9000 People Used Our COVID Assessment — A Few Things We Learned
Healthcare access and virtual care adoption remain trivial
On March 27, we launched a virtual care program to help individuals screen, detect, and manage COVID-19 symptoms at home. In less than three weeks, 1.2 million people have gone through our resource center and over 9000 people around the world have used Mira COVID self assessment.
This experience revealed two important insights:
- COVID-19 didn’t break healthcare, it exacerbated what was there before and surfaced many things we didn’t pay attention to — the forgotten uninsured middle-class, health disparities, and the overly institutionalized system we have in U.S. healthcare.
- Building a digital health product is solving a multi-dimensioned problem. Healthcare by nature is complex and boiling it down to a straight forward digital experience requires deep industry knowledge, plus technical abilities, plus entrepreneurial resilience — an equally tough challenge for the biggest companies and the smallest of startups.
There are many similar tools, why did we do it?
While there are hundreds if not thousand quizzes, virtual care services, and a multitude of chatbots out there, one thing that I found so troubling were that the users were often left in a vacuum to wonder “what’s next” — causing fear of the unknown that could lead to much anxiety.
For many assessments, users have to spend 7 to 10 painful minutes going through a convoluted series of questions just to be told “call your doctor”.
Users sometimes have an option to get a virtual visit, while these are often low to no-cost for a selected few with great health plans, they cost north of $99 to $150 for those without insurance plus hours of wait time.
Though this recommendation is both from good intention and to limit liability, as a user, I felt like I was thrown into a constant loop of limbo.
I was troubled.
First, because there are over 30 million-plus people in this country living without health coverage — by virtue having no healthcare provider.
Second, as someone who is living in the middle of New York City with the highest likelihood of getting infected, it didn’t help me with the two things I cared most about: Should I go get tested, where? And if not, what do I do next?
72 hours, 4 people, zero budget
From the get-go, troubled by our frustrating experience, we want to build a better product to accomplish three objectives:
- An assessment tool that cuts to the chase and could be completed in 30 seconds or less.
- Instead of telling people to “talk to your doctor”, give them actionable and tactical resources. In this case, an affordable virtual care option accessible with or without insurance.
- Build a mechanism to learn from this data.
I realize that we didn’t have the money and the luxury of other VC-backed startups to run a formal design, prototype, test, build process. We had to do it as low-cost and as quick as possible.
For three days, I slept very little. With two engineers and a physician, we leveraged multiple public and private sources of information to design an easy-to-use and straight forward assessment that has a conversion rate of over 80%.
As a result, over 9000 people around the world have used Mira’s COVID Care assessment since launched.
Three things we learned
Following our north star, we wanted to use this opportunity not only to help people but also bring to light the disparities in healthcare access between the have and the have nots.
Besides questions related to the COVID-19 risk profile, we decided to also ask users whether they have insurance and where they typically seek primary care.
While these additional questions were outside of the risk scoring algorithm, it helps us better understand how accessible care is to this population, should they be at-risk for COVID-19.
By analyzing the data, we were surprised yet also alarmed by three things:
Access
One in three people has no access to a primary care provider. For those with a provider, 20% still rely on alternative sites for primary care (urgent care, ER, retail care) — indicative of a deeper access problem.
Delay care
Uninsured people are 3 times more likely to delay care vs. those with coverage (30.6% vs. 9.9%). Uninsured people are also 3.7 times more likely to use the ER for primary care.
Virtual care adoption
This is perhaps the biggest surprise, only 1.8% to 3.3% reported using virtual options (online doctor) for primary care. More uninsured people use virtual care compared to those with coverage.
We thought that because of the quarantine, more people would see virtual care as a substitute for in-person care but what we found was the complete opposite.
Many users we spoke to still wanted to be seen in-person to “get things checked out”. This is not to say that virtual care is not an effective option. Telehealth is superior to help patients manage symptoms at home instead of seeking care at the ED, but perhaps people still associate primary care with seeing the doctor in-person. Will it change, soon? I don’t know.
What’s the so-what?
I recognize we are still early in this journey and the pandemic still has months ahead to fully subside.
Overall, the results are very telling and have important implications for many stakeholders in healthcare as we are moving forward with expanding public testing and other measures.
For public health agencies, now more than ever, there are millions of people without health coverage. Relying solely on commercial insurance plans, Medicare, and Medicaid to expand access is not good enough because one of five people is now outside of the system.
For healthcare startups and providers that are thinking about pivoting completely to virtual offerings because of COVID-19. You must rethink consumer adoption from the ground up. Digital acceleration across sectors may not be the same, more people using Zoom doesn’t translate to a permanent behavior change in how people getting care — as shown by the data above.
For investors, the healthcare ecosystem is undeniably complicated, think deeply about consumer adoption and have data to back that up before pressuring portfolio companies into pivoting. In these times, making irreversible bets could be detrimental if the timing is not right. Second, you have a natural inclination for novelty and complexity, but reconsider what novelty and complexity do to healthcare costs and access. As simplicity becomes a scarcity in healthcare, what may be where the returns lie.
Making things simple in healthcare is very complicated — it is vastly under-appreciated.
