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Today’s interview in the Scale Capitals founder story series is with Rohit Agarwal, who is CEO and Co-founder of the digital health startup DoctorPlan.
We started DoctorPlan just about three years ago. The idea is health happens between doctor visits. So if we think about our normal interaction in a healthcare system, we go see a physician and at the end of the meeting, the physician, the doctor, the surgeon, gives us some treatment, some more diagnostics. Then, over the next two months, we’re supposed to follow through, we started the company with a thesis that health happens between doctor visits.
Our goal is to guide patients, and help doctors and specialty physicians guide patients through their diagnostic and treatment journey. At the end of the day, we want to see the patient get better, faster, get better, cheaper, and to have a much better clinical outcome. So that’s effectively what DoctorPlan does.
We’ve built a very comprehensive platform to even automate all the intake and follow up process. So not only does it help guide the patients to better outcomes, that actually helps save the doctor a bunch of compliance, make sure the documentation is accurate, as well as save them time on documentation, charting, and follow up.
The timing couldn’t have been better.
I’ll answer it three different ways:
First, because patients actually have access to smartphones, almost everybody has it, they have the ability to have kind of a mini doctor on their phone.
Second, if you think about the healthcare system, especially in the U.S., the cost of healthcare keeps rising. So the industry in general is trying to figure out how to reduce the cost of care, but yet improve outcomes and improve the end result. So the idea of technology, helping a doctor save 10 minutes for every patient visit, as a simple example, ends up being quite useful in terms of reducing ultimate care costs.
The third is being able to prove using data that this particular treatment was effective. It reduced pain by 65%, three months after 80%, six months after the insurance companies and the government can analyze the data to now say we see this particular implant work better than this one. In every other aspect, and in every other industry, we have data to guide our decisions, but in healthcare, there’s a doctor’s opinion to guide the decisions, right. So being able to incorporate data into making better decisions for the clinician for the doctor, but also for whoever’s writing the check whether it’s socialized medicine, whether it’s an insurance company, whether it’s Medicare in the U.S. , being able to use data to guide the decision process, and how much the compensation should be, is extremely useful.
So the timing for digitizing healthcare couldn’t have been better. And then as we think about COVID, when patients couldn’t see doctors face to face, and a lot of this information is being captured through telemedicine, this becomes a whole different ballgame, a whole different beast. Now, if you’re not seeing the patient face to face, having access to what happened to this patient of the last 30 days, last 90 days, and having that collected remotely, is extremely useful. So we see the trend of data-driven medicine be extremely valuable over time for a variety of different reasons. And the timing that we’re coming out with the solution. We’re already seeing huge value add to these physicians on these patients.
We’re a small team of about 25 people. What we found was, of course, the technical ability, the ability to code, the ability to serve as customers, the ability to solve their problems is extremely valuable, but what we found is we’ve had the pleasure of working with people who actually understand the problem and can relate to it and want to solve these problems in a meaningful way.
So it becomes a passion project. It’s something that people actually want to solve. So we’ve been blessed in many ways to have team members that are understanding the problem and can relate to it and really put in a little bit more than what you would expect of them, because they could see the value to people near and dear to the heart.
We measure the first line of success measurement for us, as our patients using it and our doctor seeing value.
The second is, if we’ve done a good job of collecting the data, that should be translated into a beautiful one paragraph chart note that a doctor can use because after the patient leaves.
The doctor spends 10 to 15 minutes writing down everything the patient told them, so part the third measure of our success is how valuable is that data? And is it useful to the device company for them to prove the efficacy of their product, that device.
There’s been so many rewards, and so many struggles throughout the journey. With every startup, it’s two steps forward, one step backward. So the reward for us in the team is not only seeing customers be happy with it adding value, but we can understand long term 10 years out, we could build models that basically predict that for these 1000 patients that are coming in based on data that we’ve seen on the previous 10,000. Here’s the recommended treatment. Here’s the pathway you could take. So the exciting part is unbound, in terms of what we could do with this data because healthcare data has never been collected in a structured way.
The larger companies like Google, Amazon, Microsoft, are now trying to go back and say, let’s look at doctor’s notes. And these large health care systems, there’s electronic health record systems, and analyze and see what we can find. The problem is the doctor never documented anything, to begin with. They did the bare minimum documentation. Our strategy is if we could over the next five years collect structured data, now we can start to predict exactly what’s going to happen with this set of patients, this cohort of patients, this type of patient, and after you recommend or analyze, and use clinical decision making, based on data that could change evidence-based medicine for the long term.
Yeah, there’s been many challenges. So in year one, the fundamental challenge was how do we get patients to engage. How do we get patients to actually download an app or use electronic means to answer questions? Right. And that became a design issue. It became a workflow issue. What is the trust? How does the patient know when they get an email saying Dr. Roger Smith, right? Because this is my health data. So we have to do minor design innovations, right? That ended up having a huge value with the email comes from the doctor’s practice brand, the logo exists, the doctor’s focus, and the photo exists on the emails, simple things, or even the design of the app, right? Because it could be used by a 28 year old. But most of these patients are over the age of 60. Right? So how do we build an interface that makes it really easy for them, because they don’t understand swiping and all those things, right. So something super easy with a white background for all those things were challenges that we had to overcome in year one.
In year one, we also had to overcome that typically, in year two, what we found was when we typically work with doctors, every office and you’ve been to a doctor’s office, where they give you a paper form to fill up, those forms were written 15 years ago, it is not specific to the problem the patient is experiencing now. So when you send a patient a form to fill out electronically, what we call a “digital questionnaire”, if it is asking relevant questions, the patient is interested. But then if you’re complaining of knee pain, as an example, and you’re asking about your patients, your parents has cancer history, they start losing interest. But if you can focus deeply on what is the actual reason for the patient’s visit (knee pain), and ask 32 questions specific to the pain that a patient wants to tell the doctor, so we had to customize it and build platforms. So we could go deep into specifics for knee pain, hip pain, etc. Right? That was a challenge in year two, which is going deep, and trying to understand not only where do we add value for the patient, but things that would engage patients? Right? So each year, we’ve solved a different problem, a different challenge. But the end result is as we solve for it, we’re seeing a lot more engagement and a lot more use and a lot more value, not only for the doctor’s office and the clinics, but also for the device companies.
When we started this company, we quickly got to learn that uncertainty is just a way of life when you’re building a startup.
With COVID everybody whether it was the doctor or the patient, everybody was forced to use technology to communicate, right, so that baseline has been set. So now, technology is a given. That gives us the opportunity to actually think about five years out how it’s no longer will a patient use technology, the patient’s already using it. The opportunity becomes over the next five years, how do we use that electronic means of communication to actually connect with patients in a more meaningful way? Right. So the whole idea of using technology and data to predict and drive care models, I think, is the future of healthcare.
You know, when you’re building a startup, you’ve got a thesis, here’s the problem we’re trying to solve. In 99% of the cases, your thesis is wrong. The question becomes, are you 10% wrong or are you 80% wrong?
So what we’ve learned specifically in healthcare, especially if you think about the COVID pandemic being thrown in a year into when we started this company, we quickly got to learn that uncertainty is just a way of life when you’re building a startup. So there are a few things that we’ve learned navigating this uncertainty.
Number one is focus on the customer, and what is the problem you’re trying to solve. Stay focused on proving whether that thesis that you established is the problem that you’re trying to solve A) worth solving? Does somebody care?
Second, if you’re solving it, Who is it– Who is it delivering value for?
And third, is the monetization aspect. If there is value delivered, somebody needs to be able to say, this is valuable enough for me that at scale, I’m willing to pay for this. So navigating through the uncertainty for me, is establishing a thesis early, but then willing to accept that your thesis is going to be wrong.
The second thing, which I’ve learned from my past experience at Amazon, is something called “wandering”. If I had advice to give to young entrepreneurs, it would be leave room for wandering.
Every time we start a company, we believe we know the answer to the problem we’re trying to solve. And a lot of times, it’s a straight line from where you are to where you want to go. But if you have time, accept that your end result, this point that you established in the straight line that you getting there, is not going to be a straight line. So the second advice I would have is leave time for wandering and accept the fact that when you sit with your customers, and actually watch them use your product, you will learn things because customers don’t know what they don’t know. They’ve got a very strong bias on how they want to use technology. And nobody’s better than just us sitting in the patient’s or the doctor’s shoes, or the customer’s shoes and watching them use it.
The third thing I would say is be frugal with capital. Today, capital is cheap, but we’ve chosen not to raise tons of money until we know exactly what our model is. So don’t hire 10 salespeople, assuming that you could scale the company faster, prove your product market fit, get one more person in sales and executing, moving forward and making sure that delivering value the customer success, the customer satisfaction is there before you end up deploying a lot more capital to scale the venture. I’ve seen more ventures fail because they burnt their capital very early on, assuming that they have product market fit and you could just deploy to 100 more customers.
Absolutely. It’s a pleasure.
