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Startups seek to remodel veterinary house calls

Latest Uber-style service recalibrates to attract veterinarians


July 25, 2018
By: Lisa Wogan
For The VIN News Service


Adrian Soriano and Alex Soriano
Adrian Soriano and Alex Soriano
Photos courtesy of KwikVet
Brothers Adrian Soriano (top) and Alex Soriano co-founded KwikVet, a new app-based, on-demand veterinary house-call service.

Attempts to uberize veterinary care are well underway, with a launch scheduled on Aug. 15 of KwikVet, an app-based business that enables dog and cat owners to summon a veterinarian for a nearly immediate house call.

At least the sixth such startup in three years, KwikVet extends the trend of technology companies targeting younger, smartphone-adept, pet-owning professionals with a variation on mobile veterinary care, while simultaneously pitching veterinarians on the independent-contractor lifestyle.

Purported benefits for pet owners are convenience, low stress and possibly cost savings. For veterinarians, touted advantages include the chance to escape the corporate grind, avoid the stress and cost of clinic ownership, discover a more flexible lifestyle or simply make extra money on the side.

Similar startups include VetPronto and InstaVet, which debuted in 2015; Fuzzy Pet Health and Vetted, which debuted in 2016; and Vetter, which debuted in 2017. (For descriptions of each, see sidebar.)

KwikVet founder-brothers Alejandro “Alex” Soriano, 53, and Adrian Soriano, 44, say that while pet owners are clamoring for the service, veterinarians have been slow to sign on so far, citing concerns over a proposed consultation fee of $25 (well below competitors) and the fact that veterinary technicians were not originally part of the service.

Technology entrepreneurs with no veterinary-medical background, the Sorianos had planned to launch in early summer in Washington, D.C., but postponed the debut in order to revise elements of the service. They've since increased the basic fee and hired veterinary technicians to assist on calls. But while responding to specific complaints may convince more veterinarians to join the service, it doesn’t address some veterinarians’ concerns about the fundamental soundness of the model.

KwikVet works like ride-sharing apps in many ways. A pet owner downloads the free app, then uses it to request a veterinary appointment. (Emergency cases are directed to a hospital.) The request is relayed to the closest available KwikVet veterinarian, identified through geolocation, who can accept or decline the request for any reason. If she — 17 of the 20 veterinarians currently signed on at KwikVet are women — declines the request, it is relayed to the next closest veterinarian, and so on.

Once at the home, the veterinarian is met by a veterinary technician, who is deployed directly by KwikVet. The elder Soriano said KwikVet made this addition to the service “because many doctors are used to working with assistants.” KwikVet has hired three veterinary technicians so far. They are vetted by its veterinary advisers and receive a salary. At the outset, it’s likely a veterinarian will not know her assistant. Veterinarians rate the performance of the attending technician after each visit and eventually, veterinarians may be able to request particular veterinary technicians.

KwikVet positions itself as an alternative to mobile veterinarians who make calls in a truck or van stocked like a clinic on wheels, which requires a lot of capital investment. (Some mobile veterinarians travel more lightly, however.) Still, KwikVet practitioners use their own cars and phones, and carry their own liability, health and car insurance. The company provides essential supplies to treat common conditions, including digestive upset; parasites; skin, ear and eye ailments; allergies; diabetes; arthritis; and behavior issues. They also administer vaccinations. 

The veterinarian examines the animal and recommends treatment, which in the app’s current parlance is to “sell” a “kit” to the pet owner. For example, by purchasing the ear-exam kit, the pet owner authorizes the veterinarian to use an otoscope, disposable covers, cotton swabs, cotton balls, gloves and ear cleaner on the pet. The veterinarian also can recommend and sell supplements, therapeutic diets, medications, and other products that are not part of a specific “kit.”

These recommendations are spoken and also entered by the veterinarian into the app, which shows up on the pet owner’s phone during the consultation. Comparable to receiving a paper estimate in a clinic, the pet owner then accepts or rejects the recommendations, via the app, which charges the customer directly.

If the veterinarian determines that the animal requires services she can’t provide, she can schedule and charge in advance for additional services with mobile partners (such as a euthanasia provider, although no partner contracts are complete at this time) or refer the client to a brick-and-mortar practice. Veterinarians receive a commission for any kits or additional services sold during or as a result of the house call.

After the visit, pet owners can contact the veterinarian using the KwikVet chat tool. With the veterinary-client-patient relationship in place, veterinarians can prescribe additional treatments or complementary products, such as therapeutic food. They aren’t paid for telephone follow-ups, but if they sell products or services during the conversation, they earn commissions on the sales.

The app includes a mutual rating system. Veterinarians who draw repeated one- or two-star ratings (out of five stars) will be called by KwikVet to assess the need for any corrective action.

In addition, the Sorianos said, KwikVet offers pet owners a money-back guarantee of satisfaction. The company covers the refund; the veterinarian keeps her fee. The Sorianos said they know this guarantee may be abused, but “are hopeful that overall, this would create a virtuous cycle of goodwill toward the company and its professionals.”

The Sorianos originally conceived KwikVet as a low-cost service, hoping to attract frequent calls with a low fee of $25 per consultation. But the proposal fell flat with veterinarians. “When we told them we were going to start with a very low upfront fee to the customers and then they will make up the rest on commissions, we didn’t have that much traction,” the elder Soriano said. “The doctors … want to know how much they will be paid for sure.”

So KwikVet boosted the price of a house call to $75, of which $70 goes to the veterinarian. The Sorianos said they believe they will be able to lower the consultation charge in the future, as veterinarians learn how much they can earn through sales commissions.

Commissions will vary depending on the local market, discounts and other factors. In general, Alex Soriano said, veterinarians can expect to take home around $100 from a call. 

Some online house-call services, such as Vetted and VetPronto, deliberately avoid a commission model. "We understand most vets don't want to sell stuff," said Karan Aneja, who started Vetted in Los Angeles in 2016. 

‘Growing pains’

The recent tweaks to the KwikVet system, which Alex Soriano referred to as “growing pains,” are par for the course in the iterative world of tech startups: Throw the idea out there, see what sticks, and adjust as you go.

But in a discussion about KwikVet on a message board of the Veterinary Information Network, an online community for the profession, some veterinarians expressed discomfort with that approach and questioned the veterinary fundamentals behind KwikVet. “The model is not good,” Dr. Sandra Laden, a veterinarian in Maryland for 25-plus years, said during an interview.

In May, Laden talked to Alex Soriano after receiving an invitation from him via LinkedIn. Happy at her brick-and-mortar hospital, she called him to learn more because she’d been troubled by her first impression of the company. The follow-up conversation did little to allay her reservations.

“He had no concerns for veterinary medicine or liability,” she said. What she saw in the KwikVet approach was “a lot of upselling and not a lot of veterinary care.” In addition to questions about KwikVet’s standard of care, she has a raft of concerns, including the safety of practitioners making calls in the middle of the night (the service is pitched as 24/7), the lack of clarity about participating veterinarians’ liability, the quality of the care possible within the limited resources of the model, and the provenance of KwikVet supplies.

She specifically called out the exam, diagnostic and lab “kits,” which the Sorianos told her were developed with input from animal-health companies, including major veterinary drug manufacturers. Laden worries that the medications are driven by industry goals rather than by what veterinarians think is best.

The Sorianos have since clarified this statement, saying that only its veterinary team developed the kits and that that they chose the kit types based upon publicly available data from pet insurance providers and clinic chains. Alex Soriano said KwikVet has approached medical manufacturers and diagnostic laboratories with the idea of going direct with their products to pet owners through KwikVet, as an alternative to selling through national distributors.

“In addition to the possibility of increased sales, [manufacturers] want to be in KwikVet’s bags and shorten the time it takes for good products and innovations to reach patients,” he said.

The use of the term “kits” and the notion of getting paid via commissions raised the hackles of veterinarians discussing it on VIN. Dr. Karen Gillum, a practitioner in Ohio, fears the platform reduces doctors to the equivalent of Avon representatives.

“You need your own car and phone and you get a commission on the products pet owners buy,” she said in an interview with the VIN News Service. 

Gillum also expressed reservations about the adequacy of liability coverage for the veterinarian. “From the website, I get the impression that KwikVet has an absolute lack of understanding of what a doctor of veterinary medicine does,” she said.

Dr. Janet Henderson said she is concerned about “the quality of care [KwikVet veterinarians] are able to provide with minimal resources.” A house-call practitioner in Ontario, Canada, Henderson travels with a van full of supplies. “I learned early on that if I didn’t bring all of my equipment and supplies, I would invariably need something I hadn’t brought," she said. "Veterinary medicine tends to be very unpredictable."

Under the KwikVet model, Henderson wonders, what happens if a veterinarian doesn’t agree with the treatment provided in the kits? “Medicine is an art, and every patient is an individual,” she observed. “Creating cookie-cutter kits makes me a little apprehensive. I guess I just don’t understand how this moves medicine forward.”

Talking with VIN News about veterinarians' reservations about the kits, the Sorianos said they may need to call them by a different name. They said the kits are like a list of ingredients for addressing common ailments, much like a medical protocol in a clinic environment.

As for limiting how the veterinarian can practice medicine, Alex Soriano said, “For us, the doctor is the responsible party. She runs the show. Kits only get used if the doctor decides to prescribe them for that particular patient. The burden is always on the manufacturers to convince doctors their products are most effective.” He said KwikVet doctors are invited to make suggestions about products that should be replaced or added to the practitioners’ standard supplies.

Dr. Jessica Dewar, one of 20 D.C.-area veterinarians signed on with KwikVet so far, helped develop the kits, paring them to include “only what’s absolutely necessary.”

She balks at the notion that the veterinarians will be salespeople for specific products. “I don’t feel any pressure to get rid of stock from Company A,” she said. “My main concern is efficacy. I make sure what I’m recommending is a base plan I am just as likely to recommend from a brick-and-mortar clinic.”

Dewar, who graduated from veterinary school four years ago, said she has practiced at a traditional clinic and currently works for a mobile vaccination clinic. She plans to be a part-timer for KwikVet to augment her income when the service launches next month.

She is enthusiastic about the role KwikVet can play providing consultations in the low-stress environment of the home, which she said, “makes things easier and better for the client and the patient.” She also thinks it may offer welcome opportunities for extremely experienced veterinarians who aren’t part of a practice — maybe working in policy or pharmaceuticals — to keep their skills sharp and up-to-date.

Channeling a generational shift

KwikVet’s model draws inevitable comparisons to Uber, a comparison the Sorianos consider helpful in one way and unhelpful in another. While it quickly conveys how the technology works, it also raises the specter of a traditional industry (in Uber’s case, the taxi and limousine business) upended by disruption.

Alex Soriano, who earned a robotics engineering degree from Stanford University, where one of his classmates was Yahoo! co-founder David Filo, said he's sensed the resistance to technology-driven change. “There is a generation of more established clinic owners … [who] say, ‘Don’t come to our city,’ you know, or ‘Do not disrupt the market.’ I have to be very honest about that,” he said. “There are some of those who are unwilling to accept that technology will change the way we work in all professions, even specialized ones like veterinary medicine.” 

But the brothers, like tech entrepreneurs before them, claim the market and the preferences of younger generations are driving the change. According to their estimates, the $20 billion veterinary-services market follows an old and fragmented model spread across 26,000 brick-and-mortar clinics that’s not working efficiently anymore.

“What we believe could be what’s going to happen in the future is that pet parents would prefer the convenience of seeing a vet at their home and not have to pay for a clinic’s fixed expenses, Adrian Soriano said. The answer is not going to come from us, it’s going to come from the market.”

The younger Soriano attended Columbia University, earned an MBA and later worked as a consultant alongside Cyrus Massoumi, whom he cites as an inspiration. Ten years ago, Massoumi launched ZocDoc, a service that enables patients to make doctor appointments online. Today, the company is valued at more than $1 billion.

The Sorianos previously worked on the business side of human medicine. Now staking a claim in veterinary medicine, they insist their role is as a technology company, not a health company, something critics say is a weakness.

Expanding the market?

At the same time, veterinary bona fides don’t necessarily mean a new house-call app will be embraced by the profession. When Dr. Robert Trimble launched Fuzzy Pet Health, a “subscription-based pet healthcare company,” in the San Francisco Bay Area two years ago, he said, he didn’t experience a warm reception from established brick-and-mortar veterinarians. With time, though, that’s changing.

Rather than offering on-demand service like KwikVet, Fuzzy Pet Health requires a subscription. Monthly fees cover basic wellness, vaccinations, diagnostics, ongoing chat support and two to four in-home examinations (depending on the subscription) every year. 

Trimble said company relations with other veterinarians have improved as Fuzzy Pet Health has made referrals to clinics for more comprehensive, specialized or emergency care. While clinic veterinarians worried the new service would poach clients, Trimble suggested the model may, in fact, expand the market. He maintains that pet owners who forgo a trip to the clinic because it is inconvenient or to avoid the stressful prospect of transporting an anxious pet might, after receiving house calls, come to appreciate the benefits of veterinary care in general.

KwikVet makes a similar argument about untapped potential, saying that their model doesn’t require siphoning business from clinics.

“We are not out to compete,” Alex Soriano said. “There are pets that do not go to the clinic… We enlarge the market. We estimate the enlargement could be up to 25 percent more consultations. There is huge potential there.”

In the end, acceptance and widespread adoption of the model may come down to a generational shift — and not just among consumers. House-call apps are aimed at younger veterinarians, who grew up with the concept of the gig economy, are at home with their smartphones and see the dream of owning their own practice crushed under unprecedented school debt.

Trimble, who grew up on a dairy, graduated from veterinary school five years ago and is married to a veterinarian. He has had a front-row seat to the economic and professional realities that challenge younger veterinarians. With experience in a traditional clinic and as a house-call veterinarian, Trimble said he created Fuzzy Pet Health to offer veterinarians “control over their future.” The model isn’t about grabbing a visit here and there. Trimble said he “wants to provide a path to full-time.”

Alex Soriano said KwikVet currently is attracting veterinarians between the ages of 28 and 38, with five to 10 years of practice experience. Among practitioners in their first decade in the profession, he said, there is what he calls “under-utilized capacity.”

“They are more than happy to work after hours … without having to worry about inventory of medicines, without having to worry about marketing, without having to worry about charging and the systems for getting paid,” Soriano said. “They cannot get enough money to buy a clinic, so this is an opportunity for them to run their own business … and be independent.”

Stephen Siciliano contributed to this report




VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.



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