I tried out 7 startups that aim to make it easier and cheaper to go to the doctor. An online dermatology visit turned out to be the best one.
- I spent a few weeks in April getting all my healthcare through startups that promise to make getting care easier and potentially less expensive.
- Often, those visits were done virtually, without me having to step foot in the doctor's office. That was the case with Curology, a startup that offers prescription acne treatments and online visits with medical professionals.
- Of all the visits I did online, I found that getting my skin checked out virtually was the most useful way for me to access an appointment I would have otherwise put off for fear of a high price tag.
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Whoever promised me that acne disappears in your 20s... I am not amused.
I'm 26, and I've been meaning to go to the dermatologist for a few years now to see if there was anything more I should be doing about my skin.
I didn't get around to doing anything about it until I decided to do an experiment for Business Insider in which I tried to get all of my healthcare taken care via startups promising to make getting care easier and less expensive. I figured I should see what my options might be for taking care of the pimples that periodically make an appearance.
I called my health plan to see what services might be covered, and a representative informed me that under my current plan, I'd be expected to pay the full amount they negotiated with the dermatologist until I hit my deductible of $2,000.
I decided to try Curology to get my acne taken care of at a lower cost
When I called around to some dermatologists near BI's office, I was told a visit to discuss acne could cost somewhere between $240 to $275 on a cash-pay basis. Assuming my negotiated price would be in that ballpark, I figured an in-person visit wasn't going to be worth it.
Instead, I decided to try Curology, a company that got its start five years ago when dermatologist Dr. David Lortscher decided he wanted to find a more affordable way to get people access to skin-care services, starting with acne treatment.
At the time, it was among the only startups out there offering both a product and a visit with a medical professional. It doesn't take insurance.
In recent years, the all-encompassing model has attracted hundreds of millions of dollars for everything from teeth-straightening care to Viagra shipped straight to your door. To date, Curology has raised $28 million and has plans to expand into anti-aging skin care as well.
Those startups have expanded the scope of dermatology services offered online as well, which Lortscher finds helpful.
"The fact that now it's expanded outside of acne, it's only helped our popularity," Lortscer said.
How Curology works
The process was pretty simple. I shared my history with acne products and other prescriptions/health conditions I might have. I mentioned my concerns about using certain acne treatments given my past experience, sent in some photos of my face and neck, and off the assessment went. For my first visit, I was asked to cover shipping ($5), but that was it.
The next day, a treatment plan was waiting for me on Curology's website. It was comprehensive. My care provider, a physician assistant, had given me suggestions of different cleansers and moisturizers as well as an over-the-counter soap bar for breakouts on my chest and back. I went about ordering a new moisturizer and the bar of soap so I'd be fully prepared when my prescription cream arrived.
A few days later, my prescription arrived in a box along with moisturizer and cleanser.
I was informed I could ask one free question about my treatment per shipment (after that, I'd have to pay $10 to keep inquiring about my treatment plan). I had a question about using the topical antibiotic I was prescribed and got an answer later the same day.
I've been using the topical solution I was prescribed for a few weeks. It hasn't dried out my skin - one of my big worries going into it - and so far it's done a pretty solid job of clearing up breakouts when they arise. But a few days in, I started to notice my skin breaking out in patches where it was usually under control, filling up with small angry red dots.
I checked in with my initial care provider - sending photos again - and got a response from another provider, assuring me I was going through the "purging" phase in which my skin is adjusting and clearing out my pores. It took about three weeks, but it seems like my skin has now gotten with the program.
When I've gone into dermatology visits in the past, I've usually felt like I'm on my own to see if the course of action works for me until I schedule a new appointment. Instead, it's been nice to check in on my progress periodically. And generally, it's nice to have a plan where I didn't have one before.
The promises and pitfalls of virtual skincare
Of the visits I did virtually, I found that getting my skin checked out online was the most useful way for me to access an appointment I would have otherwise put off for fear of a high price tag.
Understanding how much an in-person dermatology visit might cost me under my high deductible health plan, I have no plans to go to a dermatologist in person any time soon. The $40 or so that Curology charges for a two-month's supply of medication and conversations with care providers seems much more palatable.
But I was worried I might be missing something I might get from an in-person visit. It prompted me to seek out dermatologists to hear their perspective on the emerging world of telemedicine in dermatology.
Dermatology is the perfect field for online healthcare
In a lot of ways, dermatology lends itself well to being done virtually.
"It helps too that it's a visual specialty," Dr. Steve Daveluy, a dermatologist and professor at Wayne State University. He sees patients virtually for the Department of Veterans Affairs, and said he's considered working with a telemedicine site so long as he has control over what he can prescribe patients.
The way Daveluy sees it, even if a patient turns to telemedicine first, it'll ideally get them thinking about coming in for an in-person visit if they need to. Getting in for an appointment with a dermatologist might take a month or two anyway.
Dr. Rosalyn George a fellow of the American Academy of Dermatology who practices in Wilmington, North Carolina, doesn't formally practice telemedicine, but she said she'll message with patients who might be away for school or do a video chat.
You'll still get more comprehensive care if you see a doctor in person
"Are there things that are different in person? Of course there are," George said. While the specialty is very visual, it can sometimes be hard to tell a small bump from a deeper cyst in a photo, for example, she said.
And had I come in person, I might have been examined for signs of skin cancer. Screening for skin cancer is especially important for those at high risk, such as people who have had a lot of sun exposure or who have had a family history of skin cancer.
George said she would find telemedicine most useful if it was integrated into in-person practices, rather than provided separately as is the case for companies like Curology.
Another point I hadn't considered: I have only corresponded with physician assistants, rather than dermatologists.
George pointed out that very few physician assistants get specific dermatology training (dermatologists themselves train for three years after medical school to learn the specialty). Daveluy said that while dermatology offices often employ PAs, doctors tend to see most patients. It's not standard for an in-person dermatology visit to only be done by a PA.
"If it's a derm condition, it should be a board certified dermatologist," Dr. Dhaval Bhanusali, a NYC-based dermatologist, said. "You can't compromise the quality of care by the assumption that the disease isn't as important."
Bhanusali founded the Skin Medicinals platform to connect people to cheaper dermatology medications and may get into telemedicine, he said.
Lortscher said that Curology has seven dermatologists on staff, including himself. All are involved in caring for patients, and they train the nurse practitioners and PAs Curology hires. The NPs and PAs go through a six-week training program before they can start to see Curology patients, he said. Training includes shadowing dermatologists, going to lectures, and responding to questions with the oversight of a Curology dermatologist.
"Our NPs and PAs are supervised by dermatologists who regularly review patient cases with practitioners, as well as the latest dermatology research," Lortscher said.
Emma Court contributed reporting.