How this Bay Area telemedicine startup is bringing second opinions to patients from Boise to Beijing

The life of Nate Lowry got turned upside down last month when the 41-year-old insurance broker in Boise, Idaho, discovered he had stage 4 colon cancer. Amid his ongoing chemotherapy treatment, he’s found some comfort in the services of MORE Health, which offers patients access to second opinions from top doctors at health care institutions like UCSF.

For me, it was about finding the best resources available without flying all over the country,” Lowry said.

Founded in 2011 by CEO Hope Lewis, the rapidly growing San Mateo-based telemedicine startup connects patients like Lowry to a network of 10,000 physicians at academic medical centers spanning the globe. Patients sign on via an online portal and receive a case manager that collects their medical data and connects them to a specialist for a second opinion.

Within three weeks, Lowry’s doctor at St. Luke's Boise Medical Center received a 17-page summary of his health condition, protocol and suggestions from Bert O’Neil, an oncologist at Indiana University Melvin and Bren Simon Cancer Center.

“More than anything, it gave me peace of mind to know we’re on the right path,” said Lowry, who plans to continue using the additional set of eyes as he undergoes chemotherapy in the coming months. That's not always the case: Second opinions given over MORE Health result in more than three-quarters of treatment plans being altered, the company said.

A practicing attorney in Hong Kong, Lewis’s path to running a U.S. medical startup was an unconventional one. Back in 2007, a high-profile legal client’s 18-month-old daughter was diagnosed with a hepatoblastoma; the Chinese doctors concluded that there was no treatment plan for the young child’s rare liver tumor.

Then, Lewis’s parents introduced her to Regis Kelly, a former executive vice chancellor at UCSF and director of life sciences incubator QB3, who said the girl may have a chance if she came to San Francisco for care. A week later, the patient was admitted to the children’s hospital to immediately begin treatment, and today she’s almost 12 years old and cancer free.

“However, the patient’s family ended up having to pay $2 million in cash,” said Lewis. “That part was the inspiration for me (to create MORE Health) because I was thinking to myself, if this were to happen in my family, I would have no way to pay for the medical expenses.”

She added, “More than that, how could these top medical specialists only serve an elite group?”

At the time, telemedicine was non-existent in China and still in infancy in the U.S., Lewis said. Yet the growing digital market has ballooned in the past decade to include players like San Francisco-based Doctor On Demand and AMD Global Telemedicine Inc., as well as online second opinion programs by major hospitals including UCSF. In 2017, the global telemedicine market was valued at $29.6 billion, according to Orbis Research.

Through Kelly, Lewis was introduced to her co-founder Dr. Robert Warren, a professor of surgery at UCSF, who would soon become the company’s chief medical consultant. Warren soon orchestrated a network of colleagues from UCSF, along with physicians practicing at top-tier institutions across the country, to join the platform.

"As a surgeon, I operate on limited patients a week. It really appealed to me because I was thinking about global health. What it meant to me was instead of treating 250 patients a year, maybe I could impact 5,000 patients," said Warren. "This was a great opportunity to improve the quality of care outside the United States."

In particular, Lewis wants to address the massive health care gap between China and the U.S. Serving China’s population of over 1.4 billion, there are only 5,500 oncology physicians part of the China Society of Clinical Oncology, according to MORE Health. What's more, most Chinese doctors see up 200 patients daily, with patient visits under five minutes long, Lewis added.

“Many are misdiagnosed,” said Lewis, noting that 70 percent of the company’s Chinese users come to MORE Health as cancer patients, though 90 percent of the pathology reports are incorrect when they arrive for a second opinion. "Sometimes it's not actually a cancer patient, but they are introduced to us as a cancer patient."

In China, MORE Health uses a fee-for-service payment model, with each patient paying in the ballpark of $2,000 to $10,000 depending on the treatment plan. But in the U.S., the company has partnered with over 140 benefit brokers to bundle its service as part of company insurance benefits plans for $1 to $3 per employee per month.

“At this moment we are only aiming for the small and medium sized employers,” said Lewis, noting that larger companies can also sign up to provide MORE Health as a benefit. "I think in the future our goal is to get everyone the world's best health care."

For American patients who aren't insured through their job, ensuring the service is covered by their insurance plan is currently the biggest barrier to usage. The service is also not available through federal insurance platforms like Medicare. Those Americans can use the service on a fee basis, though out-of-pocket payments are uncommon.

For Pierre Theodore, vice president of innovation at Johnson & Johnson Medical Devices Companies, signing up as a physician on the platform was an easy choice. Beyond being drawn to the cross-cultural efforts with China, the cardiothoracic surgeon has long witnessed the communication difficulties within the health-care industry when sharing data, including medical records and second opinions. MORE Health streamlines the process with high-quality medical imagery and data for patients all in one place.

“The challenge is maintaining high quality care while expanding access,” said Theodore. "MORE Health in a sense allows those asynchronous health care events to come together in an organized fashion."

All physicians like Theodore giving second opinions are covered by global malpractice insurance, and patients are required to have a local doctor, too.

The telemedicine startup is swiftly expanding its capacity, hoping to widen its reach beyond the some 4,000 people it assisted last year from countries including Poland, Japan, South Korea and Australia. Armed with $50 million in funding from investors like Baidu and New Enterprise Associates, the company launched the app version of its platform last fall. In January, the platform added a feature powered by artificial intelligence that allows doctors to pull up similar cases from some of the world’s best physicians for comparison.

Last month, MORE Health moved into a new San Mateo office, upsizing to a full floor at 999 Baker Way, where the bulk of its 50 U.S. employees operate. The company also has remote sales staff in Houston, Boston and New York, in addition to 150 employees spread across China’s biggest cities.

See the Published Article on the San Francisco Business Times