that changes how doctors are paid and how 180,000 people experience healthcare? We’re working with a group of 180,000 people to really design a healthcare system as if it were founded today with today’s causes and ways of doing business.
How has “Obama care” affected Hello Health, for better or worse?
Obama care is just health insurance reform. It’s not solving the access problem or the “let’s innovate how to pay doctors better” problem. So, when you add 35-50 million new people to the insurance pool without adding the same amount of doctors to cover them, you’re going to have huge access problems. Combine that with the fact that health insurance premiums double about every 7-8 years, and it’s easy to see they’re not fixing the cost problem. That’s going to push more and more highdeductible plans onto patients, and patients are going to be responsible for the first, say, $5,000.
Hello Health, I think, is the perfect key player in helping manage people’s first $5,000. In a sense, I think that Obama care, if you want to call it that, is sort of an ally with Hello Health, because if doctors can partner with their patients to let patients decide how they pay their doctors—do they pay them just for office visits or do they also pay them for communication—that’s an interesting problem to have. I think Hello Health enables that to happen. Doctors can get paid better not just for office visits but for e-mail and IM communication by the hour. And the doctor can get X amount of dollars per hour. If he can find the patients that are willing to pay that, then more power to that doctor.
What would Hello Health get out of that relationship from a physician that’s part of Hello Health?
Right now, it’s a certain percentage of the transaction.
Along with that, they get all of the support from Hello Health?
Right. That’s exactly what Hello Health is offering: customer support, like the technology support, as well as marketing support to help people market their practice.
Two years ago, you told us that success for you “would be that people start valuing healthcare and the doctor-patient relationship again.” Do you see that happening, or at least starting to happen?
I do. I think that doctors, fundamentally, need to change their offering away from just using pills and scalpels to more holistic care—things that actually help the real problems that people have. For example, when is the last time a doctor asked how much a patient makes for a living? That should very much influence whether that doctor prescribes a branded or generic medication and how he works with patients to help them create solutions that make sense for their lives. If you work with patients to create personalized solutions for their lives, rather than just say “here’s a pill” or “you need this procedure,” then the care is more about the relationship; it’s more of an understanding of the patient. If you understand the patient, then I think you can create better solutions for them.
Why not, even if a patient can afford the brand, give them the generic if it works just as well?
I 100% agree that that’s what should happen. Why is Lipitor the number-one drug in America, when there’s a perfectly good generic that’s $40 per month instead of $140 per month? It’s because doctors do not understand how much things cost. Within Hello Health, we’ve built it out so there’s a price tag next to every order, so doctors are knowledgeable about how much things cost.
The Hello Health model seems to be great for physicians who join, as well as the patients who accept the model. What happens to those patients who can’t afford, or are uncomfortable making the transition from a “regular” practice along with the doctor, thus compounding the primary care provider shortage? And what options does the physician have if he can’t keep or recruit enough patients who are willing and able to pay cash for their healthcare?
I think that we’re going to see, in the next few years, a large transition to more high-deductible plans, meaning that people are going to be forced to pay cash. You also have to look at how people use healthcare: 90% of Americans consume only 20% of healthcare resources. That means 10% of people consume 80% of healthcare. So, Hello Health is a perfect solution for 90% of Americans. If you combine those sort of services with the high-deductible plan—because the vast majority of Americans don’t meet their deductible—to me, it’s just an issue of creating a service that people love and engaging them with the brand and the concept. It’s not for every doctor and it’s not for every patient. That’s the end of the story, really. If you asked Apple to create a product that solved everyone’s problems, they’d fail pretty miserably. For Hello Health, it’s a matter of defining who their customers are in terms of doctors and patients and then creating something awesome.
How do you feel that the general doctor community has reacted to Hello Health?
I’m not really concerned with the general doctor community as much as I’m concerned with the doctors who get it. The doctors who get it embrace it and want to do it—how can we focus 100% on the product and how can Hello Health build something that they love? And they will serve as sort of the early adopters/evangelists. I was one of the first in line to get the iPhone, and it took about two or three years, but my parents now have an iPhone. It’s essentially a similar concept.
Is it too early to get a feel for the acceptance of The Future Well?
The Future Well, I think, is absolutely being accepted, but it’s a totally different concept. It’s a B2B sort of play. At the same time, Scott is working on an intelligent triage product, and that’s going to be our first product that we release. There are a ton of people out there who at 10:00 on a Friday night have belly pain and don’t know what to do. Well, there are triage lines that have existed for 30-40 years that have established protocols and evidence behind them. How can we bring that to the Internet, and how can we say, “These are some of the symptoms you’re describing, it sounds like an emergency, you need to go to the emergency room,” or, “You know what, you can wait 24 hours, here are four really amazing gastroenterologists that we know and love in New York City”? We don’t want to give them a list of 900 gastroenterologists, because that just overwhelms people.
The Future Well is also going to give patients some clues about how much things should cost, like “this is how much the average visit to the gastroenterologist should cost,” “this is how much the top 20 tests they offer cost,” and “this is how much the top 20 medications that they order cost.”
What makes Hello Health the model for salvaging our healthcare model, or do you not believe that it is?
No company can create a solution for poverty or the world’s problems. I think this can be a solution for access. I think it can also be a solution for stimulating or prodding the traditional healthcare community to innovate their services and offers. Apple, for example, came out with the iPhone, and now everyone has one. You wouldn’t buy a touchtone phone anymore; it would have to be touch-screen. There’s always going to be someone innovating what healthcare is, what it means, and how it’s paid for. I think that’s Hello Health’s role. I’d love to see it take off as essentially a secure Facebook for healthcare that gives doctors and patients the tools that they need to solve problems and get paid for them.
How would an interested physician get started with Hello Health, and what’s keeping him from going the direct-pay route on their own? What about becoming a member of another concierge/VIP medicine—type system?
It’s great that everyone has options. If they go to HelloHealth.com and poke around on the website, contact the guys there, talk to them, see what their offerings are, and choose Hello Health, that’s great. But, at the same time, I think it’s healthy that we all have options and competition. The most important thing is that doctors find what’s right for them.
What are you looking to tackle with The Future Well?
If you could view healthcare as a design problem, that’s sort of the problem that The Future Well is trying to solve. You look at healthcare over the past 100 years and you realize that it just sort of sprang up, and in the center of everything was the doctor’s time. But, nowadays, you can think of that process of healthcare delivery as a design problem. Apple sort of designed a whole ecosystem around their iPhone. That’s the kind of problem I’d like to look at with The Future Well. How do you design these processes, how do you design beautiful services that people love, and how do you design loyalty programs into healthcare, so that people have an incentive to embrace a healthy lifestyle?