Louisiana health startup aims to bring back the house call for families

Joy Fletcher-Chairs' office looked like a daycare center one recent Friday. Six kids under the age of 11 were waiting to see the nurse practitioner, all in need of vaccinations.

Three and a half hours and 11 total shots later, all had completed their annual well visits. Fletcher-Chairs taught their mom how to do a self-exam for breast cancer. Four of the kids, who had missed school over required vaccines, were now cleared to return. And the youngest two were now up to date with their childhood inoculations.

That day, Fletcher-Chairs' office was the West Bank home of a 28-year-old single mom in New Orleans. The mother, who hadn't been to a doctor herself since giving birth three years prior, had no transportation to cart the kids to the doctor's office. Without that visit, she's not sure how long it would have been before they could all see someone. When it was over, the mom asked if she could give Fletcher-Chairs a hug.

"I don't know when they would have made an appointment to get there," said Fletcher-Chairs, 47. "What doctor can take all 7? How many trips can they make back and forth?"

A host of challenges stand between a parent and a doctor's visit: transportation, child care for siblings, lost wages from missing work and hassles from school absences. House calls that might cut out these issues are often thought of as a thing of the past. But a new startup in New Orleans is aiming to bring care back into the home for families like the one Fletcher-Chairs saw that Friday.

The startup, called Nest Health, was founded by former Louisiana Department of Health Secretary Rebekah Gee, an OB-GYN and CEO of health care services at LSU Health. The idea was rooted in her previous work to improve infant and maternal mortality in Louisiana, which has among the highest rates for infant and maternal deaths.

"I founded Nest in part because half of maternal mortality and a lot of infant mortality happen because of our lack of transition of care and lack of support for new families," said Gee.

Although Louisiana's health officials have made maternal mortality a priority, the state still ranks fifth for maternal mortality. Between 2018 and 2020, only Mississippi had more infant deaths than Louisiana. An average of 464 infants in the state died each year — the equivalent of about 25 kindergarten classes. Gee draws a line between those deaths, many of which happen in the home or are tied to conditions related to pregnancy, and a lack of care.

"Only 43% of children had their well visits in the city of New Orleans," said Gee. "You're looking at opportunities to prevent bad things from happening, and the best opportunity is a well visit."

Nest Health is privately funded by the Austin-based venture capital firm 8VC. Though services are just in New Orleans now and only for patients on Medicaid's Healthy Blue Program, the plan is to expand to other insurance companies, cities and states over the next few years, said Kelsie Brandt, a registered nurse and vice president of health services at Nest.

The visits are free for Medicaid patients and will cost the same as a regular health care visit for patients with other types of insuance. Home visits are conducted by nurse practitioners or physician assistants along with a family advocate, similar to a medical assistant. Family doctors, nurses and licensed clinical social workers are available by phone and video.

The company's business model will also include telehealth, but all well visits will be in person in the home, said Brandy. The company is able to make home visits work financially because it saves on the cost of having a brick and mortar office and can see several patients at once in each household.

"We are seeing four, five, six patients in that one visit," said Brandt. "We're calling it a multiplier effect of being able to capture and touch a lot of people with the same amount of staff because we're able to povide that care to everyone in the house."

Once the company fully ramps up, each provider will see about 20 families per week.

The model is perhaps not used as much because it's harder for clinicians, said Brandt, who said it can be unpredictable for health care workers who are used to a sterile setting. But it's also a way to pick up on a lot more than a provider can in an office. Kids, especially, are more comfortable getting shots at home, said Fletcher-Chairs, the nurse practitioner.

On her recent home visit, it was easy for Fletcher-Chairs to see how hard it was for the mom just to keep up with her house, much less get alone time for an appointment.

"I am a New Orleans native," said Fletcher-Chairs. "I have home health experience, I've seen patients in assisted living facilities, in nursing homes and hospitals. But never have I seen patients in the setting of their home that were mother and child that needed the care as much as I feel the family we saw on Friday needed that care."