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Cue Health Adds DTC Subscription Services to Care Model, But Who Will it Benefit?

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NEW YORK – Since going public in September, Cue Health has been working to expand its offerings beyond COVID-19 molecular testing, including launching a membership model that includes COVID-19 testing and virtual care.

The company's "digital connectivity" has been touted as a key benefit of its test and platform, as emphasized by Cue CEO Ayub Khattak at the JP Morgan Healthcare Conference last month. That connectivity includes the integration of results into electronic health record management systems, as well as automated epidemiological reporting to public health departments and the subscription model. 

The model, which launched in November, includes two tiers: Cue+ Essential, which includes 10 of its COVID-19 tests per year, a discounted Cue Reader for those tests, 24/7 access to virtual care, and an additional 20 percent off additional tests and readers, for $39.99 per month; and Cue+ Complete, which has all of those features plus an additional 10 tests per year, supervised testing for travel, work, and school, and first access to any future offerings, for $74.99 per month. 

The company had been charging $49.99 for Cue+ Essential and $89.99 for Cue+ Complete but lowered the prices for both services this week. In a statement announcing the price change, Clint Sever, Cue's cofounder and chief product officer, said that the lower pricing is "an effort to make Cue more accessible to more people." A spokesman for the company added via email that the company is proactively working with health insurance companies to get coverage for Cue's solutions.

Sever said in an interview that the main pros of the membership are the virtual care access and the supervised testing component, which is compliant with guidelines from the US Centers for Disease Control and Prevention. That supervised testing is particularly important for travel into and outside of the US, as many countries have proctored testing requirements for entry, he said. 

The virtual care is also "appealing" to consumers because it offers access to a telemedicine provider they wouldn't otherwise have, he said. Cue is partnering with 98point6, an on-demand telemedicine provider, to offer 24/7 virtual care via Cue's app. The virtual care offering extends beyond COVID-19 testing, Sever emphasized, allowing customers to access a doctor for any healthcare need, including primary care visits and prescribing.

Cue is also in the process of crafting a new offering that would eventually allow customers to get their prescriptions delivered on the same day, Sever said, and the firm is working to make antiviral medications for COVID-19 available via its app.

In the firm's JP Morgan presentation, CFO John Gallagher said the assorted digital offerings open up a much larger digital health market, which the firm sized at "about $120 billion."

But the subscriptions don't come cheap, and if a user already has a health insurance plan — many of which come with telemedicine offerings — there could be little incentive to purchase Cue's offering. 

New York University's Arthur Caplan, a professor of bioethics in the department of population health, noted in an interview that while people can spend their money as they wish, someone would have to be "fairly well off" to spend at least $40 per month on the basic plan. 

To him, the subscriptions seem geared toward worried rich people who are "trying to make their way through the COVID-19" pandemic intact, he said. The proctored testing also doesn't seem like a "big value add" for many people — particularly since the people who can afford the service are likely traveling to places that will already have that testing in place. However, if someone is traveling to an area where there isn't a lot of testing available, the proctored testing "might be worth your money," he said.

The Cue spokesman said that offering supervised testing adds a "layer of convenience" while consumers are traveling and added that there is often a cost associated with being tested at hotels, and relying on third-party testing "can result in unexpected delays and disrupted travel plans."

"We've heard from our customers that they love knowing they can take control over their own testing needs according to their own schedules, especially when they have a need for results within 24 hours (or less)," the spokesman said.

However, Caplan raised another point about the service: While subscribers to the memberships can test themselves and their families, which might be good for high-risk populations, Caplan said, the average person "needs to rely on testing not just for themselves" but also for colleagues, coworkers, and other people who may come in close contact in settings such as schools and workplaces. Just having home testing "is nice," Caplan said, but it is "not sufficient to really give you the kind safety that I think people would be seeking," he added.

"The real question is, 'Can I send my kid to school? Can I go to work? Can I go to the sporting event? Can I go to the restaurant?'" he said. "And this isn't going to tell you that it's safer to go anywhere, even if you do home testing religiously."

To be fair, outside of Cue's direct-to-consumer offering, the firm has multiple contracts with federal and state governments, schools, employers, and other organizations to provide testing on a wider scale, including a partnership with the National Basketball Association to provide home and point-of-care testing for the teams and referees. Cue's spokesman noted that its tests are being used in "thousands of healthcare settings, workplaces across the country, and 2,000 schools in 20 states." 

The spokesman also said its enterprise employer customers have also been purchasing the subscription plans for their employees.

Regardless, Caplan said the membership plans seem to be "a little bit preying on inconvenience and fear," and added that a changing testing environment could throw a wrench in the demand for these plans. More testing is becoming available, and many COVID-19 restrictions will likely be relaxed across the world throughout the year, which could make the proctored testing offering less necessary, Caplan said. It's something "only the rich are likely to tap into," although he noted that that is a "constant feature of American healthcare" and not specific to Cue.

In addition, the virtual care component is only as good as the providers available, Caplan noted. According to Cue's spokesperson, the doctors available through the virtual care offering are board certified. 

Further, he said that by offering people fast and accurate lab-quality testing at the point of care, it is alleviating pressures on testing sites and labs.

Khattak noted in his presentation at the JP Morgan conference that the subscription model is "a new pathway, which we think will become dominant for a range of different conditions, and this is the convenience and access that consumers demand." He added that "this is the way the healthcare system can become more accessible and efficient."

CFO Gallagher added that demand "has been very solid" with the direct-to-consumer offering "off to a very strong start."

With its offerings, Cue is "closing that care loop" and creating a "much more efficient way to deliver healthcare," Sever said. "That healthcare system infrastructure comes to you."

Beyond COVID-19 

Beyond tests for COVID-19, Cue is developing new tests for a variety of other diseases, including influenza, Streptococcus, sexual health, and women's health, as well as a cardiometabolic panel, Sever said. All the tests would run on Cue's reader and be available to members of its subscription services.

The 24/7 virtual care component will be particularly helpful once Cue's other infectious disease tests come online, Sever said, because it would provide a quicker way for patients to get access to antibiotics and treatments as necessary. 

CEO Khattak noted at JP Morgan that Cue has enrolled the first patients in its clinical studies underway for its influenza test.

Khattak also said that Cue is adding cartridge production capacity into its existing infrastructure and that its strategy of vertical integration — which includes manufacturing many of its own biological components, controlling its cartridge production infrastructure, and onshoring its supply chain — has enabled it to provide its products at scale.

He added that Cue has the production capacity to manufacture any test in the firm's pipeline.