Technodoc Jay Parkinson Says Hello to Franchising
A virtual primary care practice started growing in Brooklyn last fall.
Jay Parkinson, a freshly minted physician, decided he had a better idea for caring for the under-40 crowd in neighborhoods not far from Health Blog HQ. He combined a pre-paid model (no insurance hassles, please) with housecalls and oodles of online support, which he told us about in an interview with us last September.
He’s still seeing patients the newfangled way. But he’s changed course a bit, joining Myca, a technology company in Canada, to produce what he calls a Facebook-like software platform for doctors to manage their practices. He’s also looking to take his care concept and the new technology to doctors nationally through a franchise branded as Hello Health. (You can watching the video for an overview and read a recent profile of Parkinson here.)
Parkinson has become something of an evangelist for bringing the power and coolness of the Internet to internal medicine. Today, he’s speaking on “The Healthcare Consumer Fallacy” to IT and health gurus at a meeting put on by the Healthcare Information and Management Systems Society.
We caught up with Parkinson by IM recently. Here’s the conversation, edited just a bit for length and clarity.
WSJ Health Blog: Jay, last we talked with you, you were just starting off on an experiment in delivering primary care. Can you tell us how it’s been going?
jayparkinsonmd: It’s been going better than I ever expected. Without having any sort of referral system in place except “hanging my shingle” as a website, I amassed about 300 patients in 3 months. Everything was going very well except one thing — all of the free pieces of technology I was using weren’t communicating and it was starting to become very frustrating and inefficient. I knew I needed a unified, seamless platform to make this scale.
WSJ Health Blog: So what changes are you making?
jayparkinsonmd: In mid-December, a video news story was on the front page of Yahoo for most of one day. I got about 200 emails an hour from people all over the nation either thanking me, providing encouragement, or asking if I could be their doctor. One of them was a gentleman from Quebec City — Nat Findlay. He basically just said, “We need to talk.”
He flew down the next day and we met for about three hours. Nat was in the process of retiring from Cardinal Health after selling a company he started to Cardinal about 5 years prior. He was looking to start a new company — one that focused on connecting doctors and patients.
During our first meeting, I told him of my vision to create a Facebook-like platform that connects doctors with their patients that also had some sort of EMR functionality to it to keep records. It’s evolved tremendously since then, and I’ve taken a position as Chief Medical Officer/Imagineer with Myca to build this technology and create and roll out Hello Health.
We currently have about 15 developers in Quebec cranking out code for the technology. However, selling this sort of technology to the traditional healthcare system is a losing battle so we’re creating a healthcare delivery system focused on consumers who either want or need to pay for affordable primary care who also want to use Internet communication to make their lives less complicated.
WSJ Health Blog: What sort of stuff is in the works?
jayparkinsonmd: Think Facebook, very effective data visualizations to view your patient’s medical information, iGoogle-like or Apple Dashboard-like browser “widgets” to customize your interface based on function, interface, and workflow.
WSJ Health Blog: Do you still see patients, and, if so, are you seeing them “office-less”?
jayparkinsonmd: I am currently officially not accepting new patients but continue to manage the initial 300. However, when I am in town I will see new patients on a case-by-case basis. I am definitely still seeing them “office-less.” However, the first Hello Health will be located in Williamsburg in Brooklyn on Berry and N. 8th St. It’s a 600 square foot street-level storefront that has two exam rooms. We’ll be doing about 80% of our visits in the patients’ homes, but meet patients at the “store” for those exams and procedures that aren’t appropriate for your home.
WSJ Health Blog: So to be clear, Hello Health is Jay Parkinson 2.0? A medical practice that’s technologically enabled but that also has some of the more customary trappings, like an office?
jayparkinsonmd: Hello Health is a neighborhood-based, Internet-enabled practice that sees you in person and communicates with you over the Internet. Patients become members for a Netflix-priced monthly fee and then pay fee for service. In-person visits, whether house call or in-office, will range from $75 to $150 cash. We will submit your claim to your insurance for you so you can be reimbursed but you pay cash up front.
It’s interesting to note that half of my 300 patients have insurance. Only two have filed for reimbursement — it’s the rebate concept. How many people send in those $50 rebates? It’s quite low because it’s just so painful to deal with the rebates just as it’s painful to deal with insurance companies. I offer low-cost, convenient, valuable visits and people simply pay cash.
WSJ Health Blog: Will Hello Health be a franchise arrangement then?
jayparkinsonmd: Yes, it will. Very much like Chik-fil-A. When Chik-fil-A opens a new restaurant, they announce their intentions and receive hundreds of applications for manager/operator.
They have a strict process to choose the very best one. They get so many applications because they guarantee something like a base salary of $30,000. However, they profit-share with them 50/50 and the manager can then make up to $300,000 a year. We’ll do the same with our doctors.
First, we’ll interview those doctors we think will embody the brand (and keep in mind, it’s going to be Dr. Smith, powered by Hello Health). Docs don’t have to become a brand. They retain their identity of course. Second, we’ll profit-share with them in both the monthly subscription fees and the episodic fees. Essentially docs have to only come up with a few thousand dollars as a “down payment” to become Hello Health doctors, but after this, they get VW and Virgin Airlines level marketing and the advertising to announce their services. In the end, they end up making over double the traditional PCP salary. It’s a win/win for docs, patients, and us.
WSJ Health Blog: A couple of last questions on the experience with your solo venture. Last fall a fair number of commenters to our post about you were skeptical about the technology and whether HIPAA privacy rules would be a problem for you? Was it?
jayparkinsonmd: HIPAA was my last concern. No, it wasn’t a problem, especially since my patients were aware of the unsecure kinds of communication we were using because I made them aware of this. Of course, people don’t care about the vast, vast majority of this. They’d rather choose convenience over privacy regarding their asthma for instance. Also, since HIPAA is a completely unenforced law, I wasn’t concerned.
WSJ Health Blog: Finally, was the original practice financially viable for you? I think the original goal was to pull in about 1,000 patients. Sounds like you got to 300 and then switched gears.
jayparkinsonmd: The original practice was on it’s way to becoming financially viable. Definitely. However, it was also getting to be a pain in the butt because I had to use 5 or 6 different applications and a few different websites to practice this way.
I switched gears because I recognized an opportunity to have the very, very talented resources to build a platform and brand that will enable other doctors to be entrepreneurs like myself. I would have been doing my profession and patients all across the nation a disservice had I not taken this opportunity.
Primary care docs are getting horribly squeezed by the reimbursement policies and the middlemen. And patients are paying the price.
People want accessible doctors. And they’ll pay for accessibility if they receive superior customer service for a very fair price. Doctors want to be good doctors. They don’t want to focus on volume. That’s not what they bought into on the first day of medical school. Hello Health will serve as a magnet for those doctors who want to practice good medicine and those people who want to pay a fair price for exceptional, accessible doctors who communicate the way we all communicate these days.
WSJ Health Blog: Thanks, Jay. Keep us posted.
jayparkinsonmd: Will do. It’s fascinating stuff.
Correction: The initial version of this post incorrectly said Parkinson is an internist. He’s a physician trained in pediatrics and preventive medicine.
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Best wishes.
If more physicians catered directly to their patients needs, bypassing the insurance industry altogether, the Heath Care would be a lot healthier!
Patients trying unsuccessfully to get reimbursement from their insurance companies will soon realize that being insured for day-to-day care is unnecessary and saving money on premiums by purchasing a high deductible insurance policy that protects one from major accidents and illnesses frees up enough money that can be used to cover day-to-day care purchased any way the patient wants! Less expensive insurance, no hassle personal/ internet based health care with no billing or insurance hassles; seems like a no brainer to me!
Do you really believe that insurers are going to walk away or that patients are going to pay cash for services? Not in my or your lifetime!
Jay in many ways is the latest gadfly who will revolutionize health care, we have been here before and will be again. Until there is a total health “system” reform not much is going to change.
Excellent plan! Get rid of that prepaid insurance and save the money for real ‘healthcare’ -Meaning a doctor who has the time, knowledge and desire to keep you healthy. This is going to up the quality of our care and empower us as individuals to make the right choices about or health.
Everyone wants a connected practice. His enthusiasm for yahoo/IM is infectious. But the statement that he’s not concerned about HIPAA because it’s unenforced is disturbing. These laws are meant to protect patients. Hello Health will not survive their 1st day if that their CMO’s attitute reg a federal law.
come back to reality…I agree. People won’t pay for healthcare in its current state. Just like I wouldn’t pay for an Apple computer if I had to sit on a bench and wait for 4 hours reading magazines from 1998. Luckily, Apple doesn’t do this and has figured out that people pay for service especially if its convenient, accessible, and something they value. As I hope you know, doctors are paid for volume, not for providing the consumer experience. We’ve fixed that problem and created a business model that actually pays docs for keeping people well rather than only when they get sick. But please just sit back and watch. You might be pleasantly surprised.
Hmmmm…lack of concern about privacy issues is very disturbing. Best re-frame your POV and huddle up with your general counsel.
Dear Jay:
I wish you well on your endeavor, however I believe as many before you, will be short lived, if it gets off the ground; 300 patients will not sustain a medical practice nor allow you to repay student loans. The American public has been raised to expect a low copay in return for questionable service, good luck changing a mindset and the on-coming if even marginally successful the battlefront the big payers (insurers)will bring to bear. Also as others have stated your complete disregard for HIPAA regs is disturbing and also raises significant questions on the sustainability of the model along with the questionable value of “seeing” patients via the internet. Who take the liability if/when you make a mistake and treat something that you believe is insufficient when it is not?
Actually, from past experience, it appears that many people would prefer to wait on a bench for 4 hours. Not everyone, but many more than you think.
The HIPAA thing is one of those bad issues where, while Jay may be right, the law may not be on his side. All you need is the wrong set of circumstances (cranky patient, assistant attorney general looking for a name or just annoyed that federal insurance may not pick up Jay’s tab) and you could be in a whole heap of trouble for no good reason.
“Who take the liability if/when you make a mistake and treat something that you believe is insufficient when it is not?”
This issue will always subsist, even if you always see a patient. There is a time and a place for this type of technology, as there is for a phone call to a physician.
I’d say good luck to him, but don’t lose sight of some real boundaries that exist.
One more quick thought… wouldn’t facilitating people being, at least, reimbursed by their insurance company be better service?
As far as HIPAA is concerned, I suggest people go back and read my statement. I first prefaced this with the fact that I counseled my patients about the fact that gmail was not secure. They were aware and agreed to communicate with me in this way and therefore HIPAA was not violated. If I didnt care about federal laws I wouldn’t have counseled them in the first place.
This is completely irrelevant at this time because the Myca platform is 100% HIPAA compliant and I no longer have to communicate with patients via gmail. We’ve solved the problem and therein of course proves my respect for HIPAA and patient privacy. As a matter of fact, once anyone sees the Hello Health interface and the steps you have to go through to access your medical information, you’ll fully understand my respect for patient privacy. Its much much deeper in the interface than Google Health and also requires multiple passwords to access it. If anyone wants detailed security information on our platform please don’t hesitate to contact me.
What a bunch of baloney. The patients that really need an internist are the over 40 crowd and the more sickly younger ones. It is interesting that he has picked the under 40 patient demographic……………the hypochondriac who need little else but reassurance and OTC remedies.
Medicine is in the end at its core about the strength of the doctor patient relationship. The rest of the gadgets, technologies, systems, structures, ancillaries etc are our servants and not our masters. Technology likewise is a tool not some grand new platform to revolutionize anything. This all reminds me of the hoopla around the dot com bubble days, when every domain name was launched as a company and valued at billions and we were told that the “old rules don’t matter any more”. All while the grand old master Warren Buffet was laughing all the way to the bank.
Garth…definitely. We’re building the technology from the ground up. We had to prioritize our features. Submitting claims for our members will be in the next version of our platform that will be released in a few months.
many have interpreted hipaa’s email provision as not being conditional on patient acceptance. i agree with you that its dumb, but lots of laws are.
This reminds me of all the dot com startups that had completely non-viable business plans. They’ve all bitten the dust. Apparently healthcare will be the last hurrah for them? If there is one thing that is non-fungible, it’s a doctor doing a physical exam on you. That’s hard to do by IM chat. Your ‘medical home’ doesn’t exist in cyberspace. If someone is vomiting blood, and having crushing substernal pain, I doubt Jay and his Chick-fil-A franchisees will be there for you.
“RealDoc”…thank you for your opinion. However, you are confused about what we do and how we communicate with our members. Accessible communication via the internet combined with physical exams in your home or our office is what we do…and if someone contacts us complaining of vomiting blood, we’re excellent doctors, we handle it just like you would handle it…the only difference being that we’re accessible by the internet as well as in person — and I would wager a fair bit of money that you nor your traditionalist colleagues are as accessible as us. It’s not your fault. You don’t get paid for accessibility. You play by the system’s rules and only get paid for volume. We, on the other hand, get paid for accessibility. And consumers happen to like accessible doctors when they have crushing substernal pain or they’re vomiting blood. In fact, they’ll even pay a reasonable price for it! Ask one and they’ll tell you something along these lines — “I like an accessible doctor who I can communicate normally with when I’m vomiting blood.” I also realize you are a physician and don’t really use the internet to communicate very much. However, step out of that world into the real world and you’ll see that people are using the internet to communicate — and that’s why I call the way we communicate “normal.”
Jay, you lose your wager. Since your experience with a real medical practice seems to be both limited and outdated, you are understandably confused about what a medical office does in 2008. I just filled 8 prescriptions, via SureScripts, and it is after midnight. Our patients look up their lab results, schedule appts, request refills, ask questions … all online, and have been doing that for quite a while. We get paid for web encounters ALREADY. Covered by insurance to boot. We take insurance, how bout you? We go to the ER and to the hospital. So what exactly to you do? It sounds like we have you outgunned, even before you start you franchise. IMHO, Myca should have chosen somebody with more experience.
Good luck with your endeavor. I would note that Dr. Parkinson’s comment “We’ve fixed that problem and created a business model that actually pays docs for keeping people well rather than only when they get sick” is hardly an innovation. This is what started the healthcare system Kaiser Permanente; the concept of prepayment and focus on prevention to keep people healthy.
Davis Liu, M.D.
Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
http://www.davisliumd.com
I think a few business lessons are in order. The first thing Chik-Fil-A did was to prove their business model by making money and showing that the process was highly repeatable. As far as we can tell this Hipster Doctor is up to his neck in debt and his business isn’t making profits.
Saying that he does seem very capable of ripping off 300 patients by charging them for a 24×7 Doctor Concierge service despite being out of town half the time. But i doubt this is repeatable by other self respecting Doctors.
I think Dr. Parkinson’s approach is the right combination of ‘high tech + high touch’. His practice, as many may think, is NOT 100% virtual. He uses a technology-enabled office of the future to interact with his patients. In the end he is practicing old century medicine with house calls and use technology to connect with patients in between house calls. What’s wrong about that?
realdoc….That’s excellent. Well done. You are a rare doctor in that you’ve embraced the internet in such a way. The vast, vast majority of docs haven’t. So keep it up. It looks like we’re fighting the same fight then eh? As far as finding someone with more experience, don’t worry we’ve got that covered. We’ll make the announcement very shortly about someone very important in the healthcare industry who has joined our team. Also, another very major aspect of what we’re doing is developing the technology to make your job much easier to do what you and what we do. Good luck.
“…it appears that many people would prefer to wait on a bench for 4 hours.”
of course they would, because that’s their only available option. there was a time when people communicated only by pony express, because it was the only means available. but we’ve since found better, faster, more efficient, more enjoyable solutions. i wish all the “real docs” out there were brave enough to have the vision that jay has, then we might all be able to bring about real change together instead of just waiting passively for the industry to miraculously change itself.
ReadDoc and Dr. Liu are correct. Congratulations to Dr. Parkinson on his endeavor in any case, although it is clear that he has no idea what he is doing. Have not checked out Myca yet, but modeling a medical service on a social-network site does not strike me as an effective model, particularly when there are already better models such as that described by RealDoc.
At least he is trying something different and willing to stick his neck out in doing so, so all the more power to him. Franchising the concept is untenable and a bad idea however. Wasted effort and will never work.
He is NOT an internist! He is a PEDIATRICIAN!
That’s true. I’m trained in pediatrics and preventive medicine. My partner is trained in internal medicine.
I will some day be opening up a practice that details a significant amount of housecalls and technology. As a student I am essentially JP’s future market he wishes to recruit. Well, I for one will not join any franchise. As a primary care physician, the doctor is the name. You sink and swim by your own name and standing in the community even when part of a group. Your name is the limiting factor. A franchise simply serves to be another parasite just like the insurance companies he is trying to eschew, once again cutting into the physician salary. I for one would rather be dirt poor building my own practice knowing my wage is my wage. I have been contemplating the EMR I would use myself, and the one thing I have noticed is they are slow and fit the form to the patient and not the other way around. I could punch out a more detailed, true to the patient record by typing on microsoft word then hunting for check boxes with my mouse. Since I won’t be dealing with the BS that is insurance or medicare I have no reason to use an EMR for their main function - up coding for the shell game constructed by CMS and insurance. I’ve yet to see an EMR I like.
why do the old fogey docs have to hate on this young doc who has good ideas and beleives he should be paid cash for his services(gasp!)? Maybe if the older docs had taken care of their bottom line in the past, the insurance reimbursement game wouldn’t have gotten to where it is right now. The problem is that older docs are afraid, afraid that people won’t spend 100 bucks outta pocket to come see them, so instead they contract with insurance companies so when patients come to them, they see little or no cost and the physician can squeeze a measly 30 bucks from the insurance company. Its time to change this game, and those patient-comers with 100 bucks to spend on quality time with a physician will win out, those that refuse to pay copays or retainer fees will get to see caribean trained mds or do’s. take it or leave it
Jay - as an insured non-hypochondriac brooklynite, I love your model, willingness to empower your patients to manage their care without the influence of anyone but a doctor and your photography is pretty good too. In all seriousness, as someone who has worked in healthcare IT this field will not being going away and congrats to you for helping pioneer this trail. Good Luck to you and Hello Health, I hope to use the service in the future!!
another med student,
Why are you labeling older physicians as old fogeys? Be respectful of our attendings. Complete blame can’t be placed on them. They are not afraid. Who do you think kicked off the movement for direct access medicine? Use your mind and think! I am an osteopathic student and will be using my OMM in practice. I choose to be osteopathic physician to learn these skills. People do seek out our services. Also, do not be so quick to judge the capabilities of a physician by his degree or medical school. No school or physician degree has a monopoly on quality. Again, think.
A recent in-depth profile in MDNG broke ground on this story and is a good read for additional background on Parkinson’s practice model. You can find the full-text article at http://www.mdnglive.com/articles/PC_Jay_Parkinson_Sells_Out, where you can also register for free and start an interactive dialog.
med student: For EMRs systems, look at the eClinicalWorks system which is the current standard bearer for quality, relatively low cost and comprehensiveness. E-mds is another excellent system. A cheap and good system for smaller practices is AmazingCharts. Healthmatics is more expensive that it should be but is a good system. iMedica another good system. OpenEMR is an good open-source system. There are many out there.
Calling older physicians old fogies is not helpful. They are what they are. Luddites unquestionably, but the Luddites had good reason to be what they were. It make take a generational change in providers to achieve acceptance of computer technology, simply because human beings are human beings and therefore very limited in their ability to change in advances age. Physicians are different in this regard than anyone else.
All of these comments are fascinating. Thank you all. The most interesting thing about people talking online about Hello Health is three groups always form. First, it’s the hypercritical physician who immediately criticizes. Second, it’s the consumer/patient who immediately gets it and wants to sign up. Third, it’s the young doctors who immediately get it and are looking for a way out of this miserable, health insurance slavery. What’s even more fascinating is about 20 to 25 doctors a day are contacting us through the Myca/Hello Health website asking for more information and/or how they can become a Hello Health doctor. For all the curmudgeons, sit back and watch. It’s going to be interesting because there’s a whole new generation of doctors and a whole new generation of patient consumers who expect FedEx, Netflix, and Apple and now finally realize they can get that experience with their doctor.
Dr. Harrington: please forget about franchising and the goal of making a lot on money therefrom. It will never happen and is a waste of time. Also ignore the notoriety you are gaining. Concentrate on the value you add in pursuing your concept and above all make your patients happy. Everything else is peripheral.
Sorry, Dr. Parkinson.
Don’t doctors already have brand franchises? It’s called the diploma they hang on their wall (Harvard, Johns Hopkins, etc.)
Jay - I salute your willingness to be innovative and your dedication toward developing a new platform for health care delivery. I can imagine many of my 20-something friends loving a system like this. Here’s an issue I wonder about though: I think this will work great for the young iPhone-using, facebook crawling 20-35 yo midddle to upper class population. However, this model requires a certain amount of a) tech-saavy b) computer and internet access at home and c) proactive health management. Most of the patients I meet in the clinic and hospital meet 1/3 of these criteria at best. This is not to disparage your innnovative thinking, but I believe that the panacea for health care delivery to Americans who need it most is yet to come and we need simple things at the moment: more primary care docs devoted to preventive care with fewer burdens to take on a HUGE patient load.
eClinicalWorks is the current standard? That is a horrible program. The local Juffy Lube has more intuitive software.
Pioneering changes rarely come from the large, established players, but start in areas that at the outset seem to be insignificant. But as the functionality improves and the solution is often simpler and meets the needs of groups other than traditional customers, it gradually takes over the established market.
–taken from Clayton Christenson’s theory of disruptive innovation
The global healthcare environment needs to start thinking outside the box…as did Jay and the innovators at Myca! Only then can patient/consumer empowerment really take-off!
Can this work in any form for older people? I mean the real frail elderly, or even younger, poorer people without computer gadgetry?
I love the flexibility of the house call, the easy access to contextualized information, but I’d like to see it work for the already marginalized as well. There would have to be a good old telephone option for technophobes.
Dave: eClinicalWorks’ system is excellent. If you make the statement you do, identify yourself and why you make the statement. Also what does JiffyLube do that relates to EMR systems? I fail to see the connection.
It would be helpful if some of the bloggers, such as Dave, on this site had some idea what they write about, rather than simply making irresponsible, factually-unfounded remarks.
Dr. Parkinson has essentially no clue what he is doing. Facebook or similar social networking sites have minimal useful functionality despite their appeal to those under, say 30 years of age, or whatever the cutoff point is.
The franchise concept is one that many people who know nothing about business reality immediately embrace as a means of capitalizing in a financial sense on an idea they have, such as Dr. Parkinson’s. The the idea when realized is a loss-maker, as it clearly has been for Dr. Parkinson personally. The franchisability of Dr. Parkinson’s endeavor is literally zero. The positive on his endeavor is that he is sticking his neck out to try something different in an “industry” (i.e. medical services delivery) that is starved for innovation of any kind.
Ok lets all REALLY consider the state of health care. No one knows how much they are paying, or what they are paying for. Reality to me is the increasing premiums and increasing costs for care that is sub-par.
My advice to everyone out there still holding onto their $20 co-pay, get educated. Health care is changing, whether you like it or not. I for one have decided to be part of that change and whole heartedly commend Dr. Parkinson for embarking on endeavors which will have a positive impact.
Note that “On the “cherrypicking” charge, Parkinson freely admits that his practice is not intended for—nor would it benefit—chronically ill patients.” Sure it’s an innovative idea, but the main drivers of healthcare costs are those with chronic illnesses - diabetes, congestive heart failure, COPD, stroke, cancer, and heart disease. Are doctors in it for the money or to make a difference?
I moved from Australia to Toronto to live and work. To my surprise it was impossible to get a family doctor - “Not taking new patients” was always the response.
The only option out of hours was emergency at the hospital (four to six hour wait) and in hours the option was a walk-in clinic (one to two hour wait). In any case I could not find a doctor that would take a personal interest in me, nor one who knew my full history. It was crap. I had to keep repeating myself whenever I visited. I got prescribed a different thing every time. I repeat: it was crap.
If Hello Health existed, it would have been perfect.
Imagine the time saved and the relationship that I could have with a doctor like Jay. Most of my visits were straight forward, could have done it by IM and I’d be happy.
So to all you nay-sayer doctors out there, I hope you get the message. Your system is sicker than the people you treat, and my hat is off to Jay for having the drive and the vision to create something better.
It couldn’t be any worse.
Jay,
I understand that you are a pediatrician but have been treating adult patients in your practice — is that true? This doesn’t seem safe to me– did you complete a pediatrics residency? Is there any experience with adults in pediatrics training?