[HN Gopher] Launch HN: Axle Health (YC W21) - In-Home Healthcare...
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Launch HN: Axle Health (YC W21) - In-Home Healthcare as a Service
Hey everyone, We're Connor and Adam and we're working on Axle
Health (https://www.axlehealth.com). We provide an API for sending
health professionals to people's homes to deliver medical services.
For example, a telehealth company can use our service to request an
in-home blood draw for their patient. Healthcare has traditionally
been delivered in an office or hospital. In recent years,
telehealth - providing healthcare remotely, without the need for
people to come to a healthcare facility - has taken off as
technology has improved, but physical tests are still often needed
to make diagnoses, and physical contact is needed to administer
treatment. Without physical interaction, telehealth physicians can
only handle a subset of common visit reasons. In all other cases
they're required to refer patients to a lab or in-person doctor. As
a result of this lack of continuity in the patient's care journey,
most use telehealth platforms for one-off needs like getting a
prescription filled. The goal of our platform is to be an extension
of the physician in the patient's home, working on the doctor's
orders to administer physical services that would normally require
a visit to a lab or office. I ran across this problem when I moved
from New York to Los Angeles. I had received the first dose of a
vaccine (not the COVID vaccine, unfortunately) before moving and
needed the second on arrival. My only option was to find a new
doctor who required me to do a full physical exam before I could
receive the second dose. I did it, but needed to take a couple
hours off of work. I thought "why can't I just get this done at
home". It's not just me, studies show that completion of multi-dose
vaccine courses is as low as 33%. Life just gets in the way. After
I had my experience, I called up my friend from college, Adam, who
worked at UberEats and we started thinking about the economics of
bringing care to patients' homes. The wealthy already have access
to in-home healthcare. The question was, could we drive enough
operational efficiency and optimization to make this available to
everyone while only charging a small per visit fee for companies to
use the platform. Solving this problem would have far reaching
implications by expanding access to treatment in healthcare
deserts, enabling decentralized clinical trials, improving uptake
of basic preventive services, and leading to better health
outcomes. The operational and technical challenge of sending a
health professional to a patient's home is complex. There are a
couple of old line national phlebotomy companies that go in-home,
but phlebotomy (drawing blood) is the easy part. When you start
moving up the licensure ladder from phlebotomist to medical
assistant to licensed practical nurse to registered nurse, their
scope of practice expands. Each state has its own laws governing
the scope of practice of each of those professionals. For example,
our appointment assignment algorithm needs to account for the fact
that in Florida a medical assistant can start an IV line, but in
California they can't. We need to ensure each professional has the
right mix of supplies for their daily appointments to drive maximum
efficiency - a nurse might go from administering an immunotherapy
IV at one home to a vaccine at another. Luckily Adam is crazy
enough to like these logistical headaches :P But, Adam won't need
to solve these problems manually. We've built a good bit of
software around matching patients with in-home professionals. The
process is fully programmatic meaning partners can use our API to
find available services in a zip code, pull time slot availability
and pricing by geography, indicate special instructions from the
doctor, book visits, and receive visit updates via webhooks. Health
professionals from our network use the Axle app to get shift
assignments, indicate to patients that they're en route, and write
up any visit notes. Patients can even see their health professional
on a map in real time just like an Uber. We want to make the
process of getting in-home care as seamless as possible for
patients and health professionals. Our API documentation
(https://developers.axlehealth.com) is publicly available. We're
hoping to enable the next generation of healthcare startups by
offering them the ability to physically interact with patients,
through us. We wanted to make the API as straightforward as
possible, so we welcome any feedback on the documentation or our
product at large! Thanks for reading!
Author : chailey11
Score : 37 points
Date : 2021-01-27 16:18 UTC (6 hours ago)
| abhinav22 wrote:
| Good luck
| vriad wrote:
| Looks really interesting! Similar to a company called Workpath
| [0] that was recently acquired by Ro.
|
| I'm also building a related company called Brick Health [1] that
| does something similar, but is partnering with brick-and-mortar
| facilities instead of doing home visits. This is definitely a
| huge open problem.
|
| [0] https://www.workpath.co [1] https://brick.health
| chailey11 wrote:
| Yup, two sides of the same coin. Love the name by the way :)
| Workpath isn't yet doing in-home nurse visits although it's on
| their roadmap. There's some additional complexity with the in-
| home nurse visits - will be interesting to see how they make
| the transition.
| rush86999 wrote:
| We are a new startup and we recently launched virtual primary
| care ($25 per visit) and this might be useful to us in the future
| when we have elderly patients who can't get out of bed for
| bloodwork. We'll keep you in mind when the need arises!
| (https://virtual.tangerinehealth.co/)
| bmh100 wrote:
| I work in the healthcare advertising space. Let me know if you
| need some help in that area. My email is in my profile.
| dr_ wrote:
| Congrats on your launch. So do you hire or contract with actual
| providers to go into homes?
| chailey11 wrote:
| We contract with the health professionals who go in-home
| (phlebotomists, medical assistants, LVN/LPN, and RN)
| mritchie712 wrote:
| How do these professionals make a living today? What are they
| leaving to do Axle instead?
|
| Also, a bit meta, but are you giving them benefits (e.g.
| health insurance)?
| chailey11 wrote:
| Currently we use health professional contracting agencies
| to source our health professionals. Some of these
| professionals do contracting as a side hustle while their
| w2 employment is with a hospital or clinic. Others only
| work part-time to supplement family income, and some do it
| full-time. Health professionals who work for these
| contracting agencies on a full-time basis do generally
| receive health insurance and other benefits through the
| agency.
| zachwdc wrote:
| I hope this is successful. My dad is homebound, can't get around
| on his own, and needs to get blood drawn on a regular basis at a
| Coumadin clinic. He can usually get a friend to give him a ride,
| but not always.
| chailey11 wrote:
| Thanks for sharing..this is what we hope to make easier for
| patients struggling to access care
| dtang2299 wrote:
| Which Telehealth companies are you working with currently? I use
| Doctor on Demand and curious if they are integrated with you.
| chailey11 wrote:
| We don't currently have an integration with doc on demand.
| We're piloting so we're not releasing our customer list just
| yet, but will soon.
| yclurker wrote:
| Much needed indeed. I can imagine quite a demand for this.
|
| But how do you plan to tackle supply in meaningful way ? A
| practitioner sitting at a clinic can draw lot of samples vs the
| one travelling to homes.
| chailey11 wrote:
| Part of our thesis is that healthcare is overpowered. If you go
| into a doctor's office or clinic, there's rarely a phlebotomist
| on hand. Your blood is usually drawn by someone whose license
| allows them to do more than draw blood. We drive efficiency by
| ensuring that professionals are always operating at the "top-
| of-license". I know from personal experience: my doctor gave me
| my flu shot, which can be done by an LVN making $40/hr rather
| than a doctor making $150/hr.
|
| We also hope demand will drive an increase in the number of
| people who choose to enter these health professions, which pay
| decent wages. It takes about 6 months to become a phlebotomist,
| 12 months to become an MA, and 18 months to become an LVN.
| These professions are accessible from both a time and monetary
| standpoint.
| ircody wrote:
| In what market are LVNs making $40/hr?
| levinb wrote:
| So this is interesting, but I'm concerned you may have issues
| here, just like workpath (formerly Iggbo) and Call9 did (though
| for different reasons).
|
| There's a slight chance that this sort of service may in fact be
| illegal, or at least in a gray area, depending on who performs
| the sample draw: https://nppn.info/index.php/blog/view/iggbo-is-
| illegal
|
| Typically, if you order a test, the person performing the test
| has to be actually employed by the organization that pays them
| (ie, cannot be a contractor), and there aren't national-level
| service providers for things like phlebotomy, because the
| economics don't really work out yet.
|
| Also, if the provider (MD/NP/PA) service isn't actually doing the
| test themselves, then I believe they have to provide the option
| to the patient to choose what service they go to (Lab Corp,
| Quest, your service or another) because not providing the
| customer a choice may violate Stark law prohibitions on inter-
| provider referrals.
|
| I am sure you have considered much of this, but would love to
| hear what you've found so far.
| chailey11 wrote:
| Thanks for posting. Took me a while to get through it! Here are
| some thoughts. And first and most importantly IANAL.
|
| We have, unfortunately, spent quite a bit of money to put a
| legal framework in place. Our operating model is slightly
| different than Workpath/Iggbo, so a number of the concerns in
| the piece don't apply. I don't want to give too much away b/c
| the framework we've developed is a competitive advantage.
|
| Health professional quality, HIPAA adherence and data privacy
| are part of our core mission. They're first-class citizens both
| in our legal and product/technology frameworks.
| bovermyer wrote:
| I have Nice Healthcare as a benefit of my current employer. Free
| service, with health professionals sent to my house or wherever I
| happen to be. It's glorious.
|
| Have you interacted with Nice at all?
| chailey11 wrote:
| We've checked them out, but have spoken with them yet. We want
| to help a company like Nice scale that offering b/c that's the
| hard part.
| bozhark wrote:
| An app that helps the patient and doctors communicate would be a
| good addition to this service. Something with: 1) Data entry 2)
| Concurrent records for all the different medical professionals 3)
| Visual diagrams for patient communication (ie. imaging, reports)
| 4) medical history 5) On the professional side it would provide
| easy access to notes about the patient
| chailey11 wrote:
| That's a good point. We've been thinking about how we can have
| concurrent in-home visit with health professional + doctor
| video visit (e.g. doctor directing health professional on what
| to do), but haven't implemented that yet.
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(page generated 2021-01-27 23:01 UTC)