When the Waiting Room Is Your Living Room

Businesses can deliver everything on demand, from dinner to dry cleaning. Some will even show up at your door to give you cupcakes or walk your dog. Now, entrepreneurs are exploring a growing niche: health care.

Start-ups are offering access to doctors, prescription drugs and wellness programs as fast and easy as hailing an Uber driver. Experts say this is the early stages of a movement that could disrupt the health services industry, which critics have long contended suffers from soaring costs and reduced access to care. Seven in 10 Americans in a recent Gallup poll said they believed health care was “in a state of crisis” or had “major problems.”

“Health care delivery is so broken that we need to explore new channels — new conduits — and this represents one of them,” said Dr. Eric Topol, a cardiologist and the author of “The Patient Will See You Now.”

The on-demand economy, which offers consumers immediate access to goods and services, surged 58 percent in 2017 from the previous year to an estimated $75.7 billion, according to a study by Rockbridge Associates, a market research firm.

As the industry swells, dozens of health and wellness companies are tapping the trend.

Heal, DispatchHealth, MedZed, Dose Healthcare and Pager will send a doctor or a nurse practitioner to a person’s home or workplace to treat nonemergency problems like strep throat or a sprained ankle. The I.V. Doc offers intravenous treatments for conditions like jet lag, hangovers and food poisoning. And Capsule will deliver prescriptions to a person’s doorstep.

“People want convenience,” said Josh York, founder of GymGuyz, a “gym on wheels” that sends a trainer and fitness equipment to customers’ homes. “You could get your pizza delivered but you couldn’t get your workout delivered, and I thought, ‘This is where the future is going.’”

GymGuyz and other start-ups, like the I.V. Doc, were bootstrapped by the founders’ friends and family. But some — especially on-demand medical companies, like Heal and DispatchHealth — needed substantial cash to hire doctors, lease vehicles and bring in administrative staff to handle insurance claims.

Cue the investors, many of whom are hunting for the next billion-dollar opportunity.

Samir M. Patel, a principal and co-founder of IRA Capital, was so impressed with Heal after using it for at-home visits and an annual physical in his office that he became an investor.

“To us, this feels like we’re investing in Uber in 2010,” Mr. Patel said. “This is going to revolutionize and change the entire health care industry.”

Uber, a pioneer in the on-demand economy, could be worth as much as $120 billion as it prepares for an initial public offering this year.

Heal has raised $70 million from such investors as the former Qualcomm executive chairman Paul Jacobs, Tull Investment Group and the singer Lionel Richie, while DispatchHealth has raised $36 million from such investors as Questa Capital and Alta Partners.

But the potential to be the next “unicorn” — a start-up valued at $1 billion or more — has created a crowded field.

The popularity of the I.V. Doc prompted a flurry of smaller companies, like IVDrips, Drip Hydration and the Hangover Club/NutriDrip, to offer similar services — sometimes at cheaper prices. To fend off competition, the I.V. Doc recently expanded to offer injectable drugs, like Botox and Restylane, as well as postoperative care for plastic surgery.

Large tech companies are seeking a bigger share of the more than $3 trillion spent annually on health care in the United States. Amazon, which has been making an aggressive push into health care, announced last year that it would buy PillPack, an online service that organizes and delivers prescription medications. Apple and Alphabet, Google’s parent company, have also made significant acquisitions as they accelerate their efforts on new technologies for doctors, patients and consumers.

“Health care is a $3.5 trillion industry — who wouldn’t want a piece of that?” said Jeff Becker, a senior analyst and health care IT expert at Forrester.

But start-ups are facing challenges on their path to financial viability. Because mobility brings extra liability, one of the biggest roadblocks is insurance for themselves. Problems can crop up on the road, like traffic accidents, or in a customer’s home, like an equipment malfunction. Or perhaps a doctor, lacking sufficient equipment, makes an incorrect diagnosis. These headaches can make it difficult for start-ups to find proper protection.

Dr. Adam Nadelson, the founder of the I.V. Doc, approached five insurers in 2013 before finally finding one to sign on.

“It was a mixture of them not understanding what we were doing and then some gave us a price that was just outrageous,” he said.

Mr. York of GymGuyz had more than 30 meetings over six months to get an insurer before starting his company in 2008.

“It was very very hard; I had to really paint the vision and meet with a lot of people because the business was so different,” Mr. York said. “The doors were shut on me so hard that my nose was hurting.”

Insurance not only protects the company, business owners say, it also covers employees, who take a risk entering a private residence.

“We have walked into a house and somebody had a gun or walked into a yard where there’s a pit bull,” said Dr. Mark Prather, chief executive and co-founder of DispatchHealth. Both DispatchHealth and Heal always send two people to house calls for safety and efficiency.

Getting their customers’ health care insurers on board is equally critical, and providers are slowly coming around.

Owners who offer medical care contend that their business model will save insurers money because people will seek medical attention sooner if it’s fast, easy and affordable and does not require monthlong waits for an appointment or long waits in a doctor’s office. And they say early detection and treatment could prevent a problem from morphing into a debilitating illness that later requires an emergency room visit or hospitalization. Visits to the E.R. can cost $1,000 to $2,500, Dr. Prather said.

Entrepreneurs point out another benefit: Their doctors and nurses can identify health triggers in a patient’s home.

A Los Angeles man who had called for a Heal doctor complained of migraine headaches, recalled Nick Desai, a co-founder of Heal. The man had been to eight doctors, had three M.R.I. scans and had tried multiple medications. When the Heal doctor arrived, he noticed black mold.

“So the patient hired a cleaning person to clean the black mold — and his migraine headaches were gone,” Mr. Desai said.

Insurers are beginning to add on-demand services to their plans and even forming managed care partnerships with start-ups to visit people at home with chronic conditions, like hypertension and diabetes. Anthem, Health Net, Blue Shield, Aetna, CareFirst, United Healthcare, Cigna and Medicare are among the insurers that cover Heal visits in many of their P.P.O. plans, Mr. Desai said.

As their businesses expand, owners must navigate complex health care regulations, which can vary from state to state.

“Every state acts as their own country, with their own kooky laws, and understanding those rules and regulations costs an obscene amount of money in legal fees to understand how to operate one’s business,” Dr. Nadelson said.

Before Amazon bought PillPack, it tried to enter the world of prescription drugs with a deal to acquire a stake in Drugstore.com. But it ran into regulatory challenges, and the effort was derailed. Amazon found a solution in PillPack, which has pharmacy licenses in 50 states and relationships with the major pharmacy benefit managers and insurers.

Despite the barriers, experts believe on-demand health services are here to stay.

“This has the potential to be life-altering,” said Dr. Griffin Myers, a co-founder and the chief medical officer at Oak Street Health, a network of primary care practices for people on Medicare.