Sramana Mitra: If you were to look at the physician market, what percentage of the physician market has made that shift to the second-generation system?
Girish Navani: That’s actually an intriguing question. I think it’s still in the early phases, early in the sense that we are 18 months into that cycle.
Sramana Mitra: So probably less than 10%?
Girish Navani: Yes, I think so. I’m actually looking at next year with a lot of optimism. It will be the first year in five years that we won’t have a government mandate. The market will then try to take its own shape. That’s something that entrepreneurs find very exciting. I’m looking forward to it.
Sramana Mitra: Then let’s switch to the other side of the circle, the patient side. Tell us what those are.
Girish Navani: Two things are happening, which are I think the stimuli for this becoming a reality. One is, employers have started moving to deductible plans. So patients are picking up part of this expense through their own pockets, which was not the case 20 years ago when we all had insurance cards and assumed there was not patient pay other than the co-pay. Today, co-pays are not the only reimbursement that many employers are putting on their clients. Sometimes, it’s $1,000. Sometimes, it’s $2,000. The consumers are asking the question, “Is this the best care I can get for the cost I’m spending?” That I think is a trend.
The other one is, we’re moving reimbursements on the care delivery side from fee-for-service to outcomes. A ACO report says bonuses were paid to practices and groups that had achieved good outcomes while not spending the same amount of money as their peers. Both these trends now put the patient into focus. One, allow them to manage their care. Make them aware of what care is costing. Engage them in such a way that they get preventive care or avoid unnecessary care. Either of those two can result in positive outcomes.
That tells us that you need to have technology for consumers now. You can hail a taxi using Uber. I think you should be able to, at least, look up online what your MRI is going to cost. These are basic things you should be able to do. We are investing heavily. We’ve committed $75 million in R&D in this business unit. It’s called Healow (Health and Online Wellness.)
Sramana Mitra: For that business, what is the business model?
Girish Navani: It’s an intriguing question. If you go back to our original article, you asked me that question. I’ve always thought about making a difference first and then figuring out how to make money from it. eClinicalWorks wasn’t that different. People didn’t think you could get an MRI for $250 a month. We said we could. I think the long-term business model for patients is saving costs.
Sramana Mitra: For the physicians?
Girish Navani: For both sides – patients or provider. Saving costs, yet obtaining outcomes. Don’t compromise the outcome. In fact, the outcome should get better – not worse. The business model might translate into reminders to patients. There might be a monthly model because rather than having to sit there and make manual phone calls and come up with archaic ways of communicating, technology could do it through text messages, voice reminders, or app notifications. There could be a model on just matching supply and demand. If I found a doctor a new patient, would he pay for that new appointment? We do that in all e-commerce settings.
Sramana Mitra: It’s a marketing vehicle for doctors.
Girish Navani: Yes, and we’re doing that. We’ve launched it nationwide.
Sramana Mitra: Are they willing to pay for it?
Girish Navani: For an appointment, yes. If you have an unused, open slot, you now get to fill it.
Sramana Mitra: What are the numbers of the business? You can give me ranges. In 2010, you were already at $100 million.
Girish Navani: We forecast this year that we will reach $320 plus million in revenues.
Sramana Mitra: You still don’t have desire to exit this company and take it public? You want to run a private company, right?
Girish Navani: Yes.