The house call, once a staple of American medicine, is now typically reserved for the small set of wealthy clientele willing to pay out-of-pocket for a home visit. But a startup in New York believes that an evolving healthcare system paired with an increasingly delivery-friendly consumer may create the right environment for on-demand medicine.
“It comes down to different incentives in the overall health care industry,” said Toby Hervey, an early team member at GIlt City and Waywire, the now-sold video startup associated with New Jersey mayor Cory Booker. “For house calls, it became more economically attractive for doctors to set up offices and cram in patients to bill for services. But as we change some of those incentives, something like house calls can be more applicable.
Earlier this year, Hervey joined Oscar Salazar, an early engineer at Uber, to launch Pager, a mobile app that allows users to call on nearby doctors to stitch wounds and give flu shots in the comfort of their own home. The company believes the application could turn the house call from a bespoke service to the next iteration in an on-demand movement now-gripping the tech industry.
Hervey says that the service, which operates exclusively in New York, can put a doctor or registered nurse at the doorstep of anyone in Manhattan — with a smartphone and some spare cash — within two hours. The physicians, often employed doctors and nurses moonlighting between shifts, promise availability for a few hours at a time and Pager connects them with various clients, managing the billing, navigation even some basic supplies.
With a visit running you between $200-$300 — currently all out of pocket — the service is right now largely a luxury for New York’s gilded set. But Hervey says the company will soon support health insurance, and in doing so begin the process of expanding the house call market beyond wealthy families.
Once the company begins accepting insurance, the prospects for growth grow substantially. The idea, says Hervey, is to build a viable alternative for medical delivery that will allow an increasingly small pool of physicians in the U.S. to treat the growing number of insured Americans without straining an already over-taxed emergency and critical care infrastructure.
The project undoubtedly draws on some of the basic marketplace mechanics that Salazar, the company’s co-founder, help build into Uber. But Hervey argues sees the Uber-for-Doctors pitch as problematic, arguing that the model more closely resembles Grubhub, the food delivery services that hit public markets last years.
Most notably, the team does not want Pager to replace the existing medical institutions. Hervey says the firm is in talks with a handful of large hospitals in New York to create a partnership that could hypothetically allow medical staff to serve patients through the app. The idea is to build take advantage of remnant supply in an existing industry — not replace it altogether.
That’s both good and bad. On the one hand, a part-time model allows the company to avoid some of the labor relations issues faced by Uber by not assuming the legal and labor liability of a full-time provider. Consequently, the company can to rely on a physician’s individual coverage as well as hospital affiliation to assume the risk of a robust and complex medical malpractice industry.
But a bevy of part-time suppliers also means the company needs to manage a larger and less-dedicated pool of providers. To ensure availability, the company guarantees doctors a minimum amount of revenue per hour that they are on-call for the service. Hervey says the company plans on providing physicians with additional support including basic medical equipment and customer service.
In many ways, the company faces a much different opportunity than Grubhub or Uber. With telemedicine quickly entering mainstream practice, the company has the opportunity to offer a service that moves easily from remote and in-person fulfillment. A user could consult with a physician first via video chat, share vitals via increasingly accessible sensors and other information, and then the physician could decide whether the level of care needed by the patient.
It’s notable, in part, because building both a physical and remote marketplace is difficult. Groupon tried (and failed) to execute a similar strategy in retail with its goods division, but the complexity and cost implicit in managing an ecommerce supply chain has largely sunk the company’s profitability. A service, on the other hand, can be delivered exclusively through the existing web infrastructure to a consumer who may often end up also paying for an in-person visit as well.
More and more, these two visions of the future — the virtual world imagined by Amazon and others and the augmented one emerging with mobile — will come together.
Steven Jacobs is Street Fight’s deputy editor.