D2C Telemedicine Startups and Pandemics
As I write this from the safety of my couch, the COVID-19 / coronavirus pandemic is spreading across the US and world.
The US government has set aside half a billion dollars to try to encourage telemedicine during this crisis. Telemedicine makes a lot of sense when dealing with a communicable disease, since a doctor or physician’s assistant can help a patient with many problems without having to expose themselves (or patients in a waiting room) to other, potentially sick individuals.
The infrastructure for telemedicine has been around for a while, but in the past few years Silicon Valley and technology entrepreneurs have taken the reigns and created some pretty compelling direct-to-consumer telemedicine business models.
While many of these entrepreneurs were probably not founding their business to prepare for a global pandemic, their unique healthcare delivery models are a perfect example of how technology innovation and venture capital can produce solutions that go beyond their original intention.
The most “famous” of today’s crop of telemedicine startups began in verticals far from anything that revolves around infectious diseases. Hair loss, other sexual issues like birth control and STD testing — issues that are, on the surface, as far from COVID-19 as you can get. But there are several factors that I think make these startups important to the future of “distributed” medicine, and that will become increasingly important to the ability of countries to fight contentious diseases like COVID-19, and deal with other potential pandemics.
Reasons telemedicine startups will increasingly help deal with pandemics like COVID-19
- Infrastructure for diagnosis — The current group of telemedicine startups like Blink Health, Hims and others have developed an impressive set of remote medicine technologies. From online questionnaires to rapidly and efficiently gather a patient’s medical situation to online chat and video where remote doctors can ask questions and conduct a visit — these startups have the basic infrastructure to help consumers, where ever, whenever. An update — we are now seeing a number of telemedicine startups announcing at-home COVID-19 test kits, like Nurx, MyLab Box and Everlywell. We are excited to see these go live, and hope that the FDA allows them to proceed (and hope that they work and help patients!)
- Infrastructure for care delivery — If there is anything that Silicon Valley style startups try to do, it’s using technology to drive efficiencies. Telemedicine startups are no exception, and these companies are able to rapidly scale and deliver treatment through their telemedicine pharmacies. So patients located anywhere can have access to shipments of drugs after they get a diagnosis/prescription. This leads to our next point:
- Access in remote/rural areas — May parts of the US have critical shortages of healthcare providers, in particular primary care physicians. The infrastructure developed by VC-backed companies should lead to technologies that can be used in rural areas, increasing access to doctors.
- Willingness/adoption — Given the large amount of marketing dollars these startups are investing, more and more consumers are learning that they can see a doctor online. As the growth of these providers takes off, and as more consumers have positive experiences with online medicine, people will become more comfortable with their first call to a doctor being online. This can reduce the burden on today’s physical healthcare system, and will have several more benefits:
- Slowing the spread — Sitting in a doctor’s waiting room during a pandemic is, quite frankly, a bit scary. You don’t know if the person sitting next to you is sick with a dangerous disease; you don’t know if you are spreading that disease either! If you can meet with a doctor without leaving your house, you reduce the risk of spreading the disease.
- Triage — Telemedicine may not be able to do everything an in-person doctor’s visit can do (see our problems section below). But it is reasonable that an online doctors visit can efficiently help with the initial consultation, letting which patients know that they should go to an hospital or see a doctor in person, vs. which ones should simply take certain actions at home. This alone could dramatically free up valuable physical assets (like space in emergency rooms) and also let doctors in hospitals and other clinics have more time to focus on the people who need help “in the flesh.”
- Helping treat other conditions during a crisis — so OK, maybe erectile dysfunction isn’t quite at the same level as a highly contagious, deadly virus. But, even then, it’s not great if someone doesn’t get the care they need for a condition because the medical system is overwhelmed or because they are afraid to go to a doctor’s waiting room. This is clearly an area where the existing startups already shine. They can take on less critical cases that might not be seen; that free up time for primary care physicians to treat more urgent problems. So if your cold sores are causing you problems in the middle of a novel coronavirus outbreak, no problem! Get the help you need, keep out of the traditional medical system’s hair and stay safe on your couch.
Issues that telemedicine will have helping combat a pandemic
- Inability to physically examine a patient — This is the most obvious problem faced by telemedicine proviers. They can’t take temperatures, listen to lungs, easily look down throats, take samples. BUT, who knows, it’s totally conceivable that with the advancements in mobile technology this may not be as much of a problem in 10 years…
- Medicine delivery — Pharmacies aren’t like other technology companies that can have their workers work from home. Pharmacists and pharmacist assistants need to physically go to their “office” to fill prescriptions, prepare medicine deliveries, etc. Forcing employees to physically get together during a contagious pandemic is an obvious source of potential problems. And if your pharmacists become sick, you may not easily be able to fulfil your medicine orders (and obviously you have employees who you care about, so you don’t want them getting hurt working for you.) Hopefully medical employees and companies are more savvy than the local WeWork at using protective gear, but still, this is a source of risk.
- Diagnosis of pandemic problems — It’s unclear how much remote diagnosis has to advance for telemedicine to take over some of the diagnosis of viral infections. A remote physician can’t easily take the temperature or listen to a patient’s lungs. They can’t physically take a fluid sample. So the current crop of direct-to-consumer telemedicine startups may not be able to help directly combat the COVID-19 crisis. But, telemedicine certainly can tell a patient to go to the emergency room or make an appointment to do an in-person visit with a primary care doctor.
- Sample collection and analysis — So imagine a telemedicine provider is analyzing thousands of fluid samples per day; consumers mail the samples to a centralized lab that the startup runs. How do you keep your lab team safe if a certain percentage of the samples may have a pathogen? Obviously laboratories have infrastructure to keep samples and lab workers from contaminating each other, but still with fluid or tissue from thousands of individuals flowing through your system, this is a real source of risk. Adding in the postal infrastructure and people who collect and ship the samples is an additional source of risk — likely very small, but as the numbers increase, the potential does as well. And a centralized laboratory has the same problems as a pharmacy, in that lab employees can’t telecommute and work from home; they have to get together in the lab.
It’s a scary moment. Let’s hope that our current healthcare system is up to the task of combating COVID-19. But, thanks to these startup founders, it’s becoming easier and easier for patients to get medical advice remotely. This crisis should galvanize our enthusiasm and support of telemedicine — and once we get to the other side of COVID-19, I expect entrepreneurs and venture capitalists to find other innovative ways for consumers to improve their health without having to physically interact with the medical establishment.
My team and I write a lot about, and review, direct-to-consumer companies on Fin vs Fin, and have a particular focus on telemedicine startups. If there are other telemedicine startups that we should know about, let me know in the comments. And if you have other thesis and ideas on how technology entrepreneurs will improve the fight against pandemics leave a comment!!
