This year has seen quite a few stories appear in this column that cover various telemedicine startups. This obviously makes sense because of the pandemic, but also because telemedicine is about accessibility. Covid has forced the masses to reassess how (and where) they can access services such as non-emergency medical care. As with video conferencing and working from home, telehealth is often described as en vogue largely thanks to the pandemic. While it’s true that society’s reliance on technology for daily sustenance has grown exponentially over the past two years, the truth is that doing everything remotely – in this case, getting healthcare healthcare – has been in vogue in the disability community long before coronavirus has become an ingrained part of the everyday vernacular. This is a point I’ve made several times in this column, but bears repeating. What the media likes to portray as adapting to new lifestyles is really just the status quo for the tens of millions of people (in America, at least) who identify with a disability. The pandemic has given able-bodied people a crash course in accessibility – in other words, the scramble to adapt to harsh reality in order to live is precisely what people with disabilities have been forced to do all along.
Telemedicine is particularly interesting. All of the companies featured in this space have focused on the remote aspect: one person at each end conversing with each other. It’s a concept that clearly works and is certainly beneficial for those who can’t or shouldn’t venture into a community clinic or hospital, but one crucial element is missing. The DocGo team has identified the missing piece and is working to fill the void. The company’s mission is highlighted in large, bold white letters on its website for all to see: “Where telehealth providers stop, we go. Where homebound people receive treatment on the spot, we go. Where long waits in crowded emergency rooms do more harm than good, we go. And when all reason says it can’t be done, we do what we always do, we leave.
In terms of accessibility, the key is there in the second sentence. If traditional telemedicine is accessible by preventing people at risk from leaving their homes dangerously and unnecessarily, then DocGo aspires to make it even more accessible by literally bringing telemedicine to you. This adds a dimension that the aforementioned peers of DocGo lack; telemedicine is great, but even greater is the ability to see someone and have them come to treat you.
“DocGo is the nation’s largest fully mobile healthcare provider. We believe in virtual and mobile healthcare first. Our proprietary technology allows us to deploy APNs [licensed practical nurse] and on-site paramedics, providing care under the direct televised supervision of a nurse practitioner,” DocGo President Anthony Capone said in an interview earlier this month. “Key to the successful delivery model is our open primary dispatch and patient EHR [electronic health records] system. This highly efficient, technology-driven solution, along with the lower-cost labor model, enables us to deliver high-quality healthcare. »
DocGo’s business model makes healthcare accessible in both senses of the word. Companies send their workers to places like private homes, homeless shelters, senior residences, etc. They also have buses that act as mini emergency and primary care centers. Additionally, DocGo has partnered with organizations such as the All-Inclusive Senior Care Program, commonly referred to as PACE, to provide free non-emergency care to elderly San Diego County residents. A similar program has been forged up north in association with LA Care Health Plan to serve Medicaid and Medicare beneficiaries in Los Angeles.
DocGo meets patients where they are, usually at the request of the HMO or primary caregiver. The clinician carries an iPad Pro with them on every call, on which they communicate with a nurse practitioner who guides them through the clinical portion of the visit. “The LPN has been specially trained and will use our remote diagnostic tools. These tools allow them to do a skin test, remote thumb reach, blood pressure [tests], pulse oximeters or ECGs,” Capone said. “The LPN administers all of these tests, and [those] diagnoses are transmitted live and in real time to the nurse practitioner, who monitors and interacts with the patient via video.
The majority of DocGo’s patients are Medicaid/Medicare patients, homeless people and uninsured people, according to Capone. In terms of staffing, Capone said recruiting new employees is “the bedrock of the business.” He added that DocGo has a large internal recruitment team, responsible for hiring between 2 and 500 clinicians each month. “His [recruitment] something we have to be very good at to survive because every dollar of revenue that comes into the business; every service we provide is provided by a clinician,” he said.
It is fortuitous for DocGo that Covid, miserable virus that it is, has aligned itself with the company’s mission to provide on-demand home healthcare. Between mandatory shelter-in-place orders in the early days and immunocompromised people being at risk if they leave home, the pandemic has created an even wider opening through which DocGo could fill its unique niche. DocGo recognizes this. “Our theory that we follow is that if you are sick, stay home. I think if Covid has taught us anything. It’s that if you’re sick, stay home,” he said. “Right now the model of health care is if you’re sick, go where there are other sick people. Go to an emergency department, spread it around. Our belief is that if you are sick, stay home. We will come to you.
(Capone’s view of the state of health care in this country is certainly conducive to the reality that hospitals – and their workers – have been woefully overwhelmed for the duration of the pandemic. Go where others are sick, indeed.)
In fact, the biggest feedback DocGo gets from customers, Capone told me, is that their “we’ll come to you” model saved them from going to the ER. Especially for underinsured people, spending hours sitting in an emergency room waiting room can be a hellish experience, especially financially. Financial concerns are also accessibility issues, especially for people with disabilities, and Capone said their business has saved money. More than three-quarters of respondents surveyed, “76 to 77 percent,” according to Capone, said their only other option was to go to the emergency room. Another problem is travel: according to a 2020 study New York Times report, some 8.6 million Americans live at least half an hour from the nearest emergency room. For immobile and/or immunocompromised people, distance matters; DocGo can potentially mean the difference between care and nothing at all, as getting out is literally impossible for a sizable portion of the population.
Looking to the future, DocGo is a key player in helping to revolutionize healthcare in this country. Capone believes that the revolution is not just clinical, it is also financial. They want to make access to even non-emergency medical care inclusive and, above all, affordable for everyone.
“We believe that we can reduce the cost of health care so much that we will take this financial risk. We will become the value-based care entity for all the patients we serve. I think we’re going to move a lot more outside the four fixed walls [of the hospital]virtual and mobile [care],” he said. “The pandemic has already affected us dramatically, but [the future of America’s healthcare system] moves extremely towards value-based care, where every provider providing care is in value-based care arrangements. The era of procedural billing will cease to exist; it will be the supplier who will share the risk with the [entity] who is the payer, [be it] health plan or government health plan or commercial health plan. That’s where I think it’s going, and I think we’ll be at the forefront of that.
The bottom line? DocGo thinks it delivers.
“There’s nothing out there that’s both high quality and very affordable,” Capone said. “Our model will be able to provide that or a very large portion of the population.”