HouseCall MD

Total national health expenditure in the USA is $3.8 trillion, or 17.7% of total GDP.  The majority (>72%) of healthcare services provided daily are provided to people over the age of 65.  Of these 22.6% are considered to be in fair or poor health and 8.3% have difficulty with self-care.

5.6% of the elderly are mostly or completely homebound and cannot leave their home for any healthcare without the assistance of an ambulance.

7 out of 10 people in the US require assisted living care in their lifetime.  Of these, 71% will have memory impairments and be unable to care for themselves.  The average cost of assisted living is $4,300/mo.  According to the peer-reviewed journal HealthAffairsBy 2030, these costs are expected to average $5,779 and $7,776 by 2040.  These increasing costs will price out the majority of Americans, meaning they will not be able to afford living in a retirement community or other long-term care facility (assisted living/memory care, etc). For this reason, it is expected that the community-dwelling elderly population will be expected to increase by 4-6 times it's current level.  This means that there will be an estimated 28-36 million elderly residents in their homes who cannot feed themselves, clothe themselves, bathe themselves, or drive themselves if they needed care.

This increase in home-bound elderly has already more than doubled in the past decade.  This increase was disproportionately among Blacks and Hispanics, who also experience poorer health and less digital health access.

This "silver tsunami" of a drastic increase in the elderly population is expected to strain the healthcare systems of nearly all nations.  Some nations expected to have a near or complete collapse of their healthcare system.  For example, in the US, the Medicare Hospital Trust Fund is expected to be insolvent by next year.  

Currently, there is an overuse of the most expensive types of healthcare delivery services; urgent care and emergency department visits.  The elderly often will use even more expensive ambulance services both to and from these visits as well.  For example, a typical case of cellulitis (a soft-tissue infection commonly seen in the elderly population) costs on average $80-120 at a primary care office, $350-800 at an urgent care, and $5,250-10,100 in an emergency room.  

Many companies have felt that they could help solve this issue by utilizing telemedicine to see these patients in their homes.  Unfortunately, the elderly population struggles to use the software needed for telemedicine visits.  In fact, due to cognitive decline, vision and hearing issues, and lack of familiarity and confidence in technology, less than 25% of elderly patients are able to adequately use telemedicine.  So essentially telemedicine has mostly failed the population it was originally designed to serve.  

Simply put, there are very few options for the elderly who need healthcare at home.  HouseCall MD has tried to provide a solution for this.  We have discovered that by offering multiple different visit types, and utilizing varying levels of technological integration, we are able to serve all patients. Especially ones who are home-bound.

HouseCall MD provides several levels of care based on the patient's needs and their ability to interact with technology.  We have SMS and basic telemedicine visit for simple cases.  But also, as the name of the company implies, we also provide house calls to patients' homes when necessary.  We originally envisioned HouseCall MD as being "Uber for Urgent Care".  However, unlike Uber, not just anyone with a car can provide our service.  It also requires a medical degree.  In a world where there is already a severe shortage of medical doctors, and where the average medical provider is already overworked and typically only sees a patient for 5-7 minutes in the clinic, house calls are not, and have not been a financially viable avenue for healthcare since the 1960's.  

While we do have medical providers go out to see more complex patients, the majority of the visits could easily be managed via telemedicine.  However, due to limitations of cognitive decline, hearing/vision problems, and difficulty with technology, most elderly patients cannot adequately use telemedicine software.  For this reason, HouseCall MD instituted is what we call "augmented telemedicine".  We are the first medical practice in the US to use this method of healthcare delivery.  Augmented telemedicine is the practice of sending out a trained technician (EMT, MA, LPN, RN) to perform what we call a guided exam.  This trained medical technician obtains vitals from the patient and also utilizes the advances in technology to obtain a physical exam which is directed by the doctor from afar.  The technician uses a digital stethoscope to record heart and lung sounds; a digital otoscope to obtain digital images of the ear canal, throat, and eyes; a digital camera to send images/video of skin or extremity exams; and can perform point of care tests like strep, influenza, COVID, urinalysis, monospot, RSV, and basic blood work on site.  In addition, we have units that have mobile x-ray and ultrasound available for more advanced cases.  

These visits are done with the technician on-site, who collects the data needed for the medical provider to make a proper diagnosis.  This is done concurrently while the provider is directing the physical exam and asking questions of the patient and family.  According to studies, the diagnostic accuracy rate of traditional telemedicine is approximately 75%.  This means that a physician gets the diagnosis wrong 1 in 4 times via telemedicine.  With augmented telemedicine, physician now has data that isn't normally available to them (vitals, heart/lung sounds, EKG, labs, etc).  With this additional data, the diagnostic accuracy is now 95%, which is comparable to an in-person physician visit.

HouseCall MD currently serves all patients of all ages who request our services.  We see infants with fever, teenagers with acne, young adults requesting STI screening or birth control, and elderly patients who need hospice care.  Due to the nature of our unique service of providing mobile urgent care, the majority of our patients are elderly and home-bound.  

Our services improve the lives of those with dementia.  Those with ALS.  Those with super obesity (500 lbs+).  Those who are at high risk of falls/fractures.  Those with agorophobia.  Those who are blind.  Essentially, we serve those who otherwise could never leave their home to get medical care.  

We engage with these patients daily.  We see them in private homes, adult-family homes, memory care, assisted living, and nursing care facilities.  We understand their needs, because we hear from them every single day.  We know how they often can't hear the words spoken through the phone.  We know that they are scared to leave their retirement community since the last time they left they slipped and broke their hip.  We know that they ran out of their insulin because they weigh 540 lbs and haven't left their home in over 2 years and their primary doctor refuses to refill her medicines until "she can be seen".  We know that they have ALS and have developed a bed sore because they needed their doctor to renew their home health care order for it to be covered by their insurance, but the doctor wanted to see them first.  We know that the patient's doctor was refilling their medication, but then the doctor retired and now they have no way to get to a new clinic to get their critical medications refilled.

These are all daily scenarios that we see at HouseCall MD.  We could list thousands more.  The reality is, people across this nation are dying everyday because of lack of access to medical care.

We also engage with nursing staff at long-term care facilities daily.  We hear from them how hard it is to get ahold of the doctors of their residents.  We hear how one of their residents is developing urinary symptoms, and they legally need an order from the resident's doctor in order to test their urine.  But their request for the order is not responded to for over a week.  And in that time the patient's UTI developed into urosepsis and they were admitted to the ICU.  

HouseCall MD interacts with these nurses daily, and see's the patient's on the same day that they request an evaluation.  HouseCall MD has created a unique HIPAA compliant software to engage with these nurses.  We provide orders within 15 minutes of the nurses request.  We provide urgent care in a fraction of the time it would normally take, and treat illnesses early.  Pneumonia, cellulitis, UTIs, etc all develop rapidly in the elderly and chronically ill.  Even a few hours delay can mean the difference in life and death in this patient population.  

HouseCall MD has been a functioning practice since 2018.  We have been directly involved in serving the elderly, infirm, and home-bound since before the COVID pandemic.  We continued to serve them, despite the hardships placed on our staff and supplies during this time.  We can proudly say, for all long-term care facilities with which HouseCall MD was partnered, there was not a single COVID outbreak.  This is due to the fact that we were able to help facilitate in-facility care and prevent residents from having to leave the facility to go to an urgent care or emergency department waiting room and get exposure to the virus.

Our team has over 40 years of experience working in over 4 healthcare systems (USA, UK, Malawi, Tanzania).  Our founder worked with the very first telemedicine platform in existence, bringing medical expertise into remote villages of central Africa.  They have worked providing free clinics to migrant farmworkers, the homeless, and refugees.  Working with these populations has given them perspective on where modern healthcare is best serving it's communities, and where it is failing them.

Having worked in various healthcare systems our team has discovered that the prevailing problem in all systems in all countries is not quality or cost, it is access.  Getting access to the ever-dwindling number of qualified medical providers is the greatest hurdle a patient has no matter what country they are from.

My experience providing healthcare in Malawi was primarily that my patients often took more than a week to travel to one of the central hospitals for care.  Families would camp in tents outside the hospital while their loved one received care inside.  I would travel to the villages, and provide what care I could while I was there, but I could only stay a day or two before travelling to the next village, not to return again for several months.  

It was this experience when I decided that I would train one or two of the local villagers to be my "eyes and ears".  I trained them in what to look for, how to before certain tests, and how to perform a basic exam.  Then they would call me and discuss the case.  In this way, the patients in these remote villages did not have to travel more than a week to get to a clinic or hospital, they could recieve care at home from a trained technician, who was under the guidance of a skilled medical provider.  

The greatest asset in healthcare is medical knowledge held by a select few highly trained professionals.  The greatest burden is getting that knowledge to those who cannot easily drive down the street and be seen by a doctor in a clinic.  

The advances in technology have gotten us to the point where I now carry an ultrasound machine in my pocket, and an EKG machine which attaches to my smartphone.  I have an iStat machine which can run blood tests in 5 minutes which fits in my lab coat.  These devices are easy to use, and with minimal training, a technician can use them as well.  They can collect the data I need to make an accurate diagnosis.  Multiple technicians accross multiple rural areas now means I can provide expertise accross a wide footprint.  

This model will have to be widely adopted, because we lost 1/3rd of medical and nursing staff during the pandemic.  There are not enough medical school graduates to replace the number of physicians retiring.  

We have delivered our services while slowly improving our technology platform.  Now that the technology platform is complete, we hope to utilize the prize to expand our services, primarily through marketing and obtaining further community partnerships.  Our hope is that we can take our services nationwide, and ultimately globally so that the barriers to healthcare can be removed for all those in need.

Garrett Soames, Founder and CEO of HouseCall MD is the team lead. Garrett has over 20 years of experience in the healthcare space and he has created several successful healthcare companies in the past.  He is intimately involved in the long-term care community and sits on several local committees for elder care and aging in place.

HouseCall MD has already had one imitator, Amazon.  HouseCall MD was the first to the market utilizing direct text-only (SMS) medical visits.  We have been providing SMS-only visit types since 2019.  AmazonHealth originally ventured into telemedicine but found the regulations too difficult to manage, so they discontinued all telemedicine and instead instituted text-only visits in 2023.  

HouseCall MD provides several different visit types:

1. SMS - simple visits for mild medical conditions

2. Telephone -for simple medical conditions and medication refills

3. Telemedicine - more complex conditions, for tech-savvy patients

4. Augmented telemedicine - utilizing a medical technician on-site to facilitate a telemedicine visit, allows the medical provider to have additional data for more accurate diagnosis.  Works for patients who are unable to do telemedicine.

5. House Call - MD/DO, NP/PA arrive at the patient's home and provide direct care

Amazon has already seen the value of providing ease of access to medical care.  However, they just became frustrated with the changing regulations regarding telemedicine laws and reduced their services to text-only visits.  HouseCall MD is comfortable in the healthcare space, as we have been doing this for a while now.  We continue to provide additional methods for patients to interact with their doctors because we have already been dealing with the hurdles to access to care.  We believe that if Amazon was willing to copy our SMS visit model, they may also see the value in why we also offer in-person visits as well.

All of healthcare has changed due to technology.  The advances in technology have gotten us to the point where I now carry an ultrasound machine in my pocket and an EKG machine that attaches to my smartphone.  I have an iStat machine that can run blood tests in 5 minutes which fits in my lab coat.  These devices are easy to use, and with minimal training, a technician can use them as well.  They collect the data I need to make an accurate diagnosis.  Multiple technicians across multiple rural areas now means I can provide expertise across a wide footprint.  

With the increasing deficit of healthcare providers due to retirement and the aging population, HouseCall MD's model of healthcare delivery will be a necessity in order for all citizens to get care.  Bringing the expertise of medical providers into patients' homes is the wave of the future.  While some companies have tried using patient-operated home medical kits to help assist in collecting objective data during telemedicine, these have failed due to operator error.  Also, more importantly, they are missing the human touch.  Having an empathetic person holding your hand when you are feeling scared or unwell cannot be bottled, and cannot be replaced by technology.  Also, someone still needs to be on-site to administer medications.

HouseCall MD has already changed the market, in our small corner of Seattle.  Our neighbor here in Seattle, Amazon, has recognized the value of this model already.  It is conceivable that this model will spread worldwide once people know it is available.

We hope to increase access to healthcare while also reducing healthcare costs.  We will do this by continuing to grow our practice, so that more people become aware of our practice model.  

Our impact goal for the next year will be to expand from two states (WA and CA) to all 50 states.  

In 5 years we hope that any time someone is feeling sick and is unable to get from their home to a clinic or hospital, they consider calling HouseCall MD to be seen and taken care of for less than $300 instead of foregoing care or being seen in an emergency department for $7-10,000.

We hope to achieve our goals of visibility and increasing access through marketing efforts.  We will increase community outreach by sending advocates into the community and partnering with long-term care facilities, chronic disease support groups, social workers, and others in the geriatric and home-bound spaces.

We are measuring our progress via daily patient counts.  But more indirectly, we work with our long-term care facilities to monitor for a decrease in residents needing urgent care or emergency department visits.  On average, among our >50 partner facilities, we are averaging a decrease of outside facility acute care visits by 87%.  This means that residents are taking 87% fewer ambulance rides due to the fact that their illnesses are caught early, and intervention (treatment, prescription medications, etc) is initiated early.  

We also have developed the Fall-O-Up program.  Like its name, we follow-up on residents of long-term care facilities after a fall.  The incidence of a second fall occurring within one week of a first fall is over 50%.  HouseCall MD comes in and evaluates the resident for injuries, and also performs a fall assessment. We then intervene with physical therapy orders and fall precaution orders, reducing the incidence of subsequent falls resulting in hip fractures or head injuries.

In the facilities which have partnered with us in the Fall-O-Up program, we have reduced in-facility falls an average of 425%.  Of course, this contributes to decreased emergency department visits as well.

We expect our solution to have an impact on the problem because we have already seen it in action.  We have been using this model since 2018, and have worked through the kinks.  We have had to make several adjustments along the way, but we have arrived at a final product that provides for the best ease of access for patients and their families.  

HouseCall MD has developed and utilizes a HIPAA compliant teleconferencing software and patient portal.  We are in the process of completing our own proprietary electronic medical records system and anticipate it's launch within 6 months.

We have a unique patient registration and appointment request system which is the first of it's kind.  It is the first patient portal system designed to allow access to the caretakers and nursing staff at long-term care facilities.  We have developed this HIPAA compliant software to allow for better ease of access for these overworked nurses at these facilities.  With other medical practices, these nurses can only interact with the doctors offices via phone or fax, and do not have access to the various patient portals of each of their residents.  HouseCall MD have designed a system that allows these nurses to bypass phone trees and outdated fax systems and immediately message our staff.  We guarantee a response within 5 minutes.  

This allows the nurses to implement doctors orders without delay, improving care all around.  The records of the interaction are also available to the patient's primary care team, so there is no duplication of services.

Full-time: 8

Part-time: 12

Contractors: 2

We have been working on HouseCall MD for 6 years

HouseCall MD demonstrates it's committment to diversity, equity, and inclusivity daily.  Here are a few examples of how:

1. HouseCall MD is a minority and woman-owned business.  

2. We are committed to serving the underserved community.  

3. We have contracts with local tribal communities in the Pacific Northwest to provide care on reservations.  

4. We also are committed to providing care to our veterans and active-duty military.  We demonstrate this by obtaining security access to our local military bases, so that members of the military and their families can receive convenient access to healthcare.

5. We are registered as Kink Aware Medical Professionals.

6. Our staff is multi-lingual.

7. HouseCall MD provides a quarterly free medical clinic for the homeless.

8. HouseCall MD is a registered Walk with a Doc practice.  We encourage healthy lifestyles by organizing nature walks in impoverished communities.

HouseCall MD's business model is to remove all possible barriers to patient care.  We attempt to make patient registration (intake, insurance information, demographics) simplified through our portal system.  We provide services to all of the community, regardless of insurance or lack of.  

As mentioned before, we provide 5 different levels of service: SMS, telephone, telemedicine, augmented telemedicine, and house call.  These services are provided at no additional cost to the patient at facilities with which we have partnerships.

We provide on-site medical testing, x-rays, and ultrasounds.  Anything that could normally be done at urgent care, we can do in the comfort of the patient's own home.

We do this through a reduced staffing model, relying on our registration/scheduling/communication software to reduce the administrative burdens of healthcare.

All patients who have tried HouseCall MD become repeat customers because they have quick, easy, and efficient healthcare delivered to them based on their individual needs.

HouseCall MD does bill health insurers, so we currently sell services to cover our expenses.  However, because we are committed to providing urgent care services at primary care rates, we are seeking grants in order to help with the process of expansion and marketing of our services.  We have had government contracts in the past (contract with Washington State to provide COVID testing for the home-bound within the state).  We are currently in discussion to serve a medical contract with the Bremerton Naval Shipyard, the largest on-site employer in Washington State.

HouseCall MD currently generates revenue daily by billing health insurers for the care provided to patients.  Average patient volume per day per medical territory (service areas are divided by areas covered by medical providers) is 15-20.  This more than pays for the cost of staffing.  Our telemedicine providers can see on average of 60-70 patients per day.  We bill traditional primary care rates for the majority of our visits.

We hope to remain financially stable by continuing to rely on a reduced staffing model.  Unlike other healthcare systems, we don't have a bloated administrative staff.  The average healthcare organization has 10 administrative staff per medical provider.  This means there are 10 people who never see the patient, but derive their salaries off of the work of the actual care team.  All of our staff are on the medical care team.  This means they are all MDs, PAs, NPs, RNs, LPNs, EMTs, or MAs.  We divide up any necessary administrative work amongst the care team.  This allows them to make administrative decisions and implement ideas they have to improve the company as a whole.  This is the opposite of the top-down approach, because there is no top.  We all work as a team and all are involved in the growth of the business.

We primarily lean on technology and our software solution to reduce administrative burden.  This reduces staffing needs significantly.  The typical medical practice does not make money until around the 5th or 6th patient of the day (accounting for expenses).  With our model, we begin making money by the second patient of the day.