Startup Insider: SnapMD

As hospitals and health systems embrace technology to achieve improved quality of care and greater access and convenience for patients, they have begun developing and implementing telemedicine programs. Dave Skibinski, President and CEO of SnapMD, knew this when he co-founded the health IT company in 2013.

Glendale, Calif.-based SnapMD positions itself as a virtual care company in the telemedicine space.

"We view telemedicine as point of care, so as a result we have developed a complete virtual care management platform with a superior clinical experience," Mr. Skibinski says.

Mr. Skibinski recently spoke with Becker's Hospital Review about how SnapMD started and why its focus is telemedicine.

Note: Interview has been lightly edited for length and clarity.

Question: How did the company start?

Dave Skibinski: We're a spin-out from the University of Southern California's Master of Medical Management program. Rustin Morse, MD, one of our co-founders, was the chief of the emergency department at Phoenix Children's Hospital and was pursuing his master's degree, and as part of that program he had to develop a new product or service concept in healthcare. I happen to have an MBA from the University of Southern California, and I was volunteering as a mentor within the program, and Dr. Morse had a very clear and concise value proposition. He wanted to offer a video triage service to the parents of the greater Phoenix area so they could have their child assessed prior to coming to the emergency department. The idea was for a parent to go online before they ever left home, say, "This is what's going on with my 4-year-old daughter," and have a member of the emergency department staff triage that. In at least half the cases, they would be able to tell those folks, "This is not a medical emergency. In the meantime, here's how to handle it before you go to see your primary pediatrician."

We took his kernel of an idea and examined the market. We noticed there was an opportunity for a private label platform company to come into the market. We found that the early entrants in the market, in part due to market conditions, opted to become service providers on top of having their telemedicine platform. And their primary value proposition has been to offer to health plans and self-insured corporations virtual care visits for their employed individuals or insured lives as an alternative to urgent care and emergency room visits. Our view is that while we can enable what those companies offer for our clients, the higher value of telemedicine will be in the management of the chronically ill and in the management and follow-up care of those patients going through acute treatment.

Q: Why did SnapMD choose to focus on telemedicine?

DS: We had a team of people that were in a business consulting firm and branding agency at the time, and we had a very good boutique business. But it had not scaled into a very large business. So we were looking for a great business opportunity. The interesting thing about the Medical Management program at USC that I participated in is all 40 doctors get up and present a new product or service concept in healthcare, and each of these physicians has been in practice on average 15 or more years. They then do a feasibility study and a business plan on their concept. What was amazing to me is all the doctors in the room said telemedicine would be part of the standard delivery of healthcare within the next 10 years.

After hearing that, I asked Dr. Morse if he was going launch this service and he said "no" as he was moving forward in his career and accepted a position as the chief quality officer at the Children's Medical Center in Dallas. The company's co-founders then took his idea, included him as a co-founder and did our own feasibility and market research over a nine-month period and assessed the marketplace. That's when we saw the structure of the telemedicine market at the time, how business models functioned, what the needs of the customers were and more importantly what the landscape was going to look like over the next three to five years.

The good news was that the early entrants in telemedicine had set the stage because they had started to acclimate the market to broader forms of reimbursement for telemedicine visits. When we saw that trend in place, we knew it was going to provide a tailwind behind a model like ours, which was to help the existing health systems. Major health systems across the country have strong brands and they are trusted as providers in their marketplace. We want to empower those kinds of health systems to offer virtual visits the way they need to deploy them, as a complement to their current methods of care. The reason they all need to do that is today's marketplace — the consumer in healthcare, the new patient and the new mindset — needs greater convenience and greater access to care. With the shortage of primary care doctors in America, one of the ways we can leverage those assets in the healthcare system is through telemedicine.  

Q: What other benefits are there to fixing the telemedicine problem?

DS: For instance, we can address problems of patients going through acute treatment. Patients commute long distances to reach National Cancer Institute-designated Comprehensive Cancer Centers. A patient is more than likely willing to do that to have their diagnosis made and their treatment plans developed, but a significant amount of their care, especially the management of the patient after they started their regimen and the side effects related to their conditions, can be done remotely. This can also be done within children's medicine. For instance, there's an autoimmune disease calledepidermolysis bullosa that causes children's bodies to reject their skin. The families must become caregivers for children with this disease. Through telemedicine and an android tablet with a telemedicine platform such as SnapMD, for about $500 you could have a remote clinic in the home of every one of those children. One of the things we're proudest of at SnapMD is that we have more than 40 clinical use cases on our platform today, everything from managing adolescent type 1 diabetics to elderly patients that are part of the chronic care management program within Medicare to urgent care operators who simply want to offer the convenience of virtual visits to the patients they already serve. We also have two clients that are in the business of offering lactation counseling 24 hours a day to mothers who are having problems nursing their newborns. The mother can go online and in the security and privacy of her home and speak to a lactation counselor.

Q: What's in the works in the next year for SnapMD?

DS: We have some very exciting new things we are doing with our platform. We have recognized in the market the innovative nature of how health systems and other healthcare providers are responding to the current market conditions. Not only are they working hard to become in-network providers with health plans, but in some cases they are also contracting directly with their customer, such as an employer, a city school system or a city workforce of some sort. As a result, they are setting up their own direct contracts with groups of patients that need to be serviced. So we are building a financial services engine that will allow our customers to put the terms of their agreements into our tool. Our customers will also be able to recognize the patient as they enter our platform and apply those terms of service and service requirements directly to that patient. This allows the customers to uniquely create contracts to meet the needs of the employer and deliver valuable services to those patients from those employers.

We will also continue to enhance our powerful scheduling system that allows patients and staff to set appointments with specific providers. We are marrying this system with a refined routing engine to route patients to specific services or providers based on a health system's criteria. We will also ensure these systems are easily integrated with the other systems operated by our clients such as EHRs and billing systems.

Our team is also focused on providing the best-of-breed digital examination room. We already use web services, and we are going to be expanding these services so that all the tools required to assess patients and manage their care are at the clinician's finger tips. For instance, today a very common task in telemedicine is to write a prescription. What we will do in the very near term is be able to launch additional services such as lab orders and patient assessments. We think by building this entire examination room experience, where the physician in one interface can do all the things they need to do to assess and develop treatment plans and execute those treatment plans with patients, we will provide that full capability and make it even more robust than what we have today.


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