How Consumers Enter the System

My last post about HealthTap was meant to be a broader post about how people find and access care, both now and in the future. As an update to my HealthTap adventures, I’ve since received a few better responses from doctors. Overall, HealthTap is a pretty cool service that has a place. Whether that place is big enough to be a massive success for its investors remains to be seen, but the way it is generating content will boost its Google rankings as people search for health information and answers.

This time I’m thinking about doctor finding.

I started thinking about doctor finding and appointment booking — what I used to think of as the entry points into the health system — several years ago. I remember hearing about ZocDoc when it first launched, before it had raised oodles of venture funding or grown beyond New York. I didn’t get the hype or relate to the founder’s personal story about why he launched the company. I also didn’t think the name ZocDoc helped. 

Almost two years ago, I wrote about ZocDoc and the companies I considered at that time to be its main competitors. Each had a slightly different approach. Way back then in 2011, nobody knew HealthTap and Practice Fusion was still just an EMR company. By the time I wrote the post, I understood how big the market could be (funny how "OpenTable for healthcare" helped me get it.)

It’s interesting how much I missed the mark on ZocDoc and the market in general. I thought at the time that ZocDoc’s shared investors with Practice Fusion might leverage Practice Fusion for integration into more provider systems, which could help launch a PHR or a scheduling system that would tie into patient records. I also thought ZocDoc would start doing eligibility and patient financial responsibility at the time of booking but, as far as I know at least, that hasn’t happened. The main expansion I’ve seen is the ZocDoc Q&A site, which is a direct competitor to HealthTap.

Now Practice Fusion has launched Patient Fusion, which does doctor finding, provides a PHR, and pulls in patient insurance information. It also has doctor reviews from patients who have been verified as actually having seen the doctor. Patient Fusion is free compared to the $250 per provider per month that ZocDoc charges.

ConsultingMD raised $10 million this week to help people find second opinions at an average cost of $3,750 per consult. That’s not a typo — almost $4,000 for a consult (screenshot above as proof.) My favorite part of the $3,750 is the "Recommendations" section from the sample ConsultingMD report, shown below.

That’s expensive advice without "treatment," ConsultingMD is similar to 2nd.MD, a concept I’ve liked for years that has never really taken off. As far as I know, 2nd.MD is considerably cheaper than ConsultingMD.

Then there are all the geographically based ZocDoc clones. Look at this list of European versions of ZocDoc. Clones in France and Australia have raised money recently to solve local doctor search and scheduling.

And how about this one. Want to launch your own ZocDoc? Here’s a very cheap PHP platform that looks to be a pretty good technology version of ZocDoc, at least based on the screenshots (one is below). For $499, the code is all yours.

The reality is that it’s not about the technology at all. It’s about distribution, and distribution in healthcare is expensive, hence the massive funding for companies like ZocDoc and Castlight. Doctors need a supply of patients, but the target is the consumer. In the case of Castlight, access to the consumer is through the employer. There is also the roundabout way of using payer tools for finding providers. I’ve heard payer search tools aren’t very good, and I know of at least a couple of medium to large payers that are looking to improve them.

But for ZocDoc, HealthTap, ConsultingMD, DocASAP, iTriage, and a few others, it’s a matter of getting consumers to your site, or maybe to use your mobile app. You need them on your site to book appointments so providers see a reason to pay for their listing. Or you need them so you can sell ads. Getting them to your site is a matter of winning the battle for search engine optimization (SEO) supremacy.

I’ve been told — and it makes a ton of sense — that ZocDoc spends a lot of money on SEO. If you search for a specific specialty in a certain geography, ZocDoc is often at or near the top of the list. So are more established sites such as  Healthgrades and Vitals.com. That’s probably why ZocDoc launched its Q&A site.

Many people leverage the Internet to search for health-related information and to have health-related questions answered, so that will be how many of them will enter the health system. Search, ask, find, and then book. More people will start out looking for health information rather than seeking an appointment.

Content sites such as HealthTap and WebMD seem better suited to capturing consumers than appointment booking sites or even iTriage, which will use athenahealth’s new API to expose appointments to app users searching for health information. ZocDoc either needs its own content or needs to work through third parties.

OpenTable succeeded by integrating with Yelp and Evernote, so you aren’t required to use its own app. ZocDoc is probably placing ads on Healthgrades and Vitals, though I haven’t seen them, to address this. I also noticed that ZocDoc is the listing service for MD.com, though I have an unfounded suspicion that ZocDoc is involved more closely with MD.com somehow.

I’m waiting to see if HealthTap can win the SEO battle using health information and then tap into scheduling systems using APIs like athenahealth’s, reducing the cost of adding appointment slots. It’s not that simple, and the challenge for HealthTap is that it will probably never gain a critical mass of engaged doctors. Or maybe HealthTap has no intention of doing scheduling and I’ll look back on this post in a few years and see how much I was off again.

I don’t know who will win or how. One thing I do know is that healthcare is local and requires saturating geographies with enough listings to get consumers to use it. ZocDoc started out doing that very well. I can’t tell at this point if ZocDoc is getting the sustained uptake to keep docs paying month to month. Any docs want to weigh in?

What do you think? Are you as fascinated as I am about how engaged patients are going to enter the health system?

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Todd Johnson

    Great post Travis. It seems to me that these solutions really need to figure out how to create very personalized experiences for their patients to be sticky.

  • Mr. M

    ZocDoc is def on a side of a patient, although doctors are fueling its belly every month. Looking at our own bookings, most patients who scheduled through ZocDoc have been referred to us by another specialist or internist. Google ad words drive more business to us than anything. Zocdoc is only used for booking, but the lead wasn’t generated by Zocdoc. Our culture is loosing the “art of communication” where people rather txt or email, vs call. ZocDoc does just that, allows customers to quickly book an appt without calling doctors office, and more times that none, make mistakes in booking (missing Ins. info, reason for visit, wrong contact info) which puts a burden on a physicians office to correct it quickly. Disputing a review is extremely hard, because again, they are on the side of a patient. You cannot post a reply to a comment of a patient. I think they also pay a patients $25 if an office reschedules there original appt to a different time/date, which in a way rewards a patients and showcases ZocDoc’s loyalty to its customers.

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