What we learned about the U.S. healthcare system by including “FREE” in our Google AdWords campaigns
When we opened Accesa Health in 2008, we were confronted with the handful of advertising options that local businesses face to help customers find them: print ads (yellow pages, weekly mailer services, flyer services, etc.), and the internet.
Print ads seemed like an expensive proposition, demanding upfront fees with no guarantee that customers would show up. The internet seemed like a big place for a small brick and mortar health care business to advertise, but we found Google AdWords which would let us take baby steps with spending and iterate quickly on messages. It would also, theoretically, connect us with patients when they actually needed our services, not randomly as with most print ads.
With health only comprising 2% of reviews on Yelp, the big unknown at the time was would people use the internet to shop for health care services? My partner and I still remember the first patient who came in and said that he had found us on the internet. It was a so-called aha moment, but there were problems.
A few things to point out: 1) 90+% of US health care expenses are currently paid by some form of insurance, and 2) We don’t accept insurance.
Simple, fuzzy math says that at best only 10% of people searching the internet for health care services in Los Angeles would possibly be searching for a service like ours. And if you believe what you read, those 10% are probably too poor to afford health care and don’t have access to the internet anyway. Were we crazy?
We believed in our mission to bring price transparency to everyday health care, so we pressed on. A primary challenge with Google AdWords is determining which keywords are best for connecting with your target audience.
We started very simply with terms like “clinic” and “urgent care”. Predictably, the early phone calls came from people asking us whether or not we accepted their insurance. As a bootstrapping entrepreneur, I could physically feel the money leave my pocket with each ad clicked by those callers.
We also received many calls asking us whether or not we were a “Free” clinic. Strangely, we weren't receiving many calls asking us how much a service cost. How could this be? Americans are GREAT at shopping.
More calls about insurance and free clinics led to more frustration until we started saying “Not Free, but affordable” in our Google ads. An interesting thing started to happen. People started calling and inquiring about our prices -- another aha moment. Many people who are searching for FREE health care services are actually willing and able to pay, but don’t know where to go.
Time and time again, this experience has been validated. And now, almost 11 years later, great than 90% of our first time patients across our businesses find us on the internet and many when searching for free health care.
There is an overriding perception about access to US Health care: Insurance or Free and no in between.
Think deeply about that for a moment and the type of system that this dichotomy creates.
We believe that Push Health can go a long way to change that perception and are excited about the journey.
If you are a medical provider, join Push Health and let us know what you think. If you are a patient, encourage your medical provider to join.
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No UBER Health until we confront SUPERFECTA Health
I love UBER. I think the so-called sharing or convenience economy is great. My first introduction to “black car” service was when I worked in New York City in the late 90’s. It was certainly a step above the yellow cab and 3 steps above the subway, but I was only able to experience it because my work was paying. A decade + later and UBER has effectively brought that service experience to the masses, myself included.
What I like most about the likes of UBER and airbnb is that through elegant technology they have empowered the interested individual, created better capacity utilization and access, and lowered prices in the process. They do have the smartphone, ubiquitous internet connectivity, and deep social graphs to thank for making it possible to scale their businesses like never before. I am hopeful that many of these same developments can positively impact health care.
While Uber and airbnb have encountered and will continue to encounter significant resistance surrounding existing regulations and tax authorities, I believe that what they face is nothing compared to what we call SUPERFECTA Health -- four business environment characteristics that create a complexity unique to the health care industry. And similar to winning a Superfecta bet in horse racing, creating an efficient marketplace while managing for SUPERFECTA Health is a long shot.
1) Heavy Regulation: The challenge with all regulation is trying to find the balance between consumer protection and anti-competition. Most people will suffer through higher prices and increased hassle if there is a meaningful benefit. Health care is guided by a complex system of regulatory bodies at both the state and national level with many competing against each other for power. In the insurance driven world, one way to get power is to control the disease and billing codes. Given this, it is no surprise that the recently released International Classification of Diseases version 10 (ICD-10) increased to 141,060 code sets, a 712 percent increase over the currently used ICD-9 set. And when it comes to billing, the Current Procedural Terminology code set is an American Medical Association owned system that is used by Medicare to determine its fee schedule for medical procedures and services – basically a government-granted monopoly. To date, it seems like many of the regulations have more to do with combating billing fraud or protecting business interests than protecting and empowering consumers with information to make well informed decisions.
2) Professional & Personal Liability: Medical malpractice insurance is one of the most expensive insurances and without tort reform will likely stay that way. As much as people talk about team medicine, the license to practice is held by the individual and therefore brings on not only personal liability but loss of license and livelihood. This fear is driven into medical providers when they start practicing, and rightly so given a New England Journal of Medicine study which found 75% of physicians in low-risk specialties and 99% in high-risk specialties face a malpractice claim during their careers. While a malpractice claim does not typically lead to loss of license, it is not surprising that many physicians do all they can to avoid being sued. Having watched a personal doctor friend get sued, I am convinced that the real value drain is the emotional stress and time spent dealing with the process.
3) 3rd Party Compensation: Public and private insurances together pay for over 90% of all reported health care costs. And given all of the different pools of money, the flow of funds from patient to provider is quite complex which means administrative burdens of up to 25%. In most situations this complexity leads to the two parties privy to the service, medical provider and patient, having no idea how much anything costs. Said another way, there is very little price transparency. As such, the ability to develop “true” market-based pricing for services falls way short. Additionally, it is likely that many technical and patient care innovations are delayed and perhaps killed based upon the inability to gain access to the 90% of flow of funds in a timely manner. If a treatment or service isn’t reimbursed, you can bet that your medical provider isn’t going to offer it.
4) Non-Profit Status: Many hospitals and facilities operate as non-profits. This status creates financial incentives to use excess cash to invest in facilities and make them ever bigger and grander without an apparent need. This of course is a self-fulfilling prophecy when it comes to an ever increasing need for money to maintain, operate and basically justify the facilities.
Many US industries deal with 1 or 2 similar characteristics, but not 3 or 4. These four traits together create a business environment so perverted that the opportunity for any true marketplace to form has been squashed from the word “go”. So much so, that one of the world’s most innovative companies, Google, won’t get involved based on the regulatory burden alone.
Perhaps technology, economics and demographics can turn the tide?
In our health care delivery businesses, we have done our best to exclude #3 & #4 and actively manage #1 & #2. How are we doing this?
No insurance.
- We list all of the prices for services
- Patients agree to services and pricing beforehand
- No diagnosis or CPT codes means both patients and providers can understand
- No billing means no receivables
Many regulatory burdens fall away when you are not billing a 3rd party
Set the terms of service and manage expectations.
- Patients agree to terms of service
- Both patients and providers agree to settle any differences through arbitration
- We have standard protocols and procedures
- We offer specific services and add new ones slowly
- We engage the patient
A more engaged and empowered patient is a better patient
Take care of business like you do patients.
- We are patient-focused
- We constantly look to improve
- We manage inventory and work tirelessly to lower our costs
- We invest our resources wisely
- We listen
Principles of caring, improving and listening can translate to success in both business and health
We think what we are doing is working. We have not accepted $1 from an insurance company, yet greater than 75% of the 100,000+ patients our services have helped state that they have some form of health insurance. Many of these insured patients say they are willing to pay for the convenience or take comfort in the fact that they know they won’t receive a bill in the mail for what was supposedly an insurance covered visit. We are effectively “capping their downside”.
We understand and appreciate the purpose and need for insurance when it comes to the unexpected and emergent need, but we think price transparency for the simple everyday health care stuff is where you have to start in order to move upward.
We are developing Push Health in this mold to help all the individual medical providers better navigate the SUPERFECTA. Our hope is that Push Health can help scale our trusted health care professionals so that we can all more easily enjoy uber health.
If you are a medical provider, join Push Health and let us know what you think. If you are a patient, encourage your medical provider to join.
From bricks to clicks to code: 100,000+ patients, 50,000+ injections, 100,000+ lab test results, and free software serving over 4,500 medical providers without $1 of insurance accepted.
In 2007, my business partner and I began our journey to work on health care price transparency and access. We studied the retail-clinic models that were popping up like Minute Clinic, Redi-Clinic, and Health care Clinic. We liked the simplicity, but didn’t want to be constrained by operating within a retail store and accepting insurance seemed like a strange thing for everyday health care needs.
In October 2008, we opened Accesa Health, a brick and mortar walk-in medical clinic in Torrance, CA. Our biggest decision at the time was to stay 100% outside of the insurance world, which would help us manage SUPERFECTA Health. As such, we had to find patients that were willing and able to pay out of pocket for health care needs. As discussed here, it was not a simple road, but we were determined. We also knew that we needed to make the experience incredible so our patients would want to come back when future needs arose and would tell their friends about us.
Over a period of several years we learned the ins and outs of running a 100% self-pay health care facility from connecting with self-pay patients using the internet, to actively listening to and providing the care desired by these patients, to setting up and managing health care vendor relationships. Over 22,000 patients, nearly 80,000 total visits and 5-Star Yelp reviews make us feel that we are doing something right.
As we listened to our patients at Accesa Health discuss their needs, the desire for better access to medical lab testing was heard time and again. Improved access not only meant getting tested, but actually receiving results (good) in a timely manner (better) and not receiving mystery bills in the mail months later (best). We had learned people use the internet to find health care services, but would they actually purchase a service online? We had a suspicion they would, so we started Accesa Labs as an online portal for patients to order lab tests, get tested and receive results in a straightforward process. The feedback was so positive that we contracted with medical providers in other states to offer the testing services nationwide. Since late 2010, over 66,000 people have used our services to get tested.
Push Health is the evolution of what we have discovered serving self-pay patients in person and online and applying scalable technology to deliver tools to the individual medical provider so that they can serve their networks in a more convenient and price transparent way. We are focused on delivering an awesome, FREE set of HIPAA compliant and secure tools for patient network building, messaging, virtual consults with 100% price transparency and things like simple documentation, e-prescribing, & pre-paid e-lab ordering built in. No more mystery bills showing up in the mail.
We have done all the work so the individual clinician and his or her network can more easily enter this new world of higher deductible insurance and increased “patient cost-sharing”. It is early innings, but we recently passed the 4,500 registered provider mark and look forward to working hard to delight them and their patients.
If you are a medical provider, join Push Health and let us know what you think. If you are a patient, encourage your medical provider to join.
Case Study Series: Organize Everyday Care for Personal Networks
CHALLENGE
An ER doctor who gladly provided care to her trusted network for everyday health care needs, found herself frustrated by the process. She knew that there had to be a better way than the back and forth texts, emails or calls, notebook documentation, and calling in prescriptions. As an “office-less” doctor, she didn’t have any work software that she could try to use or existing vendor relationships. She wanted a free, easy-to-use mobile app that would streamline the process.
SOLUTION
Connect: Using Push Health’s simple invitation process, the doctor sent electronic invites to her personal network.
Practice: Push Health made it easy for her network to request care when they needed it and for the doctor to handle the care in an organized fashion (message, document, e-rx and e-order labs). The first-of-its-kind lab integration with Quest Diagnostics was a big bonus because it provided easy access to affordable testing for her friends and seamless results retrieval for her.
IMPACT
Relax: She no longer needed to worry about collecting personal information or listening to pharmacy message systems. She was even able to handle a request while on vacation in Italy.
3 Tips to Strengthen Your Practice's Online Presence
We know that it can be a difficult and daunting task to figure out how to grow your practice. We wanted to share three SIMPLE and FREE best practices for strengthening your online presence that we have seen work for others.
Build Your Doximity Profile
Doximity, an online physician's network, can help strengthen your virtual presence with both medical providers and patients. By building your profile on Doximity and including links to your websites (if any) and your Push Health "Request an Invite" page, your search engine optimization (SEO) can greatly benefit from Doximity's web presence and its relationship with U.S. News & World Report. Improving your SEO will help when people are searching online for you or your services. When building your profile, you can include up to three web addresses under "Links". Doximity is also a great place to connect and share with colleagues.
Embrace Your Social Networks
Like most services, health care is still very much driven by word of mouth referrals. By posting your practice information and interesting articles on Facebook, Instagram, LinkedIn or Twitter, you create an easy way for people in your networks to connect with you while greatly increasing the likelihood of them using your services and telling others about you. Remember that it is not a "one and done" process. We recommend posting at least once every 2 weeks.
Build a Presence on Yelp
People are definitely using Yelp to search for health care services. List the key types of services you would like to provide when building your Yelp profile. You can get started at Yelp business. By building a listing on Yelp and using Push Health as a patient’s access point to you, you can start to build a brand within your community. Patient’s will definitely leave positive reviews if they like your service as seen at our sister facility Accesa Health.
Message Your Patients
Sending messages to your patients definitely increases their loyalty and satisfaction. Push Health offers a simple and secure way to message your patients without sharing your personal contact information.
Please let us know how these three simple tips work for you.
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Case Study Series: Extend & Grow Existing Practice
CHALLENGE
A doctor wanted to offer virtual visits as a service through a convenient mobile practice platform to her current patients and as a way to attract new patients without paying for expensive practice software and lead generation services.
SOLUTION
Connect: Using Push Health’s simple invitation process, the doctor sent personalized electronic invites to her current patients and network. She also posted her custom Push Health sign up link on her website, Facebook page, & Twitter feed to attract new patients.
Practice: Push Health made it easy for her patients to request care when they needed it and for the doctor to handle the care (message, document, e-rx and e-order labs).
Transact: The hassle-free process of setting her professional fees delivered 100% price transparency to her patients and the simple checkout process made paying for her services a breeze.
IMPACT
WIN, WIN, WIN. In less than 12 months, using Push Health’s free and intuitive software the doctor has been able to meaningfully grow her number of patients, increase patient engagement & satisfaction, and earn money. In fact, she earned $30 each time she signed into Push Health. Not too shabby!
Case Study Series: Launch & Grow a Private Telemedicine Practice
CHALLENGE
A doctor wanted to launch and grow his own telemedicine practice focused on self-pay patients without paying for expensive practice software and lead generation services. He focused on three primary requirements: 1) easy-to-use and effective tools to engage new patients through digital & social media, 2) an intuitive and patient friendly mobile practice platform to manage care, & 3) a simple way to connect with vendors and to take payment from patients.
SOLUTION
Connect: Using Push Health’s simple invitation process, the doctor sent personalized electronic invites to his current network. He also posted his custom Push Health sign up link on his Facebook page.
Practice: Push Health secure & private messaging made it easy for his patients to message him about their needs and desired telemedicine appointment times. The smart and simple practice tools (document, add-a-note, e-rx and e-order labs) have made it easy to manage the patient care.
Transact: The free e-invoice feature delivered 100% price transparency to his patients while the simple checkout process made paying for his services a breeze.
IMPACT
WIN, WIN, WIN. In 2 months, using Push Health’s free and intuitive software the doctor has been able to kickstart his telemedicine practice by attracting new patients, providing convenient care, and earning money.
New iOS and Android Apps Make Push Health Even More of a Breeze
It’s a pretty exciting way to kick off 2015 — we are launching our new App for iOS and Android. In the new app, we added the "Activity" feature to make it a breeze for both medical providers and patients to stay on top of messages, prescriptions, lab results & more.
We look forward to hearing what you think of the new apps which are available for download in the iTunes Store and Google Play Store.
Flu activity is on an upswing. The Centers for Disease Control & Prevention (CDC) is reporting that 43 states are showing high or widespread cases. Learn more.
H3N2 flu viruses continue to dominate (>95% of cases). In the past, H3N2-predominant seasons have been associated with more severe illness and higher mortality, especially in older people and young children.
There is a shortage of Tamiflu. This type of prescription flu antiviral drug works best when started soon after influenza symptoms begin (within 2 days). It is a good idea to call the pharmacy ahead of time to confirm availability and reduce delays. Learn more. Check price.
The CDC publishes flu vaccine effectiveness estimates. The current season report is expected in mid-to-late January.
We were busy in 2014 building new tools for medical providers and their patients, including:
- Secure messaging for improved communication
- Streamlined lab testing through Quest Diagnostics
- Prescription re-send and enhanced pharmacy finder
- PayPal integration for simple, secure payment
- Request an invite for easier sign up
We are excited about 2015 and look forward to making health care more convenient and price transparent for you! Remember to add the Push Health icon to your smartphone so that trusted health care is only a few clicks away.
Anya is live and ready to show you everything. Watch her strip, dance, and perform exclusive shows just for you. Interact in real-time and make your fantasies come true.
✓ Live Streaming✓ Interactive Chat✓ Private Shows✓ HD Quality
Anya is LIVE right now
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