Helpfully’s consulting teams have engaged the healthcare system from multiple client vantage points — from researching hospital patient flows, design for doctor’s office IT systems, consulting on peer-to-peer support networks for people suffering from serious conditions and working with organizations to influence health policy experts.

But no matter our health, we all share one experience: getting checkups and care at a primary care doctor’s office.

We all face it, so everyone — including VCs — knows the frustrating and disjointed and poorly designed experience from the consumer’s perspective. And when you ask doctors, they wholeheartedly agree running a doctor’s office today is full of challenges: patient volumes are high, insurance companies can be a bear to deal with, and there’s considerable IT and operational “administrivia” gumming up the works.

The trends driving change are easy to spot. First, consumer choice and consumer expectations are rising fast, even in health. People want to be in charge. People value carefully designed and delightful experiences. Second, the tech is ready, with things like video visits, text based answers, or predictive care paths. Lastly, changes to how insurance works and care gets paid for. The US system is hungry for a move from insurers paying for the service — a procedure — to paying for the outcome we all seek — good health.

Helpfully is tracking many companies innovating inside clinical care settings and each has a slightly different perspective on what’s broken and how to fix it. So this article will dig into the following startups:

• Forward
• 98point6
• HIPnation

(A quick note of disclosure: Helpfully has personal and professional friends at each of these companies.)

Forward is a startup based in San Francisco (SF) and they’re building the care a somewhat SF-centric on primary care. Forward’s team has created an experience that is tightly orchestrated and beautifully designed.

The first visit is 2-3 hours (yes, really!) and consists of the patient and doctor taking 60+ minutes to get to know one another and explore every medical and lifestyle attribute. Genetic testing and blood work is done on-site so results can be immediately brought to bear. The Forward experience focuses on a spa-like environment, some high tech elements (including a custom-designed stethoscope!), and gorgeous apps.

Forward’s business model is ‘concierge medicine,’ so their clinics have far fewer patients, but patients pay a membership fee ($149/ month) on top of their monthly insurance premiums.

Biggest differentiator: Amazing experience!

Some details:

• Founded in 2016
• Total clinics open: 7 (NY, SF, LA, DC) with plans to grow
• Details on the experience: Quartz Article, Techcrunch
• Forward’s official site

98point6 is a primary care clinic where most of the care experience is ‘in the cloud’ and delivered anywhere a member is via their web and mobile apps. They have their own clinic locations and all of the staff are employees of 98point6 (so it’s not a franchise). The team did research with consumers and the service follows a research insight into Millennial and generation Z consumers. Younger people prefer  messaging and chat interactions for solving problems, even in health. They like it even more than video messaging.

Compared to some concierge medical concepts, 98point6 seems to skew towards the episodic users. It’s great for when you’re sick with something relatively minor or things for which a patient already has a hunch and they just need a professional decision and treatment course. They market the service as an urgent care replacement. Also note that they’re now shifting their marketing focus towards corporate / enterprise partners. Surely, adding members by the thousands will in some cases be easier than adding members one at a time.

Biggest differentiator: Text-based messaging (with photos and video as needed) and AI make the magic.

Some details:

• Founded in 2015, Seattle HQ
• Total clinics open: NA, since care is virtual (but available in all 50 states + DC!)
• Cost is $20 for the year and then a per-visit fee.
• More information on the experience: Inc profile
• 98point6’s official site

HIPnation is a primary care health clinic experience that uses membership to change the operations of providing care. HIPnation does a great job of balancing consumer desires with doctor / clinician wish lists and finding a win-win between the two. It’s a membership service that includes unlimited visits and referrals to well-regarded specialists in a kind of custom ‘narrow network.’ HIPnation takes health insurance totally out of each patient’s  primary care visit. “Right now, insurance is in every aspect of healthcare, but it should be used for low frequency, high cost things,” Hall said. “You need it for a heart attack, but not for poison ivy.” HIPnation is more like car insurance — a consumer uses it for major accidents, not an oil change.

Patient loads at a traditional practice that takes insurance can be 2000 individuals or more. HIPnation clinics get by on 500-600 patients. That’s mostly because without the burden of insurance, the practice can be run with far fewer staff (no big teams doing claims, coding, billing, appealing denials, collections, etc. etc.). Which means patient appointments are 30+ minutes instead of less than 10.

Biggest differentiator: Business model innovation to deliver full health plan with a membership model for primary care, but still getting access to specialists and hospital or large-scale treatments (via a health insurance product).  

Some details:

• Founded in 2016, Alpharetta GA
• Total clinics open: 3 in Atlanta metro with 5 by year-end (see the announcements)
• Details on their business model: Atlanta Business Chronicle
• HIPnation’s official site

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