Sherpaa

Sherpaa is an online medical practice you can reach anytime and anywhere. Join today. 

[sherpaa]

A Line-by-line Analysis of a $36,000 ER Bill

Recently, a young, healthy guy went to the ER because he had a fever, a cough, and he felt terrible. He paid his $150 co-pay. A few weeks later, he got a bill for $36,000. He was responsible for ~$2,000 of that and his employer paid ~$10,000. The other $24,000 disappeared. 

This is completely normal and happens thousands and thousands of times every day in America. Confused? Here’s what happened:

He showed up at the ER. They brought him back and knew there was something going on his chest. They did the following tests:

Routine blood work looking for signs that there was some sort of viral or bacterial infection in his body and/or his blood, a blood clot in his lungs

Tests for viruses like flu, adenovirus, and other common flu-like viruses

Lyme test (just because?)

Chest X-Ray

EKG

The chest x-ray showed a mild pneumonia. He was given two common (inexpensive) IV antibiotics (Zithromax and Ceftriaxone) and normal IV saline for hydration (also inexpensive). He was watched for ~5 hours in the ER and then sent home on a course of oral antibiotics. Four ER doctors and 3 physician assistants are on record for being involved in his visit.

Two weeks later, he got the bill and sent it to me for my opinion. He’s a professional with a family and has a health insurance plan through his employer with a $1,500 deductible. Here’s the breakdown:

$36,935.27 = the total the ER billed his insurance company

$24,802.53 = the total that “wasn’t covered” by his insurance company

The “wasn’t covered” amount is the insurance company laughing at the ER for trying to bill them $24,802.53 over their contracted agreed upon reimbursement for this particular visit. However, this $36,935.27 is also the amount that the ER would charge an uninsured person to pay them for this one episode of care.

$12,132.74 = the amount that was deemed “covered” by his insurance company. This amount is what the insurance company has determined the actual bill to be shared between them and my friend.

Considering his $150 co-pay and his $1,500 contribution toward his deductible (which he blew through by stepping foot in the ER), he was responsible for his 10% co-insurance which turned out to be $1,270. So his personal final cost out of his own pocket for this treatment episode in the ER was $2,879.45. His insurance company paid $9,253.29 for this visit.

Many people have no idea how much receiving care will actually cost them out of their own pocket. They often mistake the cost of care for the co-pay amount without considering the total eventual cost of care from all the bills that will eventually come out of their bank account for that one episode.

But here’s the breakdown of the actual fair price for all the tests and medications found in this particular ER visit:

Basic Metabolic Panel: $17 Blood culture: $21 Complete Blood Count: $21 Troponin: $20 Chest X-Ray: $62 Urine Culture: $21 Respiratory Pathogen Panel by PCR: $121 D-Dimer, Qualitative: $48 Urinalysis: $6 Liver Function Panel: $17 Lyme Antibody Total: $177 EKG: $38 Ceftriaxone 1g: $8 Zithromax: $10 Cefpodoxime: $84 IV Saline: $20 Total cost of these line items from this ER visit = $643

So what about the other $11,489.74? What are those costs? They are the “facility fees” and doctor fees. As you can see, these are highly marked up. For this 5 hour stay in the ER, it was considered $2,298 per hour.

Here’s how Sherpaa would have handled this

The employee fired up Sherpaa’s app and explained the situation. We would have asked questions that led us to suspect a potential pneumonia. Based on our suspicion, we would have sent the employee to get a chest X-ray at a local imaging center, gotten the results, and prescribed an antibiotic through the app. His out-of-pocket spend would be $100 for the x-ray and then $20 for the oral antibiotics. We follow up on a daily basis with the employee to see that everything is resolving as expected.

Total cost for this episode: $270 ($150 paid for by the employer + $120 for the X-ray and medication paid for by the employee)

A $150 Sherpaa visit paid for by the employer saved the employer $10,050 and the employee $1,950.

[sherpaa]

This morning, Sherpaa launched an entirely new offering for small and medium-sized businesses.

#1: Companies can now pay for Sherpaa based on actual usage. This means each time an employee creates a medical case within Sherpaa’s app, companies are charged a flat fee. No matter how complex and long a case goes or how simple it is, it’s a flat fee. Prior to this, we were charging companies a per employee per month fee and this led to all kinds of headaches. Companies had to trust us that their employees would use Sherpaa. Then we had to spend all kinds of time and effort justifying our value. A flat rate per case eliminates this dilemma. Paying for Sherpaa based on actual usage de-risks the company. Companies can simply sign up and see what happens!

#2: It now takes less than a minute for a company to sign up for Sherpaa. You can do so here. Prior to this, selling Sherpaa was a complicated sales process. We found that companies, especially small companies, were interested in Sherpaa, yet we were not working with companies smaller than 100. Now, any company can sign up and get started implementing Sherpaa within their company in 5 minutes.

A Sherpaa case costs a company $150. Compare this to the average cost of care in traditional settings:

PCP visit: $175

Urgent Care: $350

ER visit: $2,000

When employees don’t have an access point before they get in-person care, they’re on their own trying to get their problems solved. This often results in piecemeal, expensive, paid for out of their own pocket care from urgent care centers, ERs, and random doctors. When employees have accessible doctors who can nip an issue in the bud before they spend on in-person care or direct their in-person care to exactly who and what they need, they spend their money wisely. Seventy percent of all cases created by your employees are diagnosed and treated without in-person care. Out of 100 cases diagnosed and treated by our doctors without an in-person referral, each $150 Sherpaa case prevents:

35 PCP visits at $175 each

50 urgent care visits at $350 each

15 ER visits at $2,000 each

Just considering those 15 Sherpaa visits that prevent 15 ER visits, for a $2,250 investment, you’re saving those employees $30,000. That is an unprecedented gift questionably more valuable than unlimited coffee in the office.

Here’s what this means for your company:

Based on Sherpaa’s 5 years of data, 50% of employees will use Sherpaa as their PCPs and they will create, on average, 2.5 cases per year. So, here is what you can expect per month:

10 employees = ~$150 per month 50 employees = $750 per month 100 employees = ~$1,500 per month

[sherpaa]

An Employer’s Guide: Comparing Sherpaa with One Medical

What is Sherpaa and what is One Medical?

One Medical is a traditional brick and mortar primary care practice located primarily in San Francisco and NYC that offers online scheduling and same or next day appointments. There’s a significant membership fee for individuals ($149 per year) or companies (~$40,000 for 250 employees) to join and each visit then costs employees market prices for a traditional primary care visit. Their main sources of revenue are a membership fee to individuals or companies plus traditional reimbursements from insurance companies. The more visits they do, the more revenue they generate from employees.

Sherpaa is an online medical practice powered by our full-time physicians who diagnose and treat 70% of primary care issues virtually and, for the rest, personally arrange care with local specialists or facilities. It is traditional, relationship-based primary care, just online and available 24/7 from anywhere. Our mission is to prevent the unnecessary 70% of traditional office visits, like those that happen at One Medical, to make healthcare convenient and less expensive. There’s no membership fee to join Sherpaa and our only source of revenue is a per employee per month fee only for the employees that regularly use Sherpaa. That fee covers the cost of primary care for those employees and prevents unnecessary claims.

How much does One Medical charge employers per year?

For a company of 250, it costs the employer ~$40,000 in annual fees. For a company of 150 employees, it costs ~$24,000.

What does $40,000 a year get an employer with Sherpaa?

Roughly 275 primary care visits with Sherpaa’s doctors at no cost to employees. This is enough to cover 2 visits for the 60% of employees who use Sherpaa as their primary care doctors. These 275 online primary care visits prevent ~$68,000 in costs for primary care, urgent care, and ER visits.

What does One Medical’s $40,000 a year fees get an employer?

The ability for employees to walk through One Medical’s door. It does not cover the cost of doctor visits and their add-ons. Employees must pay their own medical bills.

Should One Medical pay companies for lead generation? Yes.

One Medical has deals with brokerages and HR platforms like Sequoia and Justworks that give One Medical away for free to employees of companies that use those services. One Medical pays those companies for patient lead generation. An employer is no different. One Medical should be paying employers for their employees’ healthcare dollars. A company has employees who spend money on healthcare. One Medical wants their money. It's old-fashioned lead generation.

How much will your employees spend on traditional healthcare per year?

50% of employees spend $0 to $100

40% of employees spend $100 to $5000 or less

10% of employees spend more than $5,000 a year

Half of employees will not need a doctor in a given year. And half of your employees will use a reasonable amount of healthcare. But do they already have a primary care doctor? And are they willing to switch their care to One Medical’s doctors?

Say you have a company of 250 employees. In reality, 10-20% of them will use One Medical.

What does a $40,000 One Medical membership fee cover?

These are from the actual line items in a One Medical $40,000 proposal for a 250 person company.

#1: One Medical Membership for each eligible employee

One Medical charges employers an $11-$13 PEPM fee for all eligible employees, whether or not they use it. Companies can choose to include dependents age 14 and over. If 20% of employees use One Medical (this number is probably quite realistic), this costs you $800 per employee per year and the employee pays for each visit out of their own pocket. Compare this to the often waived $149 fee each employee would have paid if they signed up as an individual.

If x% of employees use One Medical, this is the membership cost to employers per user:

10% = $1600

20% = $800

30% = $533

40% = $400

50% = $320

60% = $266

70% = $228

80% = $200

90% = $178

100% = $160

#2: Access to high-touch primary care

Annual membership fees simply pay for access or an affiliation, not care. But in-person office care is where One Medical does a good job. It’s a well-designed traditional doctor office that offers online scheduling and same or next day appointments. That’s surely an upgrade to traditional primary care. ZocDoc also offers same and next day appointments with primary care doctors at no cost to you or your employees. One Medical also bills like a traditional doctor’s office. The more diagnoses they make, the more tests they do, the more your employees pay them. When doctors charge you more for doing more, your doctor’s economic interests are competing against yours.

#3: 24/7/365 Telehealth

This service is powered via phone or video by non-doctors for limited, simple conditions for 24/7 real-time nurseline-like care. One Medical does not charge your employees for each use of this service.

#4: Access to all offices nationally

One Medical is operating in 6 cities: 26 offices in the San Francisco area, 9 offices in NYC, 2 offices in Boston, 3 offices in LA, 3 offices in Chicago, 4 in Phoenix, and 6 in DC. If employees who use One Medical regularly travel to these cities and need medical care during normal operating hours, this could be valuable if they are within a convenient distance from one of their practices in another city. But for those remote employees who don't live or work near a One Medical practice, One Medical is irrelevant to them.

#5: Access to Women’s Health Services

These are services provided by a family practitioner or physician assistant. They are not gynecologists nor obstetricians so they will not offer services for pregnancies. Most working-age women already have a gynecologist.

#6: Travel Health Consultation

This service costs an employee $50 plus the few hundred dollars for the cost of a limited range of vaccines. Anyone can enter their itinerary here and the CDC will offer recommended vaccines to be administered in any doctor’s office.

#7: Patient Financial Navigation

There are no details to be found on any of One Medical’s materials that describe this service.

#8: Open Enrollment Communication and Support

This is an opportunity for One Medical to explain their services and attempt to drive engagement and employee revenue toward One Medical. This isn’t really a benefit to be included in an employer’s annual fees.

#9: Rise Nutritional Coaching

Rise is an app One Medical acquired that anyone can download. Your employees will need to pay a $15 to $90 a month, non-insurance reimburseable in-app purchase to use in-app nutritionist services.

And for an extra cost:

Annual on-site flu vaccination program ($18 per employee per year. Others can also visit your office to administer flu vaccines)

Annual on-site biometric screening ($60 per employee per year)

11 On site care days per year: ($25,000 per year)

Virtual-only telehealth care (an additional cost to the employer and available by request...see above for a description of their telehealth service)

Building an on-site center: Custom pricing

What is not included in your One Medical fees?

Free 24/7 physician care for your employees that prevents 70% of in-office primary care, urgent care, and ER visits from happening.

Real-time insights from a dashboard an employer can log into that shows how many employees were using One Medical services with anonymous details about actual usage. You should know at all times the value you’re getting from your investment.

How does Sherpaa add value to employers and employees?

All fees paid to Sherpaa cover the cost of our full-time, dedicated doctors’ care and expertise so it costs employees nothing to get primary care. Sixty to 70% of employees use Sherpaa each year and we prevent 70% of in-person primary care, urgent care, and ER visits your employees would have previously had to pay for out of their own pocket. And employers get a real-time dashboard to see how many of their employees are currently using Sherpaa, how many cases were created, and what types of cases.

[sherpaa]

Who should pay for primary care?

Today’s primary care is a series of one night stands from fractured silos of random providers. There’s a 22 day wait to see an experienced primary care doctor in NYC, but the future looks more like Boston’s 45 day wait. So folks turned to ERs because they were accessible. As insurance companies tried to get expensive ER overuse under control, this led to the rise of urgent care centers that were just as accessible but a bit less expensive. As every business executive knows, the more inefficient, the more expensive. Letting insurance companies pay for primary care created today’s sad state of primary care. But an accessible primary care system is the backbone of efficiency and, therefore, affordability.

So who could pay for primary care?

Insurance companies. See above.

Individuals/employees.

Employers.

Employers should pay for primary care. Here’s why.

Health insurance is a benefit meant to protect employees from financial ruin when an expensive medical issue arises. However, health insurance paying for day-to-day care, often makes employees lives harder. They’re confused by what may or may not be covered. They’re frustrated with wait times for appointments. As employers offload more of the monthly premiums to employees, they’re increasingly paying for care out of their own pocket. They hope their conditions improve on their own so they delay care until things get worse and more expensive. Meanwhile, their ability to be a good worker suffers.

Up until now, employers had no way to easily pay for scalable primary care across their workforce.

Companies have offices and remote employees scattered all over America, but healthcare systems are local. Signing deals with the best healthcare systems in each city and state is untenable. Some companies have invested in brick and mortar primary care on corporate campuses. This is fine for those employees on those campuses but irrelevant to other offices and remote employees. Also, companies shouldn’t be in the healthcare delivery business.

How much should primary care cost?

$150 per problem. Easy and crystal clear. Problems can be simple, moderate, or complex. A simple problem is a UTI treatment that takes a few minutes. A moderate problem is tweaking asthma medications throughout a person’s springtime flareup. A complex problem is arranging and organizing a team of local doctors to perform surgery on a cancer case that’s ongoing for 6 months. There will be lots of simple problems, less moderate problems, and even less complex problems. No matter what, each problem should cost the same $150 and, over the course of a year, they average out.

Why $150? Let’s look at the competition. It’s $49 for a 10 minute Doctor on Demand video visit for the very simple things like pink eye, $200 for a typical PCP visit, $300 for a typical urgent care visit, and $1,500 for a typical ER visit. Averaging all of these out in a population of normal users and each case is ~$150.

Leaving it up to insurance companies to attempt to manage your employees’ care is markedly contributing to your 12% or 20% annual cost increases.

How can new models of primary care be delivered much cheaper than traditional primary care?

Seventy percent of primary care can be delivered virtually without the cost of in-person visits the overhead from managing brick and mortar clinics. Last year, more than half of Kaiser’s patient visits were done virtually. While this is wonderful for the 7 million folks in California who have Kaiser insurance, what about the other 323 million Americans?

Primary care should be accessible anytime from anywhere, consistently acquired from the same service, and affordable. That’s where Sherpaa comes in. Sherpaa is an online primary care practice available anytime and anywhere. It’s primary care in the cloud available to all of your employees, whether on campus or remote. We charge $150 a case, no matter how simple or complex and ongoing that case is. And we make your employees happier, healthier, and more productive.

[sherpaa]

How to Spend Your Money On Healthcare

Spending thousands of dollars a year on health insurance and healthcare needs a careful strategy. You wouldn’t buy a new car or a new house without doing your best to spend wisely.

Also, having insurance doesn’t mean you have doctors when you need them. In efforts to save money, insurance companies are limiting the number of doctors available to you. And without a doctor you can easily turn to at all times who can help you figure out exactly what you need, you’ll probably overspend. Many people go to the ER because they have nowhere else to turn to. Just one unnecessary $5,000 ER visit pays for 10 years of Sherpaa’s services. Healthcare is expensive but mistakes are avoidable. Having Sherpaa helps you figure out:

Can you get diagnosed and treated online or do you need in-person care?

Can you just get a blood or imaging test and get diagnosed instead of an in-person visit?

Do you need a specialist, an internist, an ER, or an urgent care visit?

Where can I get this medication for the lowest cost?

Can I get a refill on a medication without the cost of an office visit?

How to get the most out of your insurance

Step 1: Get a high deductible plan

Step 2: Get a Health Savings Account

Step 3: Get Sherpaa

Step 4: Spend on in-person healthcare strategically and only when necessary

$1,130: Typical Savings Per Year as an Individual with Sherpaa

The Details

Sherpaa wants to ensure you spend as little of your deductible as possible. Our unlimited care membership covers the costs of treating 70% of typical primary and urgent care health issues, avoiding out-of-pocket spending on expensive in-person visits and tests. For the 30% of the time that you need in-person care, Sherpaa doctors organize in-network care for you helping you spend effectively. Most insurance plans make you spend thousands before insurance starts picking up the bills. Sherpaa is a smart layer that sits on top of any health insurance plan and helps you spend your money wisely.

Here’s how to do it:

Step 1: Choose a high deductible plan.

Use your employer, healthcare.gov, or Stride.

A higher deductible means a lower monthly premium (the typical difference is ~$50 less per month for an individual).

We recommend choosing the insurance plan with lowest monthly premium. This works best for most people.

Step 2: Get an FSA or HSA account

As an individual, you can invest $3400 pre-tax dollars per year into the FSA or HSA account (What is an HSA account?) that can be spent on healthcare, including Sherpaa. This means Sherpaa’s $40 a month fees are discounted by ~20% (pre-tax money) turning that $480 a year into ~$380 for unlimited 24/7 care.

You can get these accounts through your employer or as an individual through your bank (Bank of America, Wells Fargo, etc).

You can also invest the money in your HSA account in a service like Betterment and likely earn a return on your investment. The average return on Sherpaa’s employees’ Betterment accounts was 8% for the past year.

Step 3: Join Sherpaa: Get 24/7 doctors + financial guidance

Figuring out what you need and how much to spend is almost impossible. We’re doctors who know how to look after your health and wallet.

If you switch insurance companies, you often switch your traditional PCP. Instead, use Sherpaa as your PCP and don’t ever worry about which plan you have.

Just remember

Sherpaa never bills you for anything but our monthly membership fee. It’s unlimited 24/7 care.

If any doctor, including a Sherpaa doctor, orders tests or medications before you’ve spent your deductible, you cover the costs. If you’ve spent your entire deductible, insurance picks up the costs.

Assumptions

Average is 2.8 doctor, ER, and urgent care visits per year

Sherpaa prevents 2 out of 3 in-person visits

People get, on average, 8 prescriptions a year at an average cost of $70 a month. Sherpaa doctors prescribe medications through the app and direct you to the most cost-effective way of getting these medications.

[jayparkinsonmd]

What is unique about how Sherpaa doctors practice medicine?

You can think of Sherpaa like a corporate medical practice in the cloud. When an employee health issue arises, employees launch the app, create a case, tell us their story, answer our questions, and see their plan. When an employee has a new message from our doctors, they get an email saying they have a new message and they should go to the app to read it. Ninety-eight percent of all communications our doctors have with our patients is done via asynchronous, private messaging within our app. The other 2% is via the phone. It’s essentially secure email within our app. Needless to say, this type of communication is one everyone in the working age population is far too familiar with.

First, let’s define how this is markedly different from the traditional way of practicing.

Sherpaa is online and asynchronous vs. real-time and in-person. Traditionally, communication between doctors and patients is done in real-time in an exam room with time spent on the case dictated to the patient by the doctor. Patients must think on their feet and answer questions upon command without the luxury of contemplating the question, or looking up terms they don’t understand. Although this is how it’s always been done, it’s highly ineffective and inefficient. Granted, there is some value in in-person body language. But that is relatively rare. The vast majority of patient-physician communication is matter of fact.

Sherpaa leverages checklists when taking a history vs. not. Although most doctors are average history takers, there is risk in not having a standardized process of taking a good history from the patient. When taking a history is unstructured and not part of a formalized, repeatable process, things can get missed or you can go down a rabbit hole. At Sherpaa, when a patient reaches out to us with a chief complaint of, say, abdominal pain, all of our patients are asked the same questions, depending on their gender. We’ve created a standardized way to take an accurate, complete history. For the top 200 chief complaints, we’ve created protocols to ask the right questions— questions that rule out the serious issues but also cover all bases and lead us to the right diagnosis. This ties back in to the issue of real-time and in-person. The only way to do this is with a checklist. Essentially, Sherpaa, at almost every point in the process from history taking to treatments, utilizes the concept of a checklist. A checklist is what enables 45,000 commercial planes to take off and land every day with years in between crashes. The same should be used in healthcare to effectively take a history and treat most appropriately.

Sherpaa doctors can take a time out. Just as patients need to sit back and think about the questions being asked them, doctors sometimes need to do this too. If doctors are in an exam room with a patient trying to ask the right questions and stumble upon a situation that either stumps them or is something they don’t have a ton of experience with, how do they, in real-time, educate themselves about the best way to diagnose and treat? Remember, doctors don’t and can’t know everything. Because Sherpaa is asynchronous, our doctors can also take a time-out and read up on the condition and/or how best to diagnose and treat it. It’s extremely valuable and safe.

Sherpaa leverages all diagnostic tools, including time. Doctors have tools to make an accurate diagnosis— asking the right questions, ordering the right blood or imaging tests, conducting a skillful physical exam, and, finally, leveraging the passing of time as a diagnostic test. For example, diseases often have a relatively predictable course. Doctors sometimes say, “well, I don’t know exactly what this is now, but if we wait 12 hours and see how things develop, we’ll have a much better idea.” The problem with this is how the healthcare system isn’t set up to leverage time as a diagnostic tool. A visit separated by 12 hours is double the cost. It’s an opportunity to bill twice, when it should be simply billed once. With Sherpaa, we always have a direct communication line to the patient at all times. As doctors, if we want, we can say to the patient, “we don’t know exactly what’s going on, but with your permission, we’re going to reach back out to you in 8 hours to check in and see how you’re doing.” And, then, 8 hours later, we send a check-in message to the patient to get an update. The passing of time is a wickedly powerful diagnostic tool that doctors who practice traditional medicine simply can’t employ. If you are discharged from the ER, good luck trying to reach that same doctor 8 hours later to give them an update on your condition. So Sherpaa doctors leverage time and they also have the luxury of ordering the right lab and/or imaging tests. Every day, we send people to Quest or LabCorp to get their blood drawn or to radiology centers to get imaging. Those results are then sent back into Sherpaa’s platform and our doctors diagnose and treat accordingly. Since our doctors never see a patient in-person, we can never do a physical exam. But that’s ok for 70% of our cases. One of the four rules of practicing Sherpaa is, “if you are in any way uncomfortable, get the patient seen in-person fast.” And that happens 30% of the time.

Sherpaa treats in an evidence-based way. In the same way we’ve built 200 protocols for taking an accurate history, we’ve also built about 200 treatment protocols based on the best available evidence. You would be highly surprised to know that 90% of everything a doctor does is essentially hearsay, folklore, wisdom, and faith. There is very little scientific evidence backing up the majority of what doctors do. So we’ve taken what little evidence there is in western medicine and created protocols around them. Essentially, safety checklists again. This standardizes care and allows us to understand its efficacy by tracking outcomes. Was this treatment plan effective? What was the outcome? With an always-on direct communication line with the patient, we have the luxury of gathering outcomes and understanding how effective our treatments are. Traditional doctors don’t. Once you’re out of their office, you’re gone and it’s on you to make another appointment to update them on your outcome. That’s wrong.

Sherpaa leverages data. Since 98% of what we do is online text communication, we have access to massive amounts of analyzable data from which we can learn. Because the rest of healthcare happens verbally in real-time, that is lost data that can never be used to study and improve best practices. Sherpaa is a vast medical practice full of usable data that can be used to help us get better and better. This allows us to understand “If the patient answered yes to this one question, the diagnosis of x is 90% likely. If the patient answers yes to these 5 questions, x diagnosis is 99% likely. If the patient is treated with this treatment plan for x diagnosis, there will be a 96% cure rate.” This data-driven practice of medicine simply can’t happen anywhere else in healthcare. It can only happen because we can analyze online communication and iterate on best practices.

We’re building something that happens nowhere else in healthcare. It’s quite astounding, unique, and powerful. Once you see it in action as a doctor or as a patient, you understand how revolutionary it truly is.

[sherpaa]

If healthcare was designed for you, it’d be Sherpaa

You graduated from your pediatrician, so you’re sitting next to a 90-year old in an internist’s office. For the past few years, your relationships with random doctors have felt more like one night stands. Healthcare’s broken and backwards. It’s had decades to fix itself, but it still looks and feels too much like the DMV. And it’s out of control expensive. Your insurance premiums are $450 a month and you have to spend $5,000 out of your own pocket before insurance even kicks in. Even worse, your doctor’s ordering tests for you left and right and you’re not even told how much they’re going to cost. There goes vacation this year. It’s completely out of your control and your bank account is at their mercy.

All of you occasionally get sick or hurt. Thirty to 40% of you have ongoing problems and you need regular doctors. Things like asthma, anxiety, migraines, allergies, depression, arthritis, high blood pressure, sex issues, family, friend, and romantic relationship issues, and job stress issues. So why isn’t there a healthcare specialty that specializes in your unique issues?

And it'd be nice to have some consistency. You change jobs, move cities, change insurance companies, travel. Every time, you’re scrambling for new doctors.

If healthcare was designed around your needs, you’d see that most things don’t need to be done in person. Healthcare is just communication and problem-solving. If office visits and procedures weren’t the only way doctors got paid, you’d quickly see that 70% of healthcare communication and problem-solving could be handled virtually. You’d do everything you possibly could within an app, before you stepped it up to the inconvenient and expensive in-person visit. And when you need to spend your money, you want to know how much it’s going to cost you.

This is the vision Sherpaa has for you. We’ve had almost 5 years of a head start working with the employees of ~150 forward-thinking companies like Blue Apron, Casper, Tumblr, and Foursquare. Here’s what we’ve accomplished so far:

We’ve built primary-care-in-the-cloud powered by our team of full-time doctors and our patient-facing web, iOS, and Android apps that enable you to create cases; message with our doctors; approve or deny prescriptions, labs, and referrals; view the details of referrals to specialists and facilities; and view lab results, imaging results, and reports from specialist visits.

We’ve built a robust technological platform for our doctors allowing them to manage an entire online population of people; message with you; ask you a series of questions about your issues unique to your situation; treat you with evidence-based treatment plans; easily share with you the profiles of local specialists, urgent care centers, radiology centers, ERs, and ambulatory care centers from the proprietary network of Sherpaa-friendly resources we’ve built over the years; e-prescribe; order lab and imaging tests; receive those results; and ensure all of these online and real-world actions are accounted for and acted upon.

We’re delivering online care in 37 of the most populated states.

We’ve created a new genre of healthcare and redesigned how doctors and patients problem solve and get things done.

It’s important to have a vision. It keeps you laser-focused. But for now, purchase a high deductible plan, sign up for Sherpaa today, use Sherpaa doctors as your primary care, and join our mission to make healthcare accessible, appropriate, and affordable.

[sherpaa]

How does Sherpaa save you money?

It depends. Are you a Healthcare Spender or not? If you’re not, you’re likely pretty healthy and part of the 40% of the population that spends ~$500 or less on healthcare every year. That also means that, at any point, you can become a Spender by either getting sick or hurt. When that happens, join Sherpaa.

But 50% of people age 18-64 spend $500 to $10,000 a year on the 4 main healthcare expenses:

PCP, Specialist, Urgent Care, and ER visits

Tests

Medications

Procedures

If you’re spending this money without a strategy and without a guide who’s always thinking of your expenses, you’re going to pay more than you should and it’s likely going to be much more than the cost of a Sherpaa membership.

Sherpaa helps you spend your money wisely

The healthcare system is not set up for you to be smart with your money on your own. Sherpaa’s doctors aren’t just doctors. They’re also navigators. They’re well-versed in knowing the system, how to work it for you, how to leverage the nationwide Sherpaa-friendly network of specialists and facilities we’ve built, and how to get things done cost-effectively and efficiently. Think of Sherpaa as an online medical practice you got to first for all things healthcare. By going online first, you can work with our doctors to either be treated online (without co-pays or using your health insurance) or be strategically directed to the most appropriate and cost-effective way to get your problem solved. That’s why Sherpaa works so perfectly with most insurance plans, but especially well with high deductible plans where you have to spend the first few thousand dollars.

Doctor, Urgent Care, and ER visits

With good online and phone communication, lab and imaging tests, photos, and close follow-up, 70% of health issues are treated virtually by our doctors. This means Sherpaa avoids 70% of office, urgent care, and ER visits and the claims they generate. Also, by clearly understanding the details of the issue before you visit a doctor in-person, our doctors can determine exactly what services and which specialist you need to effectively solve your problem with as few in-person visits as possible. It’s just very efficient.

Tests

When you see a traditional doctor in-person, they order tests and effectively spend your money for you without explaining the benefits, value, and costs of the tests. MRIs and blood tests can be hundreds to thousands of dollars. We think that’s wrong. After Sherpaa doctors explain to you the value and benefits of the blood and imaging tests they order, you can approve the order in the app. You’re in control of your spend and we simply act as your expert consultants. And, again, paying cash for tests can often be far less expensive than using your insurance.

Medications

Healthcare Spenders, on average, get 8 prescriptions a year at an average cost of $70 a month. Sherpaa doctors prescribe medications through the app and direct you to the most cost-effective way of getting these medications. If it’s a medication you need that day, we can let you know you can get these medications for, say $4, at certain pharmacies. If it’s a daily medication, we can let you know how you can get this routine medication for the lowest cost by leveraging online pharmacies like Pillpack. We estimate ~20% savings in medication costs for prescriptions through Sherpaa.

Procedures

Honestly, this is the hardest one. For the most part, when you need a procedure, you need a procedure. However, some specialists have a reputation for doing more procedures than others. At Sherpaa, we believe less is more. And we also know that 6% of specialists are responsible for 60% of malpractice cases. We absolutely avoid those specialists and steer you toward those who only do procedures when it’s absolutely necessary. Paying cash can also be far less expensive than using your insurance. We’ll help you figure out what’s best for your unique situation.

[sherpaa]

The ultimate guide to how Sherpaa differs from One Medical, video visits, PCPs, retail clinics, urgent care, & ERs.

[sherpaa]

Our founder and CEO, Dr. Jay Parkinson, wrote a piece yesterday for Quartz, Do I Really Need a Primary Care Doctor?

Essentially, for 75% of Americans it’s impractical and unrealistic. We live in a mobile society where people change jobs, move to new cities, and change health insurance every few years. We ultimately need a consistent relationship with an online medical service that’s accessible no matter where you live or work or which company provides your health insurance. And that’s why we started Sherpaa— to give people an accessible doctor practice that solves real problems for people and can become your lifelong go-to for all things medical.

[sherpaa]

Sherpaa helps figure out where you start with healthcare

After less than a week of launching Sherpaa to individuals in 34 states, a pattern is emerging. First of all, people are signing up and creating a case that day. Of course, that makes sense. But we’re seeing a large cohort of people who are becoming Sherpaa members because they have something seriously wrong that’s been brewing for a month or two, they need in-depth care, but they just don’t know where to start. They don’t know who or what they need. They just know that something is very wrong. So they become a Sherpaa member and our doctors get an understanding and begin suspecting what’s going on. Naturally, because these issues are often serious, Sherpaa doctors go into care coordination mode and begin arranging care with the right surgeons and specialists to build the right team to diagnose and treat the problem as quickly as possible. Instead of being on your own, doctor shopping and being told there’s a 4 week wait to get in to see the specialist, your care team is built and doctor-to-doctor calls are made on your behalf to get you in within a day or two. And once you’ve gone to see the specialists, because our doctors were arranging the care, they are sent the specialist report and this report appears as a new file added to your case within Sherpaa’s app. I’m extremely proud of what we’ve built. It’s important and does meaningful things in people’s lives. That’s why our team loves doing what we do. It’s a whole new way of practicing medicine, but it’s something we’ve been honing for almost 5 years. I’m just happy it’s working better than expected.

[sherpaa]

Super exciting news— anyone can join Sherpaa as of today! For the past 5 years, we’ve only been  taking care of employees at companies like tumblr, Foursquare, and Casper. Now it’s for everyone!

Sherpaa is an online medical practice you can reach anytime and anywhere. Our service is as convenient as email, contained privately and securely within our app. Just subscribe, switch on our app and message with Sherpaa’s doctors. We'll diagnose, order tests, prescribe, treat, refer if we need to, and follow up until you’re all better. It's healthcare as it should be.

[jayparkinsonmd]

An entirely new genre of healthcare delivery: Always-on telehealth

For years we, and others, have struggled to describe and define Sherpaa’s healthcare delivery model. It’s not telehealth. Telehealth concepts currently in existence simply don’t go far enough. First, telehealth “visits” are transactional and typically video visits between an unknown, random doctor and patient. They are confined by a doctor-patient time slot and once the transaction is over, for further communication, you have to pay for a new time slot. But, in real life, health is an ongoing conversation with ongoing events, new updates, and needs that can’t really be forced into a time slot. Second, tele means “to or at a distance” referring to physical distance. But our doctors nor our patients feel like they are “at a distance.” As we’ve seen for years from the apps that have changed how humans communicate like Facebook, GMail, Whatsapp, Instagram, OKCupid and many, many others, online communication draws people closer and enables efficiencies. Sherpaa is also not the medical home model. It’s not an in-person brick and mortar, team-based, primary care physician-led, interaction. And finally, it’s not traditional healthcare. There are no transactional, synchronous, in-person visits within the confines of a time constraint and an exam room.

Sherpaa is an entirely new genre of healthcare delivery.

It’s not traditional healthcare. It’s not a medical home. It might be considered telehealth, but it’s telehealth on steroids and realized to its full potential.

Sherpaa healthcare delivery is:

written rather than oral

online, asynchronous and convenient

virtual when appropriate, and in-person when needed

hyperlocal

always on and omnipresent (desktop and mobile)

treatment/outcome-oriented

cost-conscious

quality-driven and checklist-based

personalized

patient-centric

transparent

powered by our team of doctors

Sherpaa is a virtual medical practice that closes the loops of healthcare and cost-effectively optimizes the health of a population. It is an online, virtual practice that functions much like the traditional, doctor-patient relationship, but instead of all the communication happening within the confines of an exam room, communication happens in a written, secure, and online format at the convenience of the patient. We take a checklist-driven history, order lab and/or radiology tests as needed, receive those results, treat appropriately, or refer you to be seen in person. Whether or not we treat you or refer you, we follow up with you to make sure you are at your best. As a patient, you can log in to your cases and see exactly what was said, view your test results, and your well-organized treatment plan.

Sherpaa is an entirely new genre of healthcare delivery and one the world has not yet seen. It is always-on telehealth. Sherpaa is the future of healthcare, delivered today.

[jayparkinsonmd]

Sherpaa does to the world what email and texting did to the phone and handwritten letters.

Prior to the invention of email, texts, and within-app messaging, we depended on things like telephones and meetings to communicate, relay messages and make decisions. Everything had to happen “synchronously.” Communication was difficult, decisions took longer to make, and execution of a strategy depended on expensive, time-consuming meetings. This was a pain, it was complex, and for the most part highly inefficient. Especially when considering that most transmission of information does not require syncing up schedules. Not everything is important enough to take to the next level and go through the challenge of expensively syncing schedules. And the kind of situation where this is needed falls into the old classic category of “you know it when you see it.” That’s why meetings are called. Or instead of texting you pick up the phone and call the person. Or instead of emailing you walk down the hall and pop your head into your coworker’s office and spend two minutes discussing something to make a decision— something that would have taken multiple email exchanges to solve. When given the option, humans have great intuition to choose the most appropriate method of communication. We’re social creatures from day one. It’s literally in our DNA to communicate efficiently and effectively.

In the last twenty years, we witnessed a huge transformation in how humans communicate. Asynchronous communication, like email and texting, is such a profound change that it’s highly likely that sociologists will eventually split the history of human communication into pre and post-synchronous communication.

And that’s why what we do at Sherpaa is such a profound change in healthcare. Ninety-eight percent of communication that happens between our doctors and patients happens via secure asynchronous messaging within our app. Only about 2% of the time do we step it up to the phone. Sherpaa does to the world what email and texting did to the phone and handwritten letters. It enables things to get done in an entirely new and efficient way. And it gives us options, both doctors and patients, to use our intuition to communicate most effectively. It’s a new era and a new genre of healthcare. One that I know will eventually change healthcare into a new epoch of opportunity.

[jayparkinsonmd]

Nice piece in Wired today: Why Telemedicine Needs to Redesign the Doctor’s Appointment. Essentially, I again make the case that video visits with doctors are essentially a bunch of nonsense. First of all, video visits with random strangers is weird and when things are weird they don’t become ingrained cultural behaviors. 

Here’s how online communication with doctors should work:

Ninety-eight percent of online communication should be asynchronous, email-like messaging within a secure app and 25% of those communications should have photos attached. When this kind of communication is inadequate, jump on the phone. This should happen about 1.5% of the time. When a doctor needs to actually visualize the movement or expression of someone, initiate a video chat. This is a very rare situation, roughly 0.5% of the time, and only applies when email, phone, and photos are inadequate. 

When consumers are involved, in the end, they always win. And they win by using the best designed solutions that jive with how they want to behave. Video visits as a thing in healthcare are a fad, because they were designed via paternalism without considering patients’ normal behaviors and expectations.

[jayparkinsonmd]

Dr. Jay Parkinson and his virtual health platform Sherpaa are quietly bringing telemedicine to the forefront of employers’ minds by providing meaningful health care with measurable results.

Hey being on the cover is always exciting. Read up to understand more of what we do at Sherpaa. 

[jayparkinsonmd]

Sherpaa vs The Others

Sherpaa doctors ask themselves two questions:

Can I diagnose and treat this issue by asking the right questions ordering the right tests, and following up with you? If I can’t, how can I best coordinate your care, refer you to the right person/place, and follow up with you?

A 12 minute office or video visit is one small snapshot in time. Health issues evolve over time requiring new updates and confirmation that you should stay the course or change strategies. You wouldn’t solve problems at work with 12 minute meetings every few weeks with your team. It’s about time we expect doctors to work with us and solve problems like we do at work and at home.