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Is It Possible to Fix Healthcare in America?

It's frustrating how little of our national discussion is based on common sense.
Nick Desai is an accomplished and visionary entrepreneur who has started and led four venture funded start-ups over the last 18 years. Nick is the Co-Founder and CEO of Heal, an on-demand doctor house call app available in Los Angeles, Orange County, San Francisco / Silicon Valley, and San Diego. For Nick, Heal is more than a company – it’s a mission to fix the broken $3 trillion healthcare system. Nick’s previous start-ups have been innovative leaders in technology-enabled fitness and weight loss, social media and mobile applications, and the web’s first self-updating address book. Nick earned his BS in Electrical and Computer Engineering from UC Irvine, where he is in the Engineering Hall of Fame, and an MS in Electrical Engineering from UCLA. Nick is on the board of the UC Irvine Alumni Association and the Los Angeles Chapter of the American Heart Association. In his occasional free time, he writes for the Huffington Post. Nick lives in Los Angeles with his wife and two little boys, who are his pride and joy.
Nick Desai is an accomplished and visionary entrepreneur who has started and led four venture funded start-ups over the last 18 years. Nick is the Co-Founder and CEO of Heal, an on-demand doctor house call app available in Los Angeles, Orange County, San Francisco / Silicon Valley, and San Diego. For Nick, Heal is more than a company – it’s a mission to fix the broken $3 trillion healthcare system. Nick’s previous start-ups have been innovative leaders in technology-enabled fitness and weight loss, social media and mobile applications, and the web’s first self-updating address book. Nick earned his BS in Electrical and Computer Engineering from UC Irvine, where he is in the Engineering Hall of Fame, and an MS in Electrical Engineering from UCLA. Nick is on the board of the UC Irvine Alumni Association and the Los Angeles Chapter of the American Heart Association. In his occasional free time, he writes for the Huffington Post. Nick lives in Los Angeles with his wife and two little boys, who are his pride and joy.

These last couple of weeks have reminded us how important?—?yet divisive —?an issue healthcare is in America. Despite all the rhetoric from both sides of the aisle?—?whether you love or hate Obamacare or TrumpCare or anything in between?—?what amazes me is how little of our national discussion focuses on common sense, cost-saving solutions that can improve the lives of patients…and the doctors who care for them.

In our country, more than 70% of emergency room visits are for non-emergency purposes, wait times for new primary care doctor visits have increased 30% in the last couple of years, doctors spend over 2/3 of their time on paperwork, and, in the last 30 years, medical bureaucracy has grown almost 3000%. About 90% of primary care doctors are so unhappy, they wouldn’t tell their kids to be doctors and the situation for patients is no better. Each year, the US healthcare system could save over $200 billion if medications were taken properly. In fact, about 60% of seniors take their medication improperly and about 140,000 die annually as a result. And, stunningly, primary care doctors would need to work an impossible 21.7 hours per day, 365 days per year to provide adequate time to their average census of patients.

The result of underserved patients and overworked doctors is that increasing numbers of patients don’t have a primary care doctor they see regularly, and the doctors they do see are so pressured with their over-crowded waiting rooms, they don’t have the time to really listen to their patients in the first place. In fact, only 1 in 4 patients get to finish their statements to their doctors and primary care patients can be interrupted as soon as 12 seconds. This in turn exacerbates all the problems above in a destructive cycle in which costs are soaring, outcomes are getting worse and patients are increasingly disenfranchised with the quality of care. Costlier care does not result in improved outcomes either?—?studies show that increased spending in procedures controlled by doctor choice in the hospital do not result in reduced mortality or readmissions. These problems exist even though we spend 22% of our GDP on healthcare.

Our way out of this quagmire will not come from cramming even more patients into waiting rooms, replacing doctors with bots, AI, or “lower cost providers,”?—?all of which serve to further disconnect patients from their doctors. The total compensation of primary care doctors in America is only 4% of the total cost of the healthcare system. Doctors aren’t the problem. Our system?—?which turns doctors from healers into bureaucrats, thereby disabling them from providing genuinely effective, personal and relationship based care?—?is.

And therein lies the incredibly simple, yet seemingly counterintuitive, solution: Return doctors to being doctors. Healers who practice unhurried, relationship-based and highly personalized medicine on patients they know not as numbers on a chart, but rather as friends and neighbors. This enables patients to see doctors they know and trust at the first sign of trouble, rather than ignoring issues or running to the ER for every little thing. For this radical approach to be financially feasible in 2017 we need ground-up innovation that brings doctors and patients closer together by eliminating every iota of inefficiency, bureaucracy and friction through software and automation. Innovation that uses technology to reconnect re-humanize the practice of medicine in a way that is fulfilling for doctors and patients alike.

If that all seems overly simplistic, consider this. If a doctor truly understands a patient’s full health history, their home environment and family life, they can prescribe more effective medications, intervene in disease earlier and most importantly, identify issues before the patient knows they exist. If we know anything about medicine, it’s that early detection is the key to improving outcomes. We also know that patients are intimidated in a doctor’s office. They often forget their questions, say what they think the doctor wants to hear, and rarely remember what medications they actually take.

Now imagine that same interaction on a Sunday in the patient’s own home. The patient can grab their pill bottles as easily as the doctor can see the black mold lurking in the corner or the neighbor’s cat that is likely causing the asthma-like symptoms the patient is experiencing. Just this simple change from doctor’s office to patient’s home is transformative to healthcare for the patient, the provider and the payer alike. We know this because at Heal we have now delivered almost 20,000 house calls. During which we have reduced avoidable ER visits 62%, driven $6.32 million in healthcare cost savings for patients and their insurance companies, reduced unnecessary antibiotic prescriptions by over 40%, and most importantly, our doctors have detected over 1,100 previously unknown health issues in the patients they have seen.

Yet, there are doubters. Those mired in the dogmatic, stale thinking of the $3 trillion healthcare industry who say, “this will never work” or that house calls cannot possibly scale or make money. Worst yet, that doctors won’t want to leave the comfort of their own offices. It’s that kind of thinking that got us into a situation where our national healthcare expenditure alone is the world’s fifth largest economy, yet our healthcare outcomes are amongst the least desirable in the developed world.

Which is why, perhaps the most important change we’ve made in healthcare is this one. We have innovated software and systems that reduce operating costs over 65% compared to traditional medicine. In doing so, we have succeeded at re-humanizing medical care. Our doctors make competitive salaries while seeing 14 instead of 40 patients/day. Our insurance and enterprise partners genuinely save money. And, our patients lead happier, healthier lives.

Sure, a house call isn’t an answer to all that ails healthcare. But, it’s a start. A start that is not partisan and not politics…but rather pragmatic. A start that takes the pain points of being in healthcare and turns them on their head by counterintuitive thinking that doctors in fact achieve more good by seeing less patients. And most importantly, a start that is approaching healthcare from the mindset of those who need it, those who provide it, and those who pay for it. All at once, all equally important.