By: Yvonne K. Okoh, MD, MPH (Head of Clinical Operations)
At Curai, we have the very human-centric mission of providing the world’s best healthcare to every individual. In order to do so, we use state of the art technology and are constantly innovating on our products and services. We talk about all of this extensively on our Tech Blog. However, though we are passionate about technology and its potential to improve healthcare, it is the human stories we hear through our service that really touch all of us at Curai. We are committed to delivering high quality healthcare and see ourselves as our patients’ partners in their health journeys. We are reminded of the power of health every time our clinical team relays a story about how we have touched a patient’s life. These stories make all of our efforts worthwhile, and we cannot wait to scale the service to everyone in the world so that we can help many more people.
Before we dive into the stories, here are a couple of interesting insights on the service that will provide some context.
Insight 1. Curai Health in the broader healthcare ecosystem
An interesting question for us is what our patients would have done if they didn’t have access to Curai Health. We keep track of that by running periodic surveys on our user population. Below you can see our latest results. It is important to note that over 20% of Curai Health patients would have gone to the ER, while more than 23% would have gone to Urgent Care. So almost half of our patients would have incurred high costs for themselves and for the healthcare system if they didn’t have access to the service.
Insight 2. Physician Insight. Beyond urgent care
At Curai Health we offer comprehensive primary care that not only includes urgent needs, but also preventative health and chronic disease management. We asked one of our physicians to reflect on that aspect.
“I feel like I have been able to guide patients through their wellness journey within the comfort of their day-to-day lives. I have been able to counsel patients daily on nutrition, and answer questions in real time about everything from healthy shopping and food preparation to worrisome blood pressure and blood sugar results. I am seeing benefits to patients suffering from metabolic disorders such as hypertension and diabetes and believe it is because there is no wait for an appointment with your physician; I am just a message away.”
-Norah Baker, MD
What follows now are 4 patient stories, as told by members of our medical team. It is important to note that in order to preserve patient privacy, and in strict observance of HIPAA rules, we have removed all identifiable information.
Patient 1: Pulmonary Embolism in a Pregnant Woman
By: Kimberly Truong, MD MPH
Patient Case:
The patient is a 20 year-old pregnant female who presented to Curai Health’s urgent care live chat while 10 weeks pregnant. Although she had no health insurance, she chose to sign up for Curai Health for a second opinion. She had been having chest pain, shortness of breath, and anxiety for the past week and had visited her local emergency department for her symptoms. She had been repeatedly discharged with withdrawal syndrome and anxiety. She had been smoking one pack of cigarettes per day up until recently. She felt she knew her body well, and had a feeling that something more than anxiety was going on.
Curai’s Intervention:
In our urgent care live chat, because chest pain and shortness of breath can be life-threatening, she was advised to go to the emergency department for her symptoms.
The patient reluctantly went to the emergency department for the third time. This time, her heart rate was fast (tachycardic) upon arrival. The emergency department performed a computed tomography (CT) angiogram of her lungs, which confirmed a pulmonary embolism (see figure 1 for an example). An ultrasound of the fetus demonstrated normal heart rate. In the emergency department, she was started on treatment for pulmonary embolism, which included blood thinners. Once she was stabilized, she was discharged on Lovenox, a self-injectable blood thinner, which she will continue using for the rest of her pregnancy.
Conclusion:
Upon discharge from the hospital, the patient was scheduled for a post-hospital follow up. Because her appointments were several weeks out, she signed onto Curai Health’s primary care clinic to chat with her primary care physician about concerns whenever she had questions about her injectable Lovenox. She also developed side effects of injection-site bruising which was managed by her Curai Health physician. She has not yet delivered, and she and her baby remain healthy.
Pulmonary embolism is the seventh leading cause of maternal mortality. While considered rare, pregnancy increases venous thromboembolism risk by 5-fold. Sedentary lifestyle, smoking, and obesity may add to the risk as well.
Impact:
Patients can often feel unheard or unwelcome in the healthcare environment. In this case, having a physician as a patient advocate to validate the concerns the patient had despite being dismissed by the ED helped to encourage her to go back to the ED to advocate for herself. This decision to go back to the ED rather than stay away eventually helped to make a diagnosis that saved the patient and her baby’s lives.
Patient 2: 53 year old M with Hypertension and a recent gap in care
By: Yvonne K. Okoh, MD, MPH
Patient Case:
A 53 year-old male with a history of hypertension who recently lost his health insurance presented to Curai Health’s urgent care live chat clinic. He takes one blood pressure medication, and had an in-person primary care physician (PCP) that had been managing this prescription. Since losing the PCP, he had tried several different telehealth platforms, eventually deciding on Curai Health.
Curai’s Intervention:
The patient uses Curai Health because it gives him a PCP that can work with him to manage his blood pressure medication prescription refills and optimize his blood pressure. Because of Curai Health’s affordable pricing and ease of access via chat, he is getting primary care labs (lipid panel, hemoglobin A1c, basic metabolic profile) drawn that were ordered by his PCP. He plans to apply for government insurance for emergencies, in case he should need a surgery or hospitalization, but expressed that he feels good knowing he has a PCP at Curai to manage his day-to-day needs.
Impact:
Decreasing financial barriers to care is a strength of Curai Health. In this case, affordability and access allowed an uninsured patient with a chronic medical condition to continue receiving care. The patient was also able to get screening labs done to prevent disease progression and feels confident that he has a medical place to call home.
Patient 3: Gastroenterology Follow Up in a Female Patient
By: Cecile Murray, MD
The patient is a 28 year-old female who came to Curai Health’s urgent care live chat clinic with a complaint of abdominal pain and diarrhea. She had recently been hospitalized for three weeks, and she had undergone an upper endoscopy and biopsy. She was told her endoscopy showed erosion, however she had not yet received her biopsy results and had not been able to schedule a follow-up appointment despite multiple attempts on her part to speak with someone in the gastroenterologist’s office.
Curai’s Intervention:
The physician caring for the patient in Curai Health’s urgent care live chat clinic called the gastroenterologist’s office on the day of the live chat visit, and was able to speak with a staff member. We were told that the patient was supposed to follow up with the hospital-based gastroenterologist, who was in a different office. We then emailed the patient and gave her the name and contact information of the doctor’s office that she should follow up with. She was very appreciative.
Impact:
This is an example of the power of having a patient advocate and partnership beyond the scope of an acute visit. By helping to investigate the barrier preventing the patient from following up with the specialist for her biopsy result, we helped to close a loop in care provided to the patient.
Patient 4 — Hypothyroidism in an Uninsured Patient
By: Kimberly Truong, MD MPH
Patient Case:
The patient is a 43 year-old male with hypothyroidism who signed up for Curai Health after losing his health insurance due to unemployment. He has a history of thyroid cancer that required complete removal of his thyroid gland (total thyroidectomy) in 2007, consequently leading to permanent hypothyroidism. Since 2007, he has been on thyroid medication (Levothyroxine) to maintain normal endocrinologic functions.
At the time of presentation to Curai Health’s urgent care live chat clinic, the patient complained of fatigue, significant weight gain, and difficulty sleeping. He had not been taking his thyroid medication because he had difficulty obtaining a doctor’s appointment for refills due to being uninsured.
Curai’s Intervention:
We immediately checked the patient’s TSH (thyroid stimulating hormone level), which returned concerningly high at 14 mU/L (normal is less than 5 mU/L). As this signified severely low thyroxine hormone levels, we started the patient on his usual dose of Levothyroxine and rechecked his TSH in 6 weeks. On recheck, his TSH was 6.6 mU/L, which was much improved but still not at goal. This was expected given his recent weight gain. His thyroid medication dosage was increased, and the patient’s TSH on the most recent recheck showed his hypothyroidism as having been successfully resolved. (see table 1)
Conclusion:
At the patient’s most recent primary care visit with Curai Health, he reported feeling much better with improved energy and sleep. He is now taking 30 minute walks during the morning and night. He is motivated to work with his Curai primary care doctor on weight loss. He appreciated having the same primary care physician that followed along with him throughout this entire process.
Impact:
The patient was able to see a reversal of an uncontrolled chronic condition that had spiraled due to lack of insurance and a subsequent gap in care. For this patient, both the financial accessibility of Curai Health and the close partnership with his PCP helped enable him to improve his thyroid function. His partnership with his PCP is also empowering the patient to make lifestyle changes that are positively affecting his health.
Hearing stories like this gives all of us at Curai a deep sense of satisfaction and purpose. To positively affect the lives of those in need is an incredibly satisfying feeling, and we cannot wait to put our service in the hands of more and more people as we scale. If you found these stories compelling and would like to be a part of the team working on this immensely important problem, please check out our careers page here.
