Generation Start-up: How one start-up is revitalising the old-fashioned doctor's home visit
Emirati brothers Humaid and Omar Alzaabi are racing to beat major health care providers to an old practice made new again with Housecall
In 1930, doctor house calls accounted for 40 per cent of all physician-patient encounters in the US.
"The image of a physician delivering care to a sick patient at home is one of the essential and enduring images in the collective consciousness of medicine," wrote Johns Hopkins medical professor Dr Bruce Leff in 2001.
By 1980, physician home visits fell to 0.6 per cent of medical visits, according to Dr Leff. But he predicted the doctor's home visit was poised to make a comeback on the back of innovations in telemedicine and increasingly compact and portable medical devices.
Nearly four decades later, patients seeing doctors or lab technicians in their homes is on the rise as venture capitalists pour money into the telemedicine industry and regulations change.
Two factors are driving the resurgence of the old-fashioned practice: app-based booking platforms and growing evidence that at-home care can have better preventative outcomes for patients and be done at a lower cost than in a clinical setting.
Capturing the opportunity in the UAE are Emirati brothers and co-founders, Humaid and Omar Alzaabi.
Housecall, their app which launched last month, offers a simple interface to book at-home primary care visits or request a delivery of a prescription refill. A home visit can also include collecting labs like blood or urine samples, a Covid-19 test, a new prescription or a referral to a specialist.
Housecall aims to increase access to primary healthcare while improving the quality of care patients receive in Abu Dhabi. Demand for outpatient consultation rooms was more than double the current supply, according to a 2016 assessment by the Department of Health.
"Home-based primary care has great potential to save the emirate of Abu Dhabi on overall healthcare spending, because you’re able to provide the same services with a reduced need for physical facilities," Omar told The National.
Primary care provides health care throughout a person's lifespan in a non-emergency, preventative approach that is as close to an individual's everyday environment as possible, according to the World Health Organisation.
The high prevalence of diabetes, heart disease and other cardio-metabolic risk factors in both young and elderly populations in the UAE, combined with a health care system that emphasises specialty care, underscores a need to shift to higher quality primary care, according to consultancy PwC which carried out an audit of the health care system.
Expanding access to primary care in the UAE would reduce avoidable ER costs and cut overall health care costs if the prevalence of chronic illnesses are reduced.
The Alzaabi brothers were encouraged by their father - a career respiratory doctor in Abu Dhabi - to come up with an innovative solution to the primary care challenge.
They started to exchange ideas and sketch out plans for an app in 2019 - Omar from the campus of UC Berkeley, where he is pursuing a PhD in nuclear engineering, and Humaid in Abu Dhabi, where he is studying economics and business at Khalifa University after attending Boston's Northeastern University. Both brothers were inspired by an entrepreneurial spirit they observed on their American campuses.
They dedicated nights and weekends to Housecall, keeping in touch online, until the pandemic brought Omar back to Abu Dhabi and the global public health crisis surfaced. That necessitated the need to roll out the app to address the situation locally.
However, setting up as a virtual clinic proved difficult at first. Such designation wasn't yet available under the guidelines of Abu Dhabi's Department of Health. But the department, which prides itself on taking innovative approaches to complex problems, was quick to work with the Alzaabis to come up with a solution.
Within just a few months, they were able to register as a medical provider and were admitted to the HealthTech Hub at Abu Dhabi's start-up space Hub71, being run by DoH. The programme provides them with an advisor from DoH and free office space.
"We’ve received an immense amount of support from the folks at the DoH from the conceptual phase leading up to our launch," Omar said.
Having a direct line of communication open with their regulator, an office space where they can interview job candidates and one day court investors, have been critical to Housecall, which was in bootstrap mode for a year.
The brothers estimate they have put in about Dh200,000 of their own money to build the app. They avoided hiring developers, instead sketching out what they wanted and outsourcing the build to a web team in Dubai.
"They are good about telling us, no, you can't afford this idea," Omar said with a laugh.
Their costs are set to go up as they make new hires, but for now they don't plan to pursue outside funding.
They are recruiting part-time doctors and nurse practitioners who work in primary care fields like family and internal medicine. They have also brought on an administrator to work with insurance providers to get their services covered.
For now, users pay Dh400 out-of-pocket to schedule a visit from a Housecall doctor.
"It's a race before the big players wake up to this opportunity of providing home visits," Omar said.
During the Covid-19 pandemic, telemedicine and home visits have been critical tools to keep patients at home rather than crowding waiting rooms at hospitals and clinics.
Since March, Abu Dhabi's private provider Seha has logged more than 200,000 medical consultations by phone, according to the group's chief executive Dr Gareth Goodier.
These remote consultations have a place in the evolution of primary care, Omar said, but there is a limit to how useful they can be.
"By having your doctor physically present, they can check your vitals, perform physical examinations and - uniquely to home visits - doctors get a deeper understanding of the social and other environmental factors that could be impacting your health," he said.
One of Housecall's first physicians, family medicine consultant Dr Ismail Dahshan, told The National that Covid-19 "has changed everything" about what people should expect from their health care provider.
Dr Dahshan spent 16 years as a physician at Seha hospitals in Abu Dhabi. When the pandemic began, he thought he would return to his native Egypt. But he saw a job opportunity with Housecall and was excited by this new model of care.
"A large part of our work is about education," he said, and he believes this can best be done in a person's home. He added there is often no reason to see someone in a clinical setting for something like the common cold or a prescription refill. Communicating via an app would suffice.
He predicted growing pains for this new old way of doing things. "It must be extremely easy to use, and insurance will need to cover home visits," Dr Dahshan said. "But I see it as the future."
Q&A with Housecall co-founder Omar Alzaabi
What successful start-up do you wish you had started?
Ever since going on a long ocean cruise and finding out that cruise ships emit three times as much carbon as an airline flight, I have been interested in technologies that could allow us to reclaim marine transport in a more environmentally responsible manner. I thought combining hydrofoils with advanced control methods could have the potential to make significant efficiency gains. It turns out there is a start-up called Boundary Layer Technologies that has been recently funded to develop hydrofoil container ships.
What new skills have you learnt from launching your venture?
Navigating a regulatory framework and developing the app in parallel meant constant changes to both our strategy and development roadmap. Having to make these corrections on a really small budget adds another dimension of complexity to this balancing act. You start to build an intuition for that type of decision-making.
If you could do it all again, what would you do differently?
At the conceptual stage we came up with all sorts of schemes and algorithms to automate daily operations before having any operational experience. I think I would have designed our application processes to be less automated and instead be capable of accepting more human interventions on-the-fly. That would have been more valuable for this early stage because we are still developing our standard operating procedures.
What changes in health care should patients expect in the next decade?
Home-based primary care is the future. We can expect to see evaluation and management procedures previously only conducted at doctors’ offices become increasingly available at home. We also see an enormous untapped potential in continuous remote health monitoring with the rise of wearables and advanced sensor technologies. Ideally, your family doctor should be the one to tie it all together; processing these inputs to better inform the complex decision-making they’re trained to do.
Updated: August 15, 2020 11:18 AM