REVOLUTIONIZING THE HEALTH SECTOR THROUGH CribMD
Henry Esomchi from Phoenix Relations interviews the Co-Founder, CribMD, Ifeanyi Ossai as he talks about the causes of the spike in covid-19 cases, how the pandemic can be managed, among others.
“As nations continue to battle with the impact of Covid-19, and as nations continue combat the impact of Covid-19 on the health sector, it is imperative that nations infuse the use of technology in the health sector”.
Q. WHAT’S YOUR TAKE ON THE SPIKE IN COVID 19 CASES, ESPECIALLY SINCE YOU ARE IN ONE OF THE HOTSPOT AREAS?
There are a variety of factors impacting the spike in cases. They include:
- Inconsistent messaging and response across different levels of government: with continued debates around the importance of mask-wearing and vaccination, social distancing, whether and when to open schools and dining areas. People hear conflicting information and don’t know what to prioritize, what is opinion vs. scientifically proven fact. In addition, the early politicization of a public health response to COVID-19 was extremely detrimental to the effort to control the virus.
- Financial strain and lack of government support plays a role: as unemployment benefits ran out, people have had to return to work, send children back to school, and move into more crowded housing situations, all of which significantly increase risk. In addition, we have a large segment of the population that lacks health insurance, and is thus significantly less more likely to delay any treatment for illness until the situation is dire.
- The cold weather has also contributed to the increase; COVID-safe, outside social interaction is less pleasant now, and so less likely than it was over the summer. The decreased ventilation and stagnant air of indoor areas increase the risk of transmission.
- People are, in general, not good at understanding risk or the potential downstream effects of their actions. A year into the pandemic, people have COVID fatigue and are no longer taking COVID-19 protocols seriously. Many went to visit families in other geographic areas for Thanksgiving and the holidays, and celebrated with friends over New Year’s. The surge we’re seeing is a direct response to those events, which involved travel by millions of people and unmasked, indoor gatherings.
And last but not least, policy changes. Below I have a graphic of the COVID-19 R, or growth rate, in Texas over the course of 2020 (April-October). The different policy changes are mapped on top – from schools, restaurants and bars opening, to closing, to the state ban on mask enforcement, and the subsequent mask requirement. It is clear that the policy changes do have an impact.
Q. HOW DO YOU FEEL THE SPIKE IN CASES CAN BE REDUCED OR PROPERLY MANAGED? IT SEEMS CONVENTIONAL METHODS AREN’T YIELDING RESULTS.
In the U.S., we have seen the politicization of certain prevention methods – social distancing, mask-wearing – and the inconsistent application of larger-scale attempts to turn the tide of the pandemic (e.g., lockdowns, business closings). These partisan policy failures, combined with science-denial trends and unrestricted travel between geographic areas, have caused immeasurable harm.
So, what can we do now? In addition supporting the well-known interventions (mask-wearing, frequent testing, vaccination, hand-washing), we / policymakers/ those in government should provide consistent messaging and a clear set of national guidelines with rationale. And in an ideal world, we’d start by locking down again and paying people significant stipends to stay home for another two to three months, strongly discouraging travel. And paying stipends for vaccination, if need be. We’d also provide universal health care: there is a significant economic and financial burden linked to having a population that is uninsured and delaying care-seeking behavior. The consequences of being uninsured are significant – in addition to the financial risk associated with catastrophic injury and debt – and often include use of fewer preventive services, poorer health outcomes, higher mortality and disability rates, lower annual earnings because of sickness and disease, and advanced stage of illness (i.e., many are “sicker” when diagnosed). This is especially true during a pandemic.
Q. LOOKING AT THE AFRICAN GOVERNMENTS’ MEASURES PUT IN PLACE FOR MITIGATING THE SPREAD OF COVID-19, WHAT IS THE MISSING LINK?
The Nigerian government was early to identify cases of COVID-19, close schools and implement lockdowns in some areas. It also started up cash transfer and food assistance programs, but these programs faced significant challenges related to corruption, inefficient information and resource flow, and theft.
I’m not sure that there is one “missing link” – Nigeria has limited COVID-19 testing capabilities, and even more limited treatment capacity for severe cases. There are also severe limitations in the country’s electronic health records, systems for data collection and reporting to quickly detect trends and outbreaks of COVID-19-like cases. However, asked to identify a single, addressable issue, I’d have to say access to health care, especially high-quality health care.
And this is not unique to Nigeria; across the developing world, the COVID-19 pandemic and lockdowns have exacerbated disparities in access to care. Healthcare costs have increased, while household income fell. People have reported increased difficulty reaching healthcare facilities and that fear of the virus discouraged them from seeking care in crowded clinics.
In Nigeria, government hospitals provide poor service, are often understaffed and lack necessary medications and poor service. Primary clinics are overbooked, and people often have to travel long distances while ill to access care and endure long queues at clinics or hospitals. The more prevalent private clinics often demand high prices and staff uncertified or “quack” doctors due to Nigeria’s shortage of real doctors. Thus, people often self-diagnose and treat with medications from local peddlers or pharmacists, but uncertified medications are prevalent: between 40-70% of medications across Nigeria are uncertified or fake. The pandemic further impacted people’s perceived ability and willingness to seek care; many decided to forgo preventive treatments, chronic condition maintenance, and even prenatal care and vaccinations. These are all issues CribMD aims to address through Telemedicine and Doctor-House-Calls.
Q. YOU MENTIONED TELEMEDICINE, CAN YOU THROW MORE LIGHT ON THAT?
In trying to improve access to high-quality care across Nigeria, we developed CribMD, which is a secure, mobile-friendly, cloud-based healthcare platform and integrated data management system that enables subscription health insurance. The CribMD platform facilitates a suite of health services, including telemedicine and doctor house calls.
CribMD’s integrated healthcare platform provides low-cost health insurance subscriptions, paid monthly, that cover a certain number of telemedicine appointments or doctor-house-call visits per month. Medications, tests, and other costs are covered as well. After choosing one of the subscription tiers, the patient can pick from a list of doctors registered with CribMD, and can choose whether to request a house visit or a video call with the doctor of his choice. If necessary, the doctor can send prescription requests to an approved pharmacy through the platform’s integrated system. If the patient is not near a verified pharmacy, they can have prescriptions delivered to their home through our verified delivery partners.
We believe that especially during a pandemic, telemedicine is the way to improve health care. The global telemedicine market has been growing rapidly, and is expected to expand from its current $38.3 billion valuation to $130.5 billion by 2025. As the COVID-19 pandemic drags on, telemedicine has direct and indirect roles in reducing the spread of infections by facilitating access to care, enabling physical distancing, tracking symptoms and outbreaks, and improving data collection and supporting policymakers in anticipating needs and deciding appropriate and timely interventions.
Unsurprisingly, in the middle of a pandemic, telemedicine appointments that limit patients’ exposure to others have become extremely popular on our platform. CribMD’s low-cost subscriptions increase healthcare access for patients who face barriers such as distance (especially those in rural areas), transportation, caretaker availability, or issues with cash to pay for fee-for-service care. We enable patients to connect with a medical professional remotely without leaving their home and risk catching the virus or infecting others – critical for those with underlying conditions who need to be especially careful not to expose themselves to infection.
In addition, CribMD’s telemedicine services enable patients previously unwilling to advocate for their own health to privately and safely seek care in the comfort of their own homes: for example, with a monthly subscription, patients can seek treatment for “embarrassing” health problems, the elderly, pregnant women and those with limited mobility can seek care without leaving home. Also, patients who wait for months to see a specialist in their geographic region can now see various specialists nationwide and get seen sooner.
Q. WHAT LED YOU TO THIS INNOVATION?
Before CribMD, we ran four clinics in Delta State, and were overwhelmed with demand at all of them: on any given day, we could attend to only 10% of the patients in a clinic’s queue. Charging $30 per session (on average) at our first clinic, we used the profits to build three more and the hospital over the course of the next two years. Our inability to keep up with demand led us to experiment with telemedicine, and CribMD was invented. The overwhelming response from both doctors and patients vying to be on the platform led us to conclude that this was a venture worth pursuing at a larger scale. Now, we have 5000 Doctors on the platform, covering every single city and village in Nigeria. They have delivered over 1000 Telemedicine sessions & Doctor house call sessions to date. Doctors are well-paid, set their own hours, and are only paid for the hours they actively work, helping them to attain some level of job satisfaction while keeping them in the country.
Clinic administrators can now utilize space more creatively and efficiently; with remote doctors, we have been able to cut 62% in clinic operating cost (driving tremendous cost savings for patients), with a reduction in ER overuse by 75% and increased medication adherence by 47% since rolling the platform out to clinic patients. We have also reduced the overhead/indirect cost to $1 per session for Doctor house call and $0.25 for a telemedicine session.
Q. IN AFRICA AND ESPECIALLY NIGERIA, PEOPLE ARE GENERALLY CAREFUL ABOUT THEIR DATA GETTING INTO WRONG HANDS. HOW WOULD YOU ENSURE THEIR DATA IS SAFE?
Security and compliance are of utmost importance to us and our Platform is designed from the ground up to meet all necessary State, National, HIPAA and GDPR requirements. Our security policies include both administrative and technical measures designed to ensure compliance of the Platform, and we are committed to working with our clients to ensure all data sharing security and sharing agreements are executed correctly.
All data integrated into the Platform is encrypted both in transit and at rest, using industry standard AES-256 encryption with keys managed by Amazon KMS (Key Management System) or Certificate Manager. We also ensure that our internal personnel are rigorously background checked, trained, and compliant with these requirements.
Q. WHAT MAKES YOU SO SURE THAT CRIBMD WOULD GAIN ACCEPTANCE?
So far, in our beta tests, we have demonstrated that there is significant demand at our $10, $20 and $50 price points, particularly for the premium and family plan. Our waitlist is growing 10x week over week, and primarily by referrals. We have only just begun to advertise, since we have been artificially limiting growth to the platform as we complete workflows and clear bugs from the queue. Most of our doctors on the platform are also referred – and because we pay doctors a higher fee than most other clinics or services, they are very willing to work for us.
With CribMD, every Nigerian with a phone or a computer can get healthcare on demand. In addition to issues mentioned above, a few of our differentiators are below:
Patients prefer to be seen in the comfort of their own home, especially during a pandemic. When they have to go to a clinic or hospital for additional treatment, we ensure they’re taken to one of our approved sites where we can do quality control, and ensure that CribMD takes care of the payment in the alternative location, to maintain the optimal healthcare user experience.
We use only verified, credentialed doctors with good patient ratings on our platform. Doctors’ credentials must be verified before they are allowed to begin seeing patients on our platform (significant when over 50% of the population has been treated by a quack doctor). And with our patient rating system, we ensure that doctors engaging in inappropriate behavior will be removed.
Similarly, we ensured that only certified medications straight from our pharmacy are prescribed (and delivered to the patient’s door, when needed). As previously mentioned, up to 70% of pharmaceuticals on the Nigerian market are fake, but our patients do not have to worry. Prescriptions from CribMD’s doctors are sent directly to a partner pharmacy, or from our approved supplier to a patient’s home.
We aim to improve continuity of care by being the default electronic health record in Nigeria. Currently, there is no centralized or electronic data collection system in Nigeria, which inhibits information-sharing and continuity of care. As paper charts are still the norm, linking patient information across providers is rare. CribMD’s integrated data platform means that, with patient approval, the next doctor the patient sees can potentially access medication and condition history, reducing likelihood of misdiagnosis, oversight, or prescription of medications with interacting effects.
Q. ARE THERE ANY SORT OF RESTRICTIONS YOU HAVE FACED SO FAR?
Our primary restriction relates to our size and capacity: our team is small and working at max capacity with our current set of customers and development priorities.
Safety Restrictions: For the safety of our doctors and employees, we also do not operate in areas of Northern Nigeria known to be terrorist hot spots. In addition, we have taken the time to create workflows that ensure safety of both doctors and patients, including implementing COVID-19 protocols, doctor and patient verification workflows for doctor house call visits, and post-doctor visit reviews to ensure accountability and safety. Patients or doctors engaging in intimidation or harassment are subject to removal from the platform.
Political Risk Mitigation: Nigeria’s laws regarding commerce are always susceptible to change. To mitigate this risk, we remain politically neutral. Our mentors often brief us on policy changes before they are made public, and work with us to ensure we’re not adversely affected.
Commercialization Risk Mitigation: Our short-term commercialization strategy includes selling individual monthly health insurance subscriptions. As a small health insurance company with low-cost options and a limited risk pool of people actively seeking health insurance, CribMD initially assumes some financial and business risk – so we currently restrict our insurance pool to people under age 65. We mitigate this risk by minimizing expenses through efficient use of physician and space resources. Some platform users will certainly be high-service utilizers, but our current efficiency level is such that each platform user could use four full-service, in-person doctor visits per month and we would still break even. Even with our early risk pool of 500 beta users, our per capita monthly profits exceed costs by 200%. Our prospective marketing, advertising and sales efforts will be both B2B and B2C-focused as we seek partnerships with businesses, universities and organizations across Nigeria to spread insurance risk over larger pools of lower-risk individuals. We are pursuing price-point research as well as partnerships that will enable us to more efficiently expand our continuum of care network (e.g., ambulance companies, testing laboratories, clinics and hospitals).
Q. WHO ARE GOING TO BE THE BENEFICIARIES OF THIS?
Of the 200M people that live in Nigeria, 28M of them have an income greater than $50K per year. These working-class Nigerians and their families are our initial target customers.
Only 3-5% of the Nigerian population has private, pre-paid health insurance; nearly 80% of health expenditures are out-of-pocket. This can be potentially catastrophic and is often cited as a main cause of debt and loan default. Although Nigeria has a government-run, public health care system, only those who cannot afford private care seek care at public health facilities (generally considered to be inconvenient, overcrowded, and understaffed, with long wait times and poor-quality care).
In our initial beta-tests of WeCare clinic patients, we have found that CribMD has significant traction among higher-income individuals eager for the convenience, assured quality, and cost-effectiveness that our platform provides. Our initial roll-out of CribMD, which aimed to test out price points and the viability of CribMD as a service, showed the majority of WeCare clinic patients were interested in signing up. We onboarded the first 1,000 willing, and now paying, customers onto the platform at price points of $20 and $50 per month, depending on their chosen subscription.
In recent months, we have enabled referrals and a platform waitlist (we are currently limiting new users). This was validated by immediate interest – a large number of people input payment information and were willing to pay for our services. Our waitlist has grown 10x week over week, and we have had to artificially limit the number of new CribMD members as we scale and implement complicated workflows, interfaces, data collection tools, forms and dashboards. In addition, our new B2B model has now been validated with over 10 paying clients for which we are the platform that facilitates telemedicine and doctor house calls. Demand has overwhelmed staff capacity and forced the company to limit the number of contracts we agree to fulfill.
Q. FROM YOUR EXPERIENCE IN THE HEALTHCARE SECTOR, WHAT IS YOUR ADVICE TO THE RELEVANT OFFICIALS ON HOW TO HANDLE THE PANDEMIC?
Clear communication of risk and prevention methods. Support vaccination; try to allay fears without shaming. Encourage distancing, but also destigmatize COVID-19 as much as possible. Encourage people to talk about their health status and notify contacts when they become ill. We’ve seen this over the course of many epidemics – from 1918 to HIV to STDs – stigmatizing health issues is never helpful.
Encourage people to get tested regularly, and not to avoid their ongoing treatments and medications for chronic conditions – especially those left untreated, are likely to worsen a case of COVID-19 (e.g high blood pressure).
Q. HOW WILL YOU REACH THOSE WHO DO NOT HAVE SMARTPHONES?
Currently, CribMD subscribers need access to either a smartphone, or the internet. However, many people in urban or semi-urban areas have access to one of the two, and that number is growing rapidly. Broadband penetration is expected to increase to 70% in 2021, and it is estimated that 42% of the Nigerian population already accesses the internet via mobile device regularly (projected to grow to 65% by 2025).
Since there are over 196M mobile subscribers in Nigeria (89% of the population has a cell phone), we are examining additional ways to serve areas without internet coverage, such as relying more heavily on text and phone services, with doctor-assisted enrollment of patients.