Lloyd Price and James Balmain came from a 15-year e-commerce background to launch Zesty, a medical appointment booking platform and one of the most successful digital start-ups with around one million users in the UK and Europe.
Here, Lloyd argues that the NHS is a prime area for tech innovation providing you tune into its rhythms.
A background of building digital businesses in six diverse areas from retail to dating may not appear the ideal credentials for a healthcare technology front-runner but Lloyd Price needed all his e-commerce expertise to navigate the NHS.
The proposition was simple: ‘Expedia for Healthcare’ – an online appointment booking platform to remove the stress from getting in front of a clinician; the delivery was a bit more complex.
Healthcare is swarming with conventions, arcane practices and a forest of legal essentials that keep the public safe but can seem a barrier to innovation.
Lloyd and James were struck by the pain of trying to book healthcare appointments and wondered why the meta-search advantages of conventional commercial websites had never been applied to health.
They had also been monitoring the progress of Zocdoc.com in the US, which was generating a lot of traction with patients, doctors and investors to the tune of $50 million funding less than three years after launching. Today, Zocdoc is worth around $2 billion.
Creating an appointment booking platform around the NHS model
In 2012, working from a small office in south London, Zesty was born.
“We soon found there were big differences between the NHS and conventional business,” says Lloyd. “You need a lot of information governance, data protection, lots of approvals, registrations and then there’s the considerable legal procedures to go through.
“Another big challenge is the difference and uniqueness of the NHS, the one payer model. Essentially, you only have one customer, the NHS. The sheer scale of healthcare surprised us – it reaches everybody and touches every age group and ethnicity, a really massive market opportunity.
“Like all disruption and innovation, there was a lot of skepticism at first when we started. Unfortunately, the healthcare IT industry has a track record of companies making big promises but being late to deliver and even failing to deliver. Nothing breaks trust like over promising and not delivering.
“As a company and management team, we are obsessed with trust and delivery through our appointment booking platform which has been essential to everything we have done in the last five years.”
Zesty focussed a lot of time and energy building a flexible appointment booking platform that worked across both private and public health in the early days, a decision which proved valuable years later as the number providers offering both private and public health services started to grow.
Supply and Demand
The supply and demand of the medical landscape has changed with GP home visits and out of office hours appointments restricted while some daytime slots go unfilled. Synchronizing both elements reduces stress and waste from the system and it’s a service people will pay for.
“Zesty works because it is very simple, we are used to booking things online in all aspects of our daily life. Our background in six previous industries means we see the digital world as transactional, a platform to book, buy and make reservations,” adds Lloyd. “In healthcare, there a lot of projects involved in awareness or information, which can help you make better decisions, but people want to do something. They want to book an appointment or get a prescription quickly, which is why it is popular. My co-founder James has a saying ‘we just remove the friction for users’. You don’t need to make six phone calls, all the appointments are there to choose and book through our online appointment booking platform.”
Their hard work paid off with Zesty getting a first-mover advantage in the UK market four years ago and subsequently attracting significant investment from both high net worth individuals and big institutional funds. But they found that ‘money is not the answer to everything’ and faced challenges along the way.
“You start a company and you own 100% but then you go along and raise venture capital. It has a lot of benefits but it is wise to be aware there a few drawbacks – you need to understand that you are signing a legally binding document and there are often conditions to that investment.
“To build a healthcare business around an appointment booking platform in the UK you need money. There is no way you can do this slowly and organically. In terms of control – we have never felt we have lost control but there are more people in the boardroom and there is more debate on bad decisions, but overall that is fairly positive. If I was to do it all again, I would try to take the business as far as I could before raising venture capital. I think that any entrepreneur will tell you that taking it early means you have these conditions around how you operate. On the flip side, we have learned a lot from our investors. They are experts with an ability to analyze and segment markets, that’s what they do for a living. Our investors have been a big positive for Zesty.”
Maintaining growth within healthcare
Experiencing the inner mechanisms of the NHS – which has around 800,000 staff dealing with 1 million patients every 36 hours – revealed its inner heart as well as the need for change to Lloyd.
“We are very proud of the NHS yet it doesn’t get the good voice and kudos it deserves,” he says. “There is not enough media coverage of the great innovation that is happening day-in, day-out.
“One of the real benefits of digital transformation and adopting new technology for the NHS is that it reduces costs; we work with health economists producing cash-releasing and non-cashing releasing models highlighting the potential areas for re-assigning staff to do different tasks because patients now have the ability to self-serve, manage their care and book appointments online through a more modern appointment booking platform.”
The Better Connected SOCITM report ‘Analysing digital performance in local authorities and local public services’ shows the average cost of the public engaging with healthcare services is £8.62 for face-to-face, £2.83 for a telephone consultation but only £0.15 via the web.
Zesty has seen the business grow significantly over the last three years but it has had to protect its service integrity through its appointment booking platform.
“One of the traps you can fall into as a young company is that everyone wants to slightly bespoke the system: ‘could it just do this, could it just do that?’ and it’s tempting to oblige in the early days because you want more clients but it would mean constantly making tweaks which slow down progress and don’t earn any more income,” says Lloyd.
“I’ve seen a lot of people trying to maintain and win contracts by over investing and over serving. It is a fine balance because you want to create value but you have to realize there isn’t much point in doing a half job for six people – you are better off delivering a full job to two people. It is a lesson we have learned on the front lines.”
Healthcare technology is increasingly needed to modernize clunky NHS-driven systems and the opportunities for business and to create real change for patients are there to be won and in Zesty’s case, through their appointment booking platform.
The drive for smarter technology across patient records and data will be a fertile area for growth but, as Lloyd advises, innovation has to be in tune with patient needs and payer demands.