Popularity of drug delivery, online care exploding

Local health providers caution people not seeing doctors, pharmacists in person

Health care apps are shaking up medicine by making it easier for people to get care online and drugs on demand.

Startup companies like Hims, Nurx, Roman, Keeps, and many others have all launched in recent years using a business model that brings doctors and prescriptions directly to people without the office or pharmacy visit.

Their lower costs and ease of use are attractive to the growing base of people that want convenient care and are comfortable getting health care through an app. Many of the brands also market that online visits are a discreet way to get care that patients might not be comfortable going to their doctor for.

But some local health care providers told the Dayton Daily News some of the complexity of conditions can get lost over the computer and health care can get siloed when people use an app instead of visiting with their provider who knows their chart and history.

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Hims chief medical officer Dr. Pat Carroll said he worked for 30 years in traditional primary care and saw how patients could struggle with access and how he struggled with having enough time for each patient, who were also increasingly wanting seven-day a week access to health care.

He said the new model lets patients get care on their own schedule when they aren’t busy and get care if they live in an area with a primary care shortage. Patients with high deductibles benefit from Hims affordable and price transparent product, he said.

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Hims was founded in 2017 and has become one of the fastest growing direct-to-consumer brands in history. The company, which sells hair loss, erectile dysfunction, and skincare medicines, has been catering to Ohio consumers since its inception.

“Ohio is a really strong market,” Carroll said.

The demand for their service is clear: the young company is already valued at $1 billion.

Hims was granted an Ohio tax incentive toward open a $1.5 million mail-order pharmacy, fulfillment center and customer support center in the Columbus area. The pharmacy will open later this year and Hims has pledged to create 500 jobs.

Planned Parenthood has also adopted the health care model as a way to bypass barriers and increase birth control access in Ohio and other states through its Planned Parenthood Direct app. App users can request birth control pills be delivered to their door, get a prescription for UTI treatment sent to a nearby pharmacy, learn about different methods of birth control, or make an appointment at a Planned Parenthood health center.

Credit: Alexander Crispin / Natural Cycles

Credit: Alexander Crispin / Natural Cycles

Many commercial ventures have also found business success through this new health model. Ro, the parent firm behind Roman, an erectile dysfunction telehealth venture, raised $85 million from investors and was valued at $500 million, Tech Crunch reported in April. The company also operates Zero, for smoking cessation products, and most recently launched Rory, an online platform with health products aimed at women in or entering menopause.

Depending on the company and the state’s rules, patients either fill out an online questionnaire or chat by phone or video chat, to see if they qualify for a prescription, with common options ranging from hair loss prevention to oral contraception to erectile dysfunctions medication.

Dr. Marc Belcastro, Premier Health chief medical officer, said consumers now need and want a more rapid turnaround for all types of services and health care. However, virtual health care and in-person health care are different experiences.

A busy person with a family doesn’t want to take off work and go to a physician office if they can get the same level of health care service over the phone, and some conditions like a rash can be treated in a high quality and quicker way over the phone.

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However, he said there’s still the question of whether a particular service looks at the patient overall given the complexity of the condition being treated.

“As the disease process gets potentially more complex, what am I sacrificing in my virtual visit? One of the basic things they teach us in medicine is the foundation of understanding what’s going on with your patient is the history and the physical. You can do a relatively short history virtually, but other than looking at the area that’s impacted, say you have an eye infection or a rash, the ability to do a full physical exam is not there,” Belcastro said.

Premier has also been feeling the pull toward convenience that’s driving these startups. The health system now has online scheduling and telehealth visits for existing patients.

Ted Inman, CEO of Dayton-based PriMed Physicians, said providers with the independent practice want to know what patients are taking from these startups.

He said in the example of patients seeking erectile dysfunction medication, there can be different root causes from psychological to heart problems and it’s important that a doctor performs a physical exam.

“If they aren’t laying hands on them, they are probably not doing enough,” Inman said.

Inman said the practice is being shaped by patient demand for convenience. They are working on online scheduling and are testing patients with reminders so they can text to cancel if needed. He said the changes are a significant investment for the practice and also require changes to their work flow.

“We understand we have to get more consumer friendly and health care does in general,” Inman said.

Antonio Ciaccia, with the Ohio Pharmacists Association, said instead of focusing on the venue, it is important that no matter where you are at to ask questions like whether the pharmacy has a good idea of other medications a patient is taking and whether they have a complete idea of what’s going on with that patient. He said the pharmacy industry in general, whether online or in person, needs to have a business model that encourages quality and personal care.

“I’m not naive enough to think there’s not essentially a fast food mentality in some health care operations,” Ciaccia said. “I care less about the venue with which health care is delivered. I care more about the standard of care that’s being upheld.”

These health care companies ease access but remain different from over-the-counter medication. Unlike those low-risk and generally cash pay medications, these consumer-facing health care products require a doctor or other provider’s sign off and patients generally seek to have the products covered by their health insurance.

Dr. Tiffany Inglis, with Anthem, which is the largest commercial insurer in the Dayton market, said they generally support and cover consumer-facing health tech, which can remove transportation barriers or stigma, but before covering the products, they are evaluating whether the service meets the same standard as an in-person equivalent.

“I think the cautionary part that we always talk about is we want to make sure that we’re removing barriers for evidence-based treatments. And by increasing convenience and simplicity, we want to make sure that — just like everything else — we look at that it’s truly evidence based, and that there’s health benefits for the person,” Inglis said.

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