Fold Health Offers Digital Platform for Direct Primary Care


Digital health startup Fold Health is working to develop an interoperable digital health operating system for direct primary care.

Co-founded by serial entrepreneurs who sold their last startup, Praxify — a mobile electronic health record app that’s now used by over 50,000 clinics across the United States — to Athenahealth, the new company is launching out of stealth with $6 million in funding.

In a recent interview, Ram Sahasranam, Fold Health co-founder, said he and co-founder Abhijit Gupta started speaking to the leadership of several direct primary care providers, such as One Medical, Iora Health, Amazon Care and others, and realized they had specific needs that weren’t being addressed. He explained how the Fold platform aims to decrease the amount of administrative work doctors are required to do. Sahasranam said that by creating one centralized interface for all of the software and tools a primary care provider uses, it gives them more time to care for patients, leading to an increase in patient satisfaction as well as revenue generation.

“These new age practices have a completely different mindset, where they want the patient at the center of care, and an experiences that we are used to in every other sector than healthcare,” Sahasranam said. “That is what was fundamentally missing, and that’s what we wanted to solve for. That includes automation across the board. We are taking this platform approach where we’ve seeded about 14 different engines in the back end. We essentially shipped the sandbox to 10 customers who came on board to co-build a product that was able to evolve at a much more rapid pace to what they want. It is a very different mindset in terms of how we are building this.”

One of the startups working with Fold is Zocalo Health headed up by Erik Cardenas, who previously worked on Amazon Care at Amazon. Zocalo is launching a virtual primary care offering targeting underserved Latino communites, starting in California with plans to launch next in Texas.

Cardenas said Zocalo and Fold are very aligned on what the experience needs to look like for both patients and providers. “I think one of the things that connected us was just our real focus on trying to build better experiences. As a startup, even though we’re funded, building technology to meet requirements can be timely and costly,” he said.  “The real interest for me with Fold was that they were able to give me a lot of latitude out of the box. I was able to build a solution that allowed us to start delivering care in a way that is reducing a dependency on how things have traditionally been done. On day one, it gave me the opportunity to build a wonderful experience for consumers, which in this virtual world, is really important. We can’t afford to have a lot of friction when trying to convince people to pay for virtual primary care, and Fold’s technology allow me to do that. The fact that I could easily put a chat widget on my website to start communicating with patients was important.”

Startups are iterative by nature, Cardenas said. “I have to have this feedback loop with my patients and my providers. The Fold team has had a lot of success building software. You might think it would be crazy, depending on another startup to help you build your startup, but these guys have done this before, and they understand the grind that goes into building something and building it right,” he said. “We’ve put in place mechanisms that allow us to really have a good efficient feedback loop. We get a lot of user research and user data and input, and we share that with them, and then they work that into their roadmap. I may have an issue one day, and it’s solved by the next because they have mechanisms that we have co-developed to make sure that we’re always improving.”

Another direct primary care provider working with Fold is Palmetto Proactive Healthcare in South Carolina. “These new age direct primary care practices are looking for out-of-the-box solutions,” Sahasranam said. “They want to launch and accelerate quickly. We have the end-to-end stack, so they don’t need to buy too much more on top of it. We basically become the virtual quarterback.”

Sahasranam said Fold is trying to automate as much as possible. “We built a very simple tool by which you could drag and drop features and build your own care plans. We are in conversations with the American Academy of Family Physicians to see how we can take some of these and actually work with them in an accelerated model in building ecosystems where we can try out some of these journeys. When I talk about journeys, it’s not just clinical automation, it is also process automation. There are a lot of manual processes and tasks. We are looking at how to integrate the two together to have a seamless experience where the patient is concerned. We want to have this opportunity where if I’m in a sandwich generation, I can take care of my parents from my phone, even if I’m not physically present. That’s the way in which we’ve designed this entire model, and that’s also to a certain extent why our current customers have been excited to work with us —  the fact that they are able to build their own IP on top of our low-code, no-code platform, by creating these interesting care journeys and care pathways for their patients.”

Eventually, they do want to take Fold beyond direct primary care. “The beauty of direct primary care is it’s driven by physicians, and most physicians are wonderful at what they do, and they are building something of their own, where they have a direct relationship with the patient,” Sahasranam said. “It is not the biggest market segment, but that’s where we saw true passion being expressed by healthcare experts, and so it was a great entry point.”




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