#StartupsEverywhere profile: David Crane, CEO, Door to Door Health
This profile is part of #StartupsEverywhere, an ongoing series highlighting startup leaders in ecosystems across the country. This interview has been edited for length, content, and clarity.
Improving Primary Medical Care for Lower-Income Patients
Based in Las Vegas, Door to Door Health is an early-stage healthcare startup that’s using technology integrated with in-person medical care to improve primary medical care services for lower-income households. We spoke with David Crane—the CEO of Door to Door Health—to learn more about his startup’s mission, how technology can be used to improve healthcare, and the steps that policymakers can take to incentivize more private investments in startups.
What in your background made you interested in launching Door to Door Health?
I’ve always been interested in healthcare at the personal level. Door to Door Health is my fourth healthcare startup, and the other three companies I launched all focused on technology and the sharing of information between care providers and patients. In every case, I noticed that gaps in accessibility to affordable and convenient medical care—particularly for lower-income communities—stood out as problems. Serious deficiencies in the process like shifting more healthcare costs to consumers with high deductible health plans and longer wait times to see a doctor cause people to delay receiving medical care, and then they would ultimately end up in the emergency room receiving much more expensive care. I started thinking about how we can reinvent primary medical care... how healthcare services should be delivered if we could build a new system from scratch.
Tell us about Door to Door Health and the work that you’re doing to improve primary medical care.
We’re an early-stage healthcare technology startup, and we launched our first pilot in the Las Vegas market. We’ll be wrapping up our plot by the end of the year and making our services generally available in Nevada starting January, 2021. Then we’re planning a national launch. Our main focus is improving access to quality, affordable primary medical care for under-served communities across the country.
Each year, 80 percent of the nation’s healthcare costs are spent on people with chronic conditions. Six in ten U.S. adults live with chronic conditions, but 50 percent of those people don’t follow their care plans. So when these people get sick, they often end up needing more expensive care. We want to reinvent the delivery of primary medical care. The way we’re doing that is by launching a low cost, tech-enabled primary care service that delivers unlimited, home-based medical care integrated with tech-enabled services to make care delivery more efficient, accessible, and affordable for lower-income households. This is a market that has suffered severe inequities in the accessibility of primary care while, at the same time, enduring a higher incidence of chronic medical conditions, so we’re focused on addressing that inequity and the significant related costs to our healthcare system.
Our PAL™ care delivery model starts with an in-person visit at the patient’s home with one of our nurse practitioners. Then we leverage technology for follow-up and medication management. This includes using telehealth and remote patient monitoring tools—such as bluetooth-enabled devices and apps to help patients adhere to their care plans—that allow our practitioners to stay in touch with patients on a daily basis. We also utilize on-site visits to help monitor our patient’s living environments, particularly when it comes to social determinants of health like food security, access to prescriptions, and home safety. In every market we enter, we plan on partnering with community service organizations to connect patients with needed support services.
How has Door to Door Health been affected by the coronavirus pandemic, and are there any steps that you believe policymakers should take at this time to further support startups and other emerging businesses like yourself?
We were just launching our first patient pilot and raising our first round of outside funding when the pandemic hit. Because of where we are in our evolution, we had to put the breaks on what we were doing because investors pulled back as a result of the economic uncertainty. At our stage of development, we’re really reliant on angel investors—high-net-worth individuals who support early-stage startups—for seed capital to fuel our growth. Venture capitalists and private equity firms don’t often invest at this stage of development, so it’s often accredited, individual investors who make the initial seed investments. The loss of these investors as a result of the pandemic affected us in a big way.
Early-stage startups are often cash poor and passion-rich. They need access to capital to launch their services, attain provable market traction, and grow into high-growth companies that employ lots of people. It’s expensive for a startup that’s doing innovative work, especially with technology, to develop these things and then roll them out on a national scale. As a result of the pandemic, we’ve experienced the double whammy of losing revenue and investor fuel needed to help us continue to innovate and grow.
From a policy perspective, we need to find ways to address the pandemic without shutting down the whole economy again—especially as localized hotspots continue to emerge. A more focused effort to locally control pandemic outbreaks is needed. Startups often begin in specific geographic areas, and if those local areas broadly shut down again, it will be difficult for many businesses to survive another period of inactivity. Prior to a vaccine, a mask mandate is probably the most important thing when it comes to protecting local economies, the health of people, and small businesses and startups. We need to continue abiding by the mandates while combating the hotspots until we have a vaccine ready for distribution.
What are some of the startup-related policy issues and concerns that you believe should receive more attention from local, state, and federal policymakers?
Policymakers at all levels of government should work to incentivize earlier investments in startups. When it comes to angel investors, there’s a huge disparity between the number of high net-worth individuals in this country and active accredited investors. We need to find ways of engaging and attracting more high-net-worth individuals to make investments and obtaining larger investments from that group, since that’s what really fuels early-stage startups and the employment growth that accompanies small business success.
To help drive investments in young companies that are doing innovative work, we should consider taking additional steps to increase the number of active angel investors, including by revising tax policies for investment in startups that meet specific criteria related to stage of development and funding amounts needed: deductions, credits, faster write-offs for losses, and lower tax impact for gains.
Another option is for the U.S. Small Business Administration to create a government-controlled investment arm focused on startups. We’ve seen the government make similar investments in the past, such as with the Troubled Asset Relief Program. We can do something similar that will create tremendous value across the country for the millions of innovative startups instead of just for big corporate bailouts. Policymakers would be amazed at what this would do for job growth if they provided startups with the financial engine they need to grow.
What is your goal for Door to Door Health moving forward?
We’re seeing patients again and we’re continuing to grow our pilot. We’re hoping to come out of our pilot at the end of the year and, starting next year, begin rolling this approach out in multiple states. Our goal, ultimately, is to roll out this model nationally. The reinvention of primary medical care is not a small thing, and it’s not just needed in one state; this needs to happen across the entire country. And the philosophy and vision of our company is to literally reinvent primary care for 350 million Americans.
All of the information in this profile was accurate at the date and time of publication.
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