Recently, I registered with the GP across the road from my flat. I’ve lived there for a year. I had put off registering beforehand due to a severe allergy to bureaucracy. Last year, I wanted to go see a specialist. I snored at my private healthcare provider’s response that I first needed to have a consultation with my doctor… Safe to say it never happened.
‘Access’, in healthcare, tends to mean availability of care, and often comes down to the affordability of the care, and the size of the audience that have access to it. My anecdotes are obviously examples of minor friction, rather than any ‘real’ issues with access to healthcare, but in the ‘on demand’ world we live in, where easy sign-up and zero-friction on-boarding is king, access also means getting the right medical ‘product’ at the time you need it.
This is the advancement in healthcare that I’m most excited about. Products are now being delivered directly to the patient – which is preferable to leaving them at the mercy of the doctor’s calendar.
The new meaning of ‘over the counter’
In grocery stores fifty years ago, there used to be a clear divide between the consumers and the goods. Groceries could be accessed only through the shop clerk, who was the gatekeeper. It was useful to have someone from whom to advice, but over time, it became clear that it was a far better to be allowed to make their own decisions.
The same switch is now happening in healthcare. Due to the improved access to information in the ‘WebMD’ era, people often have an idea of what is wrong with them when they are ill. Also, they are generally health-conscious, and therefore keen to ensure they remain healthy today’ so they don’t become a patient tomorrow.
Due to this change in behavior and improved access to information, there is now room in the market for consumer-grade healthcare products and digital tools to ensure these products are available to large audiences, in new ways.
Those who successfully build consumer products and brands in healthcare will win big in the next few years.
The new patient pathway
So people are getting healthier: what does this mean?
In the past medical products were, almost universally, reserved for patients within the healthcare system. As these move from behind the counter to the shop floor, they are repackaged and offered immediately to those who want them.
This is happening in diagnostics and testing. Companies like Werlabs in Sweden offer detailed blood testing. In the UK, Thriva offer smaller-scale, at-home testing. Labs are already processing these samples for hospitals, so why not make their excess capacity available for consumers?
The trend continues with treatment. Companies like Dr. Ed are repackaging access to prescriptions through codifying the process into an online questionnaire, which is approved by a physician before the drugs are dispatched. Products like IESO Health are enabling patients to directly connect with therapists, with no need for referral, which is likely to provide access to mental health care to those who may not have been otherwise diagnosed.
Medical data is ripe for change. Our data is currently hidden in disparate patient records, but is becoming our own again thanks to platforms like PatientsKnowBest (full disclosure, Balderton is invested).
Digital tools are also changing how we manage diseases. Behavior change programs are being turned into products, and scaled across a previously impossible large number of patients. This is particularly powerful when tackling healthcare problems that affect a nation of people, and emanate from poor lifestyle.
OurPath in the UK (disclosure: I am a personal shareholder and advisor) and Omada Health in the US are doing great work in diabetes. Users of both can go directly to a new treatment without needing to be referred to it.
But it isn’t all moving completely outside the healthcare system. We will always need professional advice from GPs and specialists. There are a number of incredible founders working on how to transform a Doctor’s wisdom into an on-demand service.
The biggest shift is in access to primary care. Technology is removing location as a barrier by enabling patients to access doctors online, therefore reducing travel and waiting time. This is particularly exciting for remote areas that have traditionally had issues with access and costs, especially in emerging markets.
Many of these products are being built by teams with a mix of experience in healthcare and consumer products.
This is happening all over Europe – from Kry and MinDoktor in the Nordics, to PushDr. and Doctor Care Anywhere in the UK, and MesDocteurs in France. Other companies, like Meru Health and Virta Health are building light-asset specialist clinics, combining digital tools for managing specific diseases with remote consultations with physicians.
The Challenges Ahead
We should always ask ourselves this question when it comes to healthcare: do consumers really know best? When should we be allowed to choose our own treatment, and when might we be harmed by doing so? The prescription processes of online pharmacies are criticised for being too loose; and the safety of new digital therapies needs to be supported by the evidence-base, much as it as in traditional medicine.
There will also be a debate on how new products fit into the existing healthcare system. On a political and philosophical level: how do we make sure consumer healthcare – which is often (but not always) private healthcare – doesn’t eat into resources of public healthcare?
Also, when do we hand over to the traditional healthcare system for diagnosis or treatment? For example, a lot can be done in dermatology using the camera attached to your phone, but at what point do we need to be referred to a dermatologist?
Finally, the main debate is around who pays. One option is for each person to pay out-of-pocket, but to make it accessible to groups where this kind of healthcare isn’t otherwise affordable, it will need to be reimbursed by state systems, which in turn are already struggling with rising healthcare costs. Another option would be to recognise these products in insurance packages, or to convince employers to pay for their teams to be healthier.
Regardless, I’m a firm believer in digital tools and consumer-grade products, and the wonders they will work in improving access to healthcare. In particular, I can’t wait to ditch the waiting rooms and bureaucracy, and to have the healthcare system at my fingertips.