A digital medicine startup that replaces doctor visits with text messages and emails is counting on the annoyances of traditional medicine — plus those pesky copays — to drive more people to alternatives.
The startup, Sherpaa, aims to fill the coverage gaps that many cheaper insurance plans leave. It’s offered employer-based plans for several years and last month began selling membership directly to individuals. Users pay $40 a month to get constant access to their doctor group via app, email, or text. The team of five to six physicians can prescribe drugs, order lab tests, and refer patients to specialists.
The model is a hybrid between two reigning telemedicine models. There are those like Teladoc, American Well, and Doctor on Demand, which provide one-off video or phone chats but often without much continuity in who you see. And there are brick-and-mortar doctors’ offices that offer their local patients virtual visits.
Sherpaa aims to be something in the middle — a small group of doctors you return to, digitally, as needed. Its founder, Dr. Jay Parkinson, calls it “primary care 2.0.”
But telemedicine is still new, laws governing it are evolving, and few large-scale studies have been carried out to show whether it benefits patients’ health or their wallets. One study that raised some concern found that doctors who see patients online are more likely to prescribe antibiotics, though it’s unclear why. Another found significant variation in the quality of care provided at eight commercial sites offering telemedicine for ailments such as sore throat, back pain, and urinary tract infection.
Diagnosis by text
Sherpaa’s approach came in handy for Caylee Betts this year when she noticed changes in a benign breast tumor.
Normally, the 28-year-old product designer, who lives in New York would have logged onto Yelp to read reviews of specialists, trying to find one that took her insurance. “I’m sure it would have taken a long time, and I might not have gone through with it until it became more problematic,” she said.
Deciding to try something different, Betts signed up for Sherpaa through her employer. Her Sherpaa doctors made her appointments to get an ultrasound and a biopsy, and then found her a surgeon. “I would consider them to be my primary physician right now,” Betts said.
Ateev Mehrotra, an associate professor of health policy at Harvard Medical School, said he’s not too sure that’s the best way to see it.
“Usually, we’ve thought about this kind of interaction as really helpful as a supplement to seeing a doctor in person,” rather than as a substitute for a primary care doctor, he said.
Sherpaa operates exclusively via messaging. Parkinson thinks that grainy video calls, used by other telemedicine outfits, retain all the hassle of scheduling an in-person visit, but at a worse quality — he likes photos much more. Unlike other telemedicine companies, Parkinson says Sherpaa can make referrals and order lab tests. The company has 10 full-time doctors on staff.
Millions in venture funds
Parkinson has been toying with the concept of primary care since he was a resident at John Hopkins University. It was 2007, and Parkinson was living in Baltimore with many uninsured friends. He was the only doctor they knew, and they would email him with medical questions. “It happened so frequently that I thought: this has to be some sort of business,” he said.
His first practice when he moved to Brooklyn later that year was also untraditional. It was a website with his biography, cell phone number, and a Google calendar. Patients could book an appointment online and Parkinson would make a house call for $100. He would then follow up over email. In 2007, the iPhone had just come out and Google calendar was a new feature; his digital-forward method got a lot of attention. In the first month, his site got 7.5 million views from curious patients and other doctors.
Several health care-related startups later, Parkinson returned to his idea that primary care could be more accessible than it is. One day in 2012, he was telling his friend David Karp, the founder of Tumblr, that there had to be an easier way. Karp’s response: “Why don’t you try it at Tumblr?”
“That’s how Sherpaa got started,” Parkinson said. “It was essentially an email address that Tumblr employees could use. A doctor would answer them and then treat them, or arrange care for them.”
Karp is an investor in Sherpaa, which has also raised millions from several venture capital funds, as well as from wealthy individuals.
Sherpaa, which is based in New York, now serves around 150 companies. Parkinson declined to say how many individuals have signed up.
Mehrotra, the Harvard Medical School professor, said Sherpaa has the flavor of “concierge medicine,” when doctors leave traditional practice (and health insurance) and take on a smaller number of patients for a flat fee, while offering more access by phone or email.
Those services are normally fairly high-dollar. Sherpaa, while not cheap, is more affordable and may be attractive for people with high deductibles and copays.
Still, at $480 a year, Mehrotra says that Sherpaa doesn’t make sense for all people.
“I think the majority of people who don’t have an urgent medical issue that arises during the year are not going to have a cost benefit,” he said. But he said it “could be helpful” for patients with a new medical problem or a need to navigate through many specialists.
Mehrotra has studied e-visit systems that doctors use through their online portal systems. He found doctors’ history-taking to be more thorough at virtual visits than at in-person visits, perhaps because people could fill them out in advance and refer back to their own medical records. Patients were also happier with e-visits because they cut down on travel time and were more convenient.
But they did find a downside: Doctors were more likely to prescribe antibiotics online compared to in person.