As a part of my interview series with leaders in healthcare, I had the pleasure to interview Nick Desai. Nick is an accomplished and visionary entrepreneur who has started and led four venture-funded start-ups over the last 18 years. Nick is the Co-Founder and CEO of Heal, an on-demand doctor house call app available in Los Angeles, San Fernando Valley, Pasadena, Glendale and Burbank, South Bay and Long Beach, Orange County, San Diego, Inland Empire, San Jose, Silicon Valley, San Francisco, Berkeley, Oakland, Sacramento, Atlanta, Washington D.C., and Northern Virginia. For Nick, Heal is more than a company — it’s a mission to fix the broken $3 trillion healthcare system.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Since I finished graduate school in electrical engineering, I’ve been a serial entrepreneur in the technology, Internet, and mobile space. Honestly, I never thought I’d get into the business of healthcare because it’s so complex and regulated. However, when my wife and I had kids, for the first time, we experienced the downfalls of the highly flawed U.S. healthcare system.
We had a horrible experience trying to take care of our infant son who was sick and needed a regular doctor’s visit on a Friday afternoon. Because he couldn’t be seen by his pediatrician, we were forced to take an emergency trip to the ER. We waited for more than eight hours, and by the time he was seen, his fever had broken. That’s when we realized healthcare needs to be dramatically and completely overhauled. Who better to do it than us? So, she, being a skilled doctor, and I, being an accomplished engineer, started Heal four and a half years ago to change healthcare for the better.
Can you share the most interesting story that happened to you since you began leading your company?
I’m continually struck by the unifying and universal power of great healthcare. Whether it’s celebrities, politicians, billionaires, or everyday people who are completely at the different end of the socio-economic spectrum — when people need healthcare, they’re at their weakest, worst and most vulnerable. When you’re sick, your kids are sick, your parents are sick — it’s the moment in your life when you’re not a politician or a celebrity. You’re a vulnerable worried father, spouse, parent, or child. At Heal, we help people in those moments. Every person on the socio-economic spectrum. The stories I get from people are distinct stories across the board.
One such story was when I was at the Consumer Electronics Show (CES) in Las Vegas, and a middle-aged guy came up to me. He was wearing a suit, clearly a business executive, and he asked if I worked at Heal. I said, “Yes!” He asked, “What’s your role there?” I said, “I’m the CEO of the company.”
He put down the bag he was carrying, and he gave me a hug. And I’m not talking about a bro hug. I’m talking about a deep emotional hug. He then proceeded to tell me how we saved his son’s life because we sent a doctor (to his house) when his son was misdiagnosed by the emergency room that he’d gone to, and if it weren’t for our doctor, his son may have actually passed away.
Can you tell our readers a bit about why you are an authority in the healthcare field?
I think what makes me good at solving healthcare problems is that I read copious amounts of information and data about healthcare from authoritative sources and I work with my co-founder, my wife, who happens to be a brilliant doctor, to solve healthcare problems through Heal, based on knowledge and research. As much as I listen to actual ‘feet on the ground’ doctors and the actual patients who use services like Heal, I understand it’s patients, doctors, insurance companies, experts, that make up the data and research that collectively can inform opinions about how to change healthcare for the better.
What makes your company stand out? Can you share a story?
I think what makes Heal stand out is that we are solving healthcare at the most immediate, most obvious, most universal pain point. There are companies out there making mind-blowing breakthrough drugs for very specific cancer patients that affect 10,000 patients or 20,000 patients worldwide. I think those breakthroughs are amazing.
There are also companies making technologies to assist people with neuroprosthetics that can implant into the brain of a paraplegic or quadriplegic patient giving them the ability to communicate with the outside world for the first time. I think those things are really interesting but the universal need in healthcare is effective, timely, affordable healthcare.
Healthcare starts with primary care and that’s why it starts with the word “primary.” Primary care is the gateway to better health outcomes and lower costs. We are making primary healthcare more accessible, affordable, simpler, transparent, and price transparent by making it as easy as touching a button on your phone to get a real, licensed, and certified doctor to come to your home at your time and your convenience, at rates that everyone can afford without paying a premium for that kind of concierge-quality care.
A story about what makes Heal standout is the day-to-day impact of our primary care and I’ll share my own story in that context. We now have three kids. The youngest is our six-month-old daughter. The day we drove our daughter home from the hospital, we, like every other parent, are so tired and drained emotionally from the experience of having our child. There was a moment where my wife Renee said to me, “You know she has her first well-baby exam tomorrow.” For a second, we forgot that we are the owners and founders of Heal and upon realizing, we were just basking in the relief that, a doctor, for a six-pound baby, and our two other kids, will come to our home and deliver a well-child exam at home. That is the universal appeal of Heal.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
The universal pain point is timely access to high-quality primary care without having to think about how much it will cost, without surprise bills, and getting the quality of care people deserve for better healthcare. It should not be accessibility and timely access are at conflict with quality. It should be that quality and timely access are available. People have been after this for a long time, and until now, it didn’t exist. When you are not feeling well or when you think you need a doctor, your choice is to wait about 24 days in the average American city to see a primary care doctor in their office. This requires you to not only wait 24 days but also to then drive to that doctor’s office and wait in a waiting room. Nowadays with people who don’t vaccinate their kids, you don’t know whom you’re sitting next to. Then to pay your copay, not know how much the total visit is going to cost you, and then, to interact with an overworked, hurried doctor who spends about seven minutes with you. After this, you get an explanation of benefits, which is neither explanatory nor beneficial. Only after, you get a bill for the visit because your coinsurance or co-pay was not enough to cover the visit.
Heal doctors spend upwards of 28.5 minutes with each patient in their homes. We are bringing the care that it should exist, which is extremely high-quality, first-rate primary care from doctors liberated from the burden of bureaucracy. That’s because, Heal has developed software to lower the operating cost of primary care delivery by 65 percent, lower the bureaucratic burden on doctors by 90 percent so that our doctors see 12 patients a day and spend 28.5 minutes with each patient. They do so in the privacy, comfort and convenience of that patient’s own home environment. People don’t have to an emergency room for every minor illness or go to urgent care where a doctor or nurse or physician’s assistant will try to triage the wound at hand, but not look at them as a patient, as a whole.
What we can see that is increasingly being understood within the critical aspects of healthcare are social determinants to health. The fall risk? The allergens? What’s in the fridge? Is there smoking in the home? Most importantly, what’s in the pill bottle? 50 percent of prescribed medications in America are never actually taken by the patient. At the same time, one-third of all-American patients are on three or more medications and are over medicated. We should not have over or under medication, and doctors who can see the patient in their home environment where the patient didn’t have to drive to them and is relaxed. On the same day, within two hours of the patient meeting that doctor, they and can put all of these factors together. This is the kind of care that Heal delivers.
The collective value of the above is that we have lowered healthcare costs on 110,000 house calls, delivering $62 million in healthcare cost savings, 71 percent reduction in unnecessary trips to the emergency room, 39 percent reduction in wasted and unwanted prescriptions, 55 percent reduction in tests and referrals to specialists. The most important stat is that in 78 percent of our adult patients, we closed three or more care gaps. This can only be delivered in a model where you go into the patient’s home and you interact with the patient and its relationship-based care. Our view is to use technology to rehumanize healthcare not dehumanize it.
Are you working on any exciting new projects now? How do you think that will help people?
We believe in “Innovate or Die.” We additionally believe that to change in healthcare, to change anything, you have to change everything. There will be more announced about these upcoming innovations soon. We recently launched the Heal hub for remote monitoring of vital signs for chronic disease patients. For the first time ever, the doctor who came into your house can have real-time access to your blood sugar, blood pressure, and your heart rate, so when you call and say, “I don’t feel well,” the doctor can know exactly why you don’t feel well. Better yet, the doctor can call you before you even know you don’t feel well based on the fact that your blood pressure is spiking and can treat you based on early changes to your vital signs before you end up in a hospital.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
The first thing I would say is how hard it is to make changes in healthcare, how complicated healthcare is, and how ridiculous some of the rules are. I remember when we were first launching Heal, we were in the office of our healthcare lawyers, going through all the compliance stuff in detail and on the way out, one of the lawyers said, “I cannot wait until I try Heal.”
I said, “Well, we’ll send you a code for a free visit.” Typical to what so many companies have done, we were going to create a friend referral program, where you’d get a free visit if you get a certain number of friends to sign up. It turns out you can do that in almost every other industry in the world, but you CAN’T do it in healthcare in the United States, because that’s considered a kickback and a violation of the federal law. While I understand the importance of the kickback statute and of course, we are compliant with it, it’s a barrier to letting people know about Heal. We have a net promoter score of +83. People love Heal and they want to tell their friends but it’s hard to make people do that when you don’t give them an incentive to do it. So, I think the regulatory environment and the burden of complying is the first thing.
The second thing is, how the entrenched the interests of large industries are. Right now in the political season, there’s a lot of conversation about Medicare for all and that question is fundamentally about who should pay for healthcare. The basic decision is that the government should pay for healthcare because nobody can afford it. This belies a more important question, which is, why does healthcare cost so much? Healthcare is the only thing Americans pay for that we don’t know how much it’s going to cost before we pay for it. I know how much my pizza is going to cost before I pay for it but not how much my doctor is going to cost. 50% of Americans who have bad credit, have bad credit because of unpaid medical bills of $200 or less. There are people in America who cannot buy a car, house, better food, or a credit card because they went to a doctor’s office that didn’t know how much it was going to cost. That’s outrageous. That’s actually the second thing, how broken healthcare is.
The third thing I would say is entrenched interests and how resistant and forceful they are against change. This comes back to the conversation of how much healthcare costs. There are hospital groups in Southern California, where we’re based that are forcing their insurance partners or managed care partners not to use Heal because they’ll cut off specialty care to that insurance partner if they do use us. That is antithetical to choice, antithetical to competition, and it’s antithetical to the best healthcare being delivered. I will not name the hospital group, but these are major well-recognized hospital groups. There are insurance companies, huge HMO plans in California, that are resistant to having their members have access to Heal because their model is a big box model, where they want to drive people to their facility. The goal of these systems is to get you into the facility, deliver you care you don’t need, and drive up the cost of the bill.
The fourth thing I would say is how hard it is to find and retain great people to build a company like Heal. Heal is not a typical startup; we don’t have 95 percent margins, we don’t have beer bashes on Fridays and volleyball courts at our facility. My wife, Dr. Renee Dua and I, believe this is a mission and we have a vision. When you are in the business of saving lives, absolute focus and dedication are required. While we believe in work-life balance, we want hard-working, committed people. In a market with low unemployment, in a competitive start-up market like California, it’s hard to find great people. We’ve had a lot of missteps in that process and while we have a great team here at Heal, it takes us three to six months to find a truly great person that can really add value to what we’re building.
I would say the fifth thing is what someone told me before I started — the same thing on the investor side. While I can’t tell you how many traditional Silicon Valley venture capital offices I’ve sat in, they don’t understand why house calls are necessary because many of them have a concierge doctor. They have completely disconnected their lives from regular people, from the people who consume healthcare, from the people who use healthcare daily. I can’t tell you how many times I’ve had that meeting. We have great investors, world-class investors who see that vision. Obviously, investors are generally hedge funds or people who are very wealthy, so they have money to invest. These are people who see beyond their own life circumstances and the privilege and blessings that they have.
Let’s jump to the main focus of our interview. According to this studycited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Unfortunately, it’s not at all shocking to me for a few reasons: First of all, look at the ranking of the U.S. healthcare system and the rankings of the U.S. education system over the last three decades. Both have precipitously fallen at the same time. The problem with our healthcare system starts in our classrooms. This is because other countries that are as developed have education that is focused on nutrition, life sciences, and life choices. The schools feed children nutritious meals. In America, it was controversial that Michelle Obama tried to create a healthy lunch program at schools. It was controversial to feed our kids healthy meals at school. People went on talk shows and politicians on the other end of the aisle rallied against healthy lunches to the point where tomato sauce on pizza was classified as a vegetable to actually get that healthy lunch program passed.
Reason number two, related to food, is because you can also track the rise of corn syrup in food to the rise of obesity in America. There was not a link in America between poverty and obesity until corn syrup was introduced as a sweetener. Corn syrup disproportionately affects the foods that are manufactured as opposed to the foods that are grown. The result of that is for lower-income people, the cheapest food is the food that’s worse for you. It costs more to eat kale, broccoli, spinach, and salads than it does to eat cheeseburgers and drink sodas. That should not be the case. It should be the best foods are the most universally available foods. It should not be controversial that good food is green food. That is related to education, but it’s also related to public policy. It’s related to a group of politicians who are more determined to tell their constituency it’s okay to be unhealthy and to get elected than it is to have the courage to stand up for what is healthy. They banned smoking to make it socially unacceptable to smoke. That’s how we cut the adult smoking rate in half. You need a public and private partnership that does not exist. That does not exist in the American public policy sector as it stands right now.
I think the other reason is because healthcare is so convoluted it is broken. When it takes 24 days to get an appointment primary care, people will either ignore primary care entirely, they will wait until it’s too late, or they’ll overuse the emergency room. This leads to doctor burnout and because the bureaucracy is so broken, doctors have to see 40 patients a day just to pay the bills. Of these 40 patients, the first 32 they see are to pay the bills of the bureaucracy.
According to a Duke University and Kaiser Family Foundation study, doctors have to work 21.7 hours a day, seven days a week, and 365 days a year to provide the kind of quality care that patients need and doctors are trying to provide. Doctors are set up to fail! Until we fix these problems, we can’t fix healthcare because doctors are meant to heal. That’s why we are called Heal, but the doctors can’t heal if they have to see 40 patients a day. They can heal when they have to see fewer patients and focus on value over volume. What does volume lead to? It leads to over medication. That’s how we got to the opioid crisis.
There has to be a systematic overhaul of our education system, society, public policy, and the way healthcare is sold. Again, we’re living in a country where you don’t know how much healthcare is going to cost and America is the only country in the world where people go bankrupt because of healthcare costs. We’re the only one of these high-income nations where that is a reality. It cannot be that way. Price transparency, better competitiveness, doctors who are unburdened, a focus on value, a focus on outcomes, patients who are invested in their own health because of their education, the availability of the right foods, and public policy all have to work together to change this system.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
The first is price transparency. For every healthcare product or service, the patient should know how much it’s going to cost upfront. To speak to what I mentioned earlier, 50% of Americans who have bad credit, have bad credit because of unpaid medical bills of $200 or less. It’s not the number of Americans that is shocking in that example; it’s the amount of $200 or less because the vast majority of those people do have $200. They probably didn’t even know they have a bill. I recently found out that my credit is less than stellar, which I fixed because of an unpaid medical bill from my sick son five years ago for $76. This is an actual true story. There has to be public transparency.
The second thing is, it should be illegal for hospital systems, insurance companies, and provider groups to sign any kind of contract with any kind of exclusivity with each other. Patients should have the right to choose the best providers for them and insurance companies should have to work with all providers as long as they meet certain quality standards. Hospitals should not be able to lock up and force insurance companies to make substandard choices.
The third thing needing change is the public policy sector. We have to regulate and deregulate at the same time. We have to get rid of the absurd regulations that are not based in the reality of the 21st century American — their life, lifestyle, the real world, their educational status, and their economic status. We have to deregulate to allow competition and to allow innovation at the same time. Think about America! It takes $100 million to get a prescription drug approved and through trials, yet there is virtually no regulation on herbal and supplemental products that are sold. Today in America, women are buying jade eggs because it helps certain parts of their anatomy. Healthcare being so heavily regulated stifles innovation.
Number four I would say is that we have to make doctors want to be doctors again. We have to liberate doctors to be doctors. We have to make it interesting. Nine out of ten primary care doctors don’t want their children to become doctors and are dissatisfied with their profession. And yes, everyone wants to make a fair and decent income, but the reason is that they’re stuck in a broken system. The system doesn’t work, and we have to make it interesting to be a doctor again. It’s not just about pay but also about liberating them from the trappings of the broken system and bureaucracy.
I would say the fifth thing is education. Patients have to know their choices. As consumers, it starts with children from ages one to five. Every preschool, grade school, and high school in America should require the teaching of nutrition science and food choices. We should all agree on what’s better because we know what’s better. We should educate our children, so they make better choices as adults.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
The first thing is that the political climate needs to revolve around what’s actually better and not what’s better to get elected. I think there is clarity, with the science being clear, the data being clear — healthy people cost less, and we know how to make people healthy in America. We don’t have the political will and that has to change. Corporations have to be liberated and self-insured companies are companies people talk about because those companies are vested in their healthcare and the most likely to make changes. That’s true and that’s good, but those companies have to be liberated from regulations to be able to offer products and services that their employees need based on the data they have that’s not stifled by local or governmental regulations.
Individuals can take better ownership of their own health, to actually care about being healthy. We have to ‘own our own healthcare’ and we have to demand better of ourselves. I’ve lost 65 pounds. I was 268 pounds and now I’m 203 pounds. I did this over the last year and three months because I decided to make a change. We have to have the will to make our own selves healthy. There’s no pill, there’s no surgery, and no hospital, no doctor that can fix something we don’t want ourselves to be fixed.
I think communities and leaders need to rally around the common purpose like we did with smoking for the greater good. We’re all talking about an opioid epidemic but no one’s doing anything about it. We’re all talking about high-cost prescription drugs, but Hasan Minhaj actually did a hilarious piece on Congress holding a hearing, and the drug companies blamed the pharmacy benefits managers, and they then blame the insurance companies. They’re all pointing the finger at each other, so no one has to do anything about it. There has to be a focus on actual change.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
With three young kids at home and this company, I still make time to read. I’d say the first thing I do is read public policy documents. I read the Affordable Care Act. I read Medicare’s 2019 rule changes as I do every year. We’re talking about thousands of pages, but I actually do read them. I care, because reading that is how you understand the basis of policy, good and bad. It’s how you understand the rationalization behind them. It’s how you understand where innovation is possible. I read a lot of books too. I rarely read books specifically about healthcare, but I did read a book by Dr. Eric Topol — “The Patient Will See You Now.” It’s a seminal and world-class thinking by a world-class doctor who I recommend to everybody. His newest book is “Deep Medicine,” which I’m in the process of reading right now.
Mostly, I read books about the human condition. A couple of years ago, I finished a book called “Sapiens.” It’s an incredible book that everyone should read. I read a lot of books about ancient tribes, untouched tribes, and the methods that they have of living, how human evolution has developed, and how we got to this place in our society. How did we get to a place where people are living longer yet the U.S. life expectancy dropped for the first time ever? Over the last decade, global life expectancy climbed five years — that’s the best single decade increase ever. At the same time, U.S. life expectancy dropped. What are the real reasons? What are the sociological, socio-economic, evolutionary reasons for that? Why do we think the way we do in America?
I also read books about business. I recently read a book called “Play Bigger or Playing Bigger,” which is a world-class book on thinking about changing everything to change anything.
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!