Virtual Care That Creates Real Connections Between Providers and Patients - Ryan McQuaid, Co-founder & CEO of PlushCare

Michael Carrese: Hi everybody. I'm Michael Carrese. Access to Primary Care remains a major concern in the United States with about twenty-five percent of adults having no regular provider. In fact, among high-income countries, Americans are least likely to have a regular doctor. Well, eight years ago, our guest Ryan McQuaid set out to address this problem -- and the related issue of the complexity of obtaining care -- by co-founding PlushCare, which provides nearly instant access to primary care from a desktop or smartphone. The company has grown considerably and now has provided primary care and behavioral healthcare to hundreds of thousands of people in all fifty states. 

PlushCare was acquired by Accolade last year and regular listeners to this show will recall that we've had Accolade's Chief Medical Officer, Dr. Shantanu Nundy, on Raise the Line previously. I think he's the only guest we've had on twice. So, I'm looking forward to learning about the PlushCare story today and where virtual care is headed in a post-pandemic world with Ryan McQuaid. Thanks so much for joining us.

Ryan McQuaid: Hi Michael, I appreciate you having me on. Excited for the discussion. 

Michael: We always like to start with our guests explaining about how they got started on their career journey and giving us some highlights. You started in the venture capital space, but obviously, found your way into healthcare. So, tell us how all that unfolded. 

Ryan: So, Michael, I would first say starting in venture capital is maybe stretching the truth a little bit. I had an internship at a fund of fund called Top Tier Capital and Top Tier invests in venture capital so I was one step removed from the portfolio companies. It was an amazing group of people and what I learned was a ton about tech trends and where the future of technology was going. I had a personal passion for health. In parallel to that internship, a college friend of mine actually spun up a motor scooter brand similar to Vespa, which I think listeners are probably familiar with. Our brand recognition was nowhere close to Vespa, and we could spend a whole podcast talking about that, but the net net was we bootstrapped the business. It took off for several years. In 2008, the power sports industry just got crushed, and so we decided to liquidate. 

For me, it was an incredible learning experience and really gave me the opportunity to figure out how to survive in real-time, something that would be critical to PlushCare’s success as we navigated through the U.S. Healthcare System. After that, I joined AT&T's management training program. In one of my rotations, I had the opportunity to be part of this new group within AT&T that was focused on digital health. I think everybody asked me, “Wait AT&T, the phone company is in healthcare?” and that is correct. AT&T was pretty far ahead of the curve as far as vision. Execution may be another matter, but that's where I really got a keen understanding of the healthcare ecosystem -- both from a B2B perspective, and also direct to consumer. And that's, of course, where PlushCare focused out of the gate. 

Michael: You said you had a personal passion for healthcare. How come? 

Ryan: I've played sports all my life. I went to UC Berkeley as a student-athlete. So, post my athletic days, I wanted to continue doing something in health because that was a real passion for me.  I slowly, as you can see, went from kind of health and wellness into getting more into traditional healthcare. Of course, our mission is to blur those lines where those aren't complete silos, and we focus on just getting people the healthiest that they can be. 

Michael: So, what was the spark for trying to tackle something that's a really large problem, which is our healthcare system doesn't work well at the primary care level. How did you decide that's what you wanted to tackle, and what were your first insights into how you might approach that? 

Ryan: It was really motivated out of my own health issue. While I was in that role at AT&T, I had chronic pain in my back that also was in other joints for over a year. It got to the point where I would wake up in the morning and I literally couldn't walk to the kitchen. I didn't have a primary care provider, and I found out a lot of Americans do not have a primary care provider. I turned to a friend, who was a Stanford physician, and asked him to take on my care and he helped navigate me through the health system via FaceTime and text messaging interactions. So that's really where it was born out of. I was diagnosed with an autoimmune disease called Ankylosing Spondylitis. I got on HUMIRA for treatment. Within a couple of weeks, I was back to normal and it was really a miracle. So, the idea was born out of that experience that I received from Dr. James Wantuck, and we said, “Let's take this human-centric personalized care done digitally and democratize it, and give it to every American.”

Michael: That's pretty ambitious. 

Ryan: Yes.

Michael: Which is what's common to most founders…they're pretty ambitious in terms of the problems they want to tackle. What's the first step with that? 

Ryan: I would say pretty ambitious and also maybe a little naïve, too. The first step was, of course, we looked at the market and telehealth was not new. But what existed was this tele- urgent care where you call up an 800 number similar to a nurse call line, you get a random doctor and they help you with that episodic issue. We wanted to lead the charge and believed that in the future, people would have ongoing relationships with a primary care provider in a virtual capacity as supposed to it being this very transactional relationship. That's what we designed the experience around. We got started, and I put together V1 of our websites. I was the care coordinator, answering the phones. And then my co-founder, Dr. Wantuck, he was our physician that was seeing patients and we bootstrapped the business to get it off the ground. 

Michael: That's amazing. So, the name PlushCare, obviously, tells part of the story. You're out to create a really convenient, easy, pleasant experience for your patients. Talk about some of the elements that are involved in doing that. 

Ryan: Yeah, we really emphasize human-centric relationships that are powered by technology. Many digital health companies these days are focused a lot on the technology versus the care team and patient experience. Hence, our hypothesis -- and it continues to be our belief -- is that people don't want a chatbot as a doctor. They want a human being that doesn't treat them like a number and that is applicable both in the in-person world, but also in the virtual world as well. And then the other aspect of it is really focusing on whole-person care to ensure that we take care of people's physical and mental health.  I saw that real-time as a patient as I struggled with that chronic pain. I saw the impact that it had on my mental health and how important it was to make sure you were taking care of both of those at the same time.

Michael: One concern that is raised about virtual care is that there's a lot of churn among the providers, and patients don't really get a chance to see the same person over and over again. What's your answer to that problem? 

Ryan: We took an approach that you see in some retail businesses, which is that if you want your end-user to be happy, you need your employees to be happy. Just as we commit to ensuring our patients have a “wow” experience, we strongly believe that that starts with delivering that “wow” experience to our doctors and therapists. The way that we go about doing that is taking care of all the administrative work. You hear about physician burnout…all of that administrative work really makes it hard to build a relationship with a patient and deliver great care. So, we take all that off their plate so physicians and therapists can focus on delivering amazing care, and building strong trusted relationships. The second one is building a community amongst our care team so they feel a strong sense of belonging and support and don't feel isolated at home by themselves where they can share their learnings and advice with their colleagues.

Michael: I'm curious about your move into behavioral health. Obviously, there's a tremendous need but what was it about that space that you wanted to get into and how are you tackling that? 

Ryan: As I mentioned, I saw firsthand the importance of behavioral health in combination with taking care of somebody's physical health. We couldn’t do everything that we wanted out of the gate. Pre-covid, we launched a therapy program that during COVID we scaled to all fifty states which we're super excited about. And the uniqueness of that behavioral health program is our therapist, our physicians, and our psychiatrist all act as one team for the patient, so you're not getting care in silos as a patient. You have this team-based collaborative care approach that we believe delivers better outcomes for the patient and a better experience for the patient. 

Michael: So, give us a sort of a real-world scenario. How would that work for a patient having this team approach? 

Ryan: The way it would work for a patient is you might come in with maybe hypertension and you meet with your PlushCare primary care provider. During that visit, they might identify through conversation that you're also suffering from depression. They will refer you in to one of our therapists to have a therapy visit, and our therapist and our physician will coordinate that care and of course make sure that you're getting any necessary medications that you need to take care of those issues. In addition, they're working together to change any dosages or make any other changes to your care. And then of course, as I mentioned, we have psychiatrists as well. They are available for our primary care doctors to have side consults with if they have anything that they need help dressing.

Michael: In practical terms, can you talk a little bit about the cost structure and if there are any limits on patients as to how frequently they log on or who they can see? Any of that sort of practical information…

Ryan: There are no limits on accessing our system. Patients can interact with their care team, either sending in-app messaging with their care team or they can add video consults with their care team. As for cost, we’re in-network with most major health plans and patients pay the same primary care visit copay that they otherwise would, and then we bill the insurance company for the remaining amount. 

Michael: I mentioned Accolade at the beginning. I’m wondering why you thought Accolade was a good partner, and as part of your answer, can you just give people a quick idea of what Accolade is all about? 

Ryan: Through partnering with Accolade, we really felt like we could accelerate the velocity of what we wanted to accomplish by combining PlushCare's primary care and mental health capabilities with Accolade's health and benefits navigation. For those unfamiliar with Accolade, it has been in the business of helping employees understand and navigate through their benefits in the health system. So, kind of like a white-glove concierge. We found that was administrative support that our physicians needed. So, if we refer a patient in to get imaging done, what is that going to cost them? What imaging center should they go to? Or if we refer to a specialist, the same questions, who are the best specialists around that individual? Can we help get them an appointment? 

So, there were incredibly strong synergies between Accolade and PlushCare. In addition, Accolade also acquired a company called 2nd.MD that provides expert medical opinions. Now we have the ability to have patients connect with the primary care provider, a mental health provider, navigate their benefits, connect them with ancillary services or providers and if they need a second opinion -- let's say a cancer patient needs a second opinion -- we connect them with 900 of the best specialists across the country. So, it’s a pretty exciting combination and very strong synergies. 

Michael: Sounds like part of this is really trying to anticipate what your patients are going to want and need. 

Ryan: That is correct. The goal is to make sure our patients are getting the preventive care they need. And as you called out, anticipating. Do they have an undiagnosed condition that we need to address? Or, are they not adhering to a certain treatment plan? Another exciting part of the combination is Accolade receives claims data and a lot of other health information to allow us to provide predictive models and make sure our patients are living their healthiest lives. 

Michael: Obviously, COVID has provided an enormous boost to the use of telehealth and the acceptance of it -- I think on both the provider and the patient part. Talk about how all of that has affected PlushCare and your patients, and what do you see as the lasting impacts and changes with regard to virtual care from the pandemic? 

Ryan: When COVID hit, we saw a step function change in patient demands. You had people who were previously not aware about virtual care existing. Now everybody was aware that it existed. You have the President of the United States and the CDC all recommend people use virtual care to get the health care that they needed. Our hypothesis was that it was going to be a while for virtual primary care to become mainstream. We believe that first tele-urgent care needed to become mainstream before people felt comfortable with actually establishing a relationship with a doctor, purely virtually. COVID just condensed that time frame altogether in which tele-urgent care and virtual primary care became mainstream. 

As far as the lasting effects or what we see in a post-COVID world, we believe that patients will continue to desire to have virtual visits with their providers. Our net promoter score is ninety compared to a brick-and-mortar average across the U.S. of a net promoter score of three, so orders of magnitude better experience. And so with that convenience and ease of access and just higher patient satisfaction, we believe that this will last post-COVID and we're seeing that in our visit data as well. 

Michael: What stands out in the feedback you're getting from patients that seems to be most important to them being happy with the experience and sticking with you guys?

Ryan: The primary feedback point that we get is ‘I can't believe how easy this was to use.’ That’s both from the time it takes to get access to their care provider but also just the user experience itself. We talked earlier about the technology component, and our goal is to try to remove the feeling of the need to use technology as much as possible to connect the patient and doctor. The second part is we hear patients say, ‘I can't believe how much that individual truly cared about me and my health and well-being.’ And that goes back to we need to deliver a “wow” experience in our physicians, our therapists, and other care providers so they have the ability to deliver a “wow” experience to patients. That's a critical piece of the puzzle. 

Michael: So, we have a lot of medical students in our audience who obviously, over the last couple of years, have been hearing about an amazing array of changes in virtual health and digital health and maybe trying to sort all this out and what they're place in it may be. What would you say to them? What's your pitch to them about getting involved in this modality, this approach to providing care to patients? 

Ryan: First, I'm not a doctor, but as someone passionate about the healthcare industry, I appreciate those who dedicate their careers to helping patients. As far as my recommendations on it, both personal and professional side, healthcare is not easy. I tell our folks -- and we hire based upon this as well - focus on the why. Why are you doing what you're doing? Your belief to help people live healthier and happier lives is really important intrinsic motivation and to make sure that that's the path that you want to go down. 

Another one is embracing innovation. It's a very exciting time in healthcare. There's going to be a significant amount of innovation. Most of the innovation for the last several decades has been based within the four walls. There was no virtual care market pre-pandemic. It's hard to build businesses when there's less than one percent penetration of virtual visits. And so, I think there's a really exciting opportunity ahead over the next ten years of the innovation that will happen relative to delivering virtual care and digital health. 

Michael: For sure, we hear that from a lot of our guests. As we're wrapping up here, we always like to ask our guests to give us some advice. We're a teaching company. We love to fill in knowledge gaps and I wonder if there's a topic that you think Osmosis should make a video about that people just don't know or should know that's of particular concern or interest to you.

Ryan: I think physician burnout is not spoken about enough. It's something we do here, but it's absolutely critical that we address this problem. Forty-two percent of doctors are experiencing burnout and as an industry, we've seen it emphasized even more during the pandemic. We have to address this issue. At PlushCare, we’re constantly listening to our physician team to ensure they feel supported. We’ve seen that when our doctors are healthy and happy, they will be the best-equipped to care for our patients, and deliver better outcomes for patients and also better experience for patients. I think that's an important topic that is not spoken about enough. 

Michael: Absolutely. We're in total agreement on that, and we're going to keep focusing on that issue on this show for sure. So, listen, we're out of time but I want to thank you very much, Ryan, for joining us today and wish you the best of luck. 

Ryan: Michael, really appreciate it. Thank you as well. 

Michael: I'm Michael Carrese. Thanks for checking out today's show. Remember to do your part to flatten the curve and Raise the Line. We're all in this together.