The Story Behind MedArrive, One Of The Most Successful Home-Based Care Startups

The path to home-based care is different for all professionals in the space.

Inna Plumb, the co-founder and COO of the New York-based MedArrive, took an interesting one as well.

Now, her company is one of the most successful startups in the home-based care space. MedArrive, which both coordinates and delivers care in the home, is expanding throughout the country.

In a recent episode of HHCN+ TALKS, Plumb sat down with Home Health Care News to talk about her unique journey to home-based care, the inception of MedArrive, how the company adapted on the fly during the COVID-19 pandemic, how the startup has been able to avoid pitfalls that have affected other startups and much more.

HHCN: Inna, can you start by giving us details on your background?

Inna Plumb: I started my career in finance as an investment banker at Evercore Partners and then made my way into private equity. At the time, I wasn’t loving not being able to actually do stuff. That’s the simplest way to put it.

I jumped ship to a little-known startup at the time, Blue Apron (NYSE: APRN). We had about 90 people when I joined. In the chaos of early-stage startups, I ended up going from working in Excel and finance to running a big chunk of the supply chain team with Blue Apron and was responsible for all the food that went into the boxes.

I was with Blue Apron through the IPO, eventually made my way to a few more startups, and then joined Redesign Health, which is a New York City-based health care venture incubator as one of the early founding partners.

My role there was to ideate and launch businesses, so I helped build some of our earliest companies like Ever/Body, Vault and Calibrate. MedArrive was actually one of the ideas that I was working on before jumping in full-time.

What made you want to continue on the health care path?

It’s just so incredibly tangible, the impact you make every day. As much as I love food and as exciting as it is to feed people every day, there’s just something so much more interesting and meaningful about working in health care where I get to actually, truly change people’s lives every day.

It’s just such an honor to be able to do that. We have such a complicated and challenged health care system in the U.S. I just think there’s so much opportunity to make it better. It’s just a really complicated problem, and I love that.

Going back to MedArrive, let’s start with the conception of the idea, all the way up to the point when you launched.

I was working on various ideas to bring care into the home, just a thesis. We were exploring. I had a strong thesis that care was moving into the home in one way or another. How do we do it efficiently? That was one of the biggest challenges that I ran into.

It’s expensive to bring a clinician into somebody’s home. They also have to drive, sit in traffic, those kinds of things. On top of that, there’s a shortage of clinicians and most of them don’t like going into people’s homes. Doctors, nurse practitioners, they like it. Then we asked ourselves, ‘How do you build an asset-like scalable model that delivers care in the home?’

Then I started researching EMS. The more I learned about both the providers in the space and their capabilities and what gets them excited, the more I saw a really interesting opportunity because what we have with EMS are providers who like going into the home. They don’t mind driving. That’s what most of their day job is.

There’s a meaningful subset of providers who are tired of just running into burning buildings or taking the same person to the ER over and over again and then not seeing them get better when they could do so much to help that person. We found a really interesting opportunity to provide high-quality, cost-effective and highly scalable care in the home.

At that point, the thesis was just care in the home. We hadn’t really refined it from there and we’ve since refined it a great deal in terms of what specific problems we want to solve in the home.

It was March of 2020. It seemed like absolutely the right time — with COVID breaking out — to bring this much-needed care right directly to people.

I was a little bit tired of starting businesses and then passing them on, starting them and passing them on. I was eager to dig into something that was mine and I was really excited about this idea. I decided to jump in full-time. I convinced Redesign, we went through our investment committee process to provide our seed stage funding. We got to know CEO Dan Trigub. We clicked really well and the rest is history.

We raised our seed from Redesign and then went on to raise an extension from Kleiner Perkins and Define Ventures, and then closed our Series A at the end of 2021. That’s our story.

Launching during COVID and it being such a volatile environment, MedArrive had to adjust to that as things were progressing. Can you explain how you did adjust on the fly to the different stages of a pandemic?

We’re still dealing with this, but early on, a lot of people just got cut off from health care either because they were too scared to go in to see their doctor or there were barriers that didn’t exist before. Or there was an increase in barriers to see their providers and get the care that they needed. At MedArrive, we’re breaking that down by bringing care directly to patients’ homes.

I will say, especially early on in the pandemic, it was hard. It’s scary for somebody who’s very vulnerable, from a health perspective, to have a stranger come into their home. There’s definitely that barrier very early on of, “Oh, I don’t want anyone in my home. My home is a COVID fortress. This is too scary.”

We were, I think, very smart with how we focused our efforts. We started with COVID vaccines for the homebound. It was April of 2021, we were working in California with SCAN and targeting patients who basically had been stuck at home for months at a time because they were scared to leave their house. Plus they were homebound, so they couldn’t go out and get vaccines.

We brought the vaccines directly to them. At their home, the risk equation makes sense. We’re only one person. They’re masked, they’re safe. We’re basically bringing freedom to people’s homes because we’re giving them this life-saving vaccine.

We got such incredible feedback from folks. They would tell us things like, “I’ve been too scared to leave my house for months and now I can do that.” Since then, our program’s evolved. Obviously, we do so much more beyond COVID vaccines, but that was definitely a critical path for us early on.

Administering COVID-19 vaccines is obviously a very acute issue. You’re probably doing less vaccines now than you were before. How do you do that without totally shifting your business completely where you’re putting too many resources into just one thing?

We were very, very intentional with how we did COVID vaccines. We were a brand new company and we had to get our start somewhere and we were glad to get our start in something so essential, and to some extent, core to our business, which is care in the home.

From the very beginning, the thing we always told our teams and everyone is that we’re not a vaccination business. This is a capability that we always need to have. Let’s start by building out this capability. It is a fairly simple use case. This is a good stepping stone. It’s all about thinking of this as a stepping stone.

If we can build the capability to send a provider from a hub into a patient’s home with the right equipment, the right information about that patient, collect information that we need during the visit, execute the visits successfully, and then move on and schedule the visits in an efficient way, that’s a lot of the groundwork that you need for all kinds of other use cases.

We saw this almost as a really nice gentle on-ramp into more complex use cases, and we were very intentional about not building too much tech that’s hyper specific to just vaccines because, like you said, right now it’s a nice add-on to what we do. Oh, we can also do a flu vaccine or a COVID vaccine during a visit. By no means is it core to our business.

What does growth look like since you launched the company? I know it’s been pretty significant, but can you explain how intentional you were about that, where you launched and why you launched there?

When we think about launching in a new area, we ask ourselves, ‘Where is there demand for the kinds of services that we’re providing?’ Where is there enough density where we can provide services efficiently? From a population perspective, where do we see that confluence of needs for working on Medicaid, where do we see a meaningful Medicaid population?”

We started in California with COVID vaccines. From there, we ratcheted up in terms of complexity, step-by-step, COVID being the simplest. Then we moved on to episodic use cases like HEDIS gap closure and facilitating annual wellness visits. That was in North Carolina with Bright HealthCare. We started with them in Charlotte last year. The program went really well. They’ve since expanded statewide with us.

Most recently, we’ve expanded to our most robust and comprehensive use case, which again ratchets up the acuity, and that is longitudinal care. We’re focusing on Medicaid populations because that’s one population that EMS providers, in particular, are just so, so good with and are so familiar with.

We don’t just see the patient once. Here, we have to start thinking about chronic condition management, ongoing care and layering in other capabilities beyond just going into the home.

What we do is we see a population of Medicaid patients that are going to the ED many times a month and we put them on a program that addresses their social determinants of health needs, their clinical needs, and bring that utilization down over time.

We’ve really thought about expansion from a complexity perspective. When we expand, we tell ourselves: let’s learn, let’s establish a base, let’s build out the tech and let’s move on in terms of complexity. We now live primarily across those kinds of programs: vaccines, episodic use cases, longitudinal and primarily operational in North Carolina and Texas.

Moving forward, what are the steps that you want to go through before you launch in other significant geographical areas?

I think we’ve accomplished a lot of them. We’re getting ready to launch in a number of different states. I can’t disclose yet, but we have quite a few on the horizon that we’re hoping to go live with over the next few months.

The key there has been building a playbook around what it means to do longitudinal care at MedArrive. What our longitudinal care program looks like. What does it mean to do it efficiently? What does our technology need to look like? Our logistics platform? And so on? We’re not just a care pro platform, we’re also logistics. We’re last-mile delivery of care into the home, and that’s a really tough challenge to solve.

It was hard for us at Blue Apron to deliver food to people’s homes, let alone bringing complex care. We’ve worked a lot over the past year to figure those pieces out and continually get better at them. Now, we’re really at a position to take advantage of that and expand to a number of different states.

For people that may not understand, how does MedArrive make its money?

Our clients or customers are payers or risk-bearing provider entities. Basically, an entity that has a population with a problem and we’re solving that problem. That’s the simplest way to think about it. We will partner with a payer, let’s say an MCO focused on a specific population. They give us the details, claims, background, contact information, everything about that specific population.

Then it’s our job to engage as much of that population as we can. We partner with the payer on doing that and provide care to that population, but ultimately, our customer, the folks who pay us, are those payers and risk-bearing entities.

Your thesis was originally just home-based care because you thought that’s where things were going. Have you noticed, even in the short time that MedArrive has been operational, that more payers are recognizing the value of that?

Absolutely. Especially in a post-COVID world, everyone has gotten so much more creative with how to deliver care, which is really nice to see. One silver lining of the pandemic is it accelerated a lot of that thinking and that innovation around care delivery.

We’re seeing a lot of payers are starting to see the value in patients who have been hard to reach. They’ve been trying to reach a certain subset of these patients and have never heard from them. They only see the claims coming in and patients are expensive. Because we see patients face to face, because we can literally go to their front door and find them that way, we’re a really valuable asset to these payers for finding hard-to-reach patients.

It’s been a very turbulent environment in the startup space in the last few months where there have been a lot of reported layoffs. It’s been tough in terms of funding. How have you been able to manage through that and mitigate some of the effects that you may be feeling?

Unless you’ve been hiding in a cave somewhere, it’s hard to avoid the turbulence. The good news for us is that at the end of the day, from a demand perspective, we’re not seeing any contraction.

First of all, people always need health care. Second, we’re not consumer-driven. We’re doing insurance-based care. You can argue that those populations actually grow when economic times get more turbulent.

We’re not seeing a contraction on the demand side. If anything, we’re only seeing acceleration. I think most of that’s driven by our success and results, but could be the macro environment as well.

The reality is that the funding environment, of course, has changed. We have to be a lot more cautious and careful with our runway and plan on our runway lasting longer. That’s just the reality for every single startup out there. We’ve always been very judicious and very fiscally conservative.

I think that that’s something that’s ingrained in me. I’d rather plan for the worst and be excited by the best and be surprised. We’ve always been very conservative, but I think we’ve gotten even more so. We’re just really careful about hiring and how we spend our cash. We’re really frugal and spend money only when we really, really need to.

In terms of partnerships, how are you augmenting your services by partnering with other companies? Can you highlight a few of those?

Partnerships sound really sexy, but at the end of the day, they have to serve a purpose. We really let the population and the needs of the population dictate what partnerships we form.

When we identify a need within a population, then we go out and find the best possible partner there. You mentioned Brave Health. They provide behavioral health services to Medicaid populations. It’s such a big factor driving patients to the ER and towards hospitalizations in that sub-segment.

We’ve had a really phenomenal partnership and incredible results with them. We have seen a really significant drop in behavioral health admits in our population. A lot of that is thanks to us being able to refer patients to Brave Health and Brave Health actually having providers who can see them. That’s the biggest challenge with Medicaid patients, and in particular behavioral health, is getting access to providers and finding a specialist that can actually see the patient and has capacity.

We’ve done a lot of HEDIS gap closure work. That’s where diabetic retinal exams come into play, hence our work with Spect. They have a really neat handheld device that you can use in the home for diabetic retinal exams.

We haven’t seen a need for other in-home devices yet, but I imagine that as we lean more into HEDIS gap closure, we probably will and we’ll end up forming more partnerships along those lines. But we’ve really let the population dictate our partnerships.

Do you think that having people in the home more is going to make the larger health care system realize how big of an issue these behavioral health issues are?

100%. We can physically see if someone has a hoarding problem that’s creating health issues. We can talk to their spouse. Sometimes the spouse will tell us something that might not come up in a typical doctor’s visit. We see the patient weekly in some of these longitudinal programs and our providers get to know them. You can tell.

We do all the appropriate behavioral health assessments as needed, but even without the assessment, our providers know our patients and they see when somebody is down, when they’re not feeling good, when they aren’t excited to do the things they used to be excited to do.

It’s not easy to convince somebody who’s never had counseling or behavioral health care before to do it. Our providers build so much trust with the patient that it’s a lot less scary and they’re a lot more likely to say yes to our providers than they might be to a doctor they’re just seeing for the first time whom they may not trust.

Where is MedArrive at with telehealth and how much do you want to balance the in-person versus the telehealth?

We are not, at our core, a telehealth company, but we recognize that the services that we provide requires telehealth in certain instances. Our Pro Care programs would be incomplete without a physician available as needed or when needed. It depends. If we’re facilitating an annual wellness visit, there’s always telehealth. That’s an episodic use case where it always makes sense to include telehealth.

If we’re doing longitudinal care, we have a really thoughtful program around this where there’s a telehealth encounter early on in the patient’s journey with us so that we can identify their clinical needs. Most of these happen with a field provider in the home. We believe that a telehealth encounter is enriched by the field provider collecting firsthand data, information and vitals from the patient in the home and then passing that information to the telehealth provider. We do very few pure telehealth encounters with the patient.

If the patient needs some ongoing clinical care as determined in that initial visit, then we provide that and we continue to provide that. We also make telehealth available for escalations because sometimes our field providers get to the patient’s homes and realize that it’s not an emergency. However, we may need a medication refill or need a doctor to weigh in on something, so we dial in telehealth.

What does the next three to five years look like for MedArrive? What are you most excited about? Where do you see the company going in that time period?

Obviously, we see continued geographic expansion. I see us being in many states over the next three to five years.

From a capabilities perspective and a use case perspective, I think we’ll continue to expand what we can do in the home. We have a really powerful asset, a provider that likes to be in the home and one that makes a deep connection with patients in the home. That’s fairly broadly scoped. I think what we’re doing today is only scratching the surface of the kinds of care that we can provide.

The world is our oyster. Name a need and we can probably meet it in the home, and that’s what’s so cool about the service.

It’s actually been harder to focus and identify use cases to not focus on and just be hyper-focused than it has been to find new things to do. I just see us continuing to expand to additional use cases and complexity levels.

Are there any use cases that you think have been overlooked?

Transitions of care is a big one. I think it’s talked about a lot, but I don’t know that it’s necessarily done well. I think that’s an important opportunity.

Maternity care for Medicaid patients is another big one.

There are a lot of potential opportunities in pediatrics. Kids aren’t getting the care that they need either and busy parents who might not have the resources to take their kids to the doctor, as often as needed, can absolutely benefit from this kind of program. Those are some of the things that we’re thinking about.