Sesame Care: Using virtual care to give providers and patients new options in the face of COVID-19
About Sesame
Sesame, launched in early 2019, connects providers and patients directly, with up-front prices and clear descriptions of medical services. At this time, the company is focusing on virtual appointments and providing COVID-19 resources to help consumers stay healthy.
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Contact usSesame, a pioneer in the movement toward consumer-driven healthcare, has pivoted to virtual appointments and a direct-payments model in response to the COVID-19 crisis, benefiting both providers and patients.
Sesame: a new kind of healthcare model
Sesame was born of the idea that healthcare should be a consumer-driven market, akin to any other market with buyers and sellers. For this to become reality, healthcare would need to transition from the current model of third-party payments via Medicare, Medicaid, and private insurance, and toward a marketplace of direct-pay healthcare.
Sesame’s founders realized that demand for a direct-pay model is potentially huge. There are nearly 30 million Americans who pay for the majority of their healthcare expenses out of pocket. Even when Americans have insurance, they may face deductibles of as much as $5,000 per individual and $10,000 per family. If these consumers don't meet their deductible, or they undergo a procedure that isn't covered, they must pay out of pocket as well—at an insurance rate that is typically twice the cash rate for the same procedure. Meanwhile, when high-deductible patients simply don’t pay, as happens more and more, providers are forced to absorb the lost income.
Within weeks of Sesame’s pivoting to a virtual care model, 86 percent of appointments made on the Sesame platform are now virtual
Sesame was designed to benefit both consumers and caregivers. Consumers get up-front pricing and clear explanations of medical services, along with a choice of qualified providers. Caregivers enjoy hassle-free payments and the freedom to set their prices, services, and availability. Because direct pay avoids the extra costs of insurance, which can add $.25 to $.40 for every $1 charged, providers can offer lower prices and pass the savings on to their patients.
Launching its direct-pay platform in Kansas City, Wichita, and Oklahoma City in January 2019, Sesame was initially focused on bringing patients into providers’ offices for in-person care. But then the COVID-19 pandemic erupted in the spring of 2020, and many providers and patients needed an alternative to in-person care. As people stayed home and in-person visits nearly dried up, providers—and Sesame—were losing revenue.
Confronting COVID-19, Sesame pivots to virtual care
With COVID-19 clamping down on in-person healthcare appointments, the Sesame team decided to pivot more heavily toward virtual provider visits. To be sure, expanding remote care had been on Sesame’s roadmap, but now it became a top priority. As Sesame VP of Product Priya Patel explains, “One of the nice things about virtual visits [vs. in-person visits] is that they are even more in line with the mission of Sesame: making healthcare accessible and transparent and affordable.”
In just a matter of days, Sesame ramped up its virtual care capability, integrating a telehealth solution from Twilio to serve as the infrastructure for Sesame’s platform. Sesame also drew on its partnership with Google Cloud, using Google Kubernetes Engine to build specific microservices to support the new infrastructure and Cloud SQL to scale in two weeks from two to 35 states.
Caregivers who would otherwise face the daunting challenge of setting up their own telehealth system can now look to Sesame for a turn-key, easy-to-implement virtual care solution. (Providers can still use their own telehealth technology if they wish.) Already 50 percent of the company’s providers have onboarded with the remote-care platform. As word of Sesame’s platform spreads, new providers from around the country have begun signing up as well.
Today, 86 percent of Sesame’s bookings are for virtual appointments, with a 25 percent increase in bookings since Sesame went to an all-virtual model. And from being available in three cities, Sesame now sees nationwide access on the horizon.
Sesame expands the definition of telemedicine in the COVID-19 era
Historically, telemedicine has been limited mostly to primary care for acute medical conditions. But with the COVID-19 crisis keeping patients at home, virtual care has become, in many cases, the only care available for patients with all kinds of conditions. Physicians and specialists who might have ignored virtual technology in the past are now active on the Sesame platform in fields such as optometry, audiology, and physical therapy. Even surgeons are figuring out how to see patients online. While these providers know it’s in their financial interest to engage with telemedicine, they are also discovering that virtual visits allow them to deliver a surprisingly broad range of care.
In addition, by rapidly expanding the area served by its telehealth solution, Sesame is making healthcare more accessible to more segments of the population. Mothers who are primary caretakers, elderly patients with mobility issues, people living far from the nearest clinic, and others who struggle to see the doctor in person now have better healthcare options thanks to Sesame’s virtual care platform.
Sesame’s virtual care puts caregivers in charge
Typically, caregivers offering telehealth services are employees or work-for-hire contractors of a telehealth company. While the company takes care of billing, record-keeping, and the overall patient relationship, it also dictates providers’ schedules, fees, and services.
In contrast, providers who want to serve their own patients and maintain control over their availability and pricing can turn to video-conferencing platforms that support HIPAA compliance. But here the challenge is that insurers don’t usually reimburse telehealth appointments held outside a telehealth company’s negotiated service. This means that in order to be paid, providers are forced to come up with and manage a direct-payment system on their own.
Sesame solves these problems by giving providers complete control over their services, prices, and availability, along with the same up-front payment model it uses with its in-person bookings. Instead of worrying about tracking down and managing payments, providers can focus on giving their patients the best possible remote care.
Sesame and virtual care, post-COVID-19
Sesame believes that virtual care has the potential to be a consumer product at a price people can afford, whether they have insurance or not. In the words of CEO David Goldhill, “We think telemedicine is perfect for direct pay, and we would like to see it continue because that will turn the actual cost benefit of doing telemedicine into a price benefit.” When an appointment is “consumerized” to $39 or $49, questions of reimbursement or being in or out of network no longer matter. At these price points, telehealth becomes accessible to consumers, while the ease and simplicity of the revenue model make it appealing for providers. By meeting the needs of both consumers and providers in this way, Sesame is laying the groundwork for large-scale growth.
The COVID-19 crisis has put the spotlight on telemedicine like never before. As Sesame is demonstrating through the success of its platform, virtual care coupled with direct payments is a model that works—a model that may shape the way healthcare is delivered long after the crisis has run its course.
Sesame and Google Cloud
Google Cloud has played a key role at Sesame from the company’s earliest days, when it participated in the Google Cloud for Startups program and benefited from the program’s mentorship, training, Cloud credits, and strategic support. Sesame’s team built the solution in accordance with Google Cloud’s microservices architecture, using Google Kubernetes Engine to develop and manage the platform. As Sesame’s co-founder Mike Botta says, “We really appreciated the flexibility and ability for Google Cloud to administer the types of Kubernetes-managed instances we wanted to build.”
This flexibility and scalability were critical as Sesame pivoted to a focus on virtual care with an aim to serve patients and providers in every state. Spinning up the remote care infrastructure in less than two weeks was possible only because Google Cloud enabled Sesame to build specific microservices and slot them in as necessary within the existing infrastructure—for example, administering payments or steering patients to a telemedicine appointment vs. an in-person visit.
Sesame also uses Cloud SQL for Postgre SQL, and Cloud Functions for web hooks, which are fed to Pub/Sub.
"Sesame allowed me to quickly and easily launch telemedicine to reach patients statewide who are in need of virtual services during the pandemic. While I already offered these services locally, they gave me a larger platform which allows me to reach more patients.”
—Dr. Rebecca Berens, Vida Family Medicine, Houston, TXTell us your challenge. We're here to help.
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About Sesame
Sesame, launched in early 2019, connects providers and patients directly, with up-front prices and clear descriptions of medical services. At this time, the company is focusing on virtual appointments and providing COVID-19 resources to help consumers stay healthy.