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Apo B and other fractions. Those have always been seen as things that you don’t get tested unless you are the CEO of Exxon.”
Kean says he’s a fan of the old Lord Kelvin quote: “If you can’t measure it, you can’t improve it.” Cost is the main reason primary-care doctors don’t order more thorough panels of blood tests, he says. Many insurance plans will pay for the less common but more revealing tests like Apo B, but only after it’s too late for preventative purposes—once a patient has already had a heart attack, say.
And there’s another diseconomy at work: some blood tests are expensive simply because they aren’t ordered in large volumes, meaning labs don’t always keep the necessary reagents on hand. “I thought that if we could add more volume to the market, we could be disruptive and change the cost structure,” Kean explains.
Kean has been in the business of helping people to take better care of themselves for a long time, but until WellnessFX, he’d never tried to intervene directly in the medical system. Back in 1995 he founded the Sapient Health Network, which grew into a group of 20 online communities for people with specific health problems such as breast cancer. WebMD acquired Sapient in 1999, and for a time Kean was its vice president of consumer services. But he soon went on to become a financier (at Bridgespan Capital, a boutique real-estate investment firm) and a consultant to builders of health-and-wellness resorts.
He says the results of one focus group that he ran in 2008 gave him a new idea. “There was this switch going on in our society. People were realizing that if you address health problems that start in your 20s, 30s, or 40s, you can stretch out your aging curve. You might not live longer, but ideally you could have healthy longevity until the last weeks of your life, then die quickly.
“But to facilitate that, you need to coordinate with a team of practitioners of your choosing, and have access to a whole bunch of biomarkers, and not have to do it within the framework of a doctor’s appointment. You want access to preventative care wherever you happen to be, even if it’s on your laptop, your iPad, or your iPhone.”
Kean designed WellnessFX’s testing and reporting service not just to drive better economies of scale in the lab business, but to make the results more understandable, and to tap physicians with underutilized time. “Most urban areas in the U.S. have a shortage of doctors, so it generally takes eight weeks to schedule a physical, but we can harvest well-trained practitioners in other areas,” he says. The average billable rate for physicians varies by geography; in the Bay Area it’s around $475 per hour, Kean says. But rural docs are happy to do WellnessFX phone consultations for $200 an hour, because it doesn’t require any up-front investment. “We are their digital storefront for telehealth,” he says.
WellnessFX deliberately recruits doctors who are open to the trend toward holistic and integrative medicine—the idea that patients’ physical, social, psychological, and spiritual health can’t be disentwined, and that there’s an important role for nutritional supplements, meditation, acupuncture, and other “alternative” treatments in optimizing health. “We are about how you manage your lifestyle,” Kean says. “I don’t see how you can manage your lifestyle if you don’t consider all the elements that go into making you who you are, which include things like nutrition and sleep. So by definition we had to be integrative.”
What’s more, Kean asserts, traditional Western doctors are crisis-oriented—they typically won’t suggest action until a biomarker is well into the red zone. “They are trained to spot a fire, grab a hose, and put it out,” he says. “But if you give [a case] to a practitioner who has an integrative overlay, they will say, ‘You are in the gray, but you can do better.’ And that will keep you that much further away from aging and chronic disease.”
Which is all great. But the big catch with holistic or integrative medicine is that the patient has to be involved, too. It’s relatively painless to shell out $199 for an initial blood panel. It’s another thing altogether to start exercising more, find foods with a lower glycemic index, and go back for another panel every four months to see how you’re doing, especially if you’re going outside the insurance system.
Kean knows cost is an issue for most people, which is why WellnessFX isn’t focused on signing up customers one at a time. Rather, it hopes most of its revenue will come from selling its testing services in bulk to large self-insured companies that offer wellness programs as part of their health benefits package.
But let’s say cost is taken out of the picture. That still leaves the problems of knowledge and motivation. I’m not sure that 15 minutes on the phone with a doctor is enough to help people extract action items from a big pile of numbers and charts. (To this point, Kean says that in the near future, WelnessFX customers will be able to pay for extra phone time.) But more importantly, the U.S. healthcare system simply doesn’t provide people with incentives to be more proactive about their health.
Kean is right that doctors are trained to be firefighters—and a big part of the reason our healthcare system is so broken is that they only get paid for putting out fires, not preventing them. But patients need to bear some of the responsibility too, and right now they don’t. If you’re insured, somebody pays you when you get sick, whether or not you ever bothered to exercise and eat right. Nobody pays you to go out of your way to get healthier—and I don’t see a lot of evidence, outside of granola places like the Bay Area, that people are proactively seeking ways to “stretch out the aging curve.”
Until those macro-level problems are fixed, I’m not sure that companies like WellnessFX will be able to thrive. At least, not in isolation. There are plenty of other companies, many of them right here in San Francisco, working to change the incentive system around health and wellness—AchieveMint, FitBit, FitnessKeeper, HealthRally, Healthy Labs, InsideTracker, Keas, Massive Health, Sessions, and Skimble are a few of the names that come to mind. Perhaps, by building on each others’ efforts, these startups may eventually be able to persuade patients, doctors, and payers that prevention really is the best cure.
Kean, for his part, is gung ho about his company’s chances. “In a perfect world, would a robust healthcare system have WellnessFX built into it? Absolutely,” he says. “But I have a lot of faith in American consumers, that if you give them the tools, they roll up their sleeves and tackle it. I don’t think it’s an intelligence issue, I think it’s a communication issue. If we can put the tools in place, and make them cheaper and more accessible, and make it okay to talk about prevention, that would be pretty good work.”
It would be good work indeed, and I hope Kean’s optimism is justified—but I’m still not giving up coffee.
Note to readers: I’m heading out on vacation, so there will be no World Wide Wade column on September 28 or October 5. The column will return on October 12.
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