Is the New Clinic, Forward, Only Reasonable for the Silicon Valley Elite?

A new clinic has been opened in San Francisco called Forward which is an attempt to reinvent the doctor’s office by several dozen former employees of Google, Facebook, Uber, and Palantir. On the one hand, this new clinic is an amalgamation of all the innovation that’s been happening in the digital health space. On the other hand, it seems to illustrate Silicon Valley excess and culture. Let’s take a look at each perspective.

Forward starts the patient experience with an iPad sign in that’s setup looks a lot like the Apple Store. It sounds like they’ve built all new software for their clinic, but tablet check in or other kiosk check in options have been in healthcare for quite a while. After checking in on the iPad, the patient then goes to a body scanner that identifies you using 2 fingers and then gathers your height, weight, body temperature, heart rate and the amount of oxygen in your blood. All of this data is available to doctors today, but this is a novel way to collect the data that likely saves time for patients and the clinic staff.

The exam rooms look like a really well designed exam room, but still feel like an exam room you might go to in most doctor’s offices. However, one notable feature of the exam room is a massive touch-screen display on the wall.

What makes the exam room and this touch screen unique is that the exam room listens to what’s being said in the room and pulls out information for the medical record and displays that information on the screen in real time. This sounds a lot like what I described in my Video EHR idea. The screen will also show the patient’s health history including sensor data and suggests diagnoses and treatment plans. How well it does at this is a good question, but in true Silicon Valley fashion I’m sure it’s an MVP (Minimum Viable Product) that will improve over time.

Many are touting Forward’s unique approach to Urine Sample collection, but this has been done in many other offices for years. Is this really an issue? I don’t think so. Forward also has essentially a health store as well that sells everything from wearable sensors to vitamins and supplements to skin care products. This has a kind of Apple Store feel as well. This can be a great revenue stream for clinics. Eventually you can imagine all of these items being ordered at the doctor’s office and delivered to your house or office by drone. Until then, UPS/FedEx/USPS will have to do.

As you can imagine, all of the biometric data that’s collected at check in, lab results, etc syncs up with a mobile app that the patient can use to access their health data. Looks like they have plans for genomic data as well. Forward has also committed to responding to messages from it’s members (yes, they call you members, not patients) within 1 minute day or night. I wonder if that response is a real human or an AI bot.

As I mentioned, this feels like an amalgamation of everything that’s been happening with digital health. If you’ve followed the digital health space, then you’ve seen almost all of these things done individually somewhere already. This isn’t necessarily a knock on Forward. The iPhone largely was an incorporation of a bunch of innovations that were available elsewhere. However, Apple packaged it nicely into an extremely usable package. Is that what Forward’s done here? I personally think that’s overstating things since they haven’t completely transformed the model (yet?), but it has made a high end medical office experience.

That leads to my second observation about Forward. In many ways, Forward just looks like Silicon Valley excess in the same vein as the over engineered $1500 Smart Oven. How many of the things mentioned above actually improve your care or inspire you to be healthier and how many of them are just for show?

I guess you could make the case that the whole package makes for a better experience that makes you want to go to the doctor, but that’s butting up against a massive desire we all have of not going to the doctor that’s been built into our DNA for years. Plus, the package doesn’t seem like it’s reached the nirvana of treating healthy patients, but instead is just a high end doctor visit experience.

I’m not suggesting that there’s anything wrong with creating a high end doctor visit experience. That very well could work in wealthy areas like Silicon Valley and other areas of the country like New York and LA. That very well could be a good business (although, my guess is they raised too much money for that to be their only business), but it’s not going to transform healthcare as we know it. I don’t see how Forward scales down to the lower end of the market. They should go and talk with ZDoggMD about his experience with Turntable Health which he just had to shut down. They could learn a lot from his experiences.

I’m not saying that no good will come from the Forward experience. It’s quite possible that the Forward clinic is used as an incubation lab for new ideas which the company can then commercialize and sell to the rest of the medical world at a reasonable price. Their excess could produce learnings that could benefit the rest of healthcare if they package it the right way and don’t just try to build a new health care system themselves. That would be an incredible outcome for healthcare.

I know every doctor would rejoice at the idea of a smart patient wall that listened to their interaction with the patient and did the proper documentation for them. That’s the face to face interaction for which doctors and patients now yearn. The big challenge here is that Forward doesn’t have to worry about things like insurance reimbursement, meaningful use, and MACRA. So, will their technology apply to the rest of healthcare? Or does it just enable the high end unlimited primary care model that they’re executing today?

Also, Forward is only working on primary care, wellness, and men’s and women’s health. That still leaves specialists in the regular insurance controlled world (Yes, you still need insurance and the $149/month membership to Forward). Can high quality primary care change healthcare? I think it could, but it’s going to take a shift in mindset (payers, employers, patients, doctors) by many for it to happen.

I know another medical practice in San Francisco that built their practice on the back of cash patients who got a great, fast customer experience. Employers in San Francisco were happy to pay cash for the visit because they knew their employee would be off work at the doctor’s office for less time then traditional healthcare paid for largely by insurance. The cash cost of a visit was much less than having that employee away from work. San Francisco is a unique culture and so that worked for this medical practice and Forward could work in San Francisco as well. I just don’t see the path for them to scale the clinic model across the country. I hope they don’t try, but instead focus on spreading their innovations across the country. If all that fails, at least the Silicon Valley elite now have an opportunity to network with other Silicon Valley elite at the doctor’s office.