Why some startups and VC firms are betting on in-person healthcare

Telehealth has become all the rage following the Covid-19 pandemic, with about 17% of appointments going virtual, up from 1% in February 2020.

But some startups and investors are still betting on in-person care.

Take Knownwell, a Massachusetts-based weight-inclusive hybrid primary care company that started serving patients in March 2023. Brooke Boyarsky Pratt, a co-founder and CEO of the company, created the startup in response to her own challenges finding a provider as a patient with obesity.

But despite the craze for telemedicine, the founders, Boyarsky Pratt and Angela Fitch, opted to build a hybrid model with clinics for face-to-face appointments, betting on the value of in-person healthcare. The company currently operates physical clinics in three states and sees patients virtually across New England, Texas, and Minnesota.

“We felt strongly that to build a longitudinal connection with patients, it was important to be convenient, which is hard to do if you’re only in person,” Boyarsky Pratt told Healthcare Brew. “But it was also important [because] parts of that relationship between a clinician and a patient that are just difficult to do virtually.”

Importance of in-person care. It’s no secret that some kinds of healthcare—like surgeries and imaging—cannot be provided virtually. For knownwell, that also includes conducting tests, doing exams, and seeing weight distribution on the patient.

But Boyarsky Pratt also said there are more than just clinical benefits.

“Keeping the patient engaged long term, which is really what matters for health, there are these other nonmedical benefits,” she said.

To make the appointments more inclusive, knownwell clinics have wider doors, larger chairs, more comfortable blood pressure cuffs, and exam tables that can weigh patients. The company also trains its clinicians to be “weight-inclusive and welcoming,” Boyarsky Pratt said.

“Step one in reducing stigma is understanding that this is a disease state, not a personal failing or moral failing of a patient, and that has meant that a lot more patients are seeking treatment or seeing once again that healthcare is a place that can help them,” she said.

Patient satisfaction rates, she said, are consistently a few points higher in person as well, 93.9% compared to 89.9% for virtual, which she credits to establishing that in-person patient-physician connection. 

“I do think it creates a sense of community, like patients knowing the staff, getting to know other people at the clinic,” she said.

Aside from patient satisfaction, the telehealth sector has recently taken a hit, as UnitedHealth Group closed its Optum Virtual Care program and Walmart shuttered Walmart Health and Walmart Health Virtual Care.

Cost conscious. And building the clinics doesn’t have to break the bank, either.

Millie, a California-based clinic designed to take a “modern approach to holistic maternity care,” is another startup that prioritizes in-person healthcare. The company, like knownwell, was borne out of personal experiences, founder and CEO Anu Sharma said, after she faced fertility struggles.

Also using a hybrid model, Millie midwives and physicians meet with patients before and after labor in the clinic, at home, or virtually. The company provides midwifery care, mental health support, patient monitoring to prevent postpartum complications, and educational resources, according to its website.

Millie’s first clinic only cost $175,000 to build, including equipment and design, Sharma said, because it was located in a medical office building already zoned for healthcare. The facility is also close to hospitals and medical testing facilities.

“With Millie, we’ve been really impressed with how efficient they are [in terms of capital],” Alice Zhang, a principal at RH Capital, a venture capital firm that invests in women’s health (including Millie), told Healthcare Brew.

Millie has one brick-and-mortar clinic, which opened its doors in Berkeley, California, in September 2022. The company is looking to open two or three more locations within the next year or so in California, but Sharma said she hopes to eventually expand nationally.

“A single visit at the six-week point is a little too late,” Sharma said. “[Millie is] a completely different take on how maternity care should be designed from the ground up in a way that is more complete, more proactive, and more right-sized.”

Bringing it home. In-person care can also extend beyond the clinic through at-home appointments to check in on patients, according to Sharma. She added that this allows Millie providers to assess the birthing parent’s recovery, give breastfeeding support, check on the baby and the physical environment, and make care referrals if necessary.

At knownwell, Boyarsky Pratt said that when there’s a virtual appointment, the company makes an effort to match providers to patients in the same area, so they can make location-informed food suggestions for each patient.

“Virtual care can provide a level of convenience, but it cannot replace [in-person] care in every instance,” Sharma said.