David Goldhill’s career began to shift in an unexpected direction as he sat vigil in a New York City hospital room. Goldhill was enjoying success at the helm of the Game Show Network and never envisioned a future in the health care industry, but as he sat helpless, watching his father succumb to a hospital-borne infection, observing systemic inefficiencies, and struggling with the opacity of hospital bills and codes, his anger gave way to action.
In 2019, Goldhill founded Sesame Care, a business that prescribes “radical simplicity” as the antidote to the overwhelming complexity of health care in America.
“Sesame is a marketplace with a full range of health services designed for value-conscious patients and patients who pay all or a lot of the health care directly out of pocket,” Goldhill says. “Sesame is a marketplace where provider doctors, nurse practitioners, physician assistants, labs and outpatient clinics can offer services directly to those patients for fixed prices. Patients have the opportunity to do some shopping around and get to know the provider.”
The result: “Terrific savings and much greater clarity for the patient.”
Fixing What's Broken
Sesame offers both in-person appointments and telemedicine, but the hallmark of the service is the fixed prices, which are clearly stated up front. The patient pays directly for a consultation, test, or treatment, often at a price far less than would be billed to their insurance because of the savings providers realize when burdensome red tape disappears. “Most practices find administrative and credit costs to be so high that having a direct patient relationship saves a meaningful amount of cost; some of those savings can be passed on to the patient,” Goldhill says.
The company launched in Kansas City and was poised to expand to Houston. Then came COVID-19 and Sesame’s telemedicine platform, SesameCare.com, became more than just an added convenience.
“When the pandemic started, most of Sesame’s physicians listed in-office services and of course, because of the lockdowns around COVID and its impact on health care providers generally, much of the consultation work in health care became virtual,” Goldhill says. “That immediately changed what we were doing. We built a telemedicine platform immediately so the doctors working with us could continue to see patients through Sesame. We opened that to any of our doctors who wanted to hang out their own telemedicine shingle. We had something like a thousand physicians join in a few weeks.”
It would be a mistake to call Sesame a telemedicine business, though. “We’re not really a telemedicine business as much as a platform that a lot of medicine business gets done on,” he says. “A lot of care can only be done in-person. Our business remains an effort to be full-scope with primary care, specialist consultations, pharma, labs, testing, and procedures. And we expect that as people get more comfortable, that will be the bulk of our business.”
Sesame untangles the confusion of health care by modeling itself after traditional business paradigms where service providers interact directly with customers. While a direct-pay relationship is the norm in a few medical businesses, notably areas such as sexual health and cosmetic procedures, it remains a rarity in medicine overall. “What we’re doing at Sesame is taking the core part of health care appointments with physicians and tests and procedures, and moving that to a direct marketplace,” Goldhill says. “It’s a pretty radical approach and something we think has worked in every other consumer-facing business. We should think of health care as a consumer-facing business instead of an industry that feels stuck in a previous century.
It’s a broken system, in Goldhill’s view, that allows obstacles and inefficiencies to be placed between patients and their physicians. Sesame aims to give control back to the people receiving the care and the professionals providing it.
“We’re about high-value health care,” Goldhill says. “Not just lower price health care. There’s no question that price is a very big motivator. The fixed price is important, too.”
The Big Swing
Goldhill’s ideas for simplifying American health care first grabbed national attention with his 2009 essay in The Atlantic: “How American Health Care Killed My Father.” That essay put him at the front of a national debate about health care and, when he went decided to launch Sesame, he found like-minded investors who were ready to put their money behind his bold approach. Goldhill brought in $24 million in investor financing for his startup, and investors continue to see the value in the company as it expands.
“We were very fortunate that our initial investors and General Catalyst as our lead investor were very supportive of the broader vision,” Goldhill says. “This is obviously a big swing at a big problem. There are investors who like big swings.
Once funded, Sesame began recruiting physicians and found plenty of highly qualified care providers who were ready to break away from the status quo. Sesame is quite selective about the physicians it invites to join the platform. “The doctors are vetted, and every transaction is rated for quality and service metrics. We vet as well on customer service and patient relationships.”
Dr. Allison Edwards, Sesame’s chief medical officer, was eager to join the team. She was already part of a direct-pay primary care practice in Kansas City, and a fan of Goldhill and his book, “Catastrophic Care: Why Everything We Think We Know About Health Care Is Wrong.” She asked Goldhill, “How can I get involved?”
In her role, Edwards helps medical providers move away from the dysfunctional system they thought was unavoidable. “You do have to market yourself and you don’t have the assembly line of insured patients coming through your door, but it’s not an unsuccessful model,” she says. “We’ve had great success!”
Sesame isn’t an either/or proposition for its providers, though. “It gives physicians the opportunity to choose how much they want to devote to the cash-based market and how much they want to do in the traditional insurance-based market,” Edwards says.
According to Goldhill, Sesame will have more than 6,000 physician affiliates by fall, and as the service expands to more cities, those numbers will continue to climb. “Physicians want to be listed on Sesame,” he says. “They have to be genuinely willing to fix their prices. None of the surprises. There’s no point in listing on Sesame as a provider unless you’re providing a special package or a value to the patient better than they can receive on their own.”
Goldhill adds that providers who gravitate toward Sesame are those who are comfortable with being reviewed and rated by patients. “They want to be accountable. We have designed with our chief medical officer a proprietary system for rating every single provider. We use it now and use it in discussions with our doctors. We intend to publish them when we get to a scale that we feel is representative and fair.
The greatest challenge, according to Sesame’s founder, is getting known and understood by the people who would benefit from the service the company provides. Once consumers try the Sesame way of accessing health care, they like it and often become repeat customers.
“We’ve benefitted because we’re doing something different and we’re growing organically,” Goldhill says, and adds that recently they have seen strong interest from employers and even from some insurance companies who are recommending Sesame for the portion of health care that insured people are financially responsible for. “At the end of the day, we launched this into a pandemic and it’s just a matter of getting known.”
Goldhill and his Sesame team know that if they are going to rewrite the book on American health care, they must keep the needs of the patient and the needs of the provider in balance. “We can bring this to health care today and it can be a win-win for both sides of the marketplace,” he says.
Goldhill is, at heart, an optimist, and it would be difficult to look at the early indicators and see anything but a bright future for Sesame.
“Sesame is growing very, very quickly,” he says. “There are high satisfaction scores from patients and providers. We have exactly what you would look for: huge numbers use us more than once and lots and lots and lots of providers are asking to join the platform. We have a high repeat rate for patients and a high retention rate for doctors and the goal is to maintain that level of satisfaction.”