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health as it happens

Startup delivers health care to workers without insurance - The Detroit News

Joseph Kitonga is a 24-year-old from Delaware County, Pennsylvania, who aims to reinvent the way primary care is delivered to hourly workers who lack health insurance.

His primary care service Vitable LLC has gotten strong reviews from employers and workers in child care, restaurants, and home care for its high quality and convenience. The firm has already signed up 10,000 people in its current markets of Southeastern Pennsylvania and Delaware.

"The best part of all that is they come to you because, when you're sick, you really don't want to go nowhere," said Elaine Green, a preschool teacher at Somerset Academy in Philadelphia, a school that uses the service.

Kitonga, who emigrated from Kenya to the United States with his family when he was 13, founded primary care provider Vitable LLC in 2019 while studying computer engineering at Pennsylvania State University and has been winning technology accolades and millions from investors.

Last year, Vitable went through the prestigious Silicon Valley technology startup accelerator Y Combinator, and Kitonga won a fellowship from billionaire tech investor Peter Thiel's foundation. The fellowship includes $100,000 over two years for young entrepreneurs who skip college or drop out to build a business.

Forbes recently named Kitonga one of its 30 entrepreneurs under 30 years old to watch in 2022.

Vitable, headquartered in Woodlyn, Pennsylvania, with a second office in Philadelphia, sells virtual and in-person primary and urgent-care services to small employers of hourly workers, charging about $50 a month per employee. The company has gained a foothold in a competitive arena, joining such tech titans as Amazon.com in aiming to eliminate inefficiencies and inconvenience in basic care.

For all the technology accolades, Kitonga's business has a human focus inspired by the health-care travails of employees at Hosana Home Health Care, a company that his parents started in 2012.

"At their small business, hourly workers made too much to qualify for Medicaid, too little to afford comprehensive health insurance, so they were stuck uninsured and overutilizing the ER," Kitonga said. "Vitable is built to be their primary-care plan that is both affordable and accessible."

Patient convenience

Vitable has been a hit at Somerset Academy, a child-care center and preschool in Philadelphia.

"You don't want to go to the doctors' office. You don't want to be bothered" when you're sick, explained Green, a veteran preschool teacher who has worked at Somerset for two years. "That's what I like. Anytime I have an issue or a problem, they're always prompt, always call, and they even check back later. I like that."

On Dec. 17, a nurse practitioner, Vicky Tubens-Lowa, who works about eight hours a week for Vitable, was at Somerset doing required annual physical exams for Green and other staff members. Somerset employs 22.

"We absolutely love Vitable," said Tiffany Chavous, Somerset's director, recalling how Vitable came to her house to check her for strep throat. Chavous also received her physical from Tubens-Lowa on the 17th.

Vitable's approach attracted a $1.6 million investment led by SoftBank's Opportunity Fund early this year, and Vitable announced in October that it received $7.2 million in venture capital to expand. The next market will be Baltimore, in February, Kitonga said.

Philadelphia's First Round Capital contributed more than 80% of the latest investment in Vitable, which employs 22 and uses about 50 nurse practitioners such as Tubens-Lowa as independent contractors to provide much of the care. Vitable did not disclose its annual revenue or profitability.

First Round partner Josh Kopelman, who chairs the Philadelphia Inquirer's board, said it's important for a startup founder to have a deep understanding of the problem the company is trying to solve, which in the case of Vitable is serving low-wage hourly employees who often have poor access to affordable health care.

"Joseph connects to this on so many levels," Kopelman said. "This isn't someone who won a business plan competition with a random idea. This is someone who is connected deeply with the problem."

Hot spot for innovation

But Vitable isn't the only company tackling primary care. There's been a flood of investment over the last 10 years in primary care and telehealth by startups and giants such as CVS Health Corp., which has primary care HealthHubs planned for stores nationwide. Plymouth Meeting's Accolade, started to help employees of large companies navigate health care providers, this year paid $380 million for PlushCare Inc., an online primary care provider.

"Within primary care, what's happening today is that all the big tech firms like Amazon and many of the digital first startups are getting into primary care because it's relatively safe to price in the risk and to manage the population," said Paddy Padmanabhan, CEO of Damo Consulting near Chicago, which specializes in digital health care. He said primary care can be very profitable under these new models, depending on the health of the population covered.

Padmanabhan noted that Vitable's approach to primary care — at small employers — is at the opposite end of the market from Amazon Care, which is trying to sign up large employers for its hybrid of virtual and in-person primary care. In-person visits are available in only some markets.

Kitonga and Kopelman said most primary-care startups are designed as a convenience for employees of large companies, people who already have good access to health care services.

"That is obviously the most profitable segment of the market, but they left the long tail of the market, small businesses, the hourly workers completely underserved," Kitonga said generally of the industry. "For me, that's where the interest lay, where I wanted to build this service for my parents and their employees. I think that's where the problem is yet to be solved."

Vitable's backbone is a software system Kitonga and his employees built that allows the company to control the "end-to-end experience," including the app for members, the electronic medical record of visits, and the dashboard for employers, said Kitonga, who dropped out of Penn State in January 2020 and turned down a job offer as a software engineer at Microsoft Corp. to focus on Vitable.

Consumers can reach Vitable by phone, email or through a smartphone app. After that initial contact, Vitable's algorithms route the patient to "the most appropriate care setting, whether it's a quick virtual visit or an in-home visit. All that enables us to have same-day visits available for members," Kitonga said. The service is not available for people 65 and older because of Medicare rules, Vitable said.

Nurse practitioners such as Tubens-Lowa, who also works in an urgent care center, notify Vitable of their availability in two-week blocks. "It gives you a lot of flexibility. I can give them as much or as little time as I have available," she said.

Services for employers

Olive Baimba, president of Elite Care Staffing LLC, in Upper Darby, was thrilled to learn about Vitable in September 2020. Her home-care workers were facing months-long delays — because of the havoc COVID-19 caused in health care — in getting the annual physicals required to work as a caregiver.

Elite's human resources director learned about Vitable when a company nurse practitioner came to their office building to give physicals at another home-care company based there. Elite soon signed up for the service and now has a three-year contract covering 150 full-timers, Baimba said. Elite employs more than 300 overall.

"When we signed up, it blew my mind. It was amazing, their quality of service," Baimba said.

Some employers see Vitable as an added benefit that can help retain and attract workers at a time of widespread labor shortages.

That's why Jon Myerow, founder and partner at Tria, which has three restaurants in Center City, buys the service for his 65 employees. Tria also offers traditional health insurance, gradually paying a greater percentage of the premium as employees' tenure increases, he said.

"Vitable is good for people both with health insurance and without health insurance," Myerow said. "It offers health care with no deductible, and it's incredibly convenient because they have nurse practitioners that go to the employees' homes or workplaces or do telehealth. I've seen people using it who have Cadillac plans just because of its convenience."