Dubai: Charlie Barlow utters the phrase “this is healthcare” at least five times throughout an hour-long interview. What he means is: A healthcare start-up is not a regular kind of start-up, and should be approached accordingly.
And he’s right. The numbers are bigger, the regulations are stronger, the penalties are heavier, and the stakes are higher.
Barlow, who spent 12 years as an investment banker, recently launched Health at Hand, an app that offers patients in the UAE on-demand video consultations with a United States board certified doctor.
Hotly tipped, it is the first start-up of its kind in the UAE, and Barlow believes it has the potential to tap in to a number of different trends across the region.
“I realised that as a country, we’re big consumers of technology,” he said, continuing: “We are big consumers of on demand technology, we use our handsets more and more to pay for things, to have laundry collected and pizzas delivered. What we call the ‘yalla economy’ here.”
After confirming that the fundamental elements were in place, Barlow says he dug deeper in to the telehealth (referring to healthcare that takes place over telecommunications technologies) market, and found that of the 59 health insurers in the UAE, at the time not one of them was making money on health.
“They were all haemorrhaging cash, because of inefficiencies in the system here,” he said.
Ultimately, however, it was a personal experience that drove Barlow towards the healthcare industry. After returning from holiday with his three young children, two were suffering from infections, and Barlow says he found it difficult to access quality advice, in a convenient way.
“All these stars aligned,” Barlow said.
The result was Health at Hand. The app allows individuals to connect to a doctor within two minutes, with whom they can then discuss their ailments.
“It’s non-emergency primary healthcare. It’s for a young mum at home whose kid has just fallen over, and they need to know whether they need to take that child to the emergency room (ER),” Barlow said. “We put a doctor in their hand…and give them the reassurance.”
“We’re trying to democratise healthcare.”
Famous for being a messy, fragmented, and politicised industry, Barlow’s stated goal of “democratising healthcare” is a lofty one for a start-up, but behind the slogan Barlow proposes a set of solid reforms.
The founder calls for greater patient access to medical records, and greater access to quality healthcare, regardless of wealth, but admits that perhaps healthcare might only be truly democratised when the state pays for it.
For now, however, the UAE has a private healthcare industry, using an insurance model typically paid for by employers.
As a result, whilst being very patient-centric, Barlow says that his start-up also provides a real solution for the insurers, also known as the payers.
Currently, individuals who wish to see a doctor can check which clinic they want to visit under their particular band of insurance.
“The second you walk in to that clinic,” Barlow says, “the insurer kind of loses control of you and the cost.”
“There is overdiagnosis, there is overprescribing,” he adds.
Barlow is quick to emphasise that this problem is not unique to the UAE: “It’s endemic across primary healthcare globally, really.”
In Europe, as much as 50 per cent of all blood and urine tests are said to not be required.
This, ultimately, impacts the patient, because the cost for the insurer increases, leading to higher insurance premiums.
“The inflation on insurance premiums here is much higher than general inflation as a result,” Barlow says.
According to the founder, telehealth and its efficiency is the solution to this issue: “All we hear from governments…is that there needs to be more spend on bricks and mortar hospitals.”
“No,” he insisted, “[instead] there needs to be much more money put in to preventative care, primary healthcare, stop having people sat in waiting rooms with other ill people who don’t need to be there, stop my daughter who’s got an ear infection going to see a surgeon in ER in the middle of the night who should be waiting for that really big case to come in.”
In the US, reports suggest that telehealth has indeed fundamentally changed healthcare. Countless stories have emerged of rural hospitals that are able to stay open, despite lacking the resources on-site, due to the ability to patch a doctor in via video call.
Elsewhere, telehealth has been described by experts as an important part of the modern healthcare system.
It has not all been smooth sailing, however.
Multiple legal challenges have hamstrung the industry’s progress over the last decade, including a ruling in Texas that a doctor must see a patient in person before prescribing medicine. That rule has now changed, but the memory lingers for US telehealth firms.
Already operating in one of the most heavily scrutinised and regulated industries in the world, healthcare start-ups are keen to work with governments to ensure that they don’t fall afoul of the laws.
Disruptive healthcare technologies have garnered negative headlines recently with the downfall of Elizabeth Holmes and her biomedical start-up Theranos, widely touted as one of the hottest prospects to emerge from Silicon Valley in recent years.
The firm was able to achieve a $9 billion valuation on the promise that it had developed a powerful self-diagnosis device, technology which was later thoroughly debunked.
Last month, Holmes was indicted on criminal charges of defrauding investors. She faces up to 20 years in prison if convicted.
Barlow declined to comment on the Theranos saga, but did concede that telehealth was rife with pitfalls.
“First of all, this is healthcare, it’s a highly regulated sector, and so it should be. If we want to be the bastions of telehealth in this region, we want it to be heavily regulated…stringent but fair,” he said.
The company is fully licensed and has malpractice insurance, and says it maintains a warm relationship with the Dubai Health Authority.
“It’s relatively new in this part of the world, so the legislation isn’t as fully cooked,” Barlow said, adding: “Sometimes technology can lead regulation, in this fast moving environment, but the authorities here have been very receptive and very open.”
“We met with them last week to talk about some areas we’ve seen in international regulations that aren’t yet here.”
When asked if the company’s choice to employ top doctors and build quality technology was hurting it financially, Barlow said: “Our burn rate is probably higher than a lot of other start-ups, but we have the intellectual property (IP) to back that up.”
“We’re the most advanced, high quality telehealth service in this region bar none,” he added. “We’re built for success.”
Alongside its government outreach, the company has also been courting investors. Health at Hand has so far raised around $4 million, and says it has generated a lot of interest since its official launch around three months ago.
“We’ll be looking to raise [money] again before the end of this year. The amount we’re saying to the market is $6 million,” he said.
For a sense of scale, established US start-up American Well most recently raised a round of $290 million, bringing its total funding to $441 million. Barlow says he is conscious of companies, like American Well, that may eventually become his competition.
“A lot of capital in this region is moving away from oil and gas and real estate. Healthcare is a defensive sector, the technologies hot, and we’re very easy to invest in because we built everything in the right manner,” Barlow said, adding: “We’ve got all our licenses, Deloitte manage our accounts.”
Ultimately, the founder is keen to point out that the company, while not a charity, is focused on helping people.
“We fundamentally believe that quality primary healthcare should be a right, and not a privilege,” he said.
“Why should a lower income worker here have poorer access to primary healthcare than someone who’s on a higher income, or a different nationality, or different colour, or different status in life? That’s what we’re trying to achieve.”
Company: Health at Hand
Founders: Charlie Barlow