In mid-April I decided to do something I hadn't done in years: see a doctor. My cough had gotten so bad that I couldn't avoid it any longer. After work, I walked into my local urgent care center for the first time and filled out some paperwork.
About 20 minutes later, the receptionist told me the center couldn't determine whether or not it accepted my insurance. He had tried calling the provider, but its office was closed for the day. He and a physician's assistant explained that I could either get treated now and risk taking on a high bill, or go home and try all over again tomorrow.
The choice was easy for me--I wasn't about to risk paying several hundred dollars for something that could wait till morning.
Then I thought of the healthcare startup I'd been researching. Seattle-based 98point6 claims it has built a platform that could replace physician visits with text chats. Via an app, users first talk with a chatbot that asks questions and collects diagnostic info. An on-demand physician then takes over the chat, asks more questions, and ultimately makes a diagnosis. The product has been approved by regulatory bodies in 10 states, including California, New York, and Michigan, and is launching in those states May 1. The company expects to be nationwide by the end of the year.
The initial cost: $20 for the year--less than the cost of an average co-pay.
Within a few minutes of me downloading the app, a self-deprecating chatbot was asking me questions about my symptoms, and seemingly, based on the appropriate follow-ups, understanding them. A few moments later, a board-certified family physician was messaging me. He drilled down on the symptoms some more (Any wheezing? Did your inhaler help? Any fever, aches, or chills?) and then made a diagnosis: acute bronchitis. He prescribed a steroid pack, the prescription for which he wired to my local pharmacy, and sent me a care plan for treating the symptoms. The whole process, including the initial signup, took about 15 minutes.
The area of opportunity 98point6 is targeting is a big one. The U.S. population is growing at a rate faster than its number of physicians. A 2018 report from the Association of American Medical Colleges projects a shortage of up to 49,300 primary care physicians by 2030. Inefficiencies in the system--a recent study found that doctors spend half their time on record-keeping--have compounded the problem. Last year, new patients in large metro areas had an average wait time of 24 days to get an appointment.
Robbie Cape, the startup's CEO and co-founder, sees 98point6 as a useful addition to the ecosystem. "We are not looking to disrupt the healthcare industry," Cape says. "We're not looking to disrupt the primary care industry. We're looking to save primary care from where we believe it will naturally go without us."
A platform like this, he argues, would help keep healthcare costs down, since patients would be more likely to seek help before their condition required more serious care. In some cases, he says, that could have a life-saving effect: The company's research found that adding a single primary care physician to a population of 10,000 people would reduce the group's mortality rate by 5.3 percent.
"A relationship with a primary care physician is likely the most important medical relationship that an individual has," Cape says. "Forty or 50 years ago, patients and their families had this very real-time relationship with their doctor. We think we have the ability to bring back primary care to when it was immediately accessible."
A new model for care.
Building an instant, digital physician platform is no easy task. Cape--who spent 12 years at Microsoft and founded family organization company Cozi, which he eventually sold to Time Warner--co-founded the company in 2015 with former Seattle Children's Hospital surgical director Gordon Cohen. They spent the interim years stocking its staff and board with medical professionals. The platform's on-call doctors are all board-certified physicians and permanent employees of the company. Cape won't reveal how many physicians the startup has hired, though he does say it's launching with 110 employees in total. The startup has $36 million in funding, all from individual investors who he says wish to remain private.
Since each state has its own regulations regarding practicing medicine over the phone and internet, the company must make sure it meets those distinct requirements in each jurisdiction before it can launch. (New York's regulations, for example, required me as a first-time patient to have about a 30-second video call with the doctor who treated me before we hung up and continued via text.) Federal regulations don't allow for-profit companies to practice medicine directly, so 98point6 had to set up smaller corporations in each state.
The startup's goal is for its platform to serve as a substitute for essentially anything, aside from annual physicals, requiring a primary care physician visit: a cough, a persistent headache, a prescription refill. Cape says that during beta testing, the system achieved a 93 percent resolution rate.
Time will tell if the model is sustainable. Doctors don't come cheap, and the company will have to employ many of them to remain as patient-friendly as it intends: The goal, Cape says, is to never have wait times of more than 30 seconds.
The $20 annual cost, meanwhile, is sure to draw people in--it essentially pays for itself after one use--but it's too good to last. After the first year the price will jump to $120, which might be worth it for some people, but not everyone. The question will be whether 98point6 can make the calculus work in its favor. It will also have a corporate offering, though Cape declined to discuss the pricing details.
Many startups have tried to change healthcare already. Companies like Pager and Heal have created doctor-on-demand platforms for home visits. Oscar, hailed as a potential disruptor to the healthcare system when it launched in 2013, has undergone shifts to its business model and is yet to turn a profit, though it says that day is coming soon. Kiosk-based health startup HealthSpot reportedly raised more than $54 million before shutting its doors last year.
One demographic that could be the key, of course, is Millennials. Only 43 percent of Millennials use a primary care physician, according to healthcare nonprofit FAIR Health. Putting that care at their fingertips could change the dynamic dramatically.
Cape sees the company as bypassing the inefficiencies of a system burdened by regulation. "A few decades ago, when someone picked up the phone to call their primary care physician, the physician wasn't worried about how to code the phone call," Cape says. "We've seen a lot of innovations attempted in primary care, and the need to cut cost and to build process into primary care. They've made things more financially efficient, but those connections between doctors and families have really started to fall apart."
The solution, he thinks, is in a quirky chatbot--and a doctor who's just a few clicks away.