Bay Area dermatologist David Wong can’t forget a patient he met during a trip to California’s Central Valley in 2009: a farmworker with a bleeding lesion on his right forearm who died within six months of Wong’s diagnosis of metastatic melanoma. The man lived less than two hours from San Francisco, and Wong says he was appalled by the “marked difference in the access to care as well as the quality of care patients were receiving.”

That experience led Wong and a fellow dermatologist to launch an online clinic in 2010. Direct Dermatology uses photos patients upload to diagnose growths, rashes, and other skin problems, usually in less than a day and at what Wong says is about half the cost of a regular doctor visit. The Palo Alto business, which has nine employees and a network of 20 dermatologists, has performed more than 10,000 consultations. Its services are covered by Medicaid and some private insurers.

Wong is one of a “huge, huge number of entrepreneurs working in health-care IT and services who really want” to improve services for poor, uninsured, and Medicaid patients, says Margaret Laws, director of the California HealthCare Foundation’s Innovations for the Underserved program. Few venture capital firms have shown interest in funding these types of startups, so donors are helping to fill the gap with grants, loans, and equity investments. Direct Dermatology got just over $1.2 million in 2012-13 from the California HealthCare Foundation and the Kresge Foundation in the form of convertible debt.

Businesses and nonprofits seeking to improve health care for the poor received more than $81 million in debt and equity investments from foundations in 2012, according to a December 2013 report from California HealthCare, which is dedicated to improving access to care. Although there is no historical data on this type of funding, Law believes the numbers are going up, propelled by the Affordable Care Act’s goal of insuring all Americans. The Obama administration is projecting that in 2014 more than 19 million people will join Medicaid, the national health-care program for the poor, now that 25 states, plus the District of Columbia, are expanding eligibility criteria for the program.

Before Obamacare, hospitals and clinics resisted incorporating entrepreneurs’ new products into their systems, says Veenu Aulakh, executive director of the Center for Care Innovations, a San Francisco nonprofit that acts as an intermediary between health-care providers and startups. There’s “now a sense of urgency” about adopting innovations that make them more efficient, she says.

Sims Preston, chief executive officer of Morrisville (N.C.) startup Polyglot Systems, says the 2010 health-care law has helped his four-year-old company sign up more than 300 pharmacies, 200 clinics, and a handful of hospitals as customers. Polyglot’s software, available in 18 languages, prints instructions for taking medicine in formats that patients with low literacy levels can understand. The shift to reimbursing for quality of care, rather than quantity of care, “means the mission that we’ve been on now has a business case to support it beyond simply the moral case,” says Preston, whose company has received about $2 million in grants from the National Institutes of Health.

Propeller Health, a four-year-old startup in Madison, Wis., that makes hardware and software to help sufferers of asthma and other respiratory diseases manage their conditions, is also partially backed by California HealthCare. Asthma attacks are a leading cause of emergency room visits and hospitalizations in the U.S., where 25 million people—many of them children in low-income families—are afflicted, according to the American Lung Association. The 22-person business received a second investment of mostly convertible debt from California HealthCare in June, for a total of just over $1 million from the foundation. Propeller Health co-founder and CEO David Van Sickle says the increase in demand for technology like his is linked to the Affordable Care Act’s efficiency push. Insurance companies are willing to pay for Propeller’s product because it reduces trips to emergency rooms, producing “savings of between $700 to $1,000 per patient, per year,” he says.

Purple Binder, a four-person Chicago startup that helps health-care workers find community services for patients, also credits Obamacare with making its online tools more compelling: “As health-care providers take on more risk, they need to leverage existing resources to keep their patients healthy,” says Joseph Flesh, the company’s co-founder and president. For instance, using Purple Binder, a pediatrician can connect a needy mother with a local church that’s handing out diapers. The startup makes money by selling subscriptions to providers and through paid listings on its site.

New York-based business accelerator StartUp Health is using a $500,000 grant it received in December from the Robert Wood Johnson Foundation to advise entrepreneurs around the world on how to build businesses that improve access for the poor. “If we’re really going to solve the big challenges in health care, we have to focus on bringing innovation to the underserved communities” that make up a large percentage of medical spending in the U.S., says Unity Stoakes, president and co-founder of StartUp Health. “It’s not just a market that needs to be served. There is a real business opportunity.”

That’s why Direct Dermatology’s Wong is confident he’ll eventually be able to raise money from venture capital firms and strategic investors such as health insurers for expansion plans that include hiring at least six more employees this year. “There’s a lot of financial incentive for adoption of solutions like ours,” says Wong, prompting “interest not only from foundations but from traditional investors.”

It’s 2 a.m. You wake up to discover your 3-year-old daughter has a high fever. What do you do?

Today, your options are limited. You can call the pediatrician only to reach the answering service, which instructs you to dial 911 in case of an emergency. You can drive 20 minutes to the emergency department where you and your daughter could wait several hours. Or you can endure a sleepless night until you can reach a doctor the next morning.

But what if a pediatrician could come to your house and advise you what to do? It could happen today. But it wouldn’t be a traditional house call.

If you’ve ever used Skype to talk face-to-face with a loved one across the country, you understand how technology can eliminate distance and time.

As a parent, how much would you pay for the ability to reach your doctor instantly? How would you feel if such a service reduced – rather than increased – what you’re paying now for your health care? It could happen.

What about when a man’s back pain flares up during a trip abroad? He could go to the local emergency room and hope there is a translator who speaks English. Or he could obtain advice from his physician back home through a video consultation. A writer for the Harvard Business Review called these “virtual visits“ a top 10 innovation that will transform medicine. However, the author points out many challenges still must be overcome before such visits with transform health care.

Medical technology can do more than just provide convenience. It also supports higher quality.

For example, the typical patient in an ICU is monitored continuously but is seen by the responsible physicians only once or twice each day. Imagine if a team of centrally located specialists could support this care and follow the patient’s progress hourly through vital-signs monitoring, the patient’s electronic medical record (EMR) and video technology. Today, there are expensive ICU robots that can assist with this function. However, with the increasing quality of cameras and the ease of transmitting video through computers and mobile devices, all ICU beds could have individual, inexpensive systems installed to help patients achieve a more rapid recovery.

The same combination of approaches could be used to provide immediate consultation for patients in the ER. For example, a small number of neurologists could evaluate patients in dozens of ERs whenever they’re presented with symptoms of a stroke. Compare this approach to waiting for the local neurologist to drive from his home or medical office. With technology, life-saving care with better quality outcomes at a lower cost is within reach.

When I talk with CEOs about their own care, they say they would be willing to pay more for these high-quality, convenient services than they do for the medical care they receive today. They just don’t believe it’s possible. That perception would change rapidly if executives knew such services were available at a reasonable cost – both to them and their employees. In fact, it would disrupt the entire health care world.

Why these technologies don’t yet apply to health care

In the past, video connections were unreliable, phones weren’t “smart” and EMR use was limited to just a few organizations. But all of that has changed. While doctors would need to be licensed in all of the states in which they provide “virtual care,” that’s not what’s holding up progress.

What’s stifling these medical innovations is the reimbursement system. If you are paid to see patients in your office, then that is what you do – even if virtual care could be provided twice as conveniently at half the price.

What the future might look like

Overcoming technological and regulatory issues is challenging but doable.

Translating potential into practice will require three shifts in health care: First, payment to doctors and hospitals has to be prepaid to reward increased efficiency. Second, physicians need to work together within and across specialties to aggregate the volume required to achieve economies of scale. Finally, doctors need to agree on how high-quality medical care should be provided for particular medical problems. This way, patients can receive the same level of excellence seven days a week, regardless of which physician is providing the video consultation at the time.

In last week’s article, I noted that some of the least cost-sensitive patients (the ones with the best health insurance who, in their day-to-day lives, expect the convenience that technology affords) will likely be the ones who first demand this virtual concierge service. But once this process starts – and once people recognize that the cost to provide this service is less than the current model – it has the potential to produce industrywide disruption.

Once mass adoption begins, the increasing volume will lower costs further and accelerate the process of adoption.

The 2 a.m. house call may be available before we know it.