DoctorNow

Currently, the global healthcare model for providing care at scale is broken. Care is optimized through the lens of creating physical care systems and structures and not focused or built for the patient or provider. Only in mature markets has the capacity for remote care begun the process of adoption. Yet telehealth’s value proposition is more profound in developing countries where care (hospitals and health systems) is located primarily in cities and receiving care means overcoming travel time, wait time, low numbers of physicians, and low rates of satisfaction.

Furthermore ensuring care for your whole family is difficult. Healthcare infrastructure is relatively new and patient models of healthcare utilization are undefined. So when you need care the most current option is to go to a local pharmacy and try and resolve the issue without seeking formal care, or if severely acute go to a hospital. This is incredibly limited and ineffective.  

Currently, the healthcare system in Africa as in Ghana fails its users.

As a result of these conditions, the utilization rate and the spending on healthcare are repressed. It is our belief and hypothesis that reducing the friction to high-quality care will unburden the end-user and unleash the consumer creating the next multi-billion dollar market in Africa.

DoctorNow is a digital-first managed marketplace. We connect users to medical providers quickly and affordably and we empower users to select the care they need when they need it. What does this look like - we have a digital application currently a phone app but moving toward a web-app where a user can login, fill out their information and get access to care. We then have a user flow that helps them navigate what care they need - is this scheduled care, urgent care, home care, or emergent care. Our approach is to build or partner to create the best experience possible. So for the case of emergent care, we have a partnership with the national ambulatory service so a patient or doctor can summon an ambulance. The rest of our services we have built out from the ground up. Our application is hooked up to the local cellular-based payment platforms to render payment for service. If urgent care we get the patient in front of a doctor in 15 minutes or less, for scheduled care they join at their selected time. Our tech stack supports video, voice, or text communication with the physician so that if service becomes an issue contact is still possible. After the consult, we prompt our patients to provide feedback on the experience. A portion of this is used internally to provide feedback to the company and the doctor on the doctor’s performance. The other component goes to public reviews so patients can see and make informed decisions on their care. We are also currently designing what a family profile will look like which will empower full families to manage their care on our app. After an appointment, the doctor puts in notes, and we have a rudimentary EMR system so that as a patient interacts with our app over time they can track their own health, communicate their previous appointments if needed, or select from care providers they have met with previously. Our aim is to provide transparency and ownership to our customers.

We are currently working to charge on an a-la-carte basis with a flat rate but plan on moving toward physician set pricing. The telehealth visits are for 15 minutes, and due to the overhead in conventional care settings, we are able to provide more than competitive rates based on the average doctor salary which creates an alternative revenue stream for doctors. Roughly 60% of our flat rate goes to the physician which still provides a market-leading take rate for DoctorNow to re-invest in growth. This has created an easy avenue for physician recruitment. Also due to the distributed nature of telehealth, we have garnered a lot of interest from a pool of Ghanaian ex-pat doctors who mostly moved to the US and Europe where they are now doctors. We have worked with the Ghanaian Ministry of health to get a certification process in place so we can onboard these doctors to provide further supply as we scale. As we hit scale we are working to develop an inclusive model with a sliding scale wherein we will be able to offer reduced-price care to patients in need. 

We take a human-centered approach and have mechanisms for feedback to learn from our customers what their needs are to inform our product roadmap. We first launched with scheduled care and quickly got feedback that there was an immediate need for urgent care which we built into the application within the first few months of launch. More recently there was growing momentum around home health to assist older family members perhaps living un-supported to be able to receive care. This interest was especially acute among a large group of Ghanaian ex-pats who are living abroad who were interested in ensuring their family back in Ghana was receiving the care they need. We launched our home health platform on Jan 21st. Today is February 21st and we have 200+ customers and have been testing out operations with the first five paying customers. We see our product roadmap as an expansion of services to provide full care continuum support.

We are building an open-access platform so theoretically anyone birth to death could receive care on our platform. Our current customers include mothers with young children to grandparents and everyone in between. As we move toward a web application the only limit is having some connection either directly or through a friend or relative who has either smartphone access or internet access via a computer to schedule and organize the care. Our home health is also managed through phone or WhatsApp. Internet penetration in Ghana is just over 50% and mobile penetration is over 100% meaning there are people with multiple phones. Our aim is to create an inclusive model of care so while not perfect we are working consistently to increase mechanisms for people to receive care and we look forward to continuing to do so.

That said as the market is just getting educated to the potential of this service our target market, our early adopters have felt the most positive impact. For our new home health, our early customers are heavily within an older demographic 50 years old+. For our telehealth solutions they are broken out into three groups:

1. Female 24-30 with children. Population characteristics: highly educated, tech-savvy, results-driven. Channels: This group has shown engagement from 2 sources- first is paid social media advertising across platforms, second is from churches which are a cultural mainstay for much of the Ghanian population and a critical source of influence in communities

2. College students generally without kids. Population characteristics: highly educated, highly engaged, tech-savvy, cost-conscious. Channels: Primary contact through direct campus outreach through a partnership with an organization that works with schools and students on preparation for post-graduation. Secondary outreach through sponsoring campus student governments programs.

3. Tech-savvy 30-40 years old, moderate to high income, both genders: Population characteristics: Higher disposable income. Late technology adopters with high technology intentionality, FOMO. Channels: Social media paid marketing- Facebook, Instagram, google, youtube.

It is our belief that much of the population is chronically underserved in terms of their opportunities to access healthcare. An example of how these communities are underserved on a consistent basis is when a mother reached out to us a few months ago to let us know how our app had helped saved her child’s life. That when a sudden and severe illness had occurred in the middle of the night. She was unable to get to a hospital or to access ambulatory care (which is a fairly new service and not widespread), but she had used our application and communication with one of our urgent care physicians was able to stabilize her child until they could reach the hospital the next day. In the hospital, she told us, they were quite surprised her child was still alive. She was writing us to thank us for aligning the resources and providing access so people could get this type of lifesaving and life-changing support. 

For those of lower means our goal is to create an inclusive model of care by offering a sliding scale and in the future perhaps even our own insurance programs. We believe that healthcare is a human right and as a technology supporting healthcare it is our responsibility to participate in creating the inclusive care models of the future.

Our solution also serves the care teams by providing them a means to expand their earnings. A successful business for us is not successful unless is supports all stakeholders. This is why as we roll out our payments and charges we aim to provide above-market rates. As our product matures we plan to empower our physicians to set their own pricing.  

Beyond the key stakeholders (patients and providers) our solution also works to serve the population-level care goals. By being the first stop of care we believe we will be on the front line of future population-level threats. Our data will hold the patterns of change at a population level and we are hoping to work closely with national and international organizations and governments to build resilient systems that can proactively tackle population-level threats.

We are a team of builders and our co-founding team has worked together for years building new products. But more importantly, we are a team made up of individuals from the communities we are building for and others like them. Two of our founders Kwab and Bright are from Ghana and it was through their and their family's lived experience that this company was made. Amongst our broader team, all but one is either directly from a developing nation or first generation. We have nine team members all of who have lived and who have families who continue to live the health disparity that we are working to solve. And there to help us maintain our focus on what is important, our two advisors have a depth of experience not only in medicine but in direct care within our customer’s communities. This dynamic allows us to work quickly to build the best technology possible while firmly anchoring our efforts in what is medically best which is prescribed by our advisors.

But, we are not building this solution for ourselves. Knowing that the best way to build a solution is with and for the communities involved we are staunch supporters of human-centered innovation. Two members of our team Chinello (head of design) and Jake (head of business) are both from the MIT IDM program which is built and centered around human-centered innovation. Our platform from day one was constructed to create multiple avenues of feedback and connection with our users. We have an active WhatsApp community, online support, and comments on our google play store. But that is not enough, so as we continue to iterate and re-design our platform we work to actively capture user feedback. An example of this is that we are currently working through a user interface re-design for our customers. Chinello has been conducting interviews not only with customers from our current markets but also within markets that we are targeting for expansion so we can build for our users. As we aim to build an inclusive business this means inclusive of all stakeholders so similar work also happens on our physician and caregiver side. We know fundamentally we only succeed if those we are building for can succeed, and that means obsessing over the experience of all people who participate in our application.

And while we are a predominately international organization today - we have on our roadmap the goal of being able to re-locate to our markets as our business expands and can support our team there. As we continue to grow and develop we have actively begun to build relationships to further onboard team members from our markets. We know the closer the designers, developers, and team members are to our users the better we can fulfill our mission. Building a successful business in the African continent without teams predominantly based in the markets we are working within we know inherently limits our impact.

We are applying to Solve because we are a group of first-time founders who know success is a difficult journey that has to be traversed over time, and we know there are common pitfalls and dangers that only through strong mentorship and support can you navigate without falling into them. We are here to learn and improve and we actively seek feedback and mentorship to drive us forward. 

Specific mentorship that we are seeking input on over the coming year is responsible growth. We are looking to expand internationally and have been approached by governments to expand to their countries. We also need support in fundraising as we are looking to fuel our growth, but have had a hard time navigating the narrative around the opportunity that digital health in Africa represents. Especially with the drastic differences in expectations and experience that international venture capital and other sources have had in the African continent. As we continue to build and deploy our solution we also want to stay focused on the fundamentals of a business to ensure we are building a resilient business.

Lastly, we want to further develop our network and develop relationships with a cohort of similarly engaged individuals trying to solve problems on a global scale. We know the best way to learn is alongside others on the same journey

DoctorNow is the only end-to-end solution building a customer-centric healthcare suite of essential digital and physical services for direct primary and urgent care - from in-app scheduling to physician selection, to direct follow-up, feedback, and integrated payment. DoctorNow is also the only team working to capture the international remittance market through healthcare services (i.e. $48bn a year is sent back from Africans living in EU/America to family members in Africa). Home health and the expansion of access to care for those who can not access care through other means also provides a critical channel to care that is often overlooked and therefore under-developed.

DoctorNow’s go-to-market strategy wins because we are democratizing high-quality healthcare (e.g. licensed doctor domestic + abroad) at scale (marketplace model) and that is open to all people in need (not just with certain insurance), which is a much bigger market with a higher margin. We scale the supply side of our marketplace as we provide an easy additional revenue stream for local doctors and a great way for doctors abroad to provide care back home.

Our mission is to reduce the friction to care. Our long-term vision is to integrate vertically and create a network of preferred providers, all of whom connect through our platform to create a seamless experience for our customers. Being able to join a customer's records of interaction between general care, hospital care, pharmacies, and labs will improve the pace and quality of treatment. Providing access to scheduling, payment, and insight into the care rendered allows for the inclusion of international family members into the process. This data at scale also provides an invaluable tool for population-level care and can be an invaluable data source for governments looking to invest further into their infrastructure, or in managing new population-level threats such as new disease outbreaks. 

Our current product and product roadmap is differentiated around a set of key characteristics that align with our mission.

-We do not require insurance. With insurance penetration low across Africa, we feel an open platform provides outsized impact.

-We provide care for the whole family. Accounts are enabled with a family setting so multiple people can receive care with individualized profiles within the account.

-We provide customers with the tools to make the best health decisions possible for themselves. An example of this is our focus on transparency and physician feedback. Our users are asked to provide a rating of physicians after each visit a portion of which go toward public comments so people feel they have ownership over their care.

-Partnerships where a superior product can boost customer value. We partnered with the national ambulatory service so customers or doctors can request an ambulance for emergent situations.

We believe our model will be the catalyst for a new paradigm of care not just in Africa but in the world. As we prove out this stakeholder-centric model will provide the proof point that emerging and established economies around the world won't be able to ignore. And this process has already begun as governments across Africa have begun reaching out to ascertain how to get our product in their countries knowing that this model will improve care. The next horizon of innovation in healthcare models is not going to come from the US, Europe, or other developed countries where regulation limits change, but it will come from Africa and other nations which require tectonic shifts in approach to meet their needs. DoctorNow aims to be a part of bringing this change to the global healthcare market.

Our impact goals center around the health and wellbeing of the communities in which we are working. We currently struggle to formulate actionable metrics as we roll out our platform and test our services - this is definitely an area where we would value mentorship and guidance in navigating how to formulate effective goals and test methods to capture outcomes. 

1 year goals:

• Less mobile patients receive drastically different care. As we role out home health, we want to create a system of support to these customers who need our services most. It is our goal to provide a high value-add service in which over 1/3 of our customers utilize our service for 5 months or more.
• 81.4% of the population has some degree of access to primary healthcare in Ghana. 30% of the population has to travel far to access primary facilities or see a specialist. It is our goal to reduce the burden of travel time to receive care increasing the rate of utilization and access. We have a 15 minute wait time goal for urgent care customers our goal for the next year is to keep >90% of customers within that time expectation
• Knowing that diversity is an asset for our organization not only internally but externally with how our customers view us. It is our goal to develop a team that represents the communities we serve and which empowers the communities we work in with opportunities. By becoming a value add for our customers' communities we will establish DoctorNow as a positive force beyond our healthcare offering. We plan to have our first development team local to Ghana in the next year.

5-year goals:

• About 40 percent of the population has policies available through the National Health Insurance Scheme (NHIS), but these only provide limited coverage with few options. It is our goal to create an inclusive system that can help facilitate care no matter a patient's insurance coverage. We plan to create mechanisms so that fundamental care like urgent care and primary care are accessible and affordable for all customers we would like DoctorNow to achieve 30% population penetration in Ghana in the next 5 years.

• Healthcare in Ghana like much of the world does not provide the same level of support for low-income communities. DoctorNow aims to create an inclusive model of care and hopes to increase health engagement for all socioeconomic strata with a focus on including low-income communities more effectively. We are targeting a minimum 10% of our users utilizing mechanisms built to support low-income communities. 
• 81.4% of the population has some degree of access to primary healthcare in Ghana. 30% of the population has to travel far to access primary facilities or see a specialist. It is our goal to reduce the burden of travel time and wait to receive care increasing the rate of utilization and access by having to travel less frequently and only for targeted reasons and for the wait time for those visits to be <30 minutes.

• Perception of healthcare quality is low (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770037/) which we feel is a proxy for trust in the healthcare system. By providing more choice and ownership of the process as well as providing a channel for feedback DoctorNow aims to improve the perception of healthcare in Ghana. During our beta we became one of the top 3 health apps in Ghana and had a 4.25/5 star rating on google play. It is our goal to maintain a score above 4 points and to become Ghana's and other African countries top health apps.

Tracking our interventions at a patient and population level while utilizing demographic information is central to our model. As we work to re-develop our application we are actively working through how to best arm ourselves to track our impact and business metrics. Our goal is to build measurement purposefully into the system and not as a byproduct (the beauty of having a data scientist as a CEO). We are working to fine-tune our ability to track impact while reducing noise with our current capabilities. This has proven to be fairly limited given our application development issues. Our current metrics that we are using to talk through the narrative of our progress are traction, early adopter demographic information, and repeat customers. Another interesting dynamic is around the social sharing of technology usage within many of our communities - so metrics around organic growth represent positive views of our users because its common for people to share their favorie apps amongst their network and social network

Beyond quantitative measures, we also try and capture qualitative measures. Our application designs have functionality for users to provide experiential feedback which will be used by our organization to provide feedback to the providers, it will also be provided to users to empower their choice. Healthcare when done well at scale provides choice and that is what we want to work to build into the system - we want our users to know they have agency in this process. Currently, we capture these qualitative dynamics through our WhatsApp and email feedback mechanisms. 

From the patient perspective: DoctorNow works by reducing the friction and frustration around receiving care by facilitating doctor consults either through our application or our home health platform. This care is rendered at prices below what receiving care at a hospital or facility costs and eliminates the travel time, wait time, and difficulty having follow-up. It is also more efficacious than going to a pharmacy and working with a pharmacist to receive drugs or treatment options which is the general first-line approach for people. Empowering patients with a means to receive affordable, high-quality, care as well as data on their conditions (digital EMR) will increase utilization and improve outcomes - reducing morbidity and mortality and increased quality of life, and faster recovery. The outcome of this shift to more active participation and access to care will be improved health and wellbeing for communities as people will spend less reacting to expensive care needs when conditions become exacerbated ultimately leading to improved economic outcomes. 

Evidence: we are still working to develop our data capturing mechanisms across our application which will allow for a longitudinal study of patients. But anecdotal evidence is rich with patients reaching out to us to share their stores- like the mother of the young child who feels accessing our application and getting help on stabilizing the child until she could get to the hospital during the day. Or we had a patient who had severe jaw pain and needed help figuring out what his options were and who he should talk to. Or one of our first home-health patients who signed up not just for an initial consult but paid the first 2 months up-front to help them as they had more challenging health needs and had trouble reaching the clinic. 

Assumptions:

• Reducing friction will increase utilization

• That we will be able to track and ensure high-quality care that matches or rivals clinic-based care

• That having access to their own data will improve ownership and use of care systems

• That improved access will improve long term outcomes

• That an improvement in health will improve communities' economic status 

From the physician perspective: DoctorNow works to connect physicians to patients efficiently and provides a better means of extended participation in a patient's health. Physicians, therefore, get to spend more time with patients and having interactions and less time dealing with all the moving parts of clinical settings. This also provides them the ability to meet with patients whom they may otherwise not be able to reach because of more remote settings. This holds true for both physicians working within Ghana as well as those Ghanaian ex-pat physicians working abroad. The outcomes of this new approach to providing care offer physicians greater access to providing care that from our interviews they find valuable. It helps to reduce burnout by anchoring physicians on providing care that many feel is of higher need but hard to do. 

Evidence: Again much of our evidence is anecdotal. When we launched our beta we had over 20 physicians local in Ghana sign up even though we had no payment mechanism to offer them. They signed up to do pro-bono care even opening their schedules to night shifts. In talking with them we learned that many felt limited by their clinical practices. That they got into care because they wanted to help people but they felt that their current capacity was limited. When the Ghanaian ex-pats reached out to us they were highly interested in finding a channel to help provide care back home. They wanted to engage with us and work with us as we worked with the government to get approval to utilize their expertise.

Assumptions:

• That DoctorNow is able to sustain the efficiency of physician time and able to quickly and easily connect them with patients.

• That patients will engage with their health portal and re-contact physicians they have already had contact with

• That providing new channels of patient access will improve job satisfaction

Beyond this theory of change, I think it's helpful to think out past horizon 1 and into the future horizons of innovation. We see these dynamics fitting into a flywheel which one turning will shift the model from which people receive care. If you can provide a high-value first stop in care you can facilitate access and improve efficiency at a system level. In a country where there is a shortage of physicians as well as hospital beds and resources - each asset must be used to its highest efficiency. Being the main artery of intake and building out all of the components for providing support across the care continuum changes how the health system will grow and evolve. This is the change we wish to bring to the world.

Our core technology components are the building blocks of mobile applications and web apps. Our platform is currently an application that is accessible on Android and iOS, but we are moving toward a web app that is more universally accessible. Our platform supports video, voice, and text-based communication between patients and care teams to more readily support the rendering of services. We use APIs to connect payment platforms of various wallets to facilitate ease of use. We are developing our solution as our offerings mature. For instance, our home health is being primarily facilitated by WhatsApp communication, but as we scale we are working to automate this process within our solution. Our underlying focus is on data collection and processing because of the future value this represents for our customers and their countries. We imagine a world with close government relationships from which we can help facilitate population-level care. By being a primary source of care we will have early data on potential population threats such as disease outbreaks which otherwise may go un-defined for days or weeks and therefore slowing the ability to stage a defense. 

10 of the 11 members of our team are either from potential target markets or within 1 generation. We represent 5+ countries including across Africa and Central America with countries of origin that have a similar need for this product as their economies grow and the healthcare markets develop. We are human-centered innovators who feel strongly that to be successful in building a product you have to do it with and for the communities which will use it. Part of this is also building local teams. We have an on-the-ground team in Ghana and as we build out our development team we plan to locate teams across the continent. Success without impacting local communities is a blunted success. 

Diversity goes beyond national origin and also gets into the various identities. Going back to one of our impact goals we hope to mirror local communities in our representation and we strive to include all identities within our team. This includes race, gender, sexual identity, religion, and more. We look forward to the opportunity to execute this vision.  

Our business model is a path to providing full care continuum support to our patients/customers and an effort to provide the medical resources which can create a sustainable business. Our end goal is to have a digital-first care application that can help facilitate all types of care a patient may need - similar to Amwell in the US but with a customer base who need our services far more. We are starting with home health and telehealth as the cornerstones of our model. Home health because it is a premium service that generates a higher value transaction and is also readily requested by Ghanain ex-pats trying to facilitate care for family in Ghana. To maximize value for home health customers we must offer a wide variety of specialties which until we are able to scale the home health customer pool will be difficult to support maintaining the critical mass of doctors to provide the breadth of expertise. Our telehealth is a much more widely applicable service that is needed in-home health, but the lower price for using this service also expands the customer pool rapidly which provides that critical mass to keep doctors on the platform. 

Our goal in centralizing care into our digital-first platform is to reduce friction in the system. The value we provide is drastic when it comes to convenience and cost. We are able to provide these services at prices far below brick and mortar care facilities and without having to leave your home and commute to the facility and wait in line. Furthermore, we offer ownership and control over the process with the ability to provide feedback providing a degree of agency in the process that the average consumer is not used to. Our application re-design also focuses on our customer needs and so we are providing first of its kind in market phone-based EMRs and patient management which can be used not only by individual members but by family units. 

The other side of the marketplace is the challenge of right-sizing the supply pool of physicians. It is our goal in phase 1 to utilize flat rates for consults. But as our business matures and we better understand the demand we hope to roll out physician-determined pricing. Our goal is to create a model which attracts medical talent for the impact they can have but also for the income they can generate. With the limited supply of physicians while we assume at some point there will be doctors using DoctorNow to replace the entirety of their income - we also appreciate that national health is best served by keeping doctors engaged in their day jobs supporting hospitals and clinics and working on our application to supplement their income. To help us scale this side of the equation we also have the pool of ex-pat Ghanaian physicians who are more interested in providing care in Ghana than generating income. This also allows us to provide services for free or heavily discounted for low-income communities.

Our goal is to develop a business model which not only supports our continued growth but also the wellbeing of our stakeholders. This means having an inclusive model which does not price out low-income customers and having a strong revenue stream to provide resources to our care teams. Our business model is currently centered around re-occurring revenue in the form of a subscription for our home health product as well as a-la-carte services for our telehealth. Home health pricing is at a flat rate of $35 which covers the home nurse visit and a telehealth consult. Our telehealth a-la-carte services are also currently targeting a flat rate of $5 but as our model matures we plan to make this dynamic pricing set by the physicians. We hope to offer a low-margin model on a sliding scale for low-income communities which will gain access via physician prescription and those on government support. 

Furthermore, these prices provide DoctorNow with a strong margin with which we can re-invest in growth while also providing above-market rates to physicians and nurses. At the starting rates stated above our take rate is roughly 40%. As our business matures there are many avenues for expanded revenue to support our financial sustainability. As we gather more data we could potentially offer our own health insurance plans. We can develop corporate partnerships to provide fast response care. We can offer hardware products. Again, the value of becoming a trusted partner in the care journey for our customers is that there are so many parts of that process that are inefficient and could provide a new revenue stream if we were to move into them.

This topic is top of mind for our team as we are predominately made up of members who have family including children and relatives abroad who are directly supported by income. Our view on this takes two lenses. First building a business on a strong path to being cash flow positive means keeping a close eye on run-rate and top-line potential. It is for this reason that we are working to test our home health business because we believe it has such a strong potential to be the economic engine of our first business horizon as we grow and mature. We also try to work efficiently with our resources aiming to keep the growth of expenses far below the growth of our revenue. We have our first five paying customers who are testing home health. Of those five one of them paid for the first 2 months upfront showing the potential repeatability. Our telehealth app beta was connecting to a payment platform for only a limited part and we were charging a nominal fee to show a willingness of customers to connect their mobile pay - we had under 100 total customers go through the process by the time our beta ended due to technical difficulties. 

The second is fundraising. Our business and customers are best served by a company that can rapidly scale to provide the services and medical specialties they need. To do this we need to raise capital either through grants or VC/Angel etc. We do not come from a scientific or government background where grant-writing is common but we have been exploring grants that are appropriate and are working to find a mentor who can support this effort. We are actively pursuing conventional fundraising on the path to venture capital. We have been working to connect with Angels and VCs that work in the space as well as accelerators, but so far navigating the international fundraising approaches including the systematic racism that exists within US and European funds has been challenging but we are confident in our ability to raise as we continue to develop and mature our business. This is an area where we could use support and mentorship as we try to perfect our narrative and improve our fundraising process. 

We have also started entering pitch and business competitions to try and expand our network. We are finalists in the Princeton Tiger Pitch which is one of the US’s largest student-run pitch competitions.