Illustration by Jon Reinfurt

Urgent Care Goes Uber

Doctors are making house calls again with a smartphone approach.

From 2009 to 2012, Dr. Jonathan Clarke served in the U.S. Navy as an emergency physician. He had loose orders to be in the clinic for at least half of the total hours he spent working. But that’s tough to pull off when a sailor gouges his or her forehead on the stabilizer of an F-18, or when an entire crew needs smallpox vaccinations in the field. 

“My primary job as a physician was to practice completely outside of a traditional healthcare environment,” Clarke says from his office in Dallas’ West End. “I was with them wherever they were, whether we were in a hangar or we were on deck in the desert out in California or in Arizona or we were doing an exercise in the Netherlands or Denmark.” 

When he returned stateside, his office hours at the hospital felt cramped. So, yes, Clarke practices freelance emergency medicine at busy ERs and trauma centers across Dallas-Fort Worth. But he’ll also practice at your home. Or your workplace. You can summon the 39-year-old, his two other physicians, or his seven nurse practitioners and physician assistants using the smartphone app he came up with last year, called Mend. 

The simple way to describe it is Uber for urgent care, taking the patient experience from the physician’s office to wherever the patient happens to be. But more complex is the fact that Clarke and his entrepreneurial ilk are part of a trend that will only become more prevalent as America dives deeper into a post-Affordable Care Act world. 

Companies like Mend and Plano’s PediaQ, wherein a parent can use an app to direct a nurse practitioner to wherever their sick child is, are evidence that healthcare is welcoming a more consumer-driven model. Lean, efficient upstarts are identifying gaps that can be exploited to improve convenience and transparency in the care patients receive. The giants are no longer the only game in town. 

“Entrepreneurs are looking and seeing that there’s no consumer convenience: you wait and wait and wait and your doctor isn’t in the office, or the ER wait is hours,” says Dr. David Albert, a serial entrepreneur who splits his time between Oklahoma City and San Francisco. He’s founded several companies, including Data Critical, an analytics business specializing in the critical care sector that went public in 1999 and was acquired by GE in 2001. “There is obviously an opportunity,” Albert says. 

“You could literally be the Uptown and the downtown doctor,” Clarke says. “That’s your beat.”

The core idea behind these smartphone service apps isn’t revolutionary. After all, house calls go back more than a century. Data published in the journal American Family Physician found that doctors typically performed 40 percent of their care in the patient’s home during the 1930s. Two decades later, with physicians opening their own practices in brick-and-mortar locations, that number plummeted to 10 percent. By the 1980s, it vanished: less than 1 percent of American healthcare was offered in the home. You went to them or you didn’t get care. 

In recent years, some physicians—many burned out from long hours and an ever-increasing amount of administrative work—began offering on-call concierge services to patients who could afford it. Most of those models involve monthly subscription fees (on top of now-federally mandated insurance coverage, mind you)—two-thirds of which average out to $180 a month, according to the trade publication Concierge Medicine Today. The physicians then offer discounts on services beyond primary care, such as imaging. 

For now, Mend operates on a flat per-visit scale: $50 for the first, then $199 for all future visits. Clarke has a boxy Nissan NV200 stocked with what you’d find in a primary and urgent care office. Eventually, he wants to have these dotting Dallas-Fort Worth so that each practitioner can stick to a four- to five-mile radius: “You could literally be the Uptown and downtown doctor,” he says. “That’s your beat, if you will.” 

Urgent care—or doc-in-a-box, as some say—has proven to be incredibly profitable since it arrived in the early 1970s, with most current estimates valuing the industry at around $15 billion. There are about 100 of these facilities in Dallas-Fort Worth, and most insurance plans help offset some of the out-of-pocket costs. Clarke believes his model will be more transparent and more convenient, enough so to carve into the market. After all, the patient doesn’t ever have to leave his or her home. 

The coasts have similar operations with more firepower: Uber co-founder Oscar Salazar is helping propel Pager in New York City, and California is home to the very first of these apps, known as Medicast. In DFW, the competition is a bit thinner, on its face; there’s Mend and there’s PediaQ. 

“If you look at the map of our competitors, the whole middle section of the U.S. is just wide open,” Clarke says, adding that expanding to Florida, South Carolina, and Virginia is a possibility.  

But that’s not to say challenges don’t come along with the business model. For one, Mend is still raising capital. And demand will be less certain for it than for rideshare apps like Uber. Sure, flu season could be huge for the startup. But Mend and PediaQ must not only wait for someone to get sick, but also for the patient (or, in the latter’s case, the parent) to be aware of the service. Then, they have to have the app and they have to have the cash. 

That last matter is a challenge being tackled by entrepreneurs of a different sort. Many of these smartphone apps are inherently cost- and technologically prohibitive for lower-income residents. While the push to increase access and convenience is certainly a noble goal, residents in southeast Dallas (where the U.S. Census pegs median household income at a few dollars above $15,000 annually) have just 54 physicians per 100,000 residents. The national average is 225. 

About 5 percent of the population accounts for more than half of the country’s healthcare costs. And roughly 20 percent of Americans are responsible for 80 percent of the money spent on care. These patients often suffer from chronic ailments that are left untreated, making it more costly when an emergency occurs. Access is frequently cited as a problem. 

A bigger threat to the smartphone apps and the already-established urgent care market may actually be big-box retailers. Walmart, Walgreens, and CVS are storming into the market, offering similar primary and urgent care services a couple aisles down from where a potential patient might be picking up dish detergent. MinuteClinic, based in Woonsocket, Rhode Island, is CVS’ brand of in-store clinics. They have been particularly aggressive, growing from about 500 in 2010 to an expected 1,075 by year’s end. In Texas, there are 93—45 of which will be open in DFW by the end of December. 

Much like the other companies in this space, MinuteClinic isn’t meant to replace a primary care physician (although Walmart has a strategy to do exactly that, particularly in rural communities). It’s there for when patients can’t get in to the doctor’s office, or when they need to see someone quickly to zap a cold or get a flu shot. All prices are posted on the website—most minor ailments range from $79 to $99—and the company accepts private insurance plans, Medicare, and some Medicaid plans. 

“I think, years ago, there was more of a mentality where the health system was at the center and the patient accessed the health center based on its availability,” says Dr. Nancy Gagliano, MinuteClinic’s chief medical officer and a board-certified primary care physician. “Consumers are becoming more expecting of their needs being met, so they are particularly interested in being able to have a little more control over when they get seen.” 

Clarke, meanwhile, is already expanding his business model. He’s contacting businesses here to offer a couple of Mend visits a year to their employees for a small fee. To boost the company’s reputation among this group, he’s says he’s inked a deal with a major health system. However, in late August, the company  still wanted to keep the announcement and details under lock and key until funding closes. So, as of this writing, the “who” in the equation is a mystery. But, Clarke says, the system is “one of the larger organizations here in North Texas” and is looking to expand its services beyond the confines of a hospital. 

“This is the first such partnership with a mobile on-demand healthcare delivery service in the country,” he adds. “To my knowledge, none of our other competitors have this sort of partnership.”

This is a promising lane for startups like Mend and PediaQ. Getting that type of co-sign would likely mean access to an established network of patients and physicians and mid-level providers, depending on the agreement they work out. 

For hospital systems, building consumer-friendly technology can be a capital-heavy expenditure. Partnering saves time and resources and gets this not-so-futuristic model into more palms. If these strategies catch on, you’ll be associating healthcare with your phone and grocer just as you do with the magazines you read in your doctor’s office.   

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