A victory for all patients
By Oliver Kharraz, M.D., Zocdoc founder and CEO
Originally published Sept. 16, 2019
Let me begin with the exciting news, both for Zocdoc and for patients across America: we recently received a favorable advisory opinion from the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG). This allows us to continue Zocdoc’s service for Medicare, Medicaid, and other federal healthcare program beneficiaries in states where we have implemented our new pricing model. Now let me take a step back and share the story behind this achievement.
Since April 2018, we’ve been in the process of changing Zocdoc’s pricing model for providers on a state-by-state basis. The goal of our new model has been to lower the financial barrier to entry so that more providers can join our Marketplace, thereby improving patients’ choice and access to care (more on this here). Today, our new pricing model is live in eight states: GA, CO, WA, PA, CT, NY, NJ, and IN. I’m proud that in each of these states, it is working exactly as intended to bring more providers on to our Marketplace, increasing selection and availability for more patients.
When I founded Zocdoc in 2007, I recognized that improving America’s healthcare experience would not be without its challenges. Most recently, we have had to navigate the ambiguity of a decades-old federal law that can impact what pricing models an innovative platform like Zocdoc can use in connection with federal healthcare programs, including Medicare and Medicaid. As a result, in states where we implemented our new pricing model, we made the difficult decision to temporarily disable Zocdoc’s booking functionality for self-identified beneficiaries of these programs until we received more clarity from the federal government.
Our mission as a company has always been to give power to the patient. I never saw it as a viable long-term option to leave these patients behind. That’s why I made it a personal and company priority to seek clarity from federal regulators so that we could again serve all patients, regardless of their insurance status. We spent hundreds of hours in Washington, D.C., met with more than 60 Congressional offices, testified in front of Congress, and received thousands of letters from our patients. With their permission, we shared these affected patients’ stories, as well as letters of support from our provider clients and state officials.
The recent advisory opinion from the HHS OIG represents the culmination of this hard work. It allows us to begin to restore Zocdoc’s service for Medicare, Medicaid, and other federal healthcare program beneficiaries in states where we have implemented our new pricing model. This is a victory for these patients who may rely on Zocdoc the most, to help them find in-network care and get in to see the doctor within 24–72 hours of booking. This is an order of magnitude faster than the average 24 days patients wait to see a doctor when booking via the phone.
On September 18, 2019, we will re-enable Zocdoc for all Medicare and Tricare beneficiaries in all states where we have implemented our new pricing model. At that time, we will also re-enable Zocdoc for Medicaid beneficiaries in Colorado, Georgia, New York, and, Indiana.
But there is still more work to be done. Although we have received favorable guidance from the federal government, certain states where we have implemented our new pricing model have state-specific regulations — similar to, but separate from the federal law — that can impact new pricing models as they relate to beneficiaries of their state Medicaid programs. As a result, we will seek guidance from those states, as we have done federally, before re-enabling our service for Medicaid beneficiaries in those areas.
Our country’s healthcare laws and regulations include many important protections. However, these laws, largely written decades ago, did not account for technological innovations like Zocdoc. We appreciate that the HHS OIG has provided guidance for new digital platforms like Zocdoc, which empower patients and make healthcare more efficient. We will continue to urge state and federal lawmakers to modernize healthcare laws and regulations to both preserve important protections and enable new innovations that America’s healthcare system and its patients so desperately need.
