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​How Doctor On Demand tackles marketing and care access in a saturated consumer market

When we talk about health coverage, a lot of what we're really talking about is access to health services. And even with health insurance, access can be disappointing for patients. It's no secret patients get frustrated when it takes them two weeks to see a primary care physician for something as simple as a persistent sore throat.

To that end, some providers are setting up shop to ease access into the care delivery system. Retail clinics have increased in size from 130 in 2006 to almost 1,400 in 2012, resulting in a third of the nation's urban population living within a 10-minute drive of a retail clinic (though a recent study shows they don't reduce ER visits). Providers such as One Medical pride themselves on same-day appointments. At the intersection of IT and access lies companies like Doctor On Demand, which aims to provide mobile, on-demand access to physicians for sessions beginning at $49 a visit. These can help individuals with sore throats consult with a physician and then move on with their day. The company recently pushed into the mental health space, a space Doctor On Demand CEO Hill Ferguson believes is ripe for growth.

Ferguson recently sat down with Healthcare Dive to discuss Doctor On Demand and where he sees mobile care delivery heading. This interview was been lightly edited and condensed for clarity.

Healthcare Dive: Can you give a quick overview of your business?

Doctor On Demand CEO Hill Ferguson: What we're focused on in the first phase is urgent care – colds, flus, rashes, etc. People also use us for triage. It's a very easy way to get an informed professional opinion on what you should do next. It's not all about full care through a telemedicine-type connection. It's about getting a consultation with a medical doctor instantly.

We partner with a lot of large companies such as Comcast and Home Depot. Most companies that have over 800 employees self insure meaning it's cheaper for them to just pay the medical bills directly than completely outsource those to health insurer companies. When employees get sick and go into the health system, that's where the company starts paying bills. An employer has two main interests: One is health, happiness and productivity of their workforce and then cost containment without sacrificing quality. This is a very challenging thing to do. Doctor On Demand plays a key part to that because not only are we a convenient solution for employees but we also save the employer a lot of money in the process. The incentives there are strongly aligned with large employers to educate their employees on our services.

The employers usually take on the burden of this cost?

Ferguson: It depends. About half of our business is what we call direct-to-consumer (DTC). The other half is the enterprise business [where it can be] subsidized. Most land around what an office visit co-pay would be but it ranges.

There are A LOT of health apps out there. How does Doctor On Demand market itself?

Ferguson: It's about adding a new growth vector to our overall business. We're still growing triple digits in our direct-to-consumer business but it's a very different type of marketing challenge because you have consumers doing a lot of different things in their daily lives. It's much more productive if your employer educates you about us than if we as Doctor On Demand educate you about us. So there's a lot of validation that comes along with your employer. On the DTC side, we try to educate the consumers but at the end of the day they make their own assumptions about things so it's very additive to have these extra channels. We also partner with health plans – like United Healthcare – and they market us to their broad plan population so its another authority with brand recognition and awareness saying "It's OK to use these guys." Healthcare is not something you use everyday; it's not like Facebook or Twitter so you need to be aware so that when you do get sick, you think of us so that means being in a lot of different channels.

The average time it takes to see a doctor is 21 days. That's why all these urgent care clinics have popped up all over the place and private equity firms are investing millions of dollars into retail accessibility. We're like the next evolution of that. It's an order of magnitude more convenient than an urgent care clinic because it's in your pocket 24 hours a day. Our company was born in the Mobile Age so we had no technical debt, no legacy technology holding us back from having the best in class.

There is the expectation that you should be able to do everything online. Particularly in our DTC business, our audiences are skewing younger. On our enterprise business, there are more new parents, the recently married but when you look at the demographics of our users, it's pretty standard distribution. We have 70-year-olds using Doctor On Demand so I think there are misconceptions around technology adoption and usage.

As a supplement to primary care, how do you deal with health data sharing?

Ferguson: We believe a patient's data are their data so we give all the records to the patient. We encourage them to make that data exportable, shareable and encourage them to give to their primary care physician. With the state of medical records being what they are, it's hard to make that seamless so you as a patient are empowered by your data in our model but the onus is on you to give it to your doctor.

How do you integrate with the broader health ecosystem to get the most complete picture to a PCP?

Ferguson: It's a very difficult thing to do well. We're not alone in this. The whole industry is stymied by this problem. Banks learned very early that people's money belong to them and in order to share it and move it around, they created networks like the automated clearing house. That hasn't happened in healthcare and it's fundamentally because the patients data are viewed not as their property so everyone tries to "own it." If you ask any individual I think they would agree that it should be shared but no one's actually changing the standards to make that data shareable in a format that's recognized and secure it with standards. I think the problem we focus on is much bigger than that because that's what I would call a "first-world problem." Think of the people who don't have primary care physicians. Just getting them in front of a doctor is a huge victory and we've taken down so many hurdles from that happening. Even individuals insured under the ACA still aren't getting primary care. As much as you may want that to happen, the reality is we can't force that so what we can do is bring the system to them through better technology and reach them when they need us. That's the problem we're trying to solve.

Doctor On Demand recently added a mental health line to its portfolio, correct?

Ferguson: There's a huge access problem there. There are only 40,000 psychiatrists in the country; there are about a half of million psychologists but if you want to prescribe medicine you need to be a psychiatrist. I think the number of people who need mental health in this country compared to the people that actually get it is a huge gap to close. Giving people more convenient ways to access care in the privacy and security of their own home with lower barriers to access is going to help a lot of people.

Any final words?

Ferguson: I started my career in the late 90s in financial services technology and helped build the first bill payment service for Yahoo. Over the course of 15 years, everything has changed. Brands were created that didn't exist before like PayPal that created a lot of trust and safety that made people comfortable with adopting a new way of doing things. Doctor On Demand has that same opportunity. We're a brand that's trying to create trust and safety because at the end of the day, we're asking you to change your behavior at a time when you're vulnerable. I look at what we're doing and think there's no way most Americans won't be accessing the majority of their care over a connected device in the comfort of their home in five years. There's just no way that can't be that case because it's too convenient, too cost effective.

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