There’s a huge, untapped market out there for telemedicine: big cities. A startup, DocChat, wants to change that, in part by targeting young adults without regular primary care physicians, but also by seeking a federal policy change.
Michael Okhravi, founder and CEO of New York-based DocChat, sees young adults as a prime target for his company. “There’s no relationship with the doctor anymore,” said Okhravi, who cited McKinsey & Co. data showing that nearly two-thirds of millennials do not have regular primary care physicians.
DocChat guarantees app-based access to a physician within 15 minutes, with video visits available 24/7 for $50. Clients get the doctor’s cell phone for follow-up care at no extra charge, Okhravi said.
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But Okhravi would like to work with another underserved demographic, namely low-income city dwellers. The problem is, the federal Centers for Medicare and Medicaid Services does not reimburse for telemedicine services delivered in urban areas. There has been an exception since the beginning of 2014 for rural portions of densely populated counties, but urban residents still can’t get Medicare or Medicaid to pay for telemedicine, leaving Medicaid populations in particular with few alternatives to expensive emergency departments for routine care.
Okhravi is inviting other telemedicine companies to join DocChat in pushing CMS to change its policy for both Medicaid and Medicare. “They have the power to do it,” Okhravi said of CMS, noting that it would not take an act of Congress.
Okhravi said DocChat has been piloting telemedicine at a primary care clinic in the Bronx. “So far, the results have been great,” he said, though he had no hard data to share just yet.
The problem, according to the DocChat CEO, is that clinics that see Medicaid patients are hard to find in many urban areas; he said that there is not a single one in Manhattan, and those in New York’s outer boroughs often close at 5 p.m. “Basically, they’re on banker’s hours,” Okhravi said.
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That leaves the ED as the only alternative. According to Okhravi, the average ED change in New York City is $1,250, and patients don’t get any follow-up, often leading to them becoming noncompliant with doctor’s orders and medication regimes.
That’s where telemedicine can fit in, even for low-income populations without smartphones. DocChat, for example, has contracts with the Indian Health Service to serve Native American communities. There, the company sets up a single point of contact, often a tablet in a hospital ED, where people can get remote care for hundreds of dollars less than they would otherwise.
“Investing in the health of poor people pays off,” Okhravi said. He only wishes CMS would do so by opening up telemedicine for urban residents on Medicaid.
