A New Vision for Primary Care

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Forward rethinks the doctor-patient relationship

Adrian Aoun

Adrian Aoun is one of a small but growing group of serial entrepreneurs tackling massive societal “hair balls” through the structure of an ambitious startup. Elon Musk wants to solve energy and transportation, Max Ventilla is taking on education, Jeff Huber’s wants to cure cancer. Aoun’s mission? To reinvent the doctor’s office — specifically, primary care doctors known as “general practitioners” — the front line of our healthcare system.

GPs are under pressure — our insurance-driven system forces them to see more and more patients, and know less and less about them. Forward, Aoun’s new startup, aims to address this problem with sophisticated technology and a new approach to patient-doctor information systems. He spoke at NewCo Shift Forum earlier this year, below is a transcript of his remarks, edited for clarity, as well as the short video presentation.

Adrian Aoun: About a year ago is, I started a healthcare company, but I have zero background in healthcare whatsoever. You have to ask yourself how I ended up here.

A lot of us have had what I call the “Don’t freak out call.” I got a call from a very close family member a couple of years ago. I was riding my bike, I got a call and there’s literally sirens blaring in the background and he says, “Don’t freak out. I’m having a heart attack. I’m in an ambulance. I’m on my way to the hospital. What do I do?”

First off, don’t call me. That’s the quick…the TLDR. I started looking at what he went through. I spent a few weeks in the hospital and given that I don’t really have a healthcare background, I have more of a tech background, I tried to look at it and say, “Well, what is going on,” because we all hear about this, healthcare is broken, but what does that really, really mean?

I started to use a framework that I understand a little more. The first thing I realized is that even though doctors are super amazing and they’re well-educated and they all mean incredibly well, they’re not set up with fantastic tools. It’s hard to do your job when you don’t have good tools.

Let’s dive in a little deeper and think about what does that mean. If you’re doctor, one of the first things that you don’t have access to is data. Somebody comes in off the street, they come in in an ambulance, and you’re like, “Hi, I need to save your life and I know nothing about you.” Could you imagine trying to do that? It turns out it’s pretty tough.

More than that, as they try and get data, one of the things that you realize is that nothing is real-time. I’m an engineer, when I write software and I hit compile, I get my results right away. Imagine if instead, I had to print it, fax it to a lab, wait a week or two for those results to come back, I’d probably be pretty bad at my job.

More than that, what you realize is that AI, even though we’re talking about it in every single field, in healthcare, it’s fundamentally an afterthought because again, if you don’t have tools, you don’t have data and nothing is real-time, how can you expect to use AI in any efficient manner? I started to try and think about, “Why is it like this? How did we end up here?”

As you start to dive into to looking at healthcare, you realize that to some extent, it’s because we’ve been solving the wrong problem. We look today at healthcare a little like a repair shop for humans. You wake up in the morning. You’ve got a rash or you’ve got something in your throat. It might be strep, so you go to the repair shop. We just call it the doctor’s office, the same way that if you wake up in the morning and you have a flat tire, you take it to the mechanic. Except, if you go and just think logically or you look at the data, we’re not dying of rashes and we’re not dying of problems with our throat.

What we’re dying of is heart disease, cancer, except nobody wakes up on a random Tuesday and says, “You know, I have high cholesterol today. I should go into the repair shop.”

So we said, “Can we refrain this from the repair shop to more of an ongoing relationship with your health, more of a preventive, more of a proactive model?” We think of it a little more like a health membership, and that’s what we are. We charge $149 a month, get unlimited access to our doctors and our technology. Let’s go ahead and dive in and see what that really is.

We set out to solve three fundamental things. The first is, we said, “Wouldn’t it be great if all your data was in one place, if everything was connected for one view of who you are?”

(Referring to slides/video) When you walk into Forward, one of the first things that you do is you walk up to a body scanner that we’ve developed. What’s that body scanner experience like? When you walk up to it, you put your hand on it, the first thing that you’re going to see is that it’s starting to put together a 3D infrared model of you and then it overlays it with the thermomap on top, and now you can see it’s starting to do what’s called red light spectroscopy. We’re actually sending light through you, looking at how blood is flowing.

That gives us measures of your heart health, your heart rate, but also we’re looking at things like the elasticity of your veins. All this information gets put straight into the exam room for you and your doctor to go over. You can see now it’s doing something known as pulse oximetry rate, looking at how much oxygen is in your blood.

It also does a bunch more things — your height, your weight, your temperature, your BMI, etc. In just 45 seconds, your doctor now gets access to all that information and when you walk into the exam room, there’s actually a screen on the wall with the model of your body and everything that we’ve learned about it.

Now, how does that work? It’s a tool for you and your doctor to collaborate on. You’ll notice things, like on the right, any sort of…so when you sign up, we actually sequence your DNA and any of your genetic information appears right away. We also do a blood test when you first walk in, that’s processed in just 12 minutes, and again those results appear right on the screen.

If a doctor needs to use a stethoscope, an otoscope, and EKG, take your blood pressure, any of this information is live appearing on the screen. Again, there’s one cohesive view of your data and your information. In fact, even your sensors at home, your phone, your watch, your scale, any of these connected devices all appear on the screen.

What it’s doing is, it’s basically collecting all these and running it through an AI model to then say, “What is the best way that we can help this person achieve their health goals.” Those goals can be illness. “I want to manage my diabetes.” They could also be wellness. “I just want to sleep better, have less stress,” etc.

That was the first step for us, was building an integrated system where all the technologies talk to one another. The next step for us was to create a good experience because if it’s not a good experience, you’re not going to engage it. We all know this. We all wake up in the morning, we’re not feeling great, and then we wait two or three days before we actually call the doctor.

We said, “Can we make healthcare something you want to engage?” Everything from just make it super easy when you come in, you can just check in at an iPad, and some things aren’t so high tech.

For example, when you walk in to the bathroom, and the doctor tells you to pee in a cup, we made it so you don’t have to walk around the whole place with your warm pee on your hands. You can just put it in that nice little jar.

Nice things, too, where as you’re going around, if we know you’re traveling and you come in for a little travel vaccine, we can just go ahead and give you a nice little travel kit.

It’s also one stop shop. We do all your women’s health, men’s health, we have a pharmacy on site, we do your vaccines, as much as possible to create just a great experience for you. We even do things like your supplements, your skin care product, whatever it is that you want, it’s all in one place.

After you build this great experience, then you have to say, “Well, how do I get this to be something that everybody can have access to, not just people who can afford $149 a month?” We said, “OK, we’re starting there,” but we want to drive the cost down. Fundamentally, healthcare should be something that’s virtually free. Technology allows us to do that.

We actually send you home with sensors when you come in to Forward, and those sensors allow us to continually monitor your progress towards the goal. It’s constantly radioing data back to a 24/7 team of nurses and AI. It’s the year 2017, so we use an app on your phone that allows you to constantly have direct access to our medical professionals.

You can message us. Within 90 seconds, we’ll respond any hour of any day. You can also see all your information right there. By creating these efficiencies, by making it so you don’t have to come in, spend an hour at the doctor, by making it so that we can keep an eye on you all the time, we can start to drive that cost down over time.

What you’re left with, after you put all these together is, you’re left with a cohesive “Built from the ground up” experience where everything is all under one roof. The good news is, we launched just two weeks ago. We’re just a few blocks from here in the financial district. If you want, swing by anytime, and we’ll show you how it works.

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