How the Hims & Hers Telehealth Platforms Enable Quality Care

At hims and hers, our first priority is enabling patients to access the highest standard of care possible. We know sometimes it’s not easy to ask tough questions about your health, and going to the doctor’s office isn’t always possible.

Telehealth has the potential to lower costs, increase access, and improve the health and wellness for millions of people around the country. That’s why hims and hers committed to building advanced telehealth platforms that address gaps around access and affordability in the healthcare market.

These networks encourage people to make more informed decisions about their health, no matter what course of treatment they choose with their doctor.

Our platforms are a critical first touchpoint for people who have felt left out of the existing healthcare system, offering convenient access to an extensive network of over 400 healthcare providers, informational resources via digital platforms, and a dialogue around typically taboo medical topics.

As part of our promise to provide access to comprehensive medical care for everyone, we want you to have a full understanding of how the hims and hers telehealth platforms work.

Below outlines the online experience for someone seeking treatment. In this example the patient would be seeking treatment for erectile dysfunction.

The patient would set up an account on forhims.com and choose the type of consultation appropriate for their medical condition. Each of these categories presents a tailored, online consultation tied to the specific health concern, and features technology inherent to the hims and hers platforms.

This ensures a comprehensive patient assessment for their licensed medical provider to evaluate prior to creating a treatment plan. For a consultation related to erectile dysfunction, patients click the Shop Sex category.

If a person is interested in erectile dysfunction treatment through the hims platform, then the related prescription - if deemed appropriate by a licensed physician - can be fulfilled through pharmacies who work with the platform or through a pharmacy of the patient’s choice outside of the platform.

After selecting a product related to their specific erectile dysfunction condition, the user proceeds to the checkout page. Payment includes:

• Cost of the drugs, which hims and hers pays to the pharmacies

• Costs for hims and hers managing pharmacy relationships and enabling customers’ online access to pharmacies' prescription fulfillment services

• Product membership fee, which is associated with a customer's overall use of and access to the platform

Hims and Hers also collects payment for the online consultation on behalf of the medical groups that employ or contract the licensed healthcare providers. These medical groups are referred to collectively as “You Health,” but consist of a number of different professional entities. These consultation fees are paid to You Health; Hims does not retain any of the physician consultation fees.

Once patients enter Hims’ secure portal, they’ll share their background medical information and a detailed description of their medical concern by answering questions about their specific medical condition. These questions were designed by expert medical advisors to give You Health providers all of the information they need to safely make a diagnosis and create a personalized treatment plan for each patient. For erectile dysfunction in particular, the questions focus on onset, duration and severity of sexual dysfunction, prior treatment history, and questions about cardiovascular status and other medical conditions that can impact safety of treatment. 

The platform was designed by our engineers with input from our expert physician advisors to generate personalized question sets for each patient based on their answers to prior questions. That makes each patient’s experience seamless and efficient - detailed follow-up questions are posed when they are appropriate, and unnecessary questions that don’t impact diagnosis or treatment are avoided. 

Of course, some questions are important for everyone. In a patient requesting erectile dysfunction treatment, for example, the questions assess for other physical genitourinary problems or symptoms such as:

• A marked curve or bend in the penis that interferes with sex, or Peyronie's Disease

• Pain with erections or with ejaculation

• Physical problems, scarring, or other issues related to your penis.

The questions also assess for the presence of the following clinical conditions that can affect the safety of ED treatment:Here, it’s important for the provider to know if the patient has been diagnosed with any of the following conditions:

• Retinitis pigmentosa

• Anterior ischemic optic neuropathy (AION)

• Blood clotting disorder, abnormal bleeding or bruising, or coagulopathy

• Stomach or intestinal ulcer

• A prior heart attack, heart failure, or narrowing of the arteries

• Stroke or severe insufficiency of the autonomic nervous system

• Peripheral Vascular Disease

• Any history of QT prolongation in you, or even your family

• Sickle cell anemia, myeloma, leukemia

• Idiopathic hypertrophic subaortic stenosis

If a patient confirms one or more of these conditions, then their responses will be flagged for the provider so that they can alter their treatment plan or tell the patient that they cannot safely be treated through the platform.

Since erectile dysfunction can be a sign of cardiovascular disease or other medical conditions such as testosterone deficiency, the platform is also designed to identify at-risk patients who would benefit from specific counseling from providers.  Since ED is very generally associated with cardiovascular risk, the platform was designed to encourage providers to counsel all ED patients about the relationship of ED with cardiovascular health, and the importance of meeting with a health-care provider regularly for cardiovascular assessment and management.  Some examples of other specific risk factors that the platform flags for counseling are:

• Diabetes. Patients who report diabetes are flagged for counseling about the importance of glycemic control for overall and sexual health. 

• Symptoms of low testosterone. Patients who report low libido or decreased energy are flagged to be counseled that they may have testosterone deficiency, and should seek in-person evaluation by laboratory testing.  

• Cigarette smoking.  Patients who report cigarette smoking are flagged for counseling about the importance of smoking cessation.

• Stress reduction. Patients who report symptoms consistent with psychogenic ED are flagged for specific counseling about the nature and management of stress-related ED.

It is very important for providers to know if patients are taking certain medications that may interact with erectile dysfunction medicines. The platform is designed to specifically ask patients if they take certain medications that cannot safely be used in combination with erectile dysfunction medications. 

• Nitroglycerin spray, ointment, patches or tablets

• Isosorbide mononitrate, or isosorbide dinitrate 

• Other medicines containing nitrates

• Alpha blockers to treat high blood pressure, prostate problems, PTSD, or nightmares

• Riociguat

Patients taking any of the above medications will be denied a prescription for erectile dysfunction medication and referred to seek in-person care to explore other treatment options for their erectile dysfunction. 

For patients with certain risk factors present, it is mandatory to share a blood pressure measurement (obtained via an at-home device, local pharmacy or PCP) when considering erectile dysfunction treatment.

The erectile dysfunction platform also includes a series of other questions that are relevant to the evaluation and treatment of ED.  This includes screening and follow-up questions about recreational drug use, specific medical conditions, and allergies (all of which can impact the safety of ED medications).  The medical consultation concludes with an opportunity for the patient to introduce themselves to their healthcare provider, and to share any medical or other information that wasn’t asked but that they feel is important to share with their provider. 

Hims’ electronic medical record (EMR) system compiles a medical chart with the patient’s information and routes it to a provider licensed in the patient’s state. The chart flags findings of particular concern or importance for the provider, such as high blood pressure, or areas where specific counseling about risk factors may be appropriate.

After reviewing the chart, the provider will commence dialogue with the patient through a secure portal. We believe in shared decision-making between providers and patients; together, they work together to select a treatment plan based on clinical evidence, balancing risks and expected outcomes with patient preferences and values.

If the treating provider decides that prescribing a medication is the right treatment plan, then they will provide the patient with details of the proposed treatment plan and provide a prescription for the medication. The patient is encouraged to read the treatment plan carefully prior to starting the medication. Some specific sections in the treatment plan include:

• When to take the medication

• Advice on dosing

• Possible side effects

• How to store the medicine

• Possible drug interactions

• Options if medication is ineffective

• Common alternative treatments

• Advice as regards ongoing communication with PCP

• Contraindications and precautions

It is important to note that certain medications may not be appropriate or safe for some patients. If the patient doesn’t meet diagnostic criteria for treatment, or if treatment is not safe for a patient because of a medical contraindication or drug interaction, the provider will counsel the patient appropriately, explain the reason why they are not able to prescribe medication, and refer them to seek in-person care with an expert or primary care provider. 

The Hims and Hers platform was built to promote therapeutic success by making clinical interactions easier. Patients that start prescription treatment have ongoing access to medical providers through their mobile devices or computers that allow them to address medication effectiveness, any side effects, or any other questions or concerns.  Patients are encouraged through emails and app notifications to perform regular online check-ins throughout the course of treatment. They are also able to connect with providers whenever they want through their online portal or through the Hims and Hers mobile application. The platform therefore enables faster and easier access to a provider than a patient would typically receive in a traditional in-person doctor-patient relationship, which enhances the likelihood of a successful therapeutic outcome. 

Our online platforms are designed to gather critical patient information that providers need to deliver exceptional medical care. Intelligent workflows ensure we address each pertinent aspect of care. This systematized, data-driven approach to care can even create more consistency than traditional in-person medical care. We are thrilled to offer this modern, technologically-enabled and accessible approach to healthcare.