i3 | May 18, 2020

Doctor On Demand's Hill Ferguson

The coronavirus has spread rapidly across the world. Because of the highly contagious nature of COVID-19, both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are recommending telemedicine as a safe alternative to an in-person doctor visit, to help halt the disease.

But telemedicine is also at the forefront of a massive shift in health care toward greater efficiency and cost reduction. Doctor on Demand, a privately held company founded in 2012, is one of the leaders in this space. The virtual care company, offers on-demand and scheduled visits with U.S.-licensed primary care physicians, psychiatrists and psychologists via a smartphone, tablet or computer. Its telehealth offerings include preventive health, chronic care management, urgent care and behavioral health.

A nationwide shortage of physicians and seniors who wish to remain at home as they age are two trends also driving telemedicine. Not having to travel to see a doctor can be a lifesaver for physically fragile patients and those that are disabled. And, tech improvements have made it easier, faster and more efficient to provide end-to-end medical care via audio or video chat with physicians.

Doctor On Demand is available 24/7 — nights, weekends and holidays. Patients can be seen for 90% of the conditions usually treated in an ER or urgent care setting, or address mental health issues such as anxiety, fear or depression. The company’s new health plan, partnering with Humana, is called On Hand and enables members to see a primar y care doctor at home, the office or in the car — wher ever they may be. Doctor on Demand acts as a concierge, organizing imaging, MRIs, x-rays and whatever follow up is needed. About 92% of cases can be r esolved over the web, the remaining 8% are referred to specialists for serious medical conditions, giving patients access to the best care possible and helping to avoid misdiagnoses.

Telemedicine is also making health care accessible to all consumers, not just those with employer-provided plans. Doctor on Demand can connect anyone — with or without insurance — to physicians, saving valuable time and money. The company, based in San Francisco, also has offices in Minneapolis and Washington D.C.

Leading this innovative company is CEO Hill Ferguson, a former senior executive at PayPal, the worldwide online payments system that supports online money transfers, and prior VP of product and marketing at Zong, a mobile payment solutions provider. He has experience leading companies at every stage of growth, from founding a company to serving as a senior executive in a high-growth public company. He shared his insights on the rise of telemedicine with i3 recently.

How is telemedicine being used in the context of COVID-19? How much has your workload increased?

The COVID-19 outbreak is driving much more broad-scale awareness for the benefits of virtual care. This is the first time we’ve seen telemedicine recommended as a first line of care by government officials, including the President of the United States, the CDC, HHS, health plans and employers. This recommendation was made to help slow the spread of COVID-19 nationwide, and we have been proud to serve this public health role while lessening the burden on the health care system.

Our team mobilized quickly and coordinated closely with the CDC to help with preparation, surveillance, triage and treatment of patients with suspected COVID-19. What we ended up seeing was an increase in visits from patients with not only coronavirus concerns, but those with acute and chronic conditions who opted to seek care at home to prevent potential exposure to illness at an in-person visit. In March, we saw 110% more demand than we had seen the month prior when the outbreak had just begun. We also saw an uptick in our behavioral health services as many patients looked for at-home options for mental health concerns. In response to the rapid increases in demand, we brought on hundreds of additional licensed physicians, psychologists and psychiatrists to provide care. We also continued to make platform enhancements to ensure the best possible patient experience for the thousands of Americans who turn to virtual care each day.

How does telemedicine bridge the gap between patients, doctors and hospitals using virtual channels?

There are many factors that inhibit patient access to quality health care — from high costs to being unable to take time off from work to not wanting to wait at a doctor’s office with other sick people. Doctor On Demand helps break down financial and geographical barriers to improve access to care. No matter where a patient is located in the U.S. or what time of day it is, they’re able to connect with a provider. Similarly, doctors can extend the reach of their care beyond their immediate area to help more patients.

One gap in the health care system that we have been laser focused on bridging virtually is primary care. Studies have found that access to primary care improves patient health outcomes and reduces costs to both the patient and the health care system (it is estimated that the health care system would save $67 billion a year if everyone saw a PCP for care first). Yet, nearly 30% of American adults don’t have a primary care physician and it takes an average of 24 days to schedule a new patient appointment in 15 of the largest cities. We have developed a platform and model to deliver comprehensive virtual primary care, with integrated behavioral health, to reach this population.

We will continue to see innovative virtual care solutions that bridge the gap between patients and doctors. Moreover, I believe we’ll see solutions that have comprehensive offerings and will be more deeply embedded in the health care system.

How does Doctor On Demand work? How does a typical teleconsultation go?

Doctor On Demand connects patients to licensed health care providers for “virtual visits” in all 50 states, 24/7. Our urgent care and behavioral health services are available to patients through health plans, employers and directly to consumers. Patients simply access Doctor On Demand through our app or website. We also o er a fully integrated health care platform called Synapse which allows health plans and employers to deliver comprehensive virtual primary care to their populations.

At Doctor On Demand, our video-first approach to care puts patients face-to-face with a doctor within minutes. A video visit is really similar to an in-person experience. The doctor will review patient history, assess their symptoms, provide a treatment plan and when needed, write prescriptions. Since the doctor can see the patient, they’re able to deliver the highest clinical quality while also developing a trusted doctor-patient relationship. We find that patients enjoy the convenience and quality of their first visit and will often opt to use virtual care again.

What are the limitations of telemedicine?

While people are often surprised by the versatility of telemedicine to triage and treat many concerns, there are still physical (i.e. suturing, resetting bones) and regulatory limitations to what a telemedicine provider can deliver. At Doctor On Demand, we believe in a video-based care model so that doctors can treat patients based on visual cues as well as the concerns the patient is voicing. During the COVID-19 outbreak, we have seen many telemedicine regulation changes which validate the quality and effectiveness of video-based care. For instance, Medicare policy changes are giving patients and their families greater assurance there won’t be any gaps in accessing care while they’re home. CMS has also updated their guidance for risk adjustment to include diagnoses resulting from telehealth appointments, which include real-time video telecommunications. These changes mean that more patients can access providers on-demand than ever before.

We will continue to see innovative virtual care solutions that bridge the gap between patients and doctors.

Hill Ferguson CEO, Doctor On Demand

What is the cost of a virtual visit at Doctor On Demand?

While insurance isn’t required for Doctor On Demand, tens of millions of Americans have access to covered medical and behavioral health visits. If your health plan or employer contracts with Doctor On Demand, you as a patient will have access to our service for a substantial discount, often for a small out-of-pocket co-payment. During the COVID-19 crisis, most plans and employers have fully subsidized the cost of our medical services, making it free for their plan members or employees. Without insurance, the cost of a medical visit is $75 and our mental health services start at $129.

How are consumers new to telemedicine reacting?

We are seeing thousands of new patients each day as people in all 50 states look to virtual care as an option to stay safe and healthy. Patients are continuing to rate their experience 4.9 out of 5 stars and are delighted by the convenience and the quality of care they receive with Doctor On Demand. Once patients have that initial experience, we find that they return to use virtual care again and again.

How does telemedicine minimize risk to health care workers and slow the transmission of disease?

There has been a high-level awareness about the importance of maintaining distance between people to prevent the spread of illness during the COVID-19 outbreak. To drive this effort, we have seen broad scale advisories to stay home, with 95% of the country under shelter in place orders. However, people still need care — for COVID-19 concerns as well as acute, chronic and mental health conditions. By turning to telemedicine, those who are sick can prevent spreading infection, and those who are not sick can stay home and prevent exposure to illness. This helps keep frontline workers safe by minimizing their exposure.

Is Doctor On Demand’s platform easy for the elderly to navigate?

Definitely. We’ve designed our platform to be straightforward and user friendly from the registration process to the face-to-face appointment with a doctor. We have tens of thousands of seniors using our service today.

With telemedicine technologies in place, can quarantined providers continue to see patients via remote feeds?

We’re proud to provide a platform for doctors to practice and provide care in a safe environment. Telemedicine makes continuing to practice an option for providers who are quarantined but otherwise healthy.

Is access to broadband an issue?

While access to the internet is necessary for face-to-face virtual care, we’re pleased to see many internet services maintaining bandwidth and rates during the COVID-19 outbreak.

Is AI being used in telemedicine to assess, diagnose or treat?

We use AI/ML in various parts of our system to enhance the user experience, to automate some of the provider workflows and to improve our ability to do insurance claims-based billing and settlement.

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