With lessons from hospitality and tech, Forward expands primary care footprint on East Coast

WASHINGTON, D.C.—The newest primary care office in the nation's capital opened just across the street from an upscale downtown development featuring luxury condos, designer boutiques from the likes of Carolina Herrera and a Tesla showroom.

With a sign hung above the door that looks like many of the retailers on the block located just around the corner from Chinatown, this 3,600-square-foot doctor's office is just the latest outpost for the trendy San Francisco-based startup Forward.

The venture-backed company has dubbed itself the primary care of the future, embarking on a nationwide expansion of its tech-enabled direct primary care business model in its bid to redefine the healthcare experience.

The experience is supposed to feel "kind of cool" when patients walk in.

"We want people to be in a space that makes them feel good and like they’re going to be taken good care of, and we don’t want it to be like your typical drab doctor's office that people don’t want to go to," Forward's Chief Medical Officer Nate Favini, M.D., told FierceHealthcare. "The traditional healthcare system has put up all these barriers to coming in and getting care. Our goal is really to remove those barriers and get people excited about taking care of their health."

Forward uses a direct primary care model, which means they don't work with insurance companies. Instead, they charge patients a $149-a-month fee the same way a patient might pay for a gym membership. Everything, including labs, is covered with that fee, he said.

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The company further sought to differentiate itself by embedding technology including artificial intelligence, sensors and mobile apps in ways that aim to make healthcare more closely mirror consumer experiences, Favini said.

For example, making an appointment typically requires making a phone call and waiting on hold, he said. The visit usually requires a long wait for the doctor, and the face time with that doctor is usually a rushed 15 minutes. At Forward, patients book appointments on their apps, know the appointment is going to start on time and last one hour and that all information will be available on their phone once they leave. There's also 24-hour access on the app, so if a question comes up after a patient left the office, they can message and get an answer.

"We're trying to make healthcare like all the other services we're accustomed to using in our lives. We can use our phone to call a ride, but we can't use our phone to interact with our doctor? It seems crazy," Favini said.

Led by serial entrepreneur Adrian Aoun, the company was launched in 2016 with $30 million in funding backed by a who's who of investors including Google chairman Eric Schmidt, Salesforce founder Marc Benioff, Oscar founder Joshua Kushner and Uber co-founder Garrett Camp.  

Favini declined to comment on whether the company is profitable or to disclose any revenue figures. He said the company is planning a number of new locations around the country through the end of this year and 2020, but didn't give specifics.

A body scanner (Forward)

Consumer healthcare

It's easy to imagine a target audience of millennials and Gen Z patients might be drawn to such a place.

During a recent visit to the D.C. location—Forward's seventh—songs from pop stars Cardi B, Taylor Swift and Halsey echo through the front lobby. (Officials implore visitors not to call it a "waiting room," since there ideally should be no waiting there.)

A sleek display case reminiscent of an Apple store offers a selection of the latest health tracking wearables for sale. 

Patients are directed to check themselves in at an iPad before walking over to one of the pieces of hardware central to Forward's advancements: the body scanner.

Patients step up on the scanner as if it were a massive scale. A digital screen instructs them to slip the fingers of their left hand into a special reader and grip a metal bar with their right hand. For about three minutes, the scanner measures vital signs including heart and metabolic rates and blood oxygenation levels, weight and measurements of the patient's body shape.

RELATED: Industry Voices—Technology alone won't save healthcare. We must revisit our primary care roots

Before the visit begins, Favini said, they are offered still or sparkling water as they enter the exam room, signaling they should expect the same kind of hospitality a consumer would find at a nice restaurant. "If you care about the detail of whether someone wants still or sparkling water, that demonstrates to people you care about the details of everything else."

Patients are ushered into the exam room where they are seated in a chair that almost resembles a recliner which faces a 96-inch touch screen monitor mounted to the wall. That screen keeps a doctor facing the patient and making eye contact during their visit rather than hunched over a laptop on their desk, Favini said. 

Physicians cover the things that might typically be covered in a visit such medical history, allergies and vaccines. But they are also prompted to discuss other lifestyle factors that are typically ignored, Favini said, such as sleep, diet, exercise and stress. They incorporate genetic testing and factor actionable information, such as whether a patient's genetic code shows they won't respond to a certain drug.

During a patient's conversation with their doctor, a medical assistant takes notes that are entered into their medical record and available via the app at the end of the visit.

"Our goal is to be more preventative and proactive than the traditional healthcare system which is really designed as a 'sick care' system and taking care of people once they have a problem," Favini said. 

The difference

An exam room (Forward)

The idea is to solve many of the problems that plague traditional healthcare.

If blood needs to be drawn, exam rooms are equipped with portable infrared vein finders to ensure the provider finds the best vein to draw blood from to reduce discomfort.

Samples are processed within about 12 minutes, he said, so the patient can get the results back and discuss them with their doctor at the same visit.

When it comes to patients needing specialty care, Forward is trying to include as much in-house care as it can. For example, he said, they are building a dermatoscope to look at people's skin lesions to have them reviewed remotely by a dermatologist. "Just like with our body scanner, all of this is designed and built in house," Favini said. For those visits that do require a specialist, Favini said the care team will match patients with dermatologists that will accept their insurance, they'll set up the visit for the patient, send over appropriate records and follow up with the specialist after the appointment.

"We are using a ton of technology on the back end to make those processes much more efficient and streamlined," Favini said. "If you can use technology to make that administrative piece of healthcare more efficient, you can lower the cost of delivering care substantially."

Visits are unlimited, they are scheduled to start on time and they last about an hour. There is never any question about bills or cost. The upfront price includes everything, Favini said. While that kind of transparency, coordination and access is revolutionary in healthcare, it's also exclusive to the subset of patients who can afford it. 

It's a critique Favini acknowledges, but only to a point.

For one, he said, patients that switch to high-deductible plans through their employers and use health savings accounts have found the price to be comparable to purchasing pricier health plans and visiting traditional physician's offices.

The price to consumers is expected to be a starting point. "If you look at the history of consumer products, almost all consumer products—as you figure out how to make them work and make them more efficient—become cheaper over time," he said. He said the goal is that the monthly cost of Forward would be within reach for anyone. 

"The reason we started with this model is that the traditional healthcare system doesn't want to do this," Favini said. "If you went out and said we're going to set out and create a model a health plan is going to pay for, you would not build this. You would build what the health plan wants you to build. We think the way to start solving some of the problems in healthcare is going directly to consumers and start building products people actually want."