When Spruce started five years ago, our vision was two-sided. We wanted to enable modern access to care for American consumers — care that was messaging-based, on-demand, affordable, and well-designed. We also wanted to build world-class software for care teams to make them far more efficient at delivering care and more coordinated amongst each other. We wanted concierge access for consumers as patients, and we wanted to ultimately scale care, reducing its cost burden on American society in the process. This vision hasn’t changed, and we’re as committed to it as ever.
— Jeff Bezos
Four years ago, we took our vision to market as a virtual clinic specializing in dermatology. American consumers could access our Spruce Dermatology Clinic app and pay $40 to complete a visit with a board-certified dermatologist. Consumers used the patient app to easily share all the relevant medical information with their care team via a “case.” Dermatologists and care coordinators used our provider app to efficiently treat those cases and coordinate care. Patients could pick up appropriate prescriptions within 24 hours of case submission, message with their care team on an ongoing basis (free for 30 days) to ask questions or receive help with prescription affordability, receive follow-up care ($40 per visit), and coordinate care with their existing primary care physicians.
The Dermatology Clinic was innovative for its time, particularly with its focus on messaging and its team-based approach to care. Patients loved it. Providers loved it. We made dermatologic care far more efficient and value-oriented. We peaked at #1 on the Medical Category in Apple’s App Store. Vogue called the experience “Priceless.” We helped tens of thousands of patients in a short amount of time.
We were only an indie hit though. The business model and distribution of the Dermatology Clinic wasn’t exactly looking like a rocket ship or the startup charts that you love to see. The unit economics of paid acquisition, assuming we didn’t try to make money from prescription or over-the-counter products, weren’t what they needed to be. And organic growth was solid but not explosive.
We needed to find a more effective and economically successful way to get our creative vision for modern care delivery and care communication out there. We successfully did that with our next product, Spruce Care Messenger. Care Messenger is also a hit, with a 4.9-star rating across nearly 2,000 App Store reviews, and it’s now used by thousands of practices across America to offer democratized concierge access to patients and to make medical communications dramatically more efficient. But that’s a story for a different day.
This post is about how the time has finally come to shut down the Spruce Dermatology Clinic as a legacy, standalone experience. The time has come because Spruce Care Messenger is now a superset of the original ideas and product, albeit in a different form factor (i.e., any dermatologist can now use the software to offer a virtual dermatology clinic experience to their own patients). It’s also come because, at this point, operating the Spruce Dermatology Clinic is pragmatically an unsustainable operational commitment for us, a small team that is putting all our love into Care Messenger. As a startup, those are the types of hard decisions that you sometimes have to make.
We know that many people still love using the Spruce Dermatology Clinic as a standalone app, and the reality of shutting it down makes us sad, too. Let’s chalk it up to the clinic being too far ahead of its time and not sufficiently aligned with the somewhat unfortunate and anachronistic economics of American healthcare. Our medical team is going to put time and energy into making sure that active patients have smooth transitions to the right venues of care, and our Medical Director is overseeing the details of this transition.
— Kanye West
We hope that the patients and dermatologists who used the Spruce Dermatology Clinic still have love for us, because we have loved serving you and Spruce isn’t going anywhere. In fact, as we jokingly like to say internally, Spruce is on the loose. All of the ideas and hard-earned lessons (design, workflow, medical, operations, and more) from the Dermatology Clinic have found their way into Care Messenger and to our current distribution strategy. In Care Messenger, we’ve created a new world where you’ll still have Spruce on your phone as a patient; it’ll just be in a slightly different context.
While the future is bright for Spruce, this particular moment is bittersweet and an opportunity for reflection and gratitude. We all know this story: the ashes of one thing act as the fertilizer for the growth of another. But we want to pause to thank you for being part of the story with us and for supporting our products. If you were a patient, thank you for giving us a shot and trusting us with your health. We hope you’ll ask your doctors to use Spruce Care Messenger. If you were a dermatologist, thank you for practicing with us and delivering such great care. And most importantly, I’d like to say, personally, how much fun it was for me to build and operate the Dermatology Clinic with everyone on the Spruce team.
This post shares the news and some of the corporate and business context. In the spirit of giving back to the digital health and medical communities, our Medical Director, Dr. David Craig, has put together a more extended post that “open sources” some of our key lessons learned. David is as smart as they come (gymnosperm knowledge notwithstanding), and at this point, I’d wager to say that our associated physicians organization has delivered more messaging-based “care of the future” than any medical group in the U.S., so check it out.
We like hearing from you. We’re also hiring. If you’d like to get in touch with us, email firstname.lastname@example.org.
Tl;dr, if you don’t like stories:
- We are taking the Spruce Dermatology Clinic app off the app store.
- The app will continue to accept new visits for the next week. After that, follow-up care will be available for an additional 30 days.
- Care coordinators will be fully accessible during this time to help patients export their medical records, should they wish to, and to assist them in navigating future care options.
- Growth means change and hard decisions. This is an overdue chapter closure of Spruce Dermatology Clinic as a standalone app and experience. Spruce Care Messenger is already a superset of its ideas and features and is used actively by thousands of practices nationwide. If you’re a provider, get it now. If you’re a patient, ask your doctor to use Spruce.