We should measure health innovations based on how much they can do and how effective they can be.

An interesting metric to understand the effectiveness of a new kind healthcare service is the raw number of diagnoses that service can diagnose, treat, and manage.

Retail Health Clinics

The list is small and the conditions are simple, like pink eye, allergies, and poison ivy. They are 30 or so issues that can be diagnosed via protocols, simple tests, and nurse practitioners. By design, to protect themselves from liability, they are limited in scope.

Number of conditions they treat: ~30

Video Telehealth Visits

Video-based physicians have a similar, yet different scope of illnesses they can diagnose. These are diseases that share two characteristics:

• They do not need tests to diagnose

• They are quick fix, simple illnesses where a “one and done” interaction suffices

Also, due to process and liability issues, they have limited capability in safely diagnosing and treating. They also have no way to follow up with you to see if their treatment was the right treatment. With no way to follow up and understand outcomes, there’s no way to measure quality. And what you can’t measure, you can’t improve.

Number of conditions they treat: 20 to 30

Sherpaa

Sherpaa routinely manages just shy of 500 conditions. From pink eye to asthma to care coordinating an acute appendicitis, Sherpaa is in a different category. Why?

Reason #1. Our communication happens more like email allowing us to manage an issue over time. Say we don’t know the exact diagnosis at this second, we can say, “hey let’s connect in 2 hours to see if your abdominal pain gets any better or worse.” If our docs suspect it’s just gas, but have a low suspicion it could be appendicitis, we can give it some time to see how things evolve. So our docs proactively reach out to you in 2 hours to follow up. Because traditional doctors and video visits are 12 minute snippets of time without the ability to follow up at any time, they are forced to make knee-jerk reactions. Reason #2. We order tests. If we want to rule out pneumonia, we send you for a chest x-Ray. If we want to diagnose thyroid issues, we order blood tests. We get the results and we diagnose and treat and follow up. Twelve minute video visits can’t do this. Reason #3. We are always a message or phone call away and we follow up. This gives our doctors unprecedented comfort in their management. For example, if you are discharged from the ER and 2 hours later something changes, good luck trying to get a hold of that ER doctor. With Sherpaa, we always have a direct communication line to you, just as your friends can always reach you via text. And in every single case we have, we follow up with you to ensure your issue is resolved. If there is no change or you are worse, we reassess and determine your next course of action. We’re constantly measuring this, so we can always improve. Reason #4. A case can last 10 minutes to 10 months. All of the activity that happens on your case is documented and available to you and our docs, including all the messages, the data, and the consult reports from specialists. This way we can handle both acute and chronic issues. Video visits with random doctors are unsafe for managing chronic illness. Reason #5. We’ve built out a network of roughly 4,000 specialists, radiology centers, ERs, and urgent care centers in the states in which we operate. This allows us to quickly find the best specialist or facility to refer you to who knows what Sherpaa is and will communicate directly with our docs to work with us on your care. Reason #6. Our doctors collaborate offline about confusing cases. When a weird case comes in to Sherpaa, our doctors will talk about it offline and then decide together next steps and then get back to the patient online. Practicing as a traditional doctor is actually quite isolating. It’s typically just you and a patient. Multiple doctor brains deciding together about one case is far safer, more effective, and allows us to do more. Reason #7: We maintain continuity. We don’t have a large bank of anonymous doctors you’ll statistically only talk to once. Our patients are assigned to small doctor groups so you’ll always be talking with your same group of small doctors. This is safer and more effective.

The breadth of diagnoses Sherpaa can manage puts us in a totally separate category than traditional telemedicine and retail health. We’re quite proud of that.