Comment by ympatel | Hacker News Reader

Comment by ympatel | Hacker News Reader

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I actually really like that idea because it fits into one of our longer-term visions of providing an off-the-shelf turnkey "care team" solution, whereby a cadre of professionals work together to provide care for our customers' patients.

Currently, we don't have such as system in place, but our customer might! In that case, a customer might use a PhD or mD from us to provider higher levels of care and then a social worker or nurse to provide ongoing higher-touch treatment. We are simply providing the health care professionals (and their time) to augment a health care organization's existing staff.

Per your second question, that's actually one of our competitive advantages! Right now, we are finding that many awesome providers who are already reputably employed at a hospital, at the VA, etc are looking to make more money (by the way, the fact that they are already reputably employed is a good screen for quality too). They would like to work an additional 10-40 hours on top of their main job in the mornings, evenings, days off, and weekends. That is a large source of potential supply that is going unused and that could help so many people! Simply put, we offer these providers a chance to make more money by using their expertise to see more patients whenever they want. We provide the patient volume and the competitive rate. All providers have to do is show up and provide the excellent care that they already do.

There are a couple issues I see with this model.

1) Credentialing is super slow in medicine and probably quite expensive. It will take your provider months to come online.

2) If you aren’t paying high at 65-70% of billable rates you will have trouble finding providers that want to go through all that hassle when they can just work more hours at their regular job.

3) It’s not clear to me that you are doing anything different than what a regular private practice would do. Everyone is full online now post pandemic so they are mostly limited by availability of clinicians. They could hire parts time folks and offer the same deal I think many just choose not to. You would get stuck with all the compliance costs and little actual revenue.

Thanks for highlighting these issues.

1. Credentialing is definitely super slow. We want to get to the point where we can handle billing for our customers as well, so we'll have to create relationships with payers to speed the process up. Right now, many of our customers and clinicians are already used to this long process, so nothing is really different here.

2+3. We are providing the patient volume at 0 cost to the clinician. This is all just extra income for the clinician at the cost of their time, regardless of whether the clinician is in private practice or working for a hospital with a fixed salary. Opportunity cost requires for the private practice to do marketing, etc to drive patient volume to them. Also, the private practice, again, has the same problems around recruiting and scheduling that a hospital would have.

What you describe is not 0 cost. You take some sort of cut for services provided, that’s what a private practice does. In exchange for patient flow computing scheduling compliance and billing they charge 30-40% of the patient bill. In a modern work from home environment a provider could contract with a local urban private practice and offer part the hours for the same arrangement. The only real difference is they would have to interview and provide stable ability, the work can be fully remote otherwise. Also typically the practice takes a higher cut if you work fewer hours.

I think that's precisely why we're needed. With the scale that we plan to have, we can actually provide stable patient volume and deal with all the pains of recruiting and onboarding. Every smaller organization otherwise will have too much difficulty piecemealing different clinician availabilities together to create FTE(s)

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