As the COVID-19 pandemic continues to change the healthcare landscape for consumers, MobiHealthNews caught up with Buoy Health CEO Andrew Le, who has been working on some of the trickiest health navigation challenges for years. 

Le discusses what his company has been up to over the last year, the consumerization of healthcare, and the brick-and-mortar versus the virtual care divide. 

MobiHealthNews: I'd love to start off with a little bit of an overview of what Buoy has been up to since we last talked in February 2020. I know, obviously, COVID was a huge part of that. So if you could just talk to me a little bit about what's been happening with the company and what you've been going through.

Le: I think back to the last time you and I chatted, but also just February 2020 until now, so much has happened. So as you remember, the last time we chatted, [Buoy] basically updated our AI to understand when we should navigate people to COVID testing. 

Because we have millions of people who use Buoy all the time, we started to see trends where we would see an area of high risk shortly before a confirmed case would pop up in that area. … The Commonwealth of Massachusetts, and then the Commonwealth of Virginia tapped us to be a COVID navigation product during the pandemic, where we were basically customizing Buoy to all of the testing services in the state, as well as all the different telemedicine services offered in the state to help people navigate when they should talk to a doctor, when they don't need to talk to a doctor, if they need testing, where testing is readily available right around the same time. 

We then launched with United Healthcare, all of Cigna … so within the span of — I want to say like a month — we were eligible from a navigation perspective to more than 180 million Americans.

Right after that, we started really understanding the problem of navigation in the workspace. So when employers were going back, we built a product called Back With Care that helps employees navigate whether they could come back to work that day or not. Launched that in July of 2020. … At our peak, we had about 100,000 employees who had the kind of frontline navigator for purposes of returning to work that brought us into 2021. We raised our Series C at the end of last year, and in 2021 we started focusing a lot on navigating for non-COVID reasons. ...

There's a natural evolution of Buoy, going from like a navigation tool to being a marketplace that navigates and actually building services directly onto Buoy — not done by ourselves, but more by partner companies — such that once you do the navigation, we now can bring you into care. That's kind of where we're headed.

MobiHealthNews: Do you think that the consumerization of healthcare and patient engagement is really moving the dial on digital health or what's out there? What's the demand?

Le: Oh, definitely. It's really fun to see this going back to 2017, like, four years ago, we were championing the fact that you have to think about the consumer ... and now to see the whole market is thinking about it that way is really exciting. And I think what COVID has done that is irreversible is proven that virtual care is something that consumers want, something that can deliver a lot of healthcare. And I would say that those two hypotheses were not truly proven before the pandemic, and now the cat's out of the bag. ...

I think it's going to bring up a lot of questions about whether healthcare really needs to be local anymore, and that hyper-local, monopolistic practices of yesterday maybe don't need to exist. And I think that is really good for the consumer. I think it's really good for society if we continue to go down and chase those trends and make an ecosystem that gets people better in the most efficient, consumer-centric, simple way.

MobiHealthNews: Are there any other trends that you're interested in coming down the pipeline, even post-COVID, that could be changing healthcare? 

Le: I talked about virtual care being like a really big thing, a really big trend. I really feel that on the brick-and-mortar side of care because of the pressure that virtual care puts on the brick-and-mortar. I think it's going to be really interesting [to see] how health systems respond to how the world is changing to be more virtual and less localized. Does this mean that health systems are going to be doubled down on being super virtual? What does this mean for ambulatory care?

… What does this mean for centers of excellence? Do they proliferate? Do more hospitals lean into becoming centers of excellence for certain sets of conditions or not? I think it really starts to kind of ask the question of the brick-and-mortar delivery of care. What is its role in the new virtual world? 

MobiHealthNews: I'm really interested in that question too. Companies that are almost like a tech-first hybrid, like say a One Medical, versus every [traditional provider] that is becoming a hybrid. ... I think that that's a really interesting divide. They're both sort of now pitching hybrid care to some degree. But what's that big divide there between a tech-first and a brick-and-mortar?

Le: I couldn't agree more that it's going to be really hard to really understand differences. As you have the brick-and-mortars move and lean into the virtual side, then you get the more tech-forward ones thinking about the brick-and-mortar. I couldn't agree more that that is going to be like a really interesting thing. And you start to wonder whether all of these different providers that have had a lot of VC [venture capital] backing, what is the end game? In many ways, they're building a health system in and of themselves … across the country.

MobiHealthNews: Something that's been coming up over and over is price. Traditionally, the patient goes into care and they come out with a bill, and it's been adjusted whatever for your insurance. But you don't actually know your cost [beforehand]. Do you think that could also change? And do you think marketplaces could be a way for that to be displayed a little bit more clearly?

Le: I compare it a lot to Uber, where if you think about the price transparency of getting into a cab, you would never know how much it would be when you got there, because the cab driver didn't know where you are going ... and they don't know traffic patterns, so they don't know how long it's going to take to get there. So they can't give you an up-front price. 

Similarly, because of that, you don't know what the up-front price is. And so there's this information asymmetry between you and the cab driver.

Uber largely solved that problem by forcing you to put in where you're going, using Google Maps, doing a real-time option with a bunch of drivers to figure out what the price should be to get you from point A to point B, and now you have a price up-front. I love that comparison to going to the doctor because the doctor doesn't know what's wrong with you.

So it's kind of hard to say, "Okay, Laura has a cough. She was at a conference last week, and then they're like, yeah, Laura, I'm going to take care of you for $55."

It’s very hard because they don't know what's wrong, which is why we have so much documentation that's necessary to make sure there's no medical waste. But there's also documentation necessary to figure out what the price should be after the fact.

If the marketplace could create a smart, clinically based match between the supply side and the demand side, and the supply side would accept that the marketplace is actually showing what's going to happen with the demand side ... it's like the cab driver knows that [you are] looking to go from the South End to Boston Logan. Then they could offer an up-front-style price. And so I think that with the marketplace, if the marketplace does the matching, that's the key; it would solve the information gap between who's providing the care and who's consuming the care, which would enable up-front pricing and competition.