Health & Medicine

House calls make a comeback. Why Sacramento patients and doctors like this new app

New technology is getting Sacramento doctors back into the business of making old-fashioned house calls, employing a mobile application in an attempt to extend the amount of time they can spend on interviewing and bonding with their patients.

Sacramento residents can schedule a doctor’s visit at their homes within two hours, using the Heal app or website. Most patients cover the cost of the visit through their insurance, paying whatever their co-pay is, said Heal chief medical officer Renee Dua, but Heal also accepts payments of $99 for the home visit.

Local doctors began working with Heal in May. Dr. Janet O’Brien, an internist who practiced for many years in Woodland, said she joined the company because she had a number of frustrations with a traditional office practice.

Patients today suffer from obesity, diabetes, blood pressure and other chronic conditions that require coaching and a holistic approach, she said, and that takes time. Yet, she said, in so many practices — including high-quality ones — the emphasis is on how many patients doctors can see.

“(Physicians) are pressured to see more patients and just not to take that much time with patients, not the kind of time you need to really effect positive change,” O’Brien said.

O’Brien said she expected her overall satisfaction with her work to improve but that she never expected the positive patient reaction she has received. Each Heal physician goes out with a medical assistant who can draw blood and help with other tasks.

“In just about every visit that I have had, the patient has been delighted to see us, happy through the visit, and they wave us goodbye,” O’Brien said. “People have said, ‘God bless you.’ Nobody ever blessed me in my private practice.”

As much as Heal was created for the convenience of patients, Dua said, it also was founded with the idea that doctors are happiest with their work when they can spend more time with patients and can develop a long-term relationship.

Doctors at the UC Riverside School of Medicine recently published research in the American Journal of Medicine that found that physicians are less happy at work than they are at home. Drs. Andrew G. Alexander and Kenneth A. Ballou noted that the levels of dissatisfaction were markedly higher among primary care physicians, family care doctors, pediatricians and emergency room doctors.

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The declining levels of workplace satisfaction are the result of a number of factors, including that:

Doctors rarely have long-term relationships with their patients anymore because employers change up insurers and insurers change up provider groups.

The insurer-client relationship comes between the doctor-patient relationship, meaning that doctors cannot guarantee patients can get the treatments they recommend.

Doctors are spending more face time with electronic medical record than they are with their patients.

At Heal, Dua said, doctors spend an average of 28 minutes talking with patients, while the average office visit is 7 minutes. For O’Brien, this means she can spend more time listening to her patients, she said.

Dua said: “Clinicians might be seeing 40-50 patients in a day, and the first 25 of those, he needs to see to pay bills. The last 15 or 20, he might see to pay back loans, feed his family, pay his mortgage. It’s not a sustainable lifestyle for a physician, and the expectation are frankly absurd.”

O’Brien said she loves the flexible scheduling she has as a Heal physician. As a full-time Heal physician, she works 16 12-hour shifts a month, she said, while part-time physicians work six-hour shifts. O’Brien said she can schedule her roughly 14 days off for one month back to back with the days from the next month. That’s what she did last spring to do some traveling.

“I flew across the country, went to my daughter’s graduation and … we flew off to Paris together,” O’Brien said. “That’s where we parted company. I had a week in Paris and then I spent a week in Amsterdam. I can do that now. I can take week off and go off with my husband, or I can plan a 10- to 14-day trip without touching my paid time off.”

Dua said that other Heal physicians have personal interests that the flexible scheduling allows them to pursue. One doctor in San Diego, she said, plays with the philharmonic orchestra when she’s not on the clock.

Doctors and medical assistants also get vision, health and dental benefits, Dua said, but they also get options in the start-up company that Dua founded in 2015 with her husband, electrical engineer Nick Desai, who has experience with high-tech entrepreneurship. The couple have so far raised more than $69 million in capital for Heal.

They launched with service in Los Angeles but now offer in it cities across California, as well as in Washington, D.C., and they have plans to extend their on-demand house calls nationwide. A kidney specialist, Dua said she wanted patients to be able to get medical care in their homes rather than waiting for hours in a germ-filled waiting room.

“I told my husband, ‘I want you to build me an app that is wireless, that is paperless, and you are going to be my medical assistant, “and you’re going to guide me around and I’m going to see patients in our community’,” she said.

What Heal likes to do, Dua said, is have the same doctors regularly serving the same neighborhoods within a region. That way, she said, they can observe health trends. In Los Angeles, for instance, Heal doctors have observed patterns of similar types of stress among high-tech workers, Dua said, and they have been able to get them the mental health services they need.

O’Brien said she trained with Heal in Los Angeles for several months before returning to practice in Sacramento. She gets paid more by Heal, she said, than she did in her Woodland practice, and the Sacramento team is looking to add a pediatrician.

Dr. Janet O’Brien talks with her patient, Sarah Gonzalez, during her medical appointment at her home on Monday in Roseville. Paul Kitagaki Jr.

Roseville patient Sarah Gonzalez said she decided to try Heal because she was new to the region and her husband had to use the couple’s only vehicle to get to work. Hayward resident Elizabeth Maciel, a legal secretary, said she tried Heal in the Bay Area because her 2-year-old daughter was sick and she didn’t want to miss work or wait in an ER late into the night.

The doctor arrived at her home at around 5:30 p.m., Maciel said. Appointments are scheduled between 8 a.m. and 8 p.m.

“It’s a great experience because I didn’t have to leave my home, and my daughter didn’t have to leave the house,” Maciel said. “That, for me, is No. 1 on the list. ... Sometimes, you have to wake up your child to go to the hospital, and they’re crying nonstop.”

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