Startup Connects Primary-Care Providers With Specialist Expertise

If you’ve recently tried to schedule an appointment with your doctor, you’ve probably been met with the option to either wait a few weeks for an in-person consultation or do a telehealth screening that same day. Try to do the same thing with your cardiologist, dermatologist or any other specialty physician and you’re looking at over a month plus before you can be seen and no other options. For primary care physicians, telehealth has assuaged the expected long waiting periods for consumers, so why can’t the same be done for specialty care?

I had a chance to talk to Kelsey Mellard about why specialty care has been underserved by consumer health tech innovation, and her approach to changing the system. As the founder and CEO of Sitka, a platform that connects primary care providers (PCPs) with asynchronous consultations from a network of specialists, Kelsey is passionate about expanding accessibility to specialty care. In our interview, she discusses her mission at Sitka is to change the healthcare system by moving the industry to a value-based care for consumers and is leveraging technological innovations to make this a reality.

Gary Drenik: Tell me more about Sitka - what got you interested in how we provide specialty care in this country, and why do you feel this is needed?

Kelsey Mellard: Growing up in rural Kansas, my mother, a pediatric OT, used to bring me along on house calls. This exposure to patients primarily on Medicare instilled within me a deep-seated desire to impact others.

Nearly every industry has seen a dramatic acceptance of improved digital technology emerging from COVID. According to a recent Prosper Insights & Analytics survey, telemedicine usage has more than doubled since the pandemic from just 12% in 2020 to now nearly 40%. Yet, access to specialists has remained painfully difficult for most.

When it comes to specialist care, the challenge is often giving the patient access to the specialist at the right time. I believe this multi-layered issue stems from how primary-care providers (PCPs) handle these complex patient cases in the first place. If we create a path for PCPs to have direct, near-immediate access to specialists for specific questions on patient care and treatment, as opposed to constantly referring patients out of their practice, everyone benefits. PCPs can more fully treat their patients to the height of their licenses and unnecessary referrals disappear which helps to clear the path for specialists to focus on informed referrals meaning hospitals experience significant cost savings. All of this and the patients benefit from significantly faster access to specialty care.

Drenik: How did your specific background prepare you for taking on what would be a large change to our healthcare system?

Mellard: A focus throughout my career is creating positive impact. I’ve worked hard to innovate structures to encourage a value-based approach. I was fortunate to have been an early employee of the U.S. Department of Health and Human Services Innovation Center. From there I worked on policy at UnitedHealth Group and went on to help build the startups NaviHealth and Honor.

I’ve worked in healthcare my whole career. I’m grateful to have parents who are well-versed in the healthcare system, an environment where it’s common to start a company to improve a system, and access to the right people to help bring Sitka to fruition. I personally have been focused on improving value-based care throughout my entire career and am now obsessed with how to improve access to speciality-care.

Drenik: How exactly does Sitka fit into the current healthcare space?

Mellard: With Sitka, we start with the PCP. We enable them to use asynchronous video and text consults with our network of specialists where they can experience nearly immediate feedback. The PCP can then share the direct feedback if helpful. For example, my doctor could say, “Kelsey, I’d like you to hear from the hematologist directly, let’s watch her response to your case.” We’re finding this helps create a deeper level of trust between a patient and their PCP by empowering this level of transparency in the communication of specialty expertise.

Sitka is saving the system money across the board. Conservatively, for each consult done there is over a 400% ROI for Sitka’s partner. In fact, within the ecosystem that Sitka has created most specialty referrals and vConsults are returned within five hours. Medical groups using Sitka’s vConsults have access to doctors across twenty individual specialties, including behavioral health. Practices using Sitka have seen impactful results including an 85% referral avoidance rate, meaning if a primary care provider uses Sitka, over 85% of the time referral to a specialist is completely avoided.

On the backend, we’re able to bring together policy expertise, interstate cooperation, adherence to regulation, including HIPAA compliance. The convenience for patients can’t be overlooked. Again, according to Prosper Insights & Analytics, over 46% of adults will initially go to their PCP for any non-life-threatening illness.

Drenik: What are some common misconceptions about specialty care?

Mellard: A common misconception is that patients need to see a specialist for a chronic condition to be managed. Additionally, there’s a belief that specialists are efficiently utilized.

Over decades of our U.S. healthcare system, unnecessary economic incentives have evolved. For example, one of our Institutional Special Needs Plans (I-SNP) partners shared with us that for every anchor visit their member has with a specialist, it results in 6-7 other visits after that anchor visit - in which not all of those visits are clinically indicated.

Specialty care is fee-for-service and therefore volume based. Conversely, value-based care is about clinical outcomes, not amount, or volume, of care.

We are playing the long game. If Sitka can incrementally move the needle showing we can successfully deliver care in a different way, creating better access to specialists in this case, we will create that positive impact and can begin to shift our massive healthcare system.

Drenik: How would our readers access physicians, hospitals, or care organizations using Sitka?

Mellard: Patients can gain access through their PCP if they are in a Medicare advantage plan, Accountable Care Organizations (ACO), or Institutional Special Needs Plans (I-SNP or IE-SNP). We also have a growing list of partnerships; currently if you receive care from Babylon Health, ChenMed, SCAN, or Optum, to name just a few, then chances are you and your physician have access to our platform.

Drenik: Kelsey, thanks so much for taking the time to chat with me about Sitka. It’s exciting to see how Sitka is helping specialty physicians enter the telehealth landscape. We’re excited to see what comes next for you and the company.