There were several reasons Kyle and I parted ways from First Opinion. Many of his reasons are different from mine, but as we work on our new ideas and consult other companies on their projects, I keep coming back to the same questions:
- Why did First Opinion not work (for me)?
- What can I take from this experience to "do better"?
As you know, I loved the people I met and worked with at First Opinion. So, while I don't regret going to San Francisco and taking the job there's still a part of me that is like, "Let's try not to let this sort of thing happen again. You lost a lot of money, you were seriously stressed and unhappy for several months, you uprooted every aspect of your life for something that appealed to you emotionally."
One of the biggest ways I've processed those answers was to first focus on these questions:
- Why was I so set on going to First Opinon?
- Why did I feel it was meant-to-be?
Well, I went to First Opinion to positively impact healthcare in this country. Yes, I really thought that I was so hard-working and special that with the right team and product, I could move the mountain that is US primary care. After spending weeks in conversation with the CEO, McKay Thomas... I was convinced together we could do this. Side note: he is a visionary as well, with grand ideas and determination so I'm sure we were fueling each other in all of these talks.
And so the story goes....
My first job with benefits.
When I moved to Utah I got a "big girl job" at a rapidly growing company, Solutionreach - providing patient communication services for healthcare providers. I worked in the engineering department doing a lot of things. My last 12 months at the company we made a push to move from dental- and vision-focused features to market "medical-specific" features in hopes primary care and non-elective offices would use the software. They loved it! However, while I was working 60-hour work weeks forging partnerships with top EHR vendors, completing RFP's for large hospital-owned medical groups, and planning IT features for updated company-wide HIPAA policies, I realized how behind the times many primary care practices were.
There were calls I would jump on to serve as a sort of sales engineer for the medical-specific sales reps when doctors had questions about integrating with health records, billing, HIPAA compliance, etc. I kept learning about issues office managers were facing running these practices. Doctors just wanted to help their patients but had so much red tape to jump through, weren't getting paid huge fractions of what they were owed by insurance companies, and patients were never really in the loop regarding what was going on. I was determined to fix these problems with digitizing patient registration, providing online bill pay and management, providing a mobile app for patients to communicate with their doctor, partnering with the top patient-education companies to get patients dianosis-related content automatically emailed, etc. There was a whole list of features on the roadmap to improve health care for both patients and doctors. I really thought we were doing great work and couldn't wait to see the impact our product would have.
Within a few months of releasing some of these features, it was clear doctors weren't using them. I messaged some of my own providers through the mobile app and didn't get responses to my questions for weeks. How could this happen? Why would offices be paying for patient portals to never use them? Solutionreach has some of the best support reps and customer training, and they were running webinars on these features daily so I knew training wasn't the issue. At that point I spent hours on the phone with office managers and doctors to learn more about practice operations and patient interactions-- how doctors spend their time and money. I could write pages and pages of blog posts about ICD, CPT, and HCPS codes, but I won't. I'll just summarize it by saying... doctors and their employees 1. have little to no extra time and 2. have little to no extra money. Additionally, patients weren't using the portals... because they weren't told about them... because the doctors didn't have the time to check them and couldn't bill for the time spent answering emails... so they weren't being checked by the offices. End of story.
Expanding my knowledge
When I moved on from Solutionreach I wanted to stay in health care, but wanted a bigger picture. I moved to peer60, a healthcare focused research company using their survey platform to get responses from the top hospital executives in the country. I learned about medical vendors, how they worked with hospitals, the kind of money hospitals spend, the long-term purchase cycles that shape the operations of specific hospital departments. I learned how government regulations were affecting hospital processes. I learned about hospital data infrastructure and the difference between every kind of radiology procedure. I learned how primary care was just a drop in the bucket in relation to all of US healthcare. I learned about specialties and hospital affiliated practices. Then I learned about healthcare in Europe dealing with vendors selling medical devices internationally. I learned so much about health care in such a short period of time, and to be honest -- I started to lose faith in America's health system. In effort to make the patient experience better and lower medical costs, government was taking the personal out of healthcare. Efficiency and reimbursements had to become the priority for a hospital to stay in business, and it continued to add more overhead to an already slow moving system.
It was then that I realized it's going to get worse before it gets better and either the government can continue to try to force healthcare to change in effort to help patients, or patients could help themselves. Seeing how government couldn't enact change quickly, and seeing how government regulations had directly led to a decreased number of primary care physicians in the US, I felt this had to be consumer-driven and wished there was a way peer60 could help. However, they were doing a different work focused on helping health care vendors make better decisions much faster which contributed to improving health care but not at the level I wanted.
So many people are unhappy about healthcare in this country but majority of them 1. know little to nothing about their own health and 2. know little to nothing about how billing, insurance, and collections even work. Time-after-time I would hear about someone who had some strange bodily sign and shrugged it off only to find stage 5 cancer years later when they finally went to the doctor with crippling symptoms. I've also heard about how a standard physical used to be a butt-naked exam from top to bottom with thorough questions about your last 6 months to insure preventative care was in order. My dad, previously diagnosed and treated for prostate cancer, had to change doctors (due to insurance). He had been going to his previous doctor for 10(ish) years but made the switch to an in-network provider who was much younger and less experienced. He went in for his physical and said he wasn't even asked to take off his shirt. With a history of prostate cancer on his chart, he didn't even do a prostate exam in the physical. My dad asked about it and the doctor said "we don't do it like that any more -- this is just your stadard physical billed to insurance". I asked my dad why he didn't demand it and he said .... "umm... I didn't think it mattered. I'll probably go to my urologist at some point in the next year or two."
I've heard about the increased wait time at doctors' offices around the country due to doctor shortages. I've heard of common bacteria building up immunity to antibiotics due to the country unnecessarily over medicating. I've read about obesity and diabetes rates increasing along with other chronic conditions showing up at younger ages. I've read about anxious patients reading WebMD or googling issues and being worried they had the worst possible diagnosis. I am married to a guy who hasn't had a primary care doctor since he moved out of his parents' house (even though he lived in the same city for 7 years) and has only been to the doctor three times in 7 years (knowing he needed antibiotics). Does he know what preventative health is? Is this an issue with mellenials today? If mellenials are always on the go -- traveling, not settling down, etc. -- how can they have primary care physicians?
Knowing your body, knowing how to know your body, knowing how to be logical about health matters, and not being afraid to ask questions (openly) about health-related issues (regardless of anxieties or worries) is a service a doctor should provide and help patients obtain. Today's doctors are pressed for time. They are overworked. Unfortunately, patients notice and often hold their tongue when they have questions or concerns or even answering basic questions for diagnosis. Combined with the practice of cook-book medicine (using tests and data to validate and diagnose rather than listening to patients) some doctors make decisions defensively to prevent malpractice claims. We need to teach patients how to interact with doctors. Patients should expect to have a much more important role in their health. They need to be empowered and educated when it comes to decisions around health. Preventative care is key.
I so wanted to fix this. All of these questions had answers in this amazing opportunity we weren't expecting.
It Must Be Fate
First Opinion was kind of dropped in front of Kyle and I randomly. All of the thoughts I had been having over the past 4 years had been coming to a head and I felt First Opinion was going to be the platform and gateway for us to actually change healthcare in this consumer-driven, patient-focused way I had imagined. With huge investors on board and a solid strategy of "getting a first opinion"-- helping patients help themselves before ever stepping into the office... helping them prepare... I was really excited to come onto the founding team of this company.
If we could get patients to be educated enough to care about their own health... we could drive healthcare costs down in our country while demanding more thorough, personalized care. If we could save doctors' time by only giving them the patients who actually need to go to the doctor, we could keep patients more satisfied after their visits. The fact that the doctor-patient relationship was what it used to be -- a 24/7 always-open line of communication with the "family doctor", would help patients gain confidence in their own ability to rely on themselves to solve problems instead of defaulting to request a prescription or going in to the doctor for a cough when really... "it's just a cough... come back if it gets worse". Not to mention... saving patients and insurance companies money on the small things. Having a doctor who can constantly check in with you to make sure you're not experiencing anything random that you might not normally bring up to your doctor because it would be inconvenient -- catching issues early. IMPROVING PATIENT OUTCOMES!!! Being able to talk to the same doctor or one of their direct assistants every time (no matter what time of day) meant you never had to re-explain yourself and could develop an actual history. It all made SO MUCH SENSE and I was so lucky to find a team where innovating and changing how the average American looks at healthcare was a challenge everyone was up for.
It was all a dream
Obviously, that didn't work out. The thing about companies is you need revenue. And the thing about changing the model of medicine for the entire country is... it will take time and a lot of marketing. Add competitors to that mix who are bringing in millions in revenue and all of a sudden your investors start to worry what you're doing and how the competition is beating you to it. Under that kind of pressure it's easy to lose sight of the original goal of "changing the world" when the customers in your market are wanting to have everything given to them at the snap of a finger. When your market cares about convenience but you care about fixing the problems they don't see consequences for... your product and service will likely suffer up front. You start seeing other ways to "change the world".
Then there's this issue of "the market is demanding something else and competitors are giving it to them". And... duh, of course telemedicine is booming. Of course a person who has everything else in their life on-demand wants to be able to press a button and have their doctor on demand. Yes, I would love to get a prescription that will make me feel 99% better in 24 hours by talking to someone on a 3-minute video chat from the covers of my queen size bed and then never have to think about it again. But, there's a REASON primary care is so important. There's a REASON relationship-based medicine is key. I'm not advocating against on-demand doctors here . It's all great. Telemedicine is wonderful and I know it's going to continue to shape healthcare. However, I do think patients are trying to speed up the process by removing the relationship from the equation and don't realize that has risks.
Firstly, it perpetuates what several have called SICKCARE in place of HEALTHCARE. Healthcare is supposed to be preventative. You can't have preventative medicine when you don't know what to prevent and you don't have a guide to help you learn what to prevent or remind you what matters as a patient. This has caused a huge increase in urgent care practices over the past few years, and although it's cheaper than the ER, it's not solving the problems. I wanted First Opinion to fill the primary care space in this new innovative way with a focus on preventative care.
Of course... the market didn't demand that. The market wanted on-demand text, on-demand video, and on-demand prescriptions. And they've also said "we'll pay for the convenience". So, in effort to meet the demand of customers... to move the ever-growing urgent care gap to telemedicine... First Opinion moved to a freemium model with plans to only require payment for treatment. This is great for the average iPhone user and has helped tens of thousands already. That said, success to me would be the focus on preventative care working so well, the need for treatment would continue to decrease. The freemium revenue model completely contradicted the altruistic vision I had in my mind.
I can't blame anyone because revenue is important, and I wanted to get there. I wanted to make money. However, I don't agree with the end result. While they might be able to accomplish both in the future, the priorities of the company dramatically shifted between my accepting the position and coming on board and there wasn't much I could do about it. When I had these huge grand visions of changing healthcare by empowering patients to educate themselves through personal long-term relationships with doctors via mobile app... the company decided to change healthcare by making it easier for patients to find a doctor. Although it was solving a problem, it wasn't a problem I felt needed solving. I felt it was a perpetuation of issues that will not fix themselves.
Why do I write all of this novel? I'm stuck. Wondering what's more important... doing what the market demands and making more money... or taking more risk up front in effort to really innovate and change the game? I'm no longer at First Opinion, so in that case I chose the latter knowing the consequences. I agreed to disagree and along with other reasons, we parted ways. Third time isn't always the charm. I guess my hope is that in whatever I do next... I can do both: innovate in a way that positively impacts an industry all while staying true to my personal convictions and still meeting market demands.