Team Name: MiDoc

Concept: MiDoc is an at-home medical device that allows physicians to remotely conduct lung and heart physical exams, revolutionizing the patient-provider telehealth experience and improving healthcare access, affordability, convenience, and quality.

Challenge: There are 3 issues with in-person doctor’s office appointments.

1. Patient’s perspective. Long waits while in agony from feeling ill: wait until the doctor’s office is open or has an available appointment, wait in traffic during the commute, and wait in line at the office. Additionally, there are patients with poor immune systems, or other obligations (i.e. parents that can’t find a babysitter) that restrict them from leaving their homes.

2. Healthcare system’s perspective. Cases that could be easily resolved with an office appointment are instead treated at an emergency room (ER), resulting in rising healthcare costs and overcrowded ERs. By one estimate, $32 billion is wasted annually in ER visits. Additionally, there are rural patients that don’t have access to in-person physicians that are often left unseen and untreated.

3. Provider’s perspective. Tediousness of note writing, inefficiencies due to late or missed appointments.

Currently, telehealth is only able to replace the conversational component of the doctor’s visit. With current technology physicians are unable to perform a physical exam, and thus do not know the full health status of their patients. This restricts their ability to make a proper diagnose and treat patients, resulting in ineffective care. For this reason, patients may still have to go into the doctor’s office due to inconclusive telehealth consults. Lastly, the lung and heart exams are the most important to a physician (as it relates to many primary complaints and medication side effects) and this vital information is not available via telehealth (phone or video).

Solution: The MiDoc helps address these issues by bringing the third dimension of telehealth: the physical exam. MiDoc is an at-home wearable product that the patient (consumer) wears like a vest, equipped with sensors which are able to perform a remote heart and lung exam: an at-home version of the stethoscope. It can also convey electrocardiogram (EKG) readings, which evaluates the electrical health of the heart.

By using MiDoc, physicians will be able to use the physical exam information gathered to support them in the making the proper diagnosis, leading to more effective treatment of their patients. Additionally, this will lead to more complete home-care telehealth visits, resulting in less referrals to a doctor’s office, easier access to rural patients or ones that cannot leave their homes, improved access to doctors, easing the stress on the healthcare system/ERs, and reducing costs. Lastly, MiDoc can auto-import patient exam data into the electronic medical record (EMR) saving physicians time in note writing, leading to increased efficiency for medical practices allowing them to see more patients and improved quality of life for doctors, especially important given the national shortage of physicians.

MiDoc will revolutionize healthcare by closing the last mile and providing at-home offerings to improve the patient-provider experience, bringing improved access, convenience and affordability to healthcare.

Market: McKinsey estimates that telehealth service utilization rates are 38x higher than pre-pandemic (as of July 2021). Additionally, in the first half of 2021, $14.7Bin VC investment went into the digital health space. There was an estimated $3.2B in telehealth provider revenue in 2020 with an 8.3% 2020-2025 projected annual growth rate. And finally, McKinsey estimated that of the multi-trillion-dollar healthcare market, $250B is poised to shift to virtual care. The takeaway is that the telehealth industry is young, growing rapidly, and there is strong investor appetite.

Our team utilized the most recent US census data to determine a target market. Our potential market is total US persons with internet, which represents 225M people or roughly 69% of the US population. From there, we identified individuals with high telehealth potential, which we broadly categorized as homebound individuals (parents with dependents, senior citizens, and immunocompromised persons) and then rural patients, which reduced our available market to 100M people or roughly 33% of the US population.

Next, we utilized a recent market study from McKinsey to estimate the interest of US consumers in telehealth, which was estimated at 40%. Thus, that leaves us with an actual target market of 40M in the US.

Lastly, we drilled down to our actual market by estimating roughly 10% future market share, leaving us with an actual market of 4M US consumers. We further drilled down between rural and urban consumers which, per the US census, is around an 80/20 split in favor of urban.

Competition: MiDoc faces several competitors, both online and in-person options. First, the in-office doctor’s visits are the standard, but a patient may have difficulty travelling to the doctor’s office, which is a problem we aim to solve. In-home options include doctor house calls (these are rare and expensive), and home nursing (which deliver nursing care, so they’re in a different space as patients still need a physician).

All of these groups may be served by Telehealth, which could be considered a competitor. However, Telehealth has no ability to do a lung or heart physical exam, and lack monitoring methods as mentioned in the Problems section. Thus, it does not overlap with MiDoc as MiDoc is trying to solve the problems and limitations of Telehealth.

A competitor is Heal, an all-in-one mobile service that seeks to match people with various in-home health offerings. These include house calls, Telehealth, and Telehealth with remote monitoring services. However, their remote monitoring services are limited to heart rate and blood pressure only (basic vitals), but no physical exam.

Lastly, Eko has a product like ours (Eko Duo) that can remotely transmit heart sounds (but not lung sounds) and EKG data to doctors. However, this device requires the patient to place it at the proper positions on their chest to get an accurate reading, which is difficulty as patients are not medically trained professionals. MiDoc is a simple vest that users wear and all the sensors line up at the correct locations (ergonomically efficient).

Value Creation: Financial Sustainability:
Revenue Drivers: primary go-to-market would be through partnerships with existing telehealth providers (e.g. Teladoc, Heal). We would sell MiDoc (one-time revenue transaction) plus share of revenue / subscription fee (continual revenue transaction), providing multiple revenue streams. As a benefit, there is natural overlap between our target markets.

Pricing: looking at multiple pricing scenarios and ultimately modeled our pro forma financials using a $500/unit price, which provides a gross margin contribution of 50%. Our variable costs sit at $250/unit comprised of $180 in raw materials and $70/unit manufacturing. One ER visit could cost hundreds to thousands of dollars, if an effective MiDoc telehealth visit could prevent one ER visit, then the customer already received a return on the money spent on the device.

Impact of Insurance: Center for Medicare & Medicaid Services has added reimbursements options during the pandemic to support telehealth services and there is possibility for expansion. Thus, although the broader medical device manufacturing industry might be seeing some pricing pains, devices in the telehealth space might be an exception. Private insurers have largely broadened coverage for telehealth services in response to COVID-19. (Sources: IBISWorld, DHHS)

ESG Benefits of Improved Telehealth (broadly):
– Environmental: Digital healthcare reduces need for patients to needlessly travel (emissions), medical centers can scale down as demand shifts online (resources and land used).
– Social: Increases access to quality care for marginalized, underserved, and rural patients through enhance affordability and convenience. Healthcare money saves could be used to spend on other social services.

Team: The team is composed of three members: Dr. Linda Wu, Lili Hostetler, and Michael Newbold.

Dr. Wu is a pediatrician and a member of the faculty at Washington University School of Medicine. She has firsthand experience with the difficulties described in the problem section and thus came up with the idea for MiDoc. Her medical knowledge and connection within the medical community will lead to early and comprehensive feedback to guide the direction of MiDoc. She also has over four years of professional experience as a human factors engineer, which will support the design and implementation of MiDoc and ensure the product is ergonomically sound and easy to use by all patients.

Ms. Hostetler has a background in Biomedical Engineering and experience building similar medical devices. She is currently pursuing a masters in Biomedical Engineering and can gain access to lab space and support from professors to help in the design of MiDoc. She also has a network of engineers and computer programmers that could be recruited to join MiDoc as supplemental team members. Lastly, she is pursuing an MBA and will be able to support the financial and marketing aspects of this product.

Mr. Newbold has a background in accounting with 6+ years of experience in the consulting world, especially innovative start-up products. He is currently an Innovation Investment Strategy Manager at EY. He is responsible for all the financial, marketing, and customer relations for MiDoc.

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