A new kind of doctor’s office opened in San Francisco this week: Forward, a membership-based healthcare startup founded by former Googler Adrian Aoun that infuses a brick-and-mortar office with data-driven technology and artificial intelligence. 

For $149 per month, Forward members can come to the flagship office that features six examination rooms – equipped with interactive personalized displays – and doctors from some of the Bay Area’s top medical systems. Members are given wearable sensors that work with Forward’s proprietary AI for proactive monitoring that can alert members and their doctors of any abnormalities as well as capture, store and analyze data to develop personalized treatment plans. Members also have 24-7 mobile access to their data, rounding out what Aoun believes is a new type of preventative care.

“In our healthcare system, doctors are kind of operating with their hands tied behind their backs,” Aoun told MobiHealthNews in an interview. “We’ve built for engineers the tools they need to do what they do quickly, so its unfair that doctors are not set up for success with a toolset they can build on.”

When someone begins a membership with Forward, they get a baseline body screening that pulls data from a body scanner, blood testing and genetic testing that all happens on-site. The company uses a variety of connected devices, from direct-to-consumer activity trackers like Fitbit to medical grade, FDA-approved devices from a range of vendors. They also have their own proprietary devices including smart thermometers and stethoscopes. Results from all are fed into Forward’s AI and the Forward mobile app. Once they get to the exam room, members and doctors can see their health history and sensor data on a display screen to augment clinical decision-making and suggest treatment plans.

“We’re really focused on proactive, not immediate and reactive care,” Aoun said. “Health isn’t a once and done singular experience like how we treat it today, and the second you are outside the office or hospital, information gets lost. That kind of delaying in things, a lack of engagement on both parties, it winds up costing everyone a lot. Think of a heart attack, which costs hundreds of thousands of dollars when we could start proactively preventing it from the beginning.”

The impetus for Forward came from a personal experience of Aoun’s. When one of his close relatives had a heart attack, he found himself sitting in the ICU and realizing healthcare wasn’t quite what he thought it was. Seeing doctors having to obtain health records from multiple sources and wait days or weeks for test results and suffering from all-around communication breakdowns within their health system, he was inspired to create an alternative model – one focused on prevention, efficiency and connected tools to create a increasingly smart healthcare plans based on each individual’s needs and goals.

“We went with the Apple approach,” said Aoun, who founded the natural language processing company Wavii and was previously head of a Special Projects division at Alphabet. “We thought, ‘Why not just do it from first principles, make it more like an Apple store than a doctor’s office, where everything works together?’ So we put everything in the same places so it learns together and becomes better over time. That’s what we’ve come to expect with technology in the rest of our lives.”
 
So last year, the Forward team (which includes former Uber executive Ilya Abyzov and Googlers Erik Frey and Rob Sebastian) set up a warehouse in the South of Market district to develop a prototype of the AI-powered doctor’s office, where they began seeing patients in the office 90 days after they started the company.

Recruits were easy to find, Aoun said, and came from a diverse range of communities including technology, research, healthcare as well as underserved populations. The latter group makes up about 15 percent of Forward’s current client base, and they have sponsored memberships where they receive services at no cost.

“A lot of members of our care team, whether they are nurses or physicians, come from a background of working at free clinics, at Planned Parenthood and places like that, so it was not hard to find people to join at all,” said Aoun.

A year later, they opened their doors with a team of over 40 people including engineers from Google, Facebook, Uber and Palantir. Funders include Khosla Ventures, Founders Fund, John Doeer and First Round Capital. Not counting members from underserved communities, most members have health insurance in addition to their Forward membership, as the company doesn’t offer every service found in a traditional hospital or healthcare system. While this means members will be paying for the $149 Forward membership on top of their existing regular monthly premiums and deductibles to cover whatever services Forward does not offer, Aoun says the goal is to ultimately build out a more comprehensive healthcare experience.

“What we now offer is what we call ‘primary care plus plus,” said Aoun. “We aren’t a 100 percent full hospital, but every day we are adding more and more services to make it so you don’t need to leave the system.”

That includes ongoing health monitoring, body scans, women’s reproductive health services, travel vaccinations, medication, nutrition consultations, blood tests and skin care. If and when they do need a service Forward can’t offer, the company assists them in navigating their regular healthcare plan to find the best and most cost-effective options. Eventually though, Forward plans to incorporate more and more services into its membership.

Forward isn't the first company to come up with the approach of charging a flat fee for digital health-enhanced primary care and eschewing the insurance market. Other companies in the space include Iora Health, which has raised more than $120 million in funding and MedLion. The similarly well-funded One Medical Group also charges a flat fee for its tech-enabled services, although it does work with most major insurance plans. One company that began in this space, Zoom+, has now expanded its operations to include serving as a health insurer for its patients. It also isn't the first company to offer a hybrid of physical and digital services. In September 2016, startup Carbon Health opened its first clinic, also in San Francisco, that offers actual clinic services with real doctors, plus a web platform and app providing telemedicine, appointment booking, prescription refills and more. Unlike Forward, it works with major insurers, and all patients must have coverage to be treated under the system. Forward's approach adds several technological pieces to the puzzle, and its commitment to the underserved also sets it apart from some similar services which position themselves more as concierge care for the wealthy.

“Built right, healthcare really can be done very efficiently, so a lot of what we do is focus on creating a really good experience so people want to engage with their health,” said Aoun.