Riding a telemedicine wave, docs trade white coats for the tech life, testing the limits of health care

Michael Grabinski works as a physician at telemedicine startup 98point6. (GeekWire Photo)

Dr. Michael Grabinski walks into the room, but he can’t talk yet.

“I just picked up a patient,” he said. “There was someone in the waiting room.”

It takes me a second to process what he’s saying. We’re in a skyscraper in downtown Seattle, with no waiting room or patients in sight.

Grabinski is the medical director for clinical quality and outcomes at telemedicine startup 98point6, and he’s referring to the digital queue that patients enter when they open the company’s app. Later, he mentions a “clinic” that turns out to be the name of a Slack channel.

Patients access primary care through an app run by 98point6. (98point6 Photo)

Grabinski is among a growing cohort of physicians who have traded clinic jobs for the tech life. With coiffed hair, stylish glasses and sneakers, Grabinski is indistinguishable from the computer engineers who also occupy the startup’s offices.

But since leaving his job at the Polyclinic in Seattle, his day-to-day hasn’t changed as much as you might think. Grabinski still sees — or, more accurately, messages — roughly the same number of patients in a day, but he’s also involved in building an app that is trying to radically change how patients seek care.

As for those patients, most seem only too happy to sacrifice the personal doctor-patient relationship if it means on-demand convenience. “The new generation doesn’t value continuity as much,” Grabinski said.

Despite the appeal of on-demand healthcare, telehealth only accounted for a tenth of one percent of all healthcare visits in 2018. But those claims have grown 1,393 percent over the last four years, according to a report from FAIR Health.

Investors seem convinced telemedicine has a bright future. The sector made up a tenth of all deal activity in health tech and brought in nearly $900 million from investors last year, according to Pitchbook. Telemedicine is expected to grow from $38.3 billion to more than $130 billion by 2025, according to Global Market Insights.

(PitchBook Chart)

Under the leadership of CEO Robbie Cape, a former Microsoft executive, 98point6 launched its virtual clinic last year and has raised $86.3 million to date. Its competitors include well-established telemedicine providers like MDLive and Doctor on Demand, as well as a new generation of rapidly proliferating startups. Also based in Seattle is Genneve, a telehealth service for menopausal women that recently raised $4 million.

For doctors willing to trade in white coats and clipboards for sneakers and laptops, there are perks. One is a flexible work schedule. Another is streamlined documentation, a common headache for clinicians. 98point6 has built artificial intelligence systems that automatically draft a medical chart for each patient following a visit.

The technology helps doctors “do more clinical work than busy work,” said Alexi Nazem, CEO of Nomad Health, which operates a telehealth staffing service. In theory, technology like this could alleviate the problem of physician burnout.

“Our hypothesis, although we’re still a young company, is that we will have more longevity of our clinician team,” said Amanda Cuda, who manages the medical group at 98point6. The team recruits across a range of longitudes so that nobody will have to work overnight. They even have one clinician in Hawaii.

98point6 doctors are also encouraged to spend around a fifth of their time improving the product, and the rest in the clinic.

Amanda Cuda, medical director of the medical group at 98point6. (GeekWire Photo)

There are no scheduled visits, and patients are admitted on a rolling basis. “We have the luxury of time,” Grabinski said. But that also presents a challenge for maintaining the quality of care over time, since it’s unlikely that a patient will see the same provider at a subsequent visit. The upshot is that 98point6 doctors must learn to work as a team rather than as independent providers.

There’s a lot of learning at this early stage. Charts are reviewed for quality, and new guidelines are implemented regularly. The idea is to standardize the process as much as possible so that it can be automated.

Grabinski sees around 18 patients per day, a number that should, in theory, go up over time and deliver the cost savings that 98point6 was designed to create. Insurers and employers may also save by reducing the number of unnecessary ER and time spent away from work at doctor’s appointments.

98point6 employs 40 accredited physicians on staff and many more are coming on board — around 10 new doctors were brought on in the six weeks prior to GeekWire’s visit. They’ll need the staff: The number of patients that 98point6 doctors see has grown by a factor of 5 in the past year.

Trading a hospital job for telemedicine isn’t as easy as it may sound, thanks to state-by-state licensing laws. Each practitioner has to become licensed in every state. Cuda said that the company’s record for securing nation-wide licensing is five months, and most doctors take six to eight months to become fully licensed.

Nazem thinks telemedicine adoption has been slowed by an “archaic belief” in state-determined licenses. “A person in Seattle with a sore throat is no different than a person in New York with a sore throat,” he said.

Those barriers help to explain why only around 15 percent of physicians work in a practice that uses telehealth, according to a survey from the American Medical Association. But providers have a strong incentive to embrace telemedicine, which can help offset the shortage of primary care physicians. “The market as a whole is supply-constrained,” Nazem said.

If Grabinksi is any indication, physicians may be fine with the new way of working. “The quality of life here is night and day,” he said.

Editor’s note: Telemedicine will be the focus of a panel discussion on the health tech stage at the 2019 GeekWire Summit in Seattle. More information about the Summit, taking place Oct. 7-9, here.

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