What lies behind the success of health tech firm Top Doctors?
The pandemic has created a need for virtual medical care and significantly transformed the acceptance of remote telehealth services among HCPs, patients, and regulators. In 2020, we witnessed an outburst of telehealth and e-consultation sessions, especially in primary care. Health tech innovators and healthcare stakeholders saw a major business opportunity and investors made serious moves into the space. How has Covid-19 disrupted the second care landscape? In a candid conversation with Alberto Porciani, Founder and CEO of Top Doctors, a leader in private medical specialist care worldwide, we talked about how the company has changed the way people access private healthcare and connect with their chosen specialist, their business model and global market entry strategy, as well as how will the market evolve and what are the near future trends.
Covid-19 has changed the way healthcare is delivered and has rapidly affected virtual care adoption and usage. Industry players have recognized the value of telehealth and acted very quickly to gain market share through acquiring or partnering with existing well known service providers (e.g., Doc Morris acquired Teleclinic (2020); Teladoc acquired Best Doctors (2017), InTouch Health (2020) & Livongo (2020); Doctor on Demand partnered with Texas health plan for virtual primary care HMO (2021)).
All around the world, governments waived restrictions and released reimbursement codes for telehealth tech licenses and service offerings. Telehealth services (a doctor — patient consultation via video, phone, and private chat) could be used for one-time consultations with new or existing patients or ongoing care for supporting chronic care therapies & treatments, acute cases and even diagnosis, e.g., in dermatology. In the midst of the pandemic, R2G’s global survey showed that 66% of telehealth users stated that they will use the service more often in the future.
In 2021, the use of remote telehealth is continuing to grow, but at a much slower pace. Within the “new normal” and the possibility to see again one’s doctor face-to-face, the adoption and usage depends not only on patients’ delightful experience and the quality of the service received, but also on doctors’ incentives to proactively offer telehealth and their awareness of how this service can nicely fit within their workflow. Primary care is leading the telehealth visits, but in 35–40% of the cases a patient needs to talk to a specialist. Finding and connecting in real time to the best specialist for our unique health problem and getting high-end care services with the right actionable insights within the context of our everyday moments and preferences, as well as being able to transfer our medical information, get electronic medical prescriptions, etc. unlocks more value and could drive positive outcomes.
How has the pandemic affected secondary care? What does innovation look like in this space? How will the market evolve in Europe and globally? Who is driving the adoption of telehealth?
To dive deeper into this topic, we talked to Alberto Porciani, Founder and CEO of Top Doctors, about the role the company plays in the telehealth and secondary care ecosystem, how their value proposition differs from other market players, what challenges tech giants might face in the digital health space, as well as what is next for Top Doctors after closing recently a $13 million Series C funding round.
Enjoy the interview!
Research2Guidance: Congrats on your $13 million in Series C funding. Can you please shortly introduce Top Doctors.
Alberto: Thank you. Top Doctors is a health tech firm, distinguished as the leader in private medical specialist care worldwide. We have highly recognised medical practitioners in key specialties in Europe (Spain, Italy, and UK) and in Latin America (Mexico, Colombia, Argentina, and Chile). Recently we opened our services in Saudi Arabia.
Our mission is to help patients find and get easy access to the right and the best specialist when faced with a health problem. Just to give you an idea of our footprint in this area so far: we have roughly 200 million patients per year who trust us to find quality care and 3% of these patients are connecting through our technology with a specialist. There are more than 100 million visits to specialists’ profiles, 100 million visits to qualified information in articles and about 6 million appointments taking place each year. On the other side, we have 90,000 top experts on our platform.
Research2Guidance: These are some notable facts. What is your service offering and how do you stand out from your competitors?
Alberto: Our core is to enable patients to find trusted and quality care at times of need.
What is unique about Top Doctors is that we have developed a selection process of top specialists. Our selection process is a combination of two main areas: peer-to-peer recommendation, where doctors nominate another doctor because they believe they are among the best in their field, and on top of that, we have our own internal auditing of doctors’ CVs. Only 1 in 5 doctors pass our rigorous selection approach. And finally, we also combine information about the doctor with patients’ ratings to maintain the highest standard of quality.
The patients who visit the Top Doctors platform to find the best doctor for their case will have access to what other doctors believe about the specialist and what other patients think about the same specialist. With this transparent and complete data, patients can make their own informative choice about the specialist they need.
In addition, our unique search algorithm is based on the matching of the pathology, treatment, or disease experienced by the patients, with the expertise of the doctor. As a result of that, the patient can easily find an expert in each pathology, treatment, or disease. Finally, we also offer telemedicine services where medical consultations with the most prominent doctors can be carried out immediately and without geographical limitations. This is crucial, especially for patients who live in ‘medical deserts’ (areas with a limited number of specialists).
Research2Guidance: What is your business model? How do you make money?
Alberto: Our business model is a Software-as-a-Service (SaaS) module.
For the patient our service is for free. Our aim is to offer them an informed choice about the best medical professionals specialising in specific physiological treatments. The doctors who pass through our selection process are listed on our platform for free, and those who want to use our system and technology to digitalise their practice and our online reputation services, pay a monthly fee for the usage of the platform.
In addition, our revenue stream comes from a transactional fee on top of the SaaS. What do I mean? As an example, for a telemedicine session to take place, the patient must pay up front. In this case, the platform is collecting the money on behalf of the doctor, and for that service we keep a transactional fee.
Another case could be if a patient prepays for a face-to-face visit. Normally, they will get a better price by doing that. In this context, we take a transactional fee.
Research2Guidance: At present, Top Doctors is in three continents and operates in eight countries. What drives your global market entry strategy? And what makes a country attractive for you?
Alberto: Our focus is on private healthcare. When choosing a country to be in, we are looking at five variables:
1. Level of the private healthcare in the country, as well as the opposite face of the same coin / the level of the public healthcare sector.
If you have a very good healthcare sector in a country, you can have high-quality private healthcare that is not fully developed, because the public healthcare takes the larger portion of patients. The best country for us is where the public healthcare system is in trouble. The trouble being in the sense that the quality is not so high because the system is overloaded. In this case, the private healthcare sector is already developed or is developing fast.
2. Penetration of the insurance companies and the business model of the insurers:
In a country like Spain, there is this all-inclusive insurance model, where all is covered. One has a kind of credit card, and everything is paid directly from the insurers to the provider. In some countries, there is the reimbursement model. And depending on that the market is more or less appealing to us, since this has a strong impact on the earnings of the doctor.
3. Internet penetration:
We can’t be in a country where the internet penetration is not of a higher level. This means, not only how many people own mobile phones, but also the usage pattern and behaviour of the patients.
4. Quality of the doctors:
We are Top Doctors, and we can’t approach countries where the level of the medical education is not of a high standard. For example, in Mexico, most of the doctors on our platform are being trained in the US. The quality of the education of the Mexican doctors is very high.
5. Level of digitalisation of single practice and hospitals:
Markets where there is a low level of digitalisation, where there is a lot of paperwork and where our solutions can help doctors and medical centres to move to a digital model is important for us.
At last, we also look at the competitive landscape. If we recognise that there are strong competitors present in a country, we ask ourselves “Why do we want to “fight” for that country, when there are a lot of other countries that are more “virgin”, and we have a better space to develop and grow?”
Research2Guidance: Top Doctors is present in countries with different cultures and mentality, maybe even patients’ behaviour. Do you have to tailor your business model to each country?
Alberto: Our investors call us a “blueprint”. Our business model is absolutely the same in all the countries we are in.
The only exception is the UK, where there is a different patient journey. In the UK, GPs are the entry point into the healthcare system. If a patient needs to see a specialist, they must get a referral letter from their personal physician. There, we partnered with Babylon in the past to provide the referral letter, now, we also provide telemedicine services specifically to primary care through the GPs on our platform.
Research2Guidance: Covid has accelerated the adoption and usage of telemedicine, yet at present, when things are a bit more back to “normal”, a lot of patients prefer in-person doctor visits, and are using telemedicine, e.g. for sick notes, medication adherence follow-ups. Was the telemedicine market overhyped? How will the market evolve in Europe and globally?
Alberto: It is an interesting question, and I am happy to share my thoughts.
First, we need to differentiate between telemedicine and e-consultations. In order to provide e-diagnosis the doctor needs to have all clinical records of the patient or there should be some kind of a medical device connecting the doctor and the patient to provide real-world data.
We are still not in the telemedicine space under this definition. Today, I believe there are just a few hospitals or just a few providers in that space. Telemedicine can bring high quality value to patients and is very good for home care, chronic disease, etc. and that is the key.
Now, most of the players are in the e-consultations space — video consultations and private messaging. In this space, our understanding is and what we are promoting is consultations that are “phygital”, a combination of physical and digital sessions. This is something that firstly doctors and secondly patients need to understand. Let’s say patients are already in this space. They see the convenience of having e-consultations because it saves time, but in many cases, they might not be happy if they do not see the doctor face-to-face.
The “phygital” model is something that also doctors must understand very well and how it applies to their day-to-day working flow. That is the biggest challenge of the market. And at Top Doctors, we continue to educate specialists so they can understand what the benefits of this concept for them are.
Second, it is very important to recognise that there is a difference between primary care vs. secondary care telemedicine / e-consultations. It is a distinct space. If we look at the numbers during the Covid-19 pandemic, there is an explosion of primary care e-consultation sessions. It is easier to have an e-consultation with a doctor if you have a flu, or even with a specialist if you are diagnosed with a chronic disease. In time you kind of become an expert patient, and you can have more frequent e-follow ups to improve medication adherence, change behaviour, etc.
When it comes to a specific pathology, most of the time you want to see a doctor in-person. Of course, this is changing, and it depends on speciality by speciality. A psychologist or psychiatrist can offer e-consultation easier, as there is no need to examine the body.
Just to give you some numbers, in our secondary care space, pre-covid, we had a limited usage of telemedicine / e-consultation sessions. With the Covid-19 pandemic, we saw an increase of 90 times of what we had before the pandemic. During the three months of lockdown, we had the same number of telemedicine sessions as 3 years. We saw a huge increase in doctors using our platform. They were proactively asking “Give me the service” because they needed to continue to serve their patients. After the lockdown, we saw that the curve went down instead of 90 times, let’s say 30 times and then we had some months stagnant. Today, we see that we are growing month by month roughly 10% from the previous month. So, there is a slow growth, but a consistent growth. We believe that the “phygital” concept is progressively entering into the mindset of the doctors.
Research2Guidance: The points you have made are interesting and valid. So, who is driving the adoption of telemedicine — the patient, the doctor, the provider, or the health insurer?
Alberto: I think patients are the earlier adopters of telemedicine / e-consultations concept, and they feel the value and can appreciate the convenience in many cases. But the real key is the doctor. Patients will push to get the telemedicine / e-consultation and probably if you are a doctor who is not able to offer them this service, they will try to find another doctor or if they still want you, because you are the best in your field, they might at this point accept what you are offering them as a service, just face-to-face. But, for how long?
I believe the real future driver will be the doctor.
Research2Guidance: What are the near future trends in this space?
Alberto: I believe telemedicine will continue to boom in primary care. Telehealth / telemedicine came to stay, and the digital concept will continue to develop. We will continue to see positive trends in the next few years.
In the coming years in the medical sector, we can expect to see the increased popularisation and consolidation between doctors and patients of the Internet of Medical Things (IoMT), which is seeing increased connectivity between hardware devices and medical software in the medical sector. Going hand in hand with this is the use of remote patient monitoring (RPM), virtual reality (VR) and augmented reality (AR) which we can start to see being implemented in the medical industry. Big data and artificial intelligence will become increasingly prominent, helping doctors to be more expansive in their treatments and surgical procedures.
Research2Guidance: Primary care is a hot sector and quite attractive for investors. Why don’t you want to be present in this market as well?
Alberto: Everybody knows their core business, where they are and what their market position is. I think that primary care and secondary care in many cases are linked. If we look at the digital journey of patients, it starts with having a symptom, seeing one’s general practitioner and then in 35–40% of the cases there is a need to talk to a specialist, thus moving to secondary care.
Only digitalising the primary care patient experience and not being able to offer the patient any digital solution for more specialised healthcare needs is a risk for the primary care sector. You are losing the patient; you are not controlling what is happening. And the same is valid for secondary care. I believe that sooner or later the primary care and the secondary care digitalisation need to be on the same level and to get together.
It is fantastic that big companies like Teladoc or Babylon are in primary care. But someone must take it upon themselves to do the tough job of digitalising the secondary care sector. Unlike the key players in the primary care model, it is impossible and not cost efficient to just have a full specialist range in house.
What we are doing is digitalising the secondary space and not only secondary, but the TOP secondary space. I do not exclude that in the future perhaps there would be some collaboration, some M&A between companies that are focused today in the primary and companies that are focused on secondary care.
Research2Guidance: Big tech giants are continuing to make moves into digital health and trying to lead health innovation. Speaking of Amazon Care, the company’s telehealth branch expanded in more states. What are your thoughts on that? What are the challenges that they might face?
Alberto: Tech giants are doing something that in my opinion is extremely positive that is trying to develop novel tools that can potentially be a very good support for doctors and empower patients. Today the accuracy or the level of the sophistication of their gadgets is still maybe not at the space of the diagnosis and treatments but the evolution of these wellness wearable products will go in the direction of being in the future a medical device.
The healthcare sector is complex and extremely regulated, and I think this is the challenge they face today. Their challenge is not a technological one, this is their core, and they can leverage their technology and business experience to develop state-of-the-art solutions and services. However, I believe that these companies will continue to have limitations in the healthcare sector because it is unfamiliar to them. And what will be the way for them to fix this issue is by buying companies which are already successful or very innovative in the segment they are interested in. Companies that know the laws and regulations, market structure, and patient-doctor relationship very well.
Research2Guidance: You founded Top Doctors in 2013. What are some of the lessons that you have learned?
Alberto: Some of the lessons I have learned since starting Top Doctors are:
- See failure as a learning opportunity. It is difficult to get it right the first time and practically all entrepreneurs who have created a successful company have had several previous failures.
- Resilience and passion are also essential ingredients to be able to undertake.
- Obsessive control of the cash flow and revenues. This ensures the success and sustainability of the company from the start.
- Fundraising is not finished until the money is in the account. Last minute problems can break the deal. So do not count on the money and do not start investing before having the money in your bank account!
Research2Guidance: What lies ahead of you?
Alberto: At Top Doctors, we are the medical benchmark of private medicine worldwide for patients and doctors.
With our latest investment our focus is on three pillars:
We are not planning to enter new countries. We are planning to accelerate the penetration of our business in the countries we are already in. The main reason for that is that we are leaders in Spain and the UK, so we want to consolidate our leadership in these countries and continue to grow there. But we are not a leader in Mexico or in Italy and we are still in early-stage development in Colombia, Chile & Argentina, and of course Saudi Arabia.
We want to continue to develop technology and add new features in our platform to first continue to help doctors digitalising their practice, and position our platform as software management for their 360o practice. Second, introduce new features on our platform for patients, to be the cornerstone of health for them.
NEW REVENUE STREAMS — HOSPITALS, LAB & RADIOLOGY CENTRES
Our technology is working properly for single doctors or single practices and middle size clinics. Entering big hospital space, labs, and radiology centres is going to complete the patient‘s journey. We are looking at this space through a potential internal organic development or through M&As.
Our team believes in the power of the B2C space. The number of patients using our platform will continue to double each year, because we have a strong incentive for them, which is to find the right and the best specialist for their unique cases, and to offer the most accurate and reliable medical information. We will continue to work as we did in the past in this direction.
And in order to achieve all of the above, we are planning to hire more than 100 people in the next 12 months. I would say the future ahead of us is exciting.