Pivotal Health brings the house call into the 21st century

The new Madison-based health care startup is taking urgent care directly to the home to provide better outcomes for patients and providers.
Feature Pivotal Health Panel

One bad health care experience in the early days of the COVID-19 pandemic was all it took for Sal Braico and some friends to realize they could do better.

The result of that subpar urgent care visit and follow-up health scare is Pivotal Health, an update on the old doctor house call model that aims to brings health care providers directly to the patient, allowing health care workers more time to treat patients and provide personalized care, while also addressing the burnout the providers have experienced over the past decade.

Pivotal Health traces its roots to that unfortunate health care experience Braico had during the pandemic. Braico, a health care entrepreneur, is no stranger to sore throats, going so far as to have his tonsils removed while in college to decrease their frequency. But in the spring of 2020, the sore throats returned.

“I had a few sore throats that led up to a serious one in May,” explains Braico. “That weekend, I called my primary care provider. The on-call physician called back and had me come to the clinic for a throat swab and a COVID-19 test outside the building. My wife and I pulled up to the designated spot, and a health care worker came out, dressed to the nines in PPE, and took two swabs while we stayed in the car. We went home, learned it was strep, and the provider called in the antibiotic. Routine, right?

“My wife drove to the pharmacy, totally not expecting what happened next,” Braico continues. “The pharmacist asked her about the antibiotic — it turns out it wasn’t the normal prescription for an adult, and they only carried it at one pharmacy on the other side of the city. The pharmacist pressed my wife to call the physician to make sure it was correct. At this point, I’m at home. It’s hard for me to talk. My throat was really swollen, I had a fever, and I didn’t want to call anyone. But I called the clinic again and got the doctor to call me back. Of course, he insisted the antibiotic was correct and refused to speak with the pharmacist or change the prescription.

“So, my wife drove over to the other pharmacy. You see where this is going, right? She got home. I took the prescription, and not only did I not get better, I actually got worse. The pharmacist was correct — the dose was too weak, and I ended up in the hospital the next night for IV antibiotics and a $5,000 hospital stay that could have been avoided. And I had the pleasure of a second tonsillectomy the next month.”

Braico kept thinking during this whole situation that there must be a better way. Why can’t health care be easier, he asked himself. When we were all directed to stay home to avoid transmitting COVID-19, why should he have to go anywhere when he was sick? Couldn’t he get two throat swabs at home? “Most people who work in health care are so caring, smart, and compassionate, but the system they are working in does them no favors,” says Braico.

So, Braico reached out to a friend, fellow entrepreneur Pete Johnson, a fellow UW–Madison graduate, who Braico met after Johnson and his family moved back to Madison from Silicon Valley. Their kids went to New Morning Nursery School together and Johnson’s wife, Monica, knew Braico’s wife, Jennifer.

Since they were both entrepreneurs, their wives introduced them and they met for coffee. “Pete and I have been meeting every month or so since then to talk about the Badgers, Packers, the local tech scene, and business ideas,” says Braico. “We’ve always wanted to start a company, but the timing was never right. Finally, after going through this situation, we saw an opportunity to start working on the solution that would become Pivotal Health.”

However, Braico and Johnson knew they also needed a physician to make sure that they were designing a platform to provide the best possible care for patients as well as the best possible experience for the clinicians who would work with them.

“We knew that we wanted a physician who was innovative and willing to take a chance — not easy to find,” notes Braico. “A friend of Pete’s introduced us to Andrew Culp, M.D., who has been working as an emergency medicine physician in south-central Wisconsin for over 15 years. Andrew has also been providing care as house calls for friends and family for years. With this background, he knew firsthand how treating people at home worked so well. He is also very entrepreneurial and has an engineering/problem-solving mindset. The three of us immediately hit it off.”

With Braico as founder and CEO, COO Johnson, and Chief Medical Officer Culp, Pivotal Health is now focused on revolutionizing the patient experience by delivering high-quality health care right in the home. The startup began seeing patients with clinician house calls in Dane County and the surrounding counties in late April. Pivotal Health has plans for expansion to the Milwaukee metropolitan area this fall and then at least four more metro areas in the Midwest in 2022. Braico notes the company is currently raising a seed round of financing to fund its expansion.

Since that soft open with limited advertising in April, Pivotal Health has treated dozens of patients, and thanks to word-of-mouth referrals, the number of patients they’ve seen has risen every week.

In addition to its chief medical officer, Dr. Culp, Pivotal Health has two full-time nurse practitioners and additional part-time advanced practice providers and physicians on its team. According to Braico, the company is actively recruiting more clinical staff in Madison and Milwaukee, and all its full-time and part-time staff are employees. “We fully vet them and perform background checks and provide extensive training. These steps are all important to us to make sure that we are providing the highest level of care possible.”

In order to schedule an in-home visit, patients can call a toll-free number, (888) 688-4746, or they can use a form online at pivotalhealth.care. In July, patients will be able to download and use the Pivotal Health mobile application for their digital devices. With the mobile app, users can create an account, enter their insurance information, and add members of their household to their account.

When patients have an urgent care or immediate care problem, they can quickly schedule an appointment with some easy-to-use drop-down menus, explains Braico. The mobile application is integrated with Pivotal Health’s electronic medical record software, so patients can see available appointment times. “Our technology platform also automatically triages the person’s problem to determine the urgency and severity. We have several red flags that can be triggered which will tell the person to go directly to the emergency room or call 911. For example, if a person has a history of heart problems and they are having chest pains, we will tell them to go to the ER.”

After the user selects the time that works best for them for the house call appointment, Pivotal Health shows them what their out-of-pocket costs are if they have insurance or if they select from the cash pricing menu. Transparent pricing is an important part of Pivotal Health’s mission because too often people do know what their medical care will cost, says Braico.

“When you go to urgent care, you might know your co-pay, but do you know what the provider is charging for your visit? They can easily compare if it makes more sense to run through their insurance or pay the cash price using their credit card, flexible spending account card, or health savings account card. Our cash prices for a visit range from $75 to $175 depending on the services provided. This is a fraction of what it costs to go to the emergency room.”

Then, though the app, Pivotal Health displays a picture of the clinician who will be coming to see the patient and keeps them updated if the clinician is running early or late and provides an approximate arrival time — think of it like Uber for house calls.

“Our clinician, typically a nurse practitioner or a physician assistant, then comes to the home wearing Pivotal Health scrubs and bringing all the necessary equipment to handle the medical issue,” notes Braico. “We always have physicians on call, so the clinician can contact one of our physicians with any questions while treating the patient. Both our clinicians and our patients love that our clinicians can focus on the immediate problem and don’t have to run from exam room to exam room. Twenty-four hours after every visit, we follow up with call or text message, depending on the patient’s preference, to see if they are feeling better or if they have any questions.”

According to Braico, Pivotal Health will also see patients at their offices, or anywhere else that is convenient, for routine bloodwork, necessary injections, and more. “We’re currently talking to a few local employers about getting the word out to their employees about Pivotal Health. Since so many people pivoted to work at home, now, if they have a sick child, they can continue working from home while they wait for a Pivotal Health provider to come to their home to treat their child’s ear infection, for instance. We’ve gotten great feedback from local companies.”

Pivotal Health is currently contracted with Anthem Blue Cross Blue Shield and The Alliance and are in the contracting process with UnitedHealthcare, Humana, Cigna, Aetna, Tri-Care, Medicare, and other health insurance organizations. Braico notes that if a patient selects to run their visit through insurance, they will pay the same co-pays and deductibles they’d pay if they went out of their way to drive to an urgent care clinic. “It was important to us to create a solution that fits into the existing health care payment framework.”

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