Bets Big on Asynchronous Care Delivery

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If you think Sherpaa is just another entrant into the national telemedicine market, look again. Between snubbing synchronous video and insisting that telemedicine providers work in a central office, it’s clear that this Brooklyn-born start-up plays by a different set of rules.

Telemedicine sat down with Sherpaa founder Jay Parkinson – dubbed ‘The Doctor of the Future” by Fast Company – to learn more. 

Telemedicine: Is Sherpaa able to deal with complex cases or is it mainly geared towards minor health issues? How quickly do cases get punted to the ED?

Dr. JAY PARKINSON: We’ve been around for a little over three years now and we’ve pretty consistently been able to handle about 65 percent of things in-house. That means 35 percent of the time you actually need to have hands laid on you. But 65 percent of the time we can order tests, take a history and we can get those results back and treat. But occasionally we say: Well, you know what? Somebody needs to listen to your lungs or press on your belly. We’re trying to practice the safest medicine. Doctors are by nature ridiculously conservative. I mean, nobody’s a renegade here.

In terms of your patient population and the age group, I’m assuming this is sort of a younger, healthier group in general who’s adopting this early?

PARKINSON: Yeah, but I’d pushback on healthier. I think it’s a different sort of disease profile than your 80-year-old with cancer. We definitely don’t have those. But 30 to 40 percent of people in this age group have a chronic illness: a lot of mental illness – anxiety, depression. There’s allergies, asthma, acne. There’s Crohn’s Disease; there’s diabetes. These aren’t critical emergencies, but I have a little bit of a chip on my shoulder about the term worried well. Everybody needs a doctor at some point and I think that’s a really important concept to get out there.

What is Sherpaa’s ability to handle trauma? How will that impact emergency departments?

PARKINSON: We take a history and send them to the radiologist around the corner; get the results back in half an hour. It’s way faster than going to the ER, and x-ray is the gold standard.

I’ve read what you’ve written about texting versus video. You make the argument that it isn’t natural to have a video conversation with a stranger. As an asynchronous platform, Sherpaa has a lot riding on this supposition. What will happen when it does become natural?

PARKINSON: It’s just a big assumption. It’s like saying we might have flying cars. That dream has been alive for 80 years. But it’s not come to fruition because I think people are less comfortable flying cars.

You argue that it’s uncomfortable to talk to a stranger face-to-face. But people have gotten used to going and being examined by a doctor that they’ve never met before.

PARKINSON: That’s going to be just a tiny fraction of care. What that means is that doctors are going to be comfortable chatting with you over video. And then patients are going to be comfortable chatting. If a doctor can make more money by seeing you in person, they’re going to see you in person. If reimbursement is the same for video or less for video, they’re going to do both – to meet with the person anyway. There’s a lot of big assumptions around video. I just don’t believe that people will ever get comfortable with it besides with their family or their girlfriend or kids. It’s just weird.

But is it really any weirder than going to a new doctor and talking to a stranger?

PARKINSON: Yeah. Definitely. Video is weird. Have you ever done a customer service video before?

What about physician gestalt, the physician’s ability to look at the patient over video and say: I’m not sure what’s going on here, but you are not well.

PARKINSON: The issue is not video or not video. The issue is synchronous versus asynchronous. I could say, “Hey, move your ankle in this way. Here’s the YouTube video of how to do it. Record it. And then upload up.” I mean, to me that’s what people would want. In our three years of operating, it’s been very clear when you need a physical exam. It’s not ever a question. You could do an exam through video. Sometimes you’ve got to have the patient jump up and down. But at the same time, why not just ask the patient, “Can you jump up and down?” I don’t need a document about it. And why would you lie?

So do you think asynchronous is the direction that telemedicine will go? Or do you think that these big companies like Vidyo and VSee are going to make synchronous video the industry standard? Where do you think the industry is going?

PARKINSON: You can’t force the behavior on a consumer group. If consumers don’t want to do something, they’re not going to do something. I mean, that’s why when you give a group of people access to Teladoc and American Well, only about two to three percent of people will use. I mean, that’s crystal clear to me that consumers actually don’t want video. However, people will absolutely do email on a regular basis.

What are Sherpaa’s usage rates?

PARKINSON: We’re getting about 85 percent of client companies registered and about 65 percent of those become regular yearly users. It’s game changing in that sense.

I saw recently that you received over 6 million in capital investment? What’s the next expansion?

PARKINSON: Basically it’s for signing up more companies, so it’s really just beefing up the sales team. We just hired the VP of Sales from TriNet, so that was a big win for us. Cheryl Swirnow, Sherpaa’s co-founder and I don’t have a ton of experience with sales. So it was more about getting the right people in here to build up the sales team.

I know you pride yourself in organic growth as the needs arise. Do you see that as in any sort of conflict with this sort of big raising of capital for growth? Are those two things at all at odds?

PARKINSON: No. I mean, you have your challenges whenever you receive that kind of funding; they want to maximize growth. But our process is simple: essentially we just put doctors on the end of an email for free, paid for by the employer. We just saved one of our self-insured companies something like $500,000 last year. That means they can hire more people and grow. Especially with self-insured companies, we can see the direct result of having Sherpaa.

What kinds of companies are you going after?

PARKINSON: We’re focusing on companies with between a hundred and a thousand employees.

What’s role will medical wearables and remote monitoring play in Sherpaa’s future?

PARKINSON: I’m always looking for interesting ways to put a test in somebody’s office building. Things like Theranos are extremely exciting. You can have walk-ins and get a test result any time. It’s amazing. I want to see how well they execute.

Will you be encouraging people in your system to be wearing any medical wearables?

PARKINSON: Not really. It’s a heart rate. That’s about it. If you’re worried about a heart rate at this point, you’re going to get a holter monitor, not an Apple watch. They’re cute wearables, but they’re not really medical diagnostic devices. I’m sure they will be someday in some element. But heart rate, oxygen saturation? If you’re that sick you need to be in the ER.

But would it be helpful for you to have more data points for the patients you’re serving?

PARKINSON: Our model is pretty simple. It’s not like we’re going to use a ton of technology. Every once in a while we need to get your heart rate. We can do that in various ways. We can tell you about those apps that you put on your finger or the flash that detects your heart rate. Those are pretty accurate.

Do you have favorite apps that you suggest to people?

PARKINSON: Yeah, absolutely. It just depends. There are some great headache diary apps. The vast majority of this type of medicine is just taking a good history and that’s where I think we excel. Right now healthcare’s just oral. It’s in an exam room. And I’m asking you questions and you’re giving me answers. Those are lost data points traditionally. But we’ve created about 175 questions. Based around your complaint; if you come at us with a sore throat, we basically just fire up the sore throat questions. And those questions are evidence-based, designed to give us the actual diagnosis but also to draw out the back stuff. Now what’s cool about that is eventually with enough data, you’re going to say like: Alright, given the way you answered this, here’s your most likely diagnosis.

Tell us a little about your medical background. You were trained in pediatrics?

PARKINSON: And preventative medicine.

Are there specific things about that particular type of practice that informed how you run Sherpaa?

PARKINSON: Healthcare is a process. And in that process it’s sort of designed and it’s going to design itself. Nobody ever sat down and said: What’s the most efficient way we can do this? We’ve just had the same tired process since doctors invented it a long time ago. So I just sat down and analyzed the process of healthcare really from the outpatient perspective and said: Can we inject some internet here? We have all this stuff. Can we inject some technology in this stuff? And basically I just tried to simplify the processes as much as possible. It helps to be a doctor to understand the details of the processes. But at the same time, I don’t know if you need to be. These processes are broken and it doesn’t take a rocket scientist to figure it out. I wrote something five months ago and it asked: Why aren’t there more doctor entrepreneurs? It’s very fascinating when there’s about 600,000 practicing doctors in America and there’s so few that are actually creating cutting edge businesses. Doctors just follow the straight and narrow.

That’s part of what we’re trying to address with Telemedicine Magazine. It’s trying to bring physicians into the fold and utilize their experience in what needs to be a physician-driven healthcare revolution.

PARKINSON: Well, they’re good people. They’re just stuck in a system that encourages them to continue the same tired process.

Do you still see patients?

PARKINSON: Not so much. I mean, we hire doctors and they work full-time for us.

Do you miss any of the physician experience, the interaction with patients?

PARKINSON: Being a doctor is a full-time job. And it’s not to be taken lightly. And I don’t think you should be doing it an hour here and an hour there. People’s lives are in your hands.

How many people here in the office are physicians taking questions from patients?

PARKINSON: We have about eight doctors now. Each doctor can handle about 5,000 people. What’s interesting about this is that a traditional way of dealing with patients is to be focused on one patient at a time. But our asynchronous model allows our providers to increase their efficiency.

Who do you see as your primary competition?

PARKINSON: Nobody’s doing what we’re doing at all. Unfortunately, people lump us into the video visit category. But they charge a ridiculously low rate and get companies signed up because nobody uses it. You know, we have to charge much more because people actually use Sherpaa. If people don’t use it, you shouldn’t exist. You’re just like a fake little company. And you’re definitely not going to move the needle on healthcare. I mean, our goal is to fundamentally change how healthcare is delivered. Cigna offers Teladoc for example. Okay, great, nobody’s going to use it. That’s our whole selling point. We are a solution that people use. And because people use us, we can move the needle on your healthcare costs. So typically what that means is, no joke, a 50 percent reduction in healthcare costs.

Can Sherpaa users come back and build a relationship with the same provider over time?

PARKINSON: Yeah. Many telemedicine companies don’t have dedicated physicians. Those doctors, for some reason, have free time. I’d be worried about a doctor with free time. Hiring doctors to be on staff allows us to own your health issue from beginning to resolution. It’s not just 15 minutes on the clock. It’s, ‘Hey, let’s deal with this on a regular basis. Let’s check in every two weeks.’ It’s a totally different experience. Because we hire our doctors, we can deliver that continuity.

Within the community of emergency physicians, there’s a big group of burnt-out docs who just need a little bit of a break. What about these docs taking a day per week to work from home to increase their quality of life?

PARKINSON: I mean, without being able to own the issue from the beginning to the end, you’re just making money. That’s all you’re doing. If you can’t solve the problem over a video and you say: Well, you need to go see a doctor and you’re on your own. Plus, you have doctors doing things that nurse practitioners have been doing, which to me, if you’re a doctor, it’s a little insulting. But if you want money, sure, it’s fine.

Would you ever move towards having one of your providers at home with the whole system set up?

PARKINSON: No, because it’s such a collaborative thing. Whenever a case comes in, the doctors here have a conversation with each other. That is the heart of what our doctors love about what we do. It’s super collaborative. Some people ask, Don’t your doctors miss the face-to-face communication? They still have that. They’re with each other. They don’t have it with the patients so much. Occasionally they have to jump on a phone.

Is this self-limiting to say we need to be in a physical location together doing telemedicine next to each other?

PARKINSON: I think the value over time is going to persist, versus a decentralized customer service model. One of the things that I did not like about being a doctor, especially when I was out on my own, is that I was out on my own. I didn’t have anybody to bounce things off of.

It sounds like you’re saying that these other telemedicine companies are competing on efficiency while you guys are trying to compete on quality?

PARKINSON: Absolutely. I mean, the theory between conventional telemedicine is there’s a couple hundred doctors in America that have some free time. And if we can leverage their free time to do nurse practitioner-level work, you can make that as efficient as possible. But you’re still a doctor with free time doing nurse practitioner stuff.

Last question: Where is Sherpaa going next?

PARKINSON: Just more space. More doctors, more companies. That’s about it.


Logan has created, edited and designed healthcare publications since 2005. After redesigning and managing Emergency Physicians Monthly, he founded Emergency Physicians International in 2010, and then launched Telemedicine Magazine in 2015 where he served as writer/editor until 2018. Logan is the co-founder of The mHealth Toolbox, a project that brings practicing physicians into the conversation about innovative medical technology. Logan also served as the Director of Communications for The IFEM Foundation, the leading non-profit supporting global emergency care development.

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