Medicine comes down to human-to-human interactions (doctor and patient) and those are really hard to scale. One Medical is basically a novelty offering nice offices and predictable visit times. It takes some of the most common complaints you have about your doctor and removes them. In my experience, the quality of doctor was incredibly low, however, the quality of doctor will not be super important to you if you are 25-40 years old because you're probably pretty healthy on average, especially the young working professionals likely to be One Medical clients.
If you actually want good medical care, over your lifetime, your best bet is to build a strong relationship with a good doctor. If you also want to never wait, concierge medicine is where you ultimately need to be (doctor is trading off a higher volume of patients for a fee to a small number of patients).
> In my experience, the quality of doctor was incredibly low,
Hmmm... never would have guessed that. In my experience, the One Medical doctor that my wife and child see is excellent. I've met him and think he is great. A colleague is also extremely pleased with her One Medical doctor.
Maybe you just had bad luck with your doctor selection? I don't mean to invalidate your experience, but it certainly varies from my experience.
I'm always really curious what people mean when they say a doctor is "great". Is this just biases about smiling and seemingly having it together, or are there medical aspects to the greatness which set them apart as doctors? How does an average person know if your doctor is, in fact, doing a good job?
A good doctor is one who pays attention. I've met my fair share of bad doctors who are overworked and just are not paying attention to what they are doing. Then they end up making mistakes, such as misdiagnosing a condition, prescribing the wrong medication, etc.
It's hard for the average person to know if their doctor is doing a good job until something goes wrong and it's too late.
My doctor now is excellent, he's excellent because he actually listens to what I'm saying. That doesn't mean he always agrees with me, I would hope he doesn't! But at least he is paying attention. Many other doctors seem to go into a keyword search mode when listening to patients. It's the difference between reading a page thoroughly and skim reading it.
Same. I have a GP who takes 40-60 minutes per patient, and gets into detail of what’s going on. I felt he truly cared. Compare that to the ~5-10 minutes of my previous GP
Thanks for asking this question... I was just about to ask this and then I got distracted before coming back. As an engineer I have no idea how to actually qualify whether my doctor is good or not. I _like_ my doctor, he's a personable enough guy, and perhaps I trust him because he hasn't harmed me yet, but I also have no idea if he is any good.
The worst graduate in a medical class is still a Doctor somewhere...
This is probably the same feeling business guys have about engineers...
The most important thing to me is an understanding that the patient is in charge of their health and the doctor's just there to support the patient. For example, if a patient is already on meds from an online pharmacy, the doctor (after ensuring that the patient isnt causing grave harm to themselves) should be willing to write a prescription for those meds.
At the same time, I think it is unethical for a doctor to continue prescribing medications that they do not believe you actually need based on your current health.
To them/me, it would be malpractice.
If you were on an antibiotic for strep throat, finished your course, and then asked your doctor for more of it without any symptoms, should they prescribe it again? You wouldn't cause grave harm (unless the aggregate risk of super resistant bacteria counts).
All of this shouldn't be conflated with patient centered care, though. I too agree that the patient should be in charge and the doctor should be there to support. But it shouldn't mean that doctors have to do whatever the patient asks of them.
In my experience, they are often young and at the beginning of their career. They are still medical doctors, not to take anything away from them, but I mostly rely on them for referrals to specialists as needed.
One Medical removes some friction from the overall system, which as a non-American I find incredibly frustrating.
Fwiw some studies show that young doctors have better outcomes. Maybe because they have been to medical school more recently, when evidence based techniques were taught with more rigor. E.g. https://www.bmj.com/content/357/bmj.j2286. Now this study only concerns hospitalists, and it's just one study, so it shouldn't make you avoid older doctors necessarily. But definitely what there is no data for is a bias against younger doctors.
I've had 4 different doctors from One Medical. One of them was pretty good but I wouldn't recommend the other three. However the email access and online scheduling makes up for it. And office staff is actually not brain dead like I've see elsewhere.
I've used One Medical in NYC for the past two years but I'll probably drop them the next year.
The primary care checkups were nowhere near as thorough as ones I've had with one-off doctors. The only benefit that I value that they provide to me is the ability to schedule appointments online, but I frequently find that it is more and more rare to find an open slot the day of (or I have to travel way further across town than I would like, with degree of urgency affecting how eager I am to do this), and many practitioners seem booked 1-3 weeks into the future. With such full scheduling, sometimes I just end up going to a local chain of urgent care clinics instead and usually see someone within 30 minutes or so.
I have serious medical needs and have built long-term relationships with a couple specific doctors at One Medical. Works very well for me — I see my doctors for specialist-y things and a random doctor if it's more urgent.
> In my experience, the quality of doctor was incredibly low
There is significant amount of doctors providing mediocre quality services in US (and given the developments like the rise of AI there will be even more of it). What does economics suggest you're to do with mass amounts of cheap low quality goods? Fastfood it. McDonalds for medical services. If that is what One Medical really does, then we have another Uber/AirBnb/etc.
>If you actually want good medical care, over your lifetime, your best bet is to build a strong relationship with a good doctor. If you also want to never wait, concierge medicine is where you ultimately need to be (doctor is trading off a higher volume of patients for a fee to a small number of patients).
Yes, good restaurant with star chief and great ambience where you're a valuable regular ...
With one medical, many of the practitioners are not doctors, but NPs and such. Some were good as far as I could tell, but others I've used are so so.
Most of the value of one medical was the easy app based scheduling, but since I've realized that something like zocdoc exists, most of it's value has disappeared for me.
Also they don't integrate with things like apple health, while larger hospitals tend to have integration built into them.
Because of that, I'm not very bullish about one medical overall, since a combo of zocdoc + apple health provides most of their benefit, with an expanded set of services available with a set of doctors that are larger than what one medical would provide.
They may be difficult to scale compared to pure software based companies, but they can still scale.
Hospitals are difficult to grow and maintain, but HCA still commands a market cap of 50 billion.
And if you believe healthcare is moving from more inpatient care to more outpatient based care...
“ For the year ended December 31, 2017 and 2018 and the nine months ended September 30, 2018 and 2019 (unaudited), the Company had customers that individually exceeded 10% or more of the Company’s net revenue...For the nine months ended September 30, 2018 (unaudited), individual customers accounted for 15% (Customer A), 12% (Customer B), 10% (Customer C) and 10% (Customer E) of the Company’s net revenue. For the nine months ended September 30, 2019 (unaudited), individual customers accounted for 14% (Customer A), 12% (Customer F), and 10% (Customer E) of the Company’s net revenue.”
“Certain of the Company’s investors are also customers of the Company. The Company recognized revenue under contractual obligations from such customers of $2,112 and $22,273 for the years ended December 31, 2017 and 2018, respectively, and $15,984 and $19,801 for the nine months ended September 30, 2018 and 2019 (unaudited)”
Sounds like they’re beholden to a handful of entities for the next year or two as they scale out.
Edit: My question is what caused these corporate customers to churn? Did they maintain spend levels with One Medical while the other customers grew spend? Did they decrease spend below reporting thresholds? Did they stop using (or sponsoring) these services entirely?
It sounds like "customer" here is defined as "corporation paying for a bunch of its employees", and not "one poor person who had lots of doctors visits".
Elsewhere in the S-1:
"In 2017, 2018 and the nine months ended September 30, 2019, our top customers accounted for 42%, 37% and 36% of our net revenue, respectively. These customers included Google Inc., which accounted for 10% of our net revenue for 2018 and the nine months ended September 30, 2019."
(Disclaimer: I work at Google, and they do pay for my One Medical membership.)
I love one medical and will not bother with anything else in the US if I can help it. They accept insurance, appointments start on time, it’s a paperless experience, I can get same day appointments. What else can one want? The doctors have great table side manners and are always professional. I have had 0 bad experiences and I hope they have a great stock market debut!
I like One Medical a lot, I hope they find some way to be profitable. Their doctors are far less rushed than any other GP doctor office I've been to, and their app is well done too.
I've been confused how they're able to do this and not charge more than they do (only $200 a year).
Long-time customer here and totally agree -- they are awesome on timing. I think they do this by virtue of having a system. They seem to have a systematic effort thru the entire office of abiding by schedule appt times. Some of that is systematic scheduling to prevent overbookings, etc.
I one time showed up 2min late and they sent me back home, that is when I knew they were the real deal. I'm so glad they did, because 1. I was never late again, and 2. I know they wouldn't be late for me in the future.
I think many times when doctors are late, it is often because
0. They have a cascade of latenesses with really just a single early appt that is actually late causing the domino of late starts and hence ends.
1. They have a patient come in late or w/o appt, cater to them or "squeeze them in"
One thing OMG has going for them is the generally professional clientele -- many of the clients dont want to arrive/leave later either, so that is good for everyone.
Last summer I had a severely broken wrist, and the orthopedic surgeon was able to "squeeze me in" a few days later - literally at the first possible moment I could have had a surgery consult. Later on I had a follow-up with him, he kept me waiting for at least half an hour, but I totally didn't care because I knew why.
But yeah, I use One Medical and it's amazing. For primary care, they really respect your time like none other.
I think a lot of it is just good software. They seem to have a lot of things automated, they let patients indicate if they need a quick or long visit, etc.
They get a few things right, mostly in terms of practice management and pseudo-vertical-integration that make the experience far nicer than a traditional doctor's office. It's nothing world-shattering, but 99%+ on-time appointment starts is a big deal.
Their online platform is very UX-focused. The app is nice and easy to use, and makes things like firing off a quick message to your PCP for an Rx refill super super simple. My old primary care doc had nothing of the sort. It was the old 1990s way of doing things. Try to get scheduled... by phone... a month out... for a refill of a skin cream I've used for 20 years. I get that they want me in yearly, but that's inconvenient and annoying.
OneMedical's practice management/online tool for patients makes scheduling dirt simple. Their offices are REALLY nice. It's a little touch, but it's trying to raise the bar on that. And they offer their own teladoc services as well, which are then obviously integrated into their EHR for your PCP services, so everyone is on the same page.
OneMedical tries to combine PCP with some urgent care services, so they have a same day component, as well as some specialty services.
Just a lot of small but meaningful ways in which they're better than a traditional PCP office. They're also apparently offering practice management and holiday support for existing practitioners, which is interesting from the perspective of the S-1. If their EHR/PMS software is as nice as their app, I imagine that's a welcome change.
Totally agree. For people who are proactive, I’ve found One Medical is excellent.
However, if you’re not keeping your own tabs on your, or someone you love’s, health, it’s easy to fall through the cracks. I wish they would improve on actual active management of subscribers‘ health. I’ve had or discussed many experiences where people expect follow ups that never come. Have an uncommon condition? Make sure you keep bugging someone to schedule the visits and lab work you need to maintain good health. With a $200/yr subscription on top of any insurance you pay I feel like these type of maintenance tasks should be handled for you. It feels more like each visit is an IT ticket/case which gets resolved shortly after your visit. It would be nice if it felt more like One Medical were managing a personalized care plan for your health profile.
Active management is expensive. I've seen it for $1800/yr and the rate of followup was still poor. If you want a doctor to take care of you like family the rate seems to be $7500-30000 annually depending on what's wrong with you. Seems like it might be cheaper to hire a healthcare advocate though most of them are more about geriatric and end of life care.
I probably assumed OneMedical did more of this than it intends to based on previous experiences and the subscription fee. Like I’ve had good care, nice offices, etc. in the past why should it now cost $200/yr?
i think that's a valid take, but i have the inkling that One Medical is prioritizing making the most common use case (just going in to see a doc for a temporary ailment) as great as possible. likely this is one of those things where you might be better served by another company that's targeting your use case?
I think it’s more that I’ve had better, more attentive, care without the $200/yr (and certainly not 1800-30k/yr as the sibling comment suggests). But that was when I lived in the less dense Midwest. Personally I’m fine and I take time to research and followup myself if needed. I’ve seen friends struggle to make sense of their own health and because they didn’t get a followup weren’t aware they needed to continually monitor or schedule specialist visits etc. It makes sense to me if they need to prioritize other things first. I hope that one of the advancements they can make is better management of cases because technology should make that possible.
I used One Medical for a year and quit, because their medical practitioners are low quality in my opinion. Probably why they are cheap. I would book appointments and I would only ever see nurses, and then when needed I would be referred to one of their doctors.
For my shoulder injury they sent me to their sports medicine doctor, who was not only rude and rushed, but told me I was fine just common tightness in shoulder. Was still in pain for a year until what I consider a real doctor correctly diagnosed it as a mild shoulder dislocation. Thanks One Medical SF.
If you have money to spend on healthcare, I would not bother with them.
I agree on the notion that the doctors feel "cheap", especially in their LA offices I've been to. It seemed like I wasnt getting a thorough evaluation and upon going to Cedars Sinai and UCLA, I felt I received much better care.
In the DC offices Ive been to, I do not feel the same. Instead I feel like I receive top quality care compared to other local doctors.
Overall, I generally use OMG when I need fast and convenient care, not necessarily quality.
Sidenote: I like how going to OMG is always in-network regardless if I'm home or traveling (for my insurance plan anyway).
Insurance is the second-cheapest way for physicians to be paid. People who can afford higher quality care regularly go to physicians who charge far more.
If the GP comment is comparing OMG vs a true concierge practice, I totally agree. A $200/yr membership vs a true concierge membership is not a good comparison.
My assumption was -- the GP is thinking that "cheap" meant the $200 Annual Fee is how they get paid. No, the Annual Fee is just for the system they provide, the care is a typical insurance paid practice.
My answer is "Why doesn't everyone use One Medical and have a doctor?"
To laser-focus on the peninsula/south-bay in the bay area; going to PAMF or Stanford Medical typically results in a 2-3 day wait to see a Dr.
If you're sick, you want to see a Dr asap. I have a doctor at PAMF, a doctor at Stanford Medical, and One Medical. If I am sick, I simply book an appointment at One Medical usually 30-min ahead of time, see them, get whatever treatment I need and go back home and be sick.
When something is truly wrong I start at One Medical for temporary help, and immediately book either at PAMF or Stanford depending on who is available sooner.
PAMF has several walk in urgent care clinics. You can also often call in and schedule a same day appointment with a primary care doctor (although perhaps not your regular PCP).
OneMedical used to be that way in NYC, now the Manhattan locations often have no appointment slots for a few days and you’ll have to go out to a Brooklyn location to get same-day or next-day care.
Same day appointments, booked via usable app or website. Doctors who took their time with you. No waiting after you show up at the right time. I could go on.
When I was using a typical doctor it would take me at least a month to get an appointment. But OneMedical I can get super fast response times. The staff is fast to reply to questions you text using the app. Recently I had a problem that was urgent, and I got a quick appointment with doctor at a OneMedical office. Their staff then got me a same day appt with a hospital for an ultrasound (through what sounds like calling someone they have a personal relationship with in a scheduling department). So just a nice touch I'm not used to with the normal doctors office routine. OneMedical docs are on-time, spend time with you, and super personable. It's been a nice change.
1. When I was a crazy-busy and overbooked professional, I could simply not afford lateness in my schedule. With OMG, I can leave my office at X:52, be at their office at X:59, be seen between X+1:00 and X+1:15 and be back at my desk by X+1:23, and be confident of making my next meeting.
When the chief variability is how long an elevator takes to arrive, you know this is a serious operation!
2. Because many doctors front desk booking services tend to become authoritarian and making booking way harder than required. I can do everything electronically w/ OMG.
3. Because they do everything electronically, which saves everyone time -- including them
4. Because they provide detailed records of everything for FSA/HSA purposes as well as for your records.
5. Because they offer multi-tier service (NPC, PA, MD // video/email/inperson) so you can save everyone's time for minor things.
6. Because they do lots of things in one place (vaccinations, bloodwork, etc.) rather than you having to go to many places
For me, one reason is that One Medical's doctor/patient communication platform is secure and provides a solid customer experience.
This might sound like a nit, but the previous primary care doctor I went to in the Bay Area emailed me a follow-up message in the form of a Word document—which mistakenly included several pages of someone else's medical information, too.
> This might sound like a nit, but the previous primary care doctor I went to in the Bay Area emailed me a follow-up message in the form of a Word document—which mistakenly included several pages of someone else's medical information, too.
This happens all the time with archiac or manual systems, but it is not a minor nit. That's a hairs edge away from being a reportable HIPAA breach and thus a headache for the doctor. If you made a fuss about it, they would have to report it.
Having good data security processes is not something a doctor's office can afford to ignore. That's definitely an advantage of a more technologically focused approach like One Medical.
> Honestly, this sounds like Kaiser. I guess One Medical is an HMO experience on top of your PPO plan
Kaiser provides an HMO plan, but Kaiser's HMO is not typical of most HMOs because most HMOs aren't integrated practices owned by the health insurer (for better or for worse).
At least one large tech company has a one medical office onsite in its big campuses, and gives employees a free membership. Didn’t think the $200/mo was worth it otherwise but it was great having the doctor there at work and other offices available if needed.
I have the same question. Especially since the site is extremely vague about the value of their service. I'd pay $200 a year to never face a surprise medical bill, for example, but it is otherwise unclear what the big advantage is for someone healthy.
For minor issues it can take weeks to get an appointment from a single doctor. One Medical solves that problem.
I use my PPO plan to get a specialist directly if I need one (usually sports medicine/getting too old for this shit).
If I had chronic/serious health issues I might seek out a regular PCP and use One Medical for the routine stuff (physicals, vaccines, cough/cold/flu etc.) Depends on if you have PPO or HMO plans of course.
Their raising fees every other year is beginning to stick in my craw though.
Their logistics are absolutely phenomenal. The general practitioners I attended before One Medical always was overcrowded, any appointment required sitting in a waiting room for an hour past the appointment time until I finally got in.
For One Medical, it’s super easy to stop by for a 10 minute “something isn’t quite right” appointment, last minute travel immunizations, etc, and, at least in NY, it’s likely there’s an office within 10 mins of where I’m going to be in the city that day.
I think a specific practitioner makes a lot more sense if you’re often sorting out several long-term issues and having a long-term affiliation with one specific practitioner is important, but if you’re a yuppie in generally good health where you’re mostly looking for annual physical, and fantastic availability for quick “I’m sick and may need a prescription” visits and std tests and such, One Medical is perfect.
The two times I used One Medical, me and the doctor just ended up googling my symptoms together. Don’t have a lot of confidence in their staff. It’s a nice idea though, although concierge care like this probably pushes health care costs even higher.
Do you have any idea how much can go wrong with a human body and in how many different ways? And we're not even close to figuring out all the illnesses. Sure, brain cancer they can detect just fine, but try to go to a doctor because you're fatigued or have joint pain or other inflammation related issues. See the shit show you'll run into then. 9 out of 10 times they'll toss you through a few machines and then claim it's psychological.
Most doctors are just guessing, some are just better at making it appear they know what they are doing to improve placebo. I rather have a doctor that's using Google than one that thinks he knows what's wrong but doesn't fact check.
Yes medicine is complicated, but I question whether a general purpose search engine, searching potentially untrustworthy or out of date medical information, is the best tool for diagnosis.
Direct primary care is (generally) much cheaper for better quality/more holistic care. I think DPC is particularly attractive if you’re a low utilizer on an HDHP and never hit your deductible.
Much cheaper than what? I also can get direct primary care through Sutter, and although the experience is probably worse (less time during appt, longer wait time) it’s probably cheaper than the concierge model of One Medical. At the very least it allows a doctor to scale to more patients.
Presumably they mean cheaper than using a fee-for-service PCP, but I don't really see how (especially in the low utilization car they mentioned... DPC makes more sense in high utilization cases, since the overhead cost is fixed)
They highly cater to the corporate benefits market:
> Historically, our revenue has been concentrated among a small number of customers. In 2017, 2018 and the nine months ended September 30, 2019, our top customers accounted for 42%, 37% and 36% of our net revenue, respectively. These customers included Google Inc., which accounted for 10% of our net revenue for 2018 and the nine months ended September 30, 2019.
I love One Medical as a "walk in" option when visiting SFBA, Seattle, NYC, etc. For the discounted annual membership fee (available through various programs), it's even easier, even if I only use them once a year on average.
A one Medical doctor "prescribed" me homeopathic medicine for my sore throat. I didn't realize what it was until I looked it up later. Other than that being a member was a nice experience.
Announcements about IPOs are regulated; employees may have a general sense that an IPO is impending but generally get confirmation at the same time as the public.
Most medical billing is far LESS transparent than a $200/year annual fee. Seriously, if you break your leg call around and try to get quotes for cost for a diagnosis and standard set and cast. You literally in most cases WILL NOT be able to talk to ANYONE who will give you this info or is willing to spend time quoting you.
Even worse, you will get a random set of bills from random providers - making it VERY hard to track what ties to what where.
Basically - if you are cash payor - you will show up and pay what they surprise you with at the end. A lot of folks going to one medical have insurance - they just find one medical MORE transparent.
Depends on the insurance company's contract with the provider. It is generally optional, though they will tell you otherwise. I would still pay it though. I feel like it is a good value and I want to maintain a good relationship the the doctor and their office.
> How much of their revenue can be attributed to their totally optional and very shady """annual fee""" they push on customers?
Of all the complaints to register against One Medical, this has got to be the weirdest. For the customer base that they're going after (higher-income people, oftentimes those who have this fee covered by their employer), $200/year is a drop in the bucket for medical expenses.
"Membership revenue accounted for 19% and 20% of our net revenue during the years ended December 31, 2017 and 2018, respectively, and 20% and 19% for the nine months ended September 30, 2018 and 2019, respectively."
If you actually want good medical care, over your lifetime, your best bet is to build a strong relationship with a good doctor. If you also want to never wait, concierge medicine is where you ultimately need to be (doctor is trading off a higher volume of patients for a fee to a small number of patients).