Concierge Care For The Poor (w/Angela and Brett Bymaster)

– [Dr. Z] Hey Z-Pac, it’s me, Dr. Z. Today we’re having a lot of fun. Hey guys, welcome to the show.

– [Brett] Hi.

– [Angela] Hello.

– [Dr. Z] Dr. Angela Bymaster, and her husband, Brett. Now the reason we’re having you guys on, and this is just so awesome, because I’ve always been talking about like hey, what about bright spots? We talk about Health 3.0 and transforming healthcare, and the alt middle, and trying to actually do a ground up clinician-led transformation of health care. And then people like, well, so how do you do that? And I’m like, well, these guys are doing it. So Angela and Brett are running a clinic in San Jose, California, which is neighbor to me, called Healing Grove Health Center. What they’ve done is nothing short of remarkable. They’ve actually combined a direct primary care model, which is one vision of Health 3.0 that I’ve been talking about for years, with a care model for our poorest, most vulnerable, uninsured patients. And they did it, they started it during a pandemic. Welcome to the show, you guys.

– [Angela] Thank you, so happy to be here.

– [Dr. Z] Man, so you guys, God, you guys are such an adorable couple, by the way. Just look at them. Look at them. I gotta show, I gotta show, I gotta show people something. So you came and you were just like “Oh, by the way, this is our family.” Look at this. Most beautiful family you’ve ever seen. Tell me a little about this picture.

– [Angela] So yeah, our oldest children are all siblings. They’re from South Sudan, and they came to us as teenagers. And then my grand baby Chelsea girl is there in the middle, and she’s the cutest baby in the world. And then Nehemiah is our biological child right there in the middle. And, yeah, we have been together for, goodness, since 2008 that we’ve had those kids.

– [Brett] So our grand baby Chelsea, she’s two now, and she’s our personal cheerleader. So when I walk in the house, she literally jumps up and down and says “Grandpa, grandpa, grandpa, grandpa.” And so she’s actually, they’re in Africa right now visiting people, and so I’ve been asking my wife to do the cheerleader thing while she’s gone, and she doesn’t, she doesn’t do it.

– [Dr. Z] Doctors don’t cheer lead very well.

– [Brett] No, they don’t. She doesn’t say “Husband, husband, husband, husband.” I’m kind of disappointed.

– [Dr. Z] So it’s funny ’cause Angela, you trained at Stanford like I did.

– [Angela] Well sort of. I mean I think we pretend to be connected to Stanford. It’s the Stanford-O’Connor program. We never actually went to Stanford, but yes.

– [Dr. Z] Family medicine.

– [Angela] It’s family medicine.

– [Dr. Z] Yeah, yeah, yeah.

– [Angela] Got their own hospital.

– [Dr. Z] And you finished in what, 2006?

– [Angela] I started in 2006, finished in 2009.

– [Dr. Z] Got it. Now you were always kind of drawn to doing a different type of care though, and why is, tell me a little bit about your backstory.

– [Angela] Yeah, for a lot of reasons. Mostly spiritual reasons. I’ve just been really, really connected with wanting to care for the most vulnerable in the community. And yeah so I started out actually with Valley Homeless Healthcare. So working for the homeless program for the county. Was there for six years, and then I worked at an FQHC in my neighborhood, working with low-income Latinos for five years, and then finally started my own clinic. And I should mention we live in a low-income neighborhood as well.

– [Dr. Z] And you felt always kind of drawn to that, both of you, right, through your spirituality, your religion, Christianity, the call to help the poor?

– [Brett] Yeah. You know, Jesus, we’re big fans of Jesus. And he had this, he had this habit of hanging out with poor people and messed up people, and the people that everybody hated. And so for us as Christians we said “Well, what would it like look like for us to do that?” And so when we moved into San Jose, we looked at a poverty map, and we just picked the poorest neighborhood in the city. We send our kids to the poorest school in Silicon Valley. So we used to have the only African American kid at an all Mexican school. And now we have the only white kid at an all Mexican school. Which there are some funny stories, as you can imagine.

– [Angela] Oh yeah. Well especially with our young, our biological child, when he was born, he grew up in this family where everybody was black who was a teenager, and everybody was white who was an adult, and he was trying to figure it out.

– [Brett] So we loved to just screw with his head, and so we’d be like “What race are you?” And he’s three and he’d be like “I’m Mexican, “or I’m black.”

– [Dr. Z] Wow.

– [Brett] So when he turned four we were like “What race are you?” And he goes “Well, right now I’m Mexican. “When I get tall,” and he points to his brother, “When I get tall like him I’ll be black. “And then when I get old I’ll be white like them.” And we all laughed so hard. We were like that is so logical. Old people are white in his family and teenagers are black. And then we realized afterwards that we never corrected him.

– [Dr. Z] So he still thinks-

– [Angela] He figured it out.

– [Brett] It took him a couple years. We were so busy laughing.

– [Dr. Z] What’s amazing about this story of yours, it’s so, we talk about alt middle in all this. We talk about transcending these very petty divisions that we have, but you guys are actually walking that walk from a spiritual standpoint, right? This idea that hey, JC was kind of down with the poor. And you actually said hey, here’s a map, instead of what everybody in the Silicon Valley does, which is where’s the best, most richest, whitest school, because the Bay area is very segregated.

– [Angela] Oh yeah.

– [Brett] It’s super segregated.

– [Dr. Z] Right, it is. And it’s this kind of, it’s been getting worse over time if anything. You did the opposite. You said we’re gonna go right into where’s the zip code that’s probably gonna have the most poverty, but then by extension the worst health, right? Why is that? Why are those correlated?

– [Angela] Yeah, so, I mean obviously. Your people know all about social determinants of health, and you see those pie graphs, and you get this much is what medical care does, and most of the rest of the graph is everything else. And it’s the fact that my neighborhood had no parks until, actually they built one so that was good. We have a park now.

– [Dr. Z] You have one park, yeah.

– [Brett] Yeah. You know, our zip code is 80% Latinos, the vast majority of which live in the bottom quintile. One zip code, or one, one census block over, literally five blocks over, 80% of the population is white, and most people are in the top quintile.

– [Dr. Z] Willow Glenn.

– [Brett] Willow Glenn, yeah, that’s right.

– [Dr. Z] I’ve been there. I’ve had their thin crust pizza. It’s delicious.

– [Brett] Oh, it’s really good. The life expectancy difference is six years.

– [Dr. Z] Oh my God.

– [Brett] Our people die six years earlier. And literally we’re five blocks apart.

– [Angela] Yeah, you know it’s not about air quality or that sort of environment.

– [Dr. Z] Yeah, ’cause you’re sharing.

– [Angela] Yeah, we’re in the same place. But it’s everything else. And so I guess, and it’s different for every group of poor people a little bit. And so part of just living there is also experiencing all of the things that everyone goes through in a way. Every time that they pass over the neighborhood in terms of road improvements or parks or anything like that, then we’re a part of that.

– [Brett] Yeah, I mean we’re walking our kid to school and he looks down at a used condom on the sidewalk, ’cause we have a lot of prostitution, and he’s like “Daddy, can I play with that balloon?” And I’m like “No, no you can’t play with that balloon.” Or a few weeks ago there was a shooting right in front of our house, and the shooting happened at four a.m., the cops show up at 7:30, and then we’re walking out, and the cops are tagging the bullets on the street.

– [Angela] Evidence, you know, there’s casings on the street.

– [Brett] And he’s like “Mommy, what’s that?” And we’re like “Don’t worry about it, it’s not a big deal.” ‘Cause if he finds out that, yeah, he’s gonna-

– [Dr. Z] And then five blocks away in Willow Glenn. The pinky is extended while sipping water. So this was clearly like a deep calling for you guys. And what’s interesting is you had worked in the sector taking care of the poor in the Federally Qualified Health Centers, the FQHCs that you mentioned and all of that, were there frustrations there? What was going on with that?

– [Angela] Oh my goodness, yes. It was extremely frustrating. And I was, just everything about it, it’s a little hard to even describe. There was a lot of problems with administration and organization and a lot of times we wouldn’t even see patients because the people at the front desk would just answer the phone, I could hear them saying “Oh, we’re busy today, “why don’t you go to the urgent care?” We got nobody in the waiting room.

– [Dr. Z] Oh my God. So it’s like a VA scenario there.

– [Angela] They just didn’t wanna do any work I guess. And I just, everything, there were holes in the floor. Half the time the fax machine didn’t work. We were constantly having temperature excursions with our vaccines. I mean it was just like, I felt like I was living somewhere else. Somewhere that did not have enough to actually provide care for their patients. And this isn’t universal, there are great FQHCs out there that do really beautiful work, who have really good organization, but for some reason I just ended up in a bad situation.

– [Dr. Z] And that sort of triggered you to go to the next thing, which is interesting, because then, now so Brett is not a doctor. What’s your background, Brett?

– [Brett] So I’m an electrical engineer so I did 15 years of analog circuit design at Silicon Valley startups, which I loved. And I, for most of my career I worked part time, and did, so part time engineering to make money, and to pay off her bloody medical school.

– [Dr. Z] You know, they’re just an albatross aren’t they?

– [Brett] It’s great.

– [Dr. Z] These doctors.

– [Brett] I’m not a doctor, but I paid for the degree.

– [Angela] He thinks he’s a doctor.

– [Brett] That should give me something, right? Although I am a very bad patient. She’s always trying to fire me.

– [Angela] I have fired him so many times.

– [Dr. Z] From your own practice?

– [Angela] From my practice.

– [Dr. Z] That’s amazing. Well there’s only so many urethral swabs you can get away with.

– [Brett] So she was coming home and complaining about the FQHC, and what I’m thinking is process, process, process, process. The engineer, like where’s your process? How are you using systems thinking to solve these really hard problems? And the reality is that when the government gets involved they put a lot of constraints on you so that you can’t use system thinking. So you can’t really design systems that are setup to give great quality care at scale.

– [Angela] Yeah, and I think it was really easy for me to be judgy and frustrated when I was there. And since then, now that I’m actually a little bit administrating my own clinic, I’m realizing so much of that was really put on them. So it wasn’t like “Oh, these are bad people.”

– [Brett] You should share your nickname. Your judgy nickname.

– [Angela] My judgy nickname?

– [Brett] Her friends used to call her Judgy Bitch.

– [Angela] I did not deserve, no, actually I really did.

– [Brett] Yeah, she does.

– [Dr. Z] If this is Christian care, I want a part of it. I’m ready to sign up.

– [Angela] JB. But I was, I was super judgy. And then afterwards I’m like “Oh, well it’s because somebody “was making them constantly report “how many mammograms we were doing.” And of course our EHR sucked in a really big way, and couldn’t even tell us how many patients we had, or anything at all. Which I also, I wrote a skit about it because I just couldn’t take it anymore. And I was just so frustrated, the inefficiency.

– [Brett] She’s such a hippie doctor. When she gets frustrated she writes skits and it’s weird.

– [Dr. Z] That’s extremely family medicine. What happens when a surgeon gets frustrated? They throw a scalpel at a tech. Family medicine’s like I wrote some slam poetry. Remind me we gotta read some of your poetry. So you had all those frustrations you recognize becoming an administrator because I did that at my clinic. I was like these administrators, I tell you, they’re breaking us all. And then you go become one, and you’re like oh my God, the constraints and the horror, and the trying to keep the lights on. And trying to do the right thing for different masters, right? It generates that moral conflict, that moral injury, right? So you somehow launched into that.

– [Angela] Yeah, so basically, I mean the truth, if you wanna know the truth, we just felt called by God to start a clinic. And we were like “Okay, let’s do it.” But we know nothing about starting clinics. And, you know, I had been flirting with the DPC idea for a long time, and sort of reading stuff. And it’s also very family medicine to love DPC.

– [Dr. Z] Direct Primary Care, for people who don’t know. And we have lots of videos on that, you can check them out on our website.

– [Angela] So we just started kind of googling how do you get involved with starting a clinic.

– [Brett] Yeah literally, we have a friend that’s got a really strong prayer gift, and he came to us, and said “Hey, I think God’s calling you to start this clinic.” And there’s this, there’s this really crazy passage at the very end of the Bible, Revelation 22, where God’s painting a picture of what heaven will be like. And there’s a throne, and out of the throne is coming a river. And the river is flowing through a city, which is really important. And the river’s crystal clear. And that represents what God’s vision, we have a river flowing through the middle of San Jose.

– [Angela] Guadalupe, not crystal clear.

– [Dr. Z] Oh yeah, it’s a little bit murky.

– [Brett] And so, and then on each side of the river there are these trees, the leaves of which bring the healing to nations. And so we stopped there and said that’s the vision. And so he said the name of the clinic is gonna be , which is in Spanish the leaves of healing.

– [Angela] And so we looked at each other, and we’re like we’re not making The Leaves of Healing Medical Clinic in the middle of San Jose. I mean, lots of people will come, but they’re gonna be so mad.

– [Dr. Z] The word medical is involved. Also something else.

– [Brett] We actually thought about starting a covert rehab center called The Leaves of Healing, and when they come in we’re like “We’re like well we don’t have marijuana, but would you-“

– [Dr. Z] We do have Jesus.

– [Angela] We’d get beat up every single day.

– [Brett] So the Healing Grove Health Center is the non-marijuana translation of .

– [Dr. Z] I see, I see, I see. And that’s how the germination of this idea, The Healing Grove Health Center started. This is where it gets really interesting, and, again, we’re kind of painting, we didn’t cut to the punchline, we’re building a case here. So it’s very easy to go “I’m gonna take care of poor people,” and then very hard to do. You came up with a very unique solution right out of something Jesus would have said, if my limited understanding of the Bible is correct, which is hey, there’s people with means, and there’s people without means. And it turns out one of the greatest things you can do as a person with means is to be compassionate towards those who have less, while still actually helping yourself too. And so what’s your model here.

– [Angela] Yeah, so either Jesus or Robin Hood or Tom Shoes, or something like that, yeah. Yeah, if people want concierge medical care they can come, we give them really good care. They pay $200 a month, and then that pays for them and two low income people to be able to receive care.

– [Dr. Z] So when I heard this I was like oh, you guys have to come on the show, ’cause I was like this is a brand new conception of how you fund care. Everyone’s talking about well maybe the government should just single pairify the whole thing, and then everyone will get the same crappy care. And physicians will be miserable, patients will be happy, but because, until they have to wait in line or whatever it is. Hey, maybe that’s an answer, I’m not taking that off the table. But I’d say this. Wait, there are plenty of people here who are, 200 bucks, so that’s 2400 bucks a year. You get the doctor’s cell phone, concierge level care from a wonderful doctor with a great sense of humor.

– [Angela] I’m texting with people’s, doctors at Stanford, their specialists. I’m coordinating care. I’m saying hey, he feels tired, it’s not his heart this time, it’s actually his neurological condition, or whatever. And I’m able to do my primary care thing, and be the quarterback, and run the show, but what it looks like to the patient is they’re getting great care and they aren’t waiting, and they’re not making those phone calls themselves.

– [Brett] And we’re charging the same price as a normal concierge clinic.

– [Dr. Z] That’s right.

– [Brett] So MDVIP is right at our price point. So what we do is, so our model is 300 paying patients and 600 low income patients, so a total panel of 900. And then we just pay our doctors crap. And it all works out. So we, my wife and I are actually just committed to retiring in poverty.

– [Angela] This isn’t gonna get more people to join us.

– [Brett] Did I say crap? I meant-

– [Angela] You weren’t supposed to say that.

– [Dr. Z] I sense that you’re joking, but you may not be. So how is, let’s dive into that. A panel of 900. So 300 high maintenance concierge where they have your cell, right? But of course you can provide amazing care to 300 patients, right? And then 600 that had nothing.

– [Angela] Yeah, totally uninsured. And this is-

– [Brett] But the beauty is they’re all getting concierge care. So here’s what’s great. In a normal poor people clinic you get a lot of “Well, they’re poor. “Yeah they come and wait for two hours”-

– [Angela] They should be grateful for what they get.

– [Dr. Z] You know what, the poors need to wake up and recognize that we’re giving them a gift.

– [Brett] Exactly.

– [Dr. Z] That’s literally what it feels like.

– [Brett] Just absolutely shitty healthcare. So we talk about there’s wealth care-

– [Dr. Z] By the way, I don’t think I approve of that language.

– [Brett] Oh well, sorry I’m a pastor. Let no unwholesome talk come out of your mouth. She’s a much better person than me. And maybe you are too, I don’t know. I don’t know you that well.

– [Angela] I would say most likely ’cause I know you really well.

– [Brett] Yeah, that’s true.

– [Dr. Z] So you were saying even the, the poor patients get this concierge level care.

– [Brett] There’s, we talk a lot about the American Healthcare System is the most segregated part of modern society where the wealth get wealth care and the poor get poor care. The poor care really is poor. I mean it’s really terrible care. And so in my, when we originally talked about this, we’re really into serving the poor, and so we thought you know what we wanna do is we wanna raise a bunch of money, and have a philanthropy-

– [Angela] Charitable clinic.

– [Brett] Charitable clinic. And I actually had this really cool experience. I read the whole Bible in seven weeks.

– [Dr. Z] Wow.

– [Brett] Just all at once.

– [Angela] In a refuge camp in Uganda. It’s a long story.

– [Dr. Z] Wow, and it wasn’t an audio book? It was like Milton Berle reads the Bible, it was reading it.

– [Brett] Reading it and taking notes. And what I realized is that Jesus did a lot of healing, and he healed mostly the poor, but not exclusively so. And so that’s where the idea of this model came from. And it’s the idea that hey, if our care is so good that some rich guy’s gonna pay $2400 a year for it, if we have a wealthy patient sitting right next to a poor patient, we’re not gonna give different care to them.

– [Dr. Z] You can’t.

– [Brett] You just can’t.

– [Dr. Z] You can’t.

– [Brett] So what this system does-

– [Angela] It’s all in the same exam rooms, it’s the same doctors, it’s the same everything.

– [Brett] It holds us accountable to give concierge care to the poor. And that’s what they need. They need it more.

– [Dr. Z] They need it more.

– [Brett] They need it more.

– [Dr. Z] They need relationship-driven understanding. It’s everything we talk about in Health 3.0. Rehumanized, analog care that takes time to know that unique patient, and their mind, body, soul issues.

– [Angela] Yes.

– [Dr. Z] Which is part of your mantra.

– [Brett] And evidence based. We’re giving them the very best of modern-

– [Angela] When evidence based makes sense.

– [Dr. Z] That’s true because sometimes, sometimes it doesn’t apply to that patient. You have to know, you have to have the grace to know when to violate whatever randomized control trial that was done in white people, you’re gonna apply to this little old lady.

– [Angela] That’s so true.

– [Dr. Z] Is there evidence-based Christianity?

– [Angela] Ooh.

– [Dr. Z] Maybe we should forge a new faith.

– [Angela] I actually think it would be super fun to do a bunch of clinical trials and studies. I’m not a researcher. I’m super, super far away from knowing how to set up studies.

– [Brett] Too much of a hippie.

– [Angela] But, about, yeah, I mean I know there’s been a couple studies about prayer and stuff, but wouldn’t it be fun to study spirituality scientifically?

– [Brett] There have been a lot of studies. And the evidence is great. The evidence is there.

– [Dr. Z] It’s just mind, body, spirit is just obvious to any chaplain. And they have to go across denominations. They just know this intuitively. And I think we kind of let that piece drop off in medicine a little bit. Now, so one question is do people who come to your clinic, if they’re poor or rich, do they have to be Christian?

– [Angela] No, absolutely not. And we love different perspectives. We love just anybody walking in. And we, always, what we say is we say “Hey, we’re a Christian clinic, “we would love to pray for you. “We would love to invite you “into these different kind of prayer nights, “and different kinds of spiritual experiences “if you want to. “But it’s optional.” If you just wanna get your biology taken care of and that’s it, that’s fine.

– [Brett] Some people are just like “I think that’s total BS, “I don’t want anything to do with it, “but I want somebody to care for me.” And that’s fine for us.

– [Angela] Yeah, that’s great.

– [Brett] That’s great.

– [Dr. Z] Man, that’s kind of awesome. So where did all this tolerance and hope and joy come from? Is this just who you are?

– [Brett] It’s cause we actually read the Bible.

– [Dr. Z] What? You actually read it? No, come on.

– [Brett] I’m sorry, that was probably.

– [Angela] That was judgy. You’re gonna get the nickname.

– [Brett] Yeah, now who’s the judgy bitch.

– [Dr. Z] Yeah, uh-huh, judgy man-bitch right here. I love it. So let’s dig in a little to the, to the logistics of this because other people here who are watching, are like either I’m a person of faith or I’m not, but I wanna do something like this.

– [Angela] But can I-

– [Dr. Z] Yeah.

– [Angela] Really quick just tell two stories?

– [Dr. Z] Absolutely.

– [Angela] That sort of demonstrate how it works with the mind, body, spirit together.

– [Dr. Z] Even better.

– [Angela] Okay, so we had one patient who, she was volunteering with us, but COVID was such a disaster in our neighborhood, and we can talk about that it you want to, but-

– [Dr. Z] Please do, yeah.

– [Angela] Everyone lost their job, everyone was poor, everyone was out of food. It was just a huge mess. And so we had this crazy, ghetto food distribution system that we set up that was awesome, and we didn’t really ever want anyone to inspect us, but it was amazing.

– [Brett] Can we edit that out?

– [Angela] Got food to people.

– [Dr. Z] So how much expired cans of food did you hand out?

– [Angela] Yeah, don’t ask.

– [Brett] No, no, no, it was good food, it just-

– [Angela] Might not have always been refrigerated. It was great.

– [Brett] It wasn’t that bad.

– [Angela] And so we had a lot of volunteers. So one of the volunteers ended up getting sick. A lot of people got sick in our neighborhood, but this one particular volunteer ended up getting sick with COVID, and her whole family had gotten it. She wasn’t really our patient, but they were all volunteering and helping out. And she had gotten it, someone in the family, of course everyone lives in these large families and small spaces. Someone had brought it home from work and then everyone got better.

– [Dr. Z] Everyone got it.

– [Angela] Everyone got better except for her and her sister. And so they were hospitalized. And then they ended up getting in the ICU, and they were very sick. So her husband and her son would come over all the time, and we would just pray with him. Of course he couldn’t go see her. And he was Spanish speaking. And he would call the hospital, but no one, he couldn’t get anyone to talk to him in Spanish, and he couldn’t figure out how she was doing. He didn’t know what was going on. And so she was just gone. And so we would, so we did the concierge thing, of just like okay, I’m gonna pretend like she’s my patient, and I’m gonna call. He’s given me permission to ask how she’s doing. And then I set it up, I realize she’s not doing well. I start setting up family meetings, and we get in there, and they’re talking about ECMO and all kinds of things. And there’s no translator there, so we’re bringing translators, and we’re getting them in there to see her. And even at one point I just really asked the team, I said “Could he,” it ended up she was clearly going to die, and he just wanted to give her one last hug. And I just said “Could we make that happen? “I 100% know he’s not gonna get COVID from her, “they all had the same strain of COVID. “I tested them myself after, “and they had it on the same day.” And of course they did not allow us to do that. That trying to humanize and ask for those things that, you know he’s never gonna forget that for the rest of his life, and if he could have just had some closure with her, that would have made a big difference. And being able to just help popple to even enter the hospital, even know how people are doing in their family, and then just all of that prayer. And then afterwards we were able to give him a certificate from the county that just said they had valued her contribution as a volunteer during COVID. Just being able to constantly honor her memory, and continue to support him through all of that was something the clinic was able to do well. And I think without us there she would have just disappeared. And there would have been no communication, and that’s amazing.

– [Dr. Z] That’s being a shepherd. That’s what primary care was designed to do, and yet it wasn’t designed to do that, it was what it was meant to do, what we were called to do for our patients, and you actually can do that. And this thing about dying alone has been, we’re gonna look back on this as one of those things that’s just a, it’s a stain on the moral fabric of the country, and we really oughta be held accountable for this behavioral because it’s unconscionable. So thank you for fighting for that.

– [Angela] Yeah. So I mean we tried. But at least he got to look at her through the glass. There were things that he did get to do, and he was able to have a piece of closure. The other story I wanted to tell is a man who came in, he was just dragging his foot, ’cause he clearly had some kind of neurological problem, and he was accompanied by his son, and he was just kind of asking if he could get care. He said “Someone said you would help me here.” And it turned out he was uninsured, Spanish speaking, and just didn’t know where to go. But he had been getting progressively weak in both arms and in one leg over about two months. And it took him a while to come in. Then by the time, of course he was uninsured. I’m thinking I need MRIs, I need a lot of things. But, we’re really passive aggressive, and we are able to like call a lot.

– [Brett] Oh, you should hear her working them on the phone. Like I swear to God she’ll be on the phone, and she’ll be like “Oh, I understand, “so he’s not gonna get an MRI, “so that means that we’re just “gonna let him sit in my office and die.”

– [Dr. Z] Nice.

– [Brett] And then there’s just this long pregnant pause, and they’re like-

– [Angela] They found a way. That was awesome. They found a way to get an MRI for him.

– [Dr. Z] Because a lot of your time must be spent coordinating care for uninsured ’cause that was our thing at Turntable too. It’s one thing if you have our care, but now we have to get you-

– [Angela] Other care.

– [Dr. Z] Yeah, yeah.

– [Angela] Yeah.

– [Dr. Z] So keep going, keep going.

– [Angela] Yeah, and the county is lovely, they just process things slowly, ’cause they have so many patients, and it makes a lot of sense. And so we just have to get the guy to the front of the list ’cause it’s really urgent, and he ended up with a big old tumor in his spinal cord.

– [Dr. Z] Oh my.

– [Angela] And county did a great job, got it out. We just were able to move it fast.

– [Dr. Z] At Valley.

– [Angela] Valley, yeah. His son had quit school in his senior year, he was at UC because he had to drop out ’cause his dad couldn’t make any money, ’cause he, you know, the family was really, really poor, but he had, through scholarships and really hard work, he was a senior in college. And so he was home again. So we immediately, in addition to them medical care, we were like, “Hey, join our men’s group.” And we got the son volunteering with us, and getting some, just health care hours. And he’s been great, and he’s going, we helped him figure out how to work out his financial aid so he can go back to school. Everything is just like, the whole family. We got them financial aid to help pay their rent. We got whole bunch of stuff to make their lives better in more ways than just the tumor. And he’s gonna be fine.

– [Dr. Z] So that’s Health 3.0. It’s, we call the social determinants of health, right, that’s the wonky way of saying people’s lives matter. How they live matters probably more than how they’re born with their genetics and all that, or at least as as much. But we have no, because in this country we’ve kind of medicalized all our social problems And so here’s somebody who’s actually solving them with the money from people who are well off and are willing to pay for great, the same great care. This seems to me, now so I have a question though. So how, how does this really work out? Like, are you absolutely broke? Like, can you make a living as a doctor doing this? ‘Cause I know the doctors that are watching are like “Yeah, but I bet she drives a, you know “just a Tesla model three,” which is the Honda civic for the Bay area.

– [Brett] No, we actually rode our bikes here. No, I’m just kidding.

– [Brett] We took the bus.

– [Dr. Z] The bus.

– [Brett] 12, 12 transfers on the way here.

– [Dr. Z] Valley Transport Authority. For people we don’t know, in the Bay area, riding the bus anywhere here on the peninsula is a fool’s errand.

– [Brett] Well let’s let’s talk business.

– [Dr. Z] Yes.

– [Brett] So here’s, we had this idea, we were trying to figure out how can you actualize it? And so at the beginning we didn’t know we were gonna do this kind of model. So we were just like, we wanna, we have this idea that we wanna care for both the wealthy and the poor. And so we got connected with a faith-based charitable clinic consulting group called ECHO. And they provide free services to people that wanna get a clinic started, and they’re awesome. So they really helped us. They’ll give you an action plan. They helped us kind of actualize a plan.

– [Angela] And they’re free.

– [Brett] And they’re free.

– [Dr. Z] So they help you for free?

– [Angela] Yeah. They’re amazing.

– [Brett] And, we got a lot of ideas, but we still couldn’t figure out how to, we kind of had DPC ideas, and we couldn’t figure out what we would do. And then we came across, there’s a clinic in Modesto called St. Luke’s, that’s a Catholic clinic. And they’ve actually been doing the model that we’re talking about for 10 years. And they got it up and running, they figured out the compliance situation really drives you towards providing terrible care. The compliance framework that we have in America needs a doctor to see a new patient every 12.5 minutes. And the goal at the end of the visit, I mean, you guys know this better than me, but really the goal is a billing code. If you generate, if every 12.5 minutes you generate a billing code, it doesn’t matter if your patients die or live. Nobody cares. You got a billing code, everything’s good. And so operating outside of that model is, is really, really difficult legally. And so we really struggled with, so in California there’s anti-kickback laws, there’s a Corporate Practice of Medicine.

– [Dr. Z] That’s right.

– [Brett] It is really, really difficult. And so St Luke’s had figured out an incorporation structure that makes it legal to do this in the state of California. And that’s the key. And so we actually have, we actually have two corporations. We have a nonprofit foundation, and then we have a nonprofit social purpose corporation. And then we got an attorney. If anybody in the DPC world, there’s a guy named Jim Eischen that’s an attorney that does a lot of work in concierge and DPC care. And we have a very carefully crafted patient agreement that allows us to operate compliantly as a, as kind of a concierge/DPC practice.

– [Dr. Z] And see people don’t realize this because we had to do this for Turntable in Nevada, it was the same thing. You can be considered an insurance company by taking a flat fee for patients, which is insane. These regulations, while I’m sure they were well-intended early on, anti-kickback and all that, now come back to stifle innovation. This is a true ground up clinician and partner, clinician by proxy, led innovation. By the way, I have to put a serious point on that. We physicians are good at what we do, we’re not necessarily good at business. And so having some people to help, whether it’s ECHO, whether it’s the attorney that you mentioned, and we’ll put links to all this stuff so that people can click through and discover this. You know, we work with a company called Hint Health that had been on the show before, Zack and those guys.

– [Angela] We have Hint.

– [Dr. Z] You use Hint?

– [Brett] We use Hint and Spruce.

– [Dr. Z] Fantastic. That’s how you bill right? Using Hint, and keep your patient lists and all that patient relationship management software. And so there are entities that are doing this, and there we’re empowering people like you to do this amazing work like the stories that you told, so this can be done. This is a true bright spot that you can shine a light on.

– And it’s, like you said, you’re fighting against the system to do it, it’s an uphill battle, but it is doable. And all these different people have kind of, kind of forged the path. So, economically our model is tough because we’re trying to, we’re trying to come in at a normal concierge price, but in most concierge clinics they have 600 paying patients on their panel. So we have half of the pain patients. And so we’re able to, our, I think we just talk about numbers. Our physicians are getting paid 90 to 120 an hour, which in the Bay area is, is probably 60% or 70% of going rate.

– [Dr. Z] Right.

– [Brett] So they’re not living in poverty.

– [Dr. Z] Right.

– [Brett] But they’re not driving Teslas.

– [Dr. Z] Right.

– [Angela] I can make a lot more today if I went and knocked on Stanford’s door, anybody like that, but it’s a trade-off right? So in my world, what I get to do is so valuable that I don’t need as much money.

– [Brett] Yeah, she’s only making whatever, $100 an hour, but she’s not suicidal.

– [Dr. Z] Exactly. And that’s what I was gonna say. You came here with like this light in your eyes, excited, there’s an energy with you guys. When a lot of doctors come here, they’re just, they’re defeated before we even started.

– [Angela] Well I felt that before. In my other jobs, I felt-

– [Dr. Z] So have I.

– [Angela] I have felt that feeling. I remember, okay, this is really weird, but one time I went to the Martin Luther King Museum in Memphis, and they have this whole thing about slavery. And I was looking at all these pictures of slavery, and I felt some kind of attachment to it. I was like this is very strange.

– [Brett] Can we cancel her for saying that?

– [Dr. Z] You’re canceled just for saying Martin Luther King and being white.

– [Brett] You gotta be kidding me.

– [Angela] I know, it’s-

– [Brett] Not the same.

– [Angela] Everyone’s in privilege, blah, blah, blah, blah, blah. But I felt like why do I feel so strongly connected to all these pictures of slavery? And I was like “Oh my goodness, “I don’t feel like I have any freedom at my work.” I don’t feel like I have, I ideas, I know what my patients need, I just don’t feel like I have the freedom to actually go into that healing space with them in the way that I really know I need to do. And I was, now, I used to just do all these well visits and all these visits with me and my stethoscope, and telling people not to eat their pizza and eat more broccoli. It just was such a waste of time. And now I can just create a sports program for all the kids in my neighborhood. And boom, I just solved a whole bunch of BMI stuff, a whole bunch of like connection stuff, loneliness, all these things that were connected to the reasons for their poor health, and their poor health outcomes. And it’s like, that is freedom.

– [Dr. Z] Okay, all right look, yes, because freedom in my mind is the capacity to be authentically who you are. Our current medical system squashes the authenticity out of every single person that goes into it, unless they’re authentically a robot, which some are. Some are authentically cyborgs, we’ve all, we’ve trained with them, we know who they are. You could probably unplug one wire, and they would just .

– [Angela] And they get really rewarded.

– [Dr. Z] And they get rewarded. And you know what we need-

– [Angela] God bless them.

– [Dr. Z] We need them. Yes, exactly. But for everyone else, this opens up this kind of freedom. So do you have to make a ton of money? Now one thing I say is part of the reason I wanted to have you guys on the show is not that I want to advocate everyone give up 40% of their salary to do this work, although for many that will be a compelling, especially post pandemic where we’ve all suffered so much, this introspective time when we go “Do we really need…?” I basically stopped doing a lot of what I was doing to hustle for money, like trying to find sponsors, and trying to do this and trying to do that, because I’m like, you know what? I have enough that my family’s happy, I love what I do, I don’t wanna have to be inauthentic pitching some garbage, I’m just gonna do this. But I bet you, if you, if your kind of model kicks in, why can’t we take this, some of this government money that’s being squandered and actually go you know what, here’s a government subsidy for poor people to help pick these kinds of clinics, and in a capitated way. And you have to show some reasonable signs of outcomes that matter to patients.

– [Brett] And we’re doing that. We have gotten a lot of grants. We are taking capitated Medi-Cal reimbursements.

– [Dr. Z] Okay.

– [Brett] So here’s our rule. We will only take money from the government, like grants, if it’s something we were already gonna do. So in other words, we’re really refusing to prostitute ourselves to whatever big grant comes along the way. And there’s these huge HERSA block grants you can get that are, you can get a lot of money, but they come with big strings.

– [Dr. Z] Oh yeah.

– [Brett] And so we did join an independent physicians group, and we are taking capitated Medi-Cal reimbursements.

– [Angela] But it’s because we want to keep families together. So we have all these uninsured parents, and they have kids who have Medi-Cal. And I’m like if I’m gonna write a referral or anything at all, Medi-Cal needs me to be the PMD. And so I can, I can do that.

– [Brett] So we’re probably not gonna get, you know they give you all these bonuses if you do what you’re told.

– [Dr. Z] Yeah.

– [Brett] And my guess is we’re probably not gonna do what we’re told.

– [Angela] We’re gonna throw those in the trash.

– [Brett] But the key is in our model that that’s not our primary revenue source, and you’re ultimately, you’re ultimately enslaved to your primary revenue source.

– [Dr. Z] Right.

– [Brett] And our primary net revenue source is taking care of our concierge patients. And that’s what we that’s, that’s our accountability, right?

– [Dr. Z] Yeah.

– [Brett] And that’s a great, that’s the kind of accountability that I, that I want.

– [Dr. Z] That you want, yeah.

– [Brett] And the beauty of the model is, if there are Christian physicians out there that are excited about this, getting a philanthropic free clinic off the ground is really tough, because you really do have to raise a couple million dollars. And it’s tough to get that first check when you don’t have a proven track record. But if there’s a physician that has, that’s in private practice, that has 2,000 or 3,000 patients on their panel, the pitch is “Hey, I’m leaving, six months I’m done. “I’ll help you find another physician. “If you want, I have this new gig, “and it’s 200 bucks a month.” All you have to do is get 10% of your patients to convert, and boom, you got a funded.

– [Dr. Z] Fully funded clinic.

– [Brett] And then you go raise money for construction costs or whatever you need. You go to your church, you go to your community groups, you go to your friends.

– [Angela] And then you can take care of whatever uninsured people you want. In our neighborhood, it’s Central American refugees. Our friend is gonna start one in Sacramento, another Healing Grove, and he’s got a whole bunch of Syrian refugees over there that he’s really excited about providing care for.

– [Brett] It can be homeless people. You figure out, although homeless people is a little tough, ’cause it’s hard to have homeless people and wealthy people in the same clinic, unless you have-

– [Dr. Z] How does that waiting room look? In general.

– [Brett] So first of all, we don’t, we don’t have a waiting room because we don’t believe in waiting.

– [Angela] We don’t wait.

– [Brett] I hate waiting. You know, you go to the doctor and they shove you, I hate this, they give you this big set of forms to fill out, and you fill it all out, and then you walk in, and some MA asks you the same questions that are on the form, and then the doctor walks in and asks you the same questions on the form, like what, you guys are illiterate or something?

– [Dr. Z] Yeah, what’s going on? I hate that.

– [Brett] And so you wait for like an hour, the doctor knocks on the door, and then they don’t wait after the knock on the door, they just barge in, they ask a bunch of questions. you get three seconds with them, then they leave.

– [Angela] Everybody in the audience is a doctor, so just tone it down.

– [Dr. Z] Only 20% of them.

– [Brett] I’m sorry. I’m not really sorry.

– [Dr. Z] Keep going. No, we love to get angry.

– [Brett] So what we say is the doctor is waiting for you, instead of you waiting for the doctor. So we don’t have a waiting room, we have a welcoming room. We have a pastor that sits in the welcoming room, and it just has the most amazing-

– [Angela] So my front desk is a Pastora named Lordes, and she’s from Honduras, and she is so good at just loving everyone who walks in. So she does sometimes more than I do, ’cause she’s just, I go in there and we’re talking about their blood pressure or whatever, she’s already talked about all of their family, and how everyone’s doing, and what they’re worried about, and their worst fears. And she is like covered it all. And so then later we’ll kind of compare notes, and I’m like “Oh wow, you kind of did more than I did.”

– [Brett] she prays for them before they get to the doctor. Sometimes by the time they get to Angie their problem’s already solved.

– [Dr. Z] So it’s like a pre-pray situation. Pre-prayed healthcare.

– [Brett] Exactly, pre-prayed healthcare, yeah, exactly.

– [Dr. Z] I love it. I love it.

– [Brett] So we do have poor people and wealthy people together, but it’s not like, I mean I think you think a free clinic, there’s a bunch of poor people-

– [Angela] An alcoholic barfing on you or something.

– [Dr. Z] Right, right, right, right, right.

– [Angela] Poor people actually aren’t as scary or gross as-

– [Dr. Z] What?

– [Brett] They’re kind of normal.

– [Dr. Z] No.

– [Brett] Yeah.

– [Dr. Z] So everything I’ve learned is a lie?

– [Brett] Yes, yes, I’m sorry.

– [Angela] Even homeless people I think are lovely. And sometimes you can, I didn’t need a TV when I worked at the homeless clinic because I would just come home from work, and I felt like I had learned so much about the world. I was good.

– [Dr. Z] Yeah, it’s really true. How many maggots can you grow in a leg? It’s serious.

– [Angela] Sometimes I had to excavate through a lot of stuff before I found the whole leg.

– [Dr. Z] I mean as a physician, homeless, taking care of the homeless was one of those things where you learned everything about medicine, and the human condition. And you were like where has my compassion stopped now? That’s a check. Do I still love this person and care about their well being? Or am I so jaded now at year three of residency that I’m just like oh, dispo to street. And so it’s a constant thing. You know we’re being authentic and honest, it’s so hard to maintain that level of love, and only, and I tell you there was a point where I had a nadir of it and then since then it’s just been growing. Because, again, when you’re allowed to be you, the walls you build around yourself start to come down.

– [Angela] I think it’s also when you’re able to actually do something therapeutic for them it makes a big difference. People who are in the ER, I have a ton of compassion for people who work in the ER, and they just see one after the other, and people like repeat, repeat, repeat. And they aren’t able to do anything really tangible for the person. And so I think that’s why you built the wall, because you’re just like I can’t help you, therefore you’re bad. Because that makes it more, and I’ve definitely been there. And I think what has helped me is in the times where I can say “Oh my goodness your impossible situation is impossible, “and why don’t you come to prayer night, “and let’s just pray about it.” Or “Well, you’re $8,000 in the hole on rent cause of COVID, “hey, good news, we got a grant for that, “and we’re gonna pay off your rent debt.” If you can actually solve a problem for someone, or bring them into a place of hope, that is so gratifying that all those walls of you’re bad because I can’t help you-

– [Dr. Z] Yeah, yeah, yeah.

– [Brett] It’s important to say, we’re, at Healing Grove, so our doctors, our CEO was the founder of the Santa Clara County Valley Homeless Health Program.

– [Dr. Z] Wow.

– [Brett] So we have, that’s kind of where our roots are, but we’re not working with homeless people at Healing Grove. So homelessness is like a cliff. If you’re one step away from a cliff, and you take a step back, it’s pretty easy. If you take one step forward, getting, climbing back up that cliff is really hard. So we’re working with the families that have not fallen off the cliff yet. So these are the extremely, the extreme working poor. So our average family at Healing Grove makes $27,500 a year living in Silicon Valley.

– [Dr. Z] Impossible.

– [Brett] Paying $18,600 a year in rent. So you do the math. And then, you know, that’s, COVID for us was such a disaster because they went from that to our families, we survey, we do a lot of surveys and data analysis. So in April our average family was making $220 a month, but the rent didn’t change. And by August they were-

– [Angela] April 2020.

– [Brett] April 2020. By August, they were making less than a thousand a month. And so they just got crushed. And so we worked, we’ve done $5.5 million in financial aid to more than a thousand families in the past eight months. And that’s all about keeping them, keeping them, they got a centimeter from the edge of the cliff, and just keeping them from falling off the cliff.

– [Dr. Z] And that’s grant money you’re using to do that?

– [Brett] It was a lot grant money-

– [Dr. Z] Philanthropy.

– [Brett] Philanthropy, grant money, stimulus money, just all sorts of churches.

– [Dr. Z] Right, right, right.

– [Brett] And we did a lot of financial aid at the beginning. We’re moving more and more towards jobs. So right now we have 45 people who lost their jobs because of COVID and fell behind on the rent who we’re actually employing. And so we have a two-month work program. We’re providing free janitorial to local nonprofits. And then this is really cool, you’ll like this. So obviously food insecurity has been a huge problem. So we right now have a crew of 28 people, we got a $1.4 million grant from the city of San Jose. We’re hiring 28 people to distribute food. And all 28 of these people lost their jobs and fell behind on their rent because of COVID. They’re distributing food to hungry families that lost their jobs because of COVID. We’ve done 96,000 grocery packages-

– [Dr. Z] Holy cow.

– [Brett] In the past six months to about 20,000 families. We’ve been able to operate at scale, using it as a tool. And all the people in the work program, they get their food handler certificate, they get COVID janitorial sanitizing certificate, forklift training, driver’s license, resume-

– [Dr. Z] So they’re getting skills as well.

– [Brett] Yeah, and then when their diabetes is out of control, then that’s her problem.

– [Angela] Yeah. But see, this is the great thing about Healing Grove, and doing this kind of work is, we’re not saying “Oh, we need to give everyone, “get their mammograms done and get their A1Cs done “and stuff, because that’s what the government “tells us to do, “We’re saying what are your problems?”

– [Dr. Z] There you go.

– [Angela] What are your needs? And right now it’s joblessness or whatever. And then a job gives you money, but it also gives you so much dignity. It gives you friends. It gives you something to do during the day.

– [Dr. Z] Purpose.

– [Angela] It gives your kids notice that you’re leaving the house and coming back. And there’s so much to that that’s just really, really tremendous.

– [Brett] And for the listeners out there, we’re raising money.

– [Dr. Z] Well, that’s good.

– [Brett] Pulling this off is not easy.

– [Dr. Z] That’s a good segue it’s a good segway because I think your model is an instructive, as we run out of card, let me just double check that, because I realized I put, I put the wrong recording card in your box, which means we’re gonna run out at about an hour and something, so I have to just keep an eye on it. But I was gonna say this, because I wanna have you guys back, and just dive deeper into some of this stuff, because there’s so much to talk about. Before the show, we talked for like five minutes, and I was like this is five hours of discussion of so much stuff that people could learn from. The action item here is you can do this if this is, if you feel called to do this. And that’s action item one. Action item two is you don’t have to wait for the government to try to fix healthcare, we can do it. It’s hard, it’s not easy, you’ve made that abundantly clear, but it’s doable with enough passion. And that passion feeds right into the authenticity. We get to be who we are again. I mean, you guys light up this whole room just by showing up. And it’s not just because you look like a Christian rock band. One of you just needs to point like this, and then we’ll just come up with a good title. And that you have, we’re gonna give resources to ECHO, we’re gonna give links to your clinic, any other links you give me, and then the fact that you’re raising money means people who, in the, especially in the Bay area who care about this can donate to you. So we’ll put that call to action, because I think what you’re doing is lovely.

– [Angela] Yeah. And we would love for you to come and see it too, if you want to.

– [Brett] We wanna, we need to do Healthcare 3.0 at Healing Grove. And we would love for you to come and hang out with our people. And so we do these-

– [Angela] Let them vomit on you.

– [Dr. Z] Oh yeah, yeah, yeah.

– [Brett] No, not those people. We can do one of each, okay. So we want you to come and hang out with our patients, and do a show at Healing Grove, but then we do these things called Luke 14 parties. So Luke 14, Jesus says when you have a luncheon or a dinner, don’t invite your rich neighbors or your friends, instead invite the poor, lame and the blind, and your reward will be at the resurrection of the righteous. And so-

– [Dr. Z] So you’re saying I’m poor, lame and blind?

– [Brett] No, no, no, no, no.

– [Dr. Z] Oh, okay, all right.

– [Brett] Well you might be, I don’t know.

– [Dr. Z] Two out of three ain’t bad.

– [Brett] So what we do is we just go out in the homeless camps, bring a barbecue, and just sit down and eat a meal with them. And it’s a great way to, it’s not, we don’t bring a bunch of stuff to give away.

– [Angela] Yeah, it’s not transactional. It’s not like look at me, I’m helping you. It’s let’s just be together. Let’s just hang out.

– [Brett] So we’d love for you to come down, hang out at Healing Grove.

– [Angela] Or you could see the sports program, or you could just come see clinic for a day.

– [Dr. Z] Listen, this is how all great inductions into a cult begin. You know what, we’re having a great party, there’s gonna be a little bit of Kool-Aid, and you just go ahead-

– [Angela] And we’ll sacrifice something on the barbecue.

– [Brett] That’s right. How many children do you have? Do you really, do you really need that many?

– [Dr. Z] I’m totally down to do that, that would be wonderful. I mean you guys are neighbors, it’d be great. And I think we should follow up this show because there’s so much, we’re gonna get a ton of questions and stuff, and I, there’s so many other things we talked about that we really need to dive into, that I think would be lovely. ‘Cause I know the questions are gonna come up in the comments. So when we do the followup we can dig into that. And then I wanna keep hearing about your progress, because this is, this is Health 3.0. Why do we have to wait for anything? You can do it, you know?

– [Angela] And we’re not the only clinic doing this.

– [Dr. Z] No.

– [Angela] So if you talk to ECHO, they can give you a whole bunch of clinics around the country who are doing really similar stuff. So this isn’t, it’s not even as rare as it seems.

– [Dr. Z] Are you thinking what I’m thinking? Road trip. The three of us in like a Winnebago.

– [Brett] Let’s go.

– [Dr. Z] That’s not a cult thing.

– [Angela] That’s awesome.

– [Dr. Z] Guys, it’s such a joy, such a joy. Really thank you for the work that you’re doing.

– [Brett] Thank you so much.

– [Dr. Z] Thank you for the work you’re doing. And we’ll share this widely. Z-Pack, you guys know what to do, share the video, leave your comments, leave your questions. Tell us stories in your community where you’re seeing bright spots, things that I should look into, that we should shine a light on with the show. We’ll put links everywhere. And we are out. Thank you guys.