We interviewed an executive at Doximity that has 20+ years’ experience in healthcare IT/digital health roles. Doximity is the private “Professional Medical Network for Physicians” that has been able to provide a simple, effective platform for care team members and physicians to connect with patients. We have had positive experiences with telehealth involving Doximity recently, which made the discussion all the more interesting!
- If we take a step back, Doctors may not need the complexity of an Amwell or chart integration with Epic. The more fluid the process is, the better. But all the bells and whistles aren’t needed to create a good patient experience.
- Doximity’s telehealth service has been free, but they plan to charge a fee starting at the beginning of 2021. We wonder if this will impact the utilization of other platforms.
- Hospitals are interested in using Epic’s solution – we think Amwell’s partnerships may help it mitigate the risk of disintermediation.
- Patient volume seems to be back to 100% for many specialties.
From your seat, and if you want to take a step back and walk us through Doximity’s recent history, please do, how is telehealth evolving? How does virtual visit growth look?
- Sure - Doximity is a professional online network for Doctors w/ >1.5MM providers on it. Traditionally, the model has been marketing-focused (campaigns in the newsfeed(s) or for recruiting, among other professional purposes). About 3 years ago, the Doximity Dialer launched (a recommendation from a physician advisory group). This allowed a user to call a patient from his/her smartphone w/ a masked number.
- Telehealth obviously became more important than ever in March because of COVID-19, so the Dialer -> Video using Twilio and AWS (this is no secret, for every visit a partner gets a fee). This provided one more reason for physicians to engage. Something reliable and easy to use was needed - had to go with two of the best (Amazon and Twilio don’t give stuff away!). The Video function is “lightweight” and will stay that way - easy to use, HIPAA compliant, etc.
- The point was to recreate a real visit - what happens in the real world, but digital. SMS message, patient touches it, face-to-face, physician leaves the room after - maybe off to chart the visit or can chart it at the same time.
- At the height of the pandemic, the platform hosted 150k - 160k visits per day (4x Amwell or others). The number of physicians, NPs, and Pharm Ds ticked higher, but not materially. There was a huge influx of “other” care team members - i.e., RNs or scheduling managers.
- JV Side note: It sounds like Doximity benefitted from hiccups with core systems, which I can attest was still the case in early October. A recent telehealth visit that was scheduled through MyChart (Epic) ended up happening via Doximity due to technical issues w/ the patient portal - my physician didn’t want to fall further behind that day. It was quite simple and effective.
- I think we hit the high-water mark ~3 months ago, and there’s been a steady, expected decline. Telehealth now has a place in every hospital’s IT strategy - that’s here to stay. It’s not a “U” scenario.
- Hospital systems are amenable to a static pricing model - tiers based on number of beds works well (e.g., $15k for up to 100 beds, and so on) for unlimited MD and non-physician use. Individual physicians can buy in the app store(s) - per month.
We were curious about the app ratings - 4.7 and 4.8 out of 5 stars on Google Play and the App Store (~85k ratings!), respectively:
Is competitive intensity rising? Who do you hear about or run into most often?
- Yeah, it seems like a lot of health systems that use Epic are trying to go with Epic’s solution. That could be a threat to the standalone [telehealth] companies. They are the one I hear most often. After that, Amwell has the most name recognition, and Teladoc is close behind.
What’s the benefit of the Epic solution?
- Epic is expensive and they are good at selling additional applications - while I don’t have a sense of actual pricing, I’m sure it’s significant, and the reasoning is “one throat to choke” – a fully integrated solution. It’s hard to know exactly what “integration” is here, but it seems like collecting copays, billing on the back end, and delivering lab results are high on the list.
- Hospitals/providers want to collect as much data as possible, but at what cost? For patients, ease of use is critical. There was one example in the South where a patient didn’t have enough memory on the smartphone and didn’t want to delete games… that’s the most extreme example I’ve heard, but still. How do you find another way to do a virtual visit in that scenario?
Who do you see driving telehealth utilization? Why?
- There’s high utilization in the primary care setting. Dermatology is another one. It’s interesting, I see care teams leveraging voice and the docs using video.
- There’s been some attrition - cardiologists who are used to making >$500k per year. Orthopedics got hit hard too because hips and knees are somewhat elective surgeries (timing). And the elderly population is more at-risk and concerned. Those were the services that took the biggest hits. Now, they are coming back. I think it’s been a “rubber band” snap-back (a lot of specialties are back to or close to 100% - you can’t keep neurology shut down for too long).
Is every MD using at least 2 solutions – primary plus a backup?
- I think ~50% have a primary telehealth option, and that’s it. The more sophisticated and wealthier practices/systems will look at a strategy in layers and offer a backup or two. In private practice, I think most doctors find the one that works best or they like best.
What else can you tell us about what’s going on with the recovery from your seat?
- More people are back in their offices - we used to do a Zoom and everyone was home. Lately, it seems like 75% of people are back in the office.
- Also, it seems like healthcare marketing is coming back, and I hope the reimbursement for telehealth stays.