For most doctors in Silicon Valley, melding technology and medicine means cutting-edge machines performing high-powered work backed by Sand Hill Road venture capital. But for Caesar Djavaherian, M.D., medical technology means a smart phone.
Djavaherian is president and co-founder of Direct Urgent Care, a 3-year-old health service with an office in Mountain View that aims to make health care accessible and complete with current-day conveniences.
“We took our clinic concept and expanded it to try and be as close as possible to the on-demand concept,” Djavaherian said. “For many of our patients’ health-care needs, instead of having to do things in person – like going to the bank to make a transaction – they can do it over their smartphone.”
The concept revolutionizes the way people talk to their doctor’s office.
“We are solving the patients’ problems as soon as possible. Time to resolution is a rate we look at. I don’t think many health-care organizations really focus on that,” Djavaherian said.
Djavaherian said that in his years of medical education and practice, which started as an undergraduate at Stanford University, medical professionals paid lip-service to putting the patient first, but it was rare to have an entire practice focusing on the patient’s desires.
“I’ve never had anyone say, ‘What we care about is making sure you are feeling better as soon as possible,’” he said.
In short, he called it “bringing health care into the 21st century.” This includes scheduling services like a prescription refill or even offering house calls via a secure messaging app.
“The health-care industry does not prioritize the patient experience,” Djavaherian said. “In the very traditional way, the family doctor may not even tell the patient why they have a certain diagnosis. That’s the feedback patients have been given over the years.”
Profiles in health
Direct Urgent Care targets millennial high-tech workers, the sort of people who say, “I can get any movie I want, so why do I have to do go through so much crap to get my illness taken care of?” according to Djavaherian. But he was surprised to note the number of seniors interested in Direct Urgent Care as well.
“The elderly patient who hates the hospital experience is a fairly common patient for us,” he said.
Paul Stivala’s father was one of those patients.
“My dad got a little bit sick and he’s 92,” Stivala said. “He gets vertigo.”
The East Palo Alto senior is dizzy for days, or even weeks, after a drive to a hospital. On a morning in early January, Stivala believed that his father needed a doctor and looked online for his options.
He found Direct Urgent Care, which sent a physician assistant to their home at 12:30 p.m. that day. The PA gave Stivala’s father a physical on their couch.
“She was concerned about it being pneumonia,” Stivala said. “She ordered a technician to come in with an X-ray machine the next day.”
Sure enough, a technician brought X-ray equipment to their home. The technician said there was no pneumonia detected but felt that an enlarged heart was a possible diagnosis. Stivala’s father has a follow-up scheduled with a gerontologist.
“The physician assistant was fabulous. She had a great bedside manner, but he was on a couch,” Stivala said. “She was very personable and caring. When you’re 92 years old, well, when anyone’s sick you want that.”
Stivala said he received phone calls from Direct Urgent Care after every step in the process to ensure that everything was going smoothly. He noted that there was an online-only text service but preferred to talk with someone over the phone.
“As I sat there and thought about it, these things are for older people or families who can’t leave the house because they have a few kids,” Stivala said. “The fact that you can get someone to get out seems to be such a great service.”
According to Djavaherian, doctors’ salaries often don’t incentivize them to provide such services.
“Doctors typically get paid for in-person visits or for procedures they’ve performed,” he said. “There hasn’t been as much motivation to change. It does take substantial energy to try and consumerize health care and try and put the patient experience first.”
Without an incentive to encourage them to reach out to doctors early on, he said, patients simply do not call a doctor until they really need one.
“What that means is that patients often delay getting cared for until they’re really sick,” he said.
Djavaherian warned that such delays are shortsighted given the types of health plans many companies offer.
“The idea of a high-deductible insurance plan or PPO has become far more in vogue,” he said. “I have talked to our patients who say the reason they come to our clinic is because they have a high-deductible plan, and they know if they go to the ER, the cost will be 10 times as much.”
Djavaherian explained that his company can keep costs down by maintaining relatively small offices and limited administrative staff. He gave the example of charts and diagnostics.
“If someone wants their chart, we can upload the chart to Box (a cloud-based server) and send the patient a secure link,” he said. “It’s 100 percent HIPA compliant, and within a manner of minutes they have access to their full medical records. That saves on us having to pay someone for a medical records department.”
Text messaging enables the doctors to stay in touch with their clients throughout the day rather than scheduling meetings.
“We use secure text messaging to check up on someone, creating a high-touch environment without having to utilize a huge staff to do so,” Djavaherian said. “If you have questions, the staff will tag us on the conversation so that we can securely message our patients and take it from there. It gives us another opportunity to solve their problems fully rather than say, ‘Here’s your prescription – good luck.’”
A growing service
Djavaherian said Direct Urgent Care’s target demographic is anyone in the area who does not have time to visit a doctor. As it turns out, that may encompass a large swath of the Bay Area.
“We see this huge variety of patients. But what they have in common is a lack of time,” he said. “They can’t afford to spend two to three hours in an emergency room. That’s the unifying theme.”
For more information, visit directurgentcare.com.