The home Dr.: how to build a network of clinics for residents of bedroom communities

Mr hurdus and Leonid Melamed believe in a personalized approach to medicine. They hope to make physicians more accessible through telemedicine.

Founder and co-owner of a network of clinics “Doctor is near” 51-year-old Vladimir Gurdus walks into his office, not taking his eyes from the screen of a smartphone: it is overwritten with the client, which the day before got hit by a car. “It is necessary to consult a traumatologist and a neurologist,” he explains to the correspondent of RBC magazine. The message he sends the patient to one of the duty doctors network and asked to contact the woman. If necessary, it will be sent team of doctors, and after her hospitalitynet at the right hospital, says the businessman.

Almost 16 years, until 2007, gurdas worked in various positions in the insurance company ROSNO , then two years headed the largest Federal network of private medical clinics, “meds” (belongs AFK “System”), parallel now owns his own “author’s clinic” — a treatment center spine and joints Re-Clinic with revenues of about 50 million RUB in 2015
and Clinic of Professor Kalinichenko working in reproductive health, with revenue of 102 million rubles in 2015 . In 2013 gurdas together long-term partner, the ex-head of ROSNO , MTS and AFK “System” Leonid Melamed has opened in the Moscow district of Nekrasovka first clinic neighbourhood Doctor.


Less than a year in Moscow and the Moscow region earned ten institutions network. For comparison, the created 20 years ago of the group of companies “Medsi” , according to its website, the Metropolitan area has 15 clinics. However, if “meds” are proud to have a full range of services for the prevention, diagnosis, treatment of diseases and rehabilitation”, institution of network “Doctor is near” by analogy with the small Shimi shopping networks in residential areas can be called the clinics “walking distance”.

A trip to the doctor should not be associated with long trips, I’m sure the Melamed. Most people want to receive medical care near home and not ready, for example, to go to the subway with a sick child, echoed gurus.

Clinic “Doctor is near” is a small premises with area up to 400 sq m, where most served the residents of nearby houses. In hospitals you can get help on a limited, but the most popular variety of services: visit a therapist, gynecologist, pediatrician etc.

At the clinics, “Dr. next is” no “heavy” equipment like x-rays. On the one hand, according to the sanitary standards, x-ray or MRI cannot be installed on the first floor of the house. On the other — is inappropriate: the concept of “intimacy” of the network implies that the specialists of “Doctor” provide key services themselves
and advise patients about possible extra help on the side, for example, suggest where to do a particular operation. The network has contracts with about 30 clinics-partners. If a customer has bought a specific program of service and requires the service that a Doctor is near can not provide, then the company pays for the required service partner clinic.

For patients Gurdus and Melamed have to compete not only with hundreds of private clinics, but with almost 200 government agencies in the capital region. Moreover, on request only “clinic at home” in the search engine “Yandex” falls 63 million references. But Gurdus and Melamed have ambitious plans: by 2018, the network neighbourhood Doctor needs to grow to 30 clinics in Moscow and the Moscow region. “From 2017 the clinic will be profitable by themselves and the entire network as a whole,” says hurdus. Thus for three years the partners have already spent “several hundred million” rubles, the total planned investment is about 1 billion rubles., says the same co-owner. What unique can offer the medical network outside the house?

30 million rubles is necessary to the opening of one clinic, a Doctor is near

25 million rubles per year maximum spent on maintenance one clinic

12-15 months , on average one clinic to exit to self-sufficiency

1350 RUB is initial reception, an ophthalmologist, or physician in the network

Source: data of the company “Doctor is near”

The response of the opposition

Small porch in residential building with green
an orange sign “the Doctor is near a ten minute walk from the metro station “Kuzminki”. Inside the freshly renovated in white and green colors, cool from the running air conditioner. On the plate — the list of specialists that you can visit: gynecologist, massage therapist, urologist, General practitioner. There is also a treatment room.

“Doctor is near” is not the first clinic, which is found on the way from the subway. A little closer is located the medical center “Megalux”, where have a greater number of services: there is, for example, dentist, neurologist, endocrinologist. Prices are about the same with a difference of a few hundred rubles for the reception. However, in the 12 hours of a weekday in the corridors of both hospitals RBC did not meet with any patient.

The ideology of the “Doctor is near” available and personalized medicine is not unique. A similar project himself Gurdus engaged while working in ROSNO, the company has developed a network of clinics “Medexpress”, which could serve clients of the insurer (in 2007 more than 20 points of the network became part of the GK “Medsi”).

The creation of a network of neighbourhood Doctor has spurred the election campaign for mayor of Moscow in 2013: one of candidates in mayors of Alexei Navalny in his program, then promised to make healthcare “more accessible” and to create “a network of modern and high-quality clinics and hospitals, accessible to every Muscovite”. Mayor Navalny did not become, but in Moscow and the region has earned the program of public-private partnerships. The aim of the program was the opening of a larger number of clinics in residential areas to Muscovites to receive sick leave next to the house.

At the time the program gurus and Melamed has worked on the business plan, a Doctor is near . “The leadership of the Department of health invited us to participate”, — said Gurdus. As a result, the clinic in Nekrasovka has become not only the first institution of the network, but also the first in the program. A few days after the launch of the clinic was visited by the new mayor of Moscow Sergey Sobyanin.

To participate in the city program signed by firms and individual entrepreneurs — only 34, told RBC representative of d epar-Department of Moscow city competition policy. Melamed and GU Rusu managed to beat all: by the beginning of 2015, the “Doctor is near” consisted of ten clinics, the competitors opened with a maximum of three agencies, recalls with a smile Gurdus. For the entire period of the program in the capital region were open 26 private clinics network “Doctor is near” — the largest of the program’s participants, confirms the source in the Metropolitan Department of city property.

All my room of size 17 0– 400 sq. m the founders of the “Doctor nearby” win the program at auction. Space for future clinic the winner receives free of charge: as follows from the description of the conditions, bargaining for the room goes for the price of the annual rent, which the applicant is required to pay until they open the clinic. The annual rent ranges from 1.5 million to 8 million rubles, according to completed auctions on the program website. To date, authorities have provided through auctions 60 premises, said the source in the Department for competition policy.

But in the original program lasted only a year: in late 2014 the rules of the game for investors have changed. Before any patient could come to a private clinic attached to the program, and the clinic received funds from the mandatory medical insurance Fund for each of the served client, says Julia mills, a Board member of the Association of private clinics of Moscow and commercial Director GK “Medkholding” (also the participant of the program).

Now get free care in hospitals program is possible only through referrals from city polyclinics, which in turn became unprofitable to “give” attached patients to other health facilities, explains mills. In the place of the planned partnership with state-dedicatory clinics private enterprises began to compete for customers, and the flow of patients at the MHI are almost gone, laments Trofimova. In capital the program “Medkholding has opened two clinics, and after the reform no one , she adds.

Gurus and Melamed have also stopped using the help of authorities: in fact they had to re-invent the strategy of the network. Over the past year and a half “Doctor is near” did not open any new clinics, but finally found the new model of promotion of “sleeping” services.


“A good start”

“State “Macdonal DSA”, which is the same menu in each restaurant, we will never grow. It would be ideal to sell the same everywhere services, but everyone is different and their needs are different,” — throws up his hands Gurdus.

In 2015, the founders of the “Doctor nearby” have focused on patients attached on the LCA, and customers who pay for services in cash. Himself Gurdus withdrew from operational management and has conceded the armchair of the General Director Alexander Pylypchuk, former Deputy Director of the VHI, Allianz, “daughter” of the German insurer.

100 thousand patients at least attached to the clinic network on VHI

400 sq. m. is the maximum area of the clinic network

158 million rubles — the company’s net loss “Doctor is near” in 2015, with revenue of 115 million rubles.

240 million rubles will achieve revenue close to the Doctor” at the end of 2016

Source: data of the company “Doctor is near”

Now managers of the “Doctor nearby” experiment with the number of doctors in different clinics, determining where and what services are most in demand: for example, recently one of the medical facilities purchased ophthalmic equipment, for the other — instruments for ENT specialist. “We need to find a balance and learn to calculate the demand for services in individual areas” — dreams Gurdus.

Partners are also forced to reconsider the approach to selecting locations for future clinics. Now investors operate on the principle “who prevents to live and who’s not,” says hurdus. The proximity to “know name” clinics — no problem for Gendusa and Melamed, and the presence of a strong brand is. So the clinic “Doctor is near” is unlikely to appear in close proximity, for example, from “meds “. “Either you know how to develop private business, and rental is part of your expenses, or do not know how, and then free rent will not save you,” said Gurdus. For future clinics you have already selected a place located in Novogireevo, Kommunarka and other rapidly developing parts of the city .

With clinics in large networks “Doctor is near” can compete with our prices. The cost of the same services in the network of Gurduza and Melamed and network institutions can t quite different, says Alexey Vetrov, Chairman of the Board of Directors of the network of clinics “Family doctor” (six institutions). He explains this factor of location: a clinic in the centre due to rental and transport accessibility can not be the same as in remote areas of the city. For example, the initial reception at the ophthalmologist in network “Doctor is near” will cost the patient approximately 1,4 thousand rbl., in “meds” — 2.7 thousand. the Cost of services compared to “single” clinics are comparable: for example, in “Delta” Clinics at metro Chkalovskaya visit an eye specialist is 1.1 thousand RUB.

Family doctor, according to Vetrov, does not feel serious competition from “the next Doctor”. “Perhaps some clients with symptoms of SARS will not reach us, and will go to the medical center “walking distance”. M the item facts the clinic is of great importance , but not less important the reputation of the clinic and doctors. “Location helps to attract the best talent,” insists the Winds.

“The Doctor is near VHI attached more than 100 thousand patients (in the larger partners, big insurance companies, including Ingosstrakh, AlfaStrakhovanie, RESO-a guarantee” etc.). Every month the number of clients paying over the counter, is incremented by 1 ,5 thousand people. According to the MLA, a Doctor is near come in about 500– 700 people a month, cites gurus.

If the clinic neighbourhood Doctor worked ten years, these figures would be considered low, says the Director of GBU “Institute of health organization and medical management of the Moscow Department of health David Melik-Guseinov. But for a startup is “a good start”, he adds.

GU Gus and Melamed agree that the “Doctor is near” — typical startup. This allows the company to experiment: in the next year “the next Doctor” plans to add the technology in a conservative market of medical services.

Dr. smartphone

“We make sure that our customers are from us, the word “no” is not heard,” says hurdus. In the fall of 2016 the network will see a mobile app for iOS and Android, and the medical analog of Skype that will allow patients to remotely communicate with physicians, “Doctor nearby,” says Pylypchuk. In the application, for example, a button that will allow the client to connect
with the doctor on duty in any hospital in the network to choose from. Through the service you can also schedule an appointment with a particular specialist.

On creating a mobile application, “Dr. next,” according to the General Director, spent about 10 million rubles, while the revenues of the company are about 115 million rubles in 2015. The company has agreed with one of the Russian developers (who — not disclosed) on leasing software, which will protect personal data of patients, says Pylypchuk. “The next doctor” keeps a history of visits and appointments for patients, which will be available to clients with mobile devices.

<p>In early 2016 Gurdus lost the post of General Director Alexander Pilipchuk, to&nbsp;this time he was responsible for&nbsp;customer service and&nbsp;work with&nbsp;hospitals&nbsp;the German insurance company Allianz.</p>


Photo: Oleg Yakovlev/RBC


In early 2016 Gurdus lost the post of General Director Alexander Pilipchuk, up to this point, he was responsible for client services and work with health care institutions in the German insurance company Allianz.

A full step in the direction of telemedicine “Doctor is near” will do until the end of 2016. The company will open offices in the offices of three foreign firms engaged in business education, sales of sports clothing and IT: they will not be doctors, but employees of companies can measure the temperature, pressure and heart rate. Special g ajeti will remotely transmit information doctor a Doctor is near.

Now employers pay for coming into the doctors office about 700– 1000 RUB per hour, says Pylypchuk. Virtual offices cost less: specific value of the CEO network is not specific, but indicates that the first two months, the partners will get the service for free. How much a company will earn on telemedicine depends on the form in which Russia will adopt the law on data services, says the CEO. The draft Federal law was submitted to the Duma in the spring of 2016, but will be considered only in the autumn session.

The idea of “virtual” offices unique to the market, says Melik-Guseinov. However, he adds, while the absence of legislation leads to the fact that mobile apps clinics are not widely available due to capacity constraints.

In the near future telemedicine to “settle in smartphones” as a basic application, as the consultation of a specialist can be necessary at any time and in any place, the expert said J’son & Partners Consulting Ivan Fil. According to him, the massive penetration of telemedicine will begin with the inhabitants of the metropolis.

“We want to reach a mass market,” says hurdus. Telemedicine should just erase the border between physical visits and virtual” excited Pilipchuk. I f tele-medicine will gain in Russia legal status, measure network “Doctor is near” will be not a number of clinics, and the “mass” of penetration in mobile devices.