A New Kind Of Primary Care (w/Dr. Brad Younggren)

– What is up ZPac? It’s your boy, ZDoggMD, Dr. Zubin Damania. and I’ve got with me the legendary, the one and only Dr. Brad Younggren, MD, chief medical officer of 98point6 which is a company up in Seattle that is transforming a way of doing primary care for both clinicians and patients. We did a live show with Brad earlier and asked for your questions. We toured this cool facility. We did all this fun stuff and we said give us your questions and we’ll go deeper in it but I wanna go back, Brad and ask you what is 98point6 and how does this work with primary care because it’s not intuitive in a way that many doctors will grok right away.

– Yeah, sure, so we’re providing virtual text-based primary care across the entire country 24/7 of everyday. So we drive through text space and we can transition to video if we need to, patients can submit photos but it’s text-based delivery of care overlaid with an AI platform on top of it.

– And why do this? I mean isn’t primary care enough, get people come to the office they wanna be seen by a doctor, right?

– Well, primary care’s in crisis. We are at a shortage of at least 20,000 primary care providers in the US health system. So patients don’t have access to care so we wanna increase access, lower cost for patients and the best way to do that is to really leverage technology to achieve that.

– Are you giving worse care then? Are you compromising in some way because I think a lot of primary care docs will be like, well, no, I mean they need to see me in person and also, I can’t bill for it unless they see me in person.

– We don’t bill insurance, for one, so we’re essentially–

– I’m already a fan.

– So a subscription-based model so that allows patients to utilize the service when they feel they have a need instead of considering whether or not they’ve have a deductible or they did, it could make a financial trade-off between some other thing they’re thinking they need to spend the money on that week. So we’re driving good engagement with patients. Nobody can really do that as lower the cost to the point, through technology, that allows for significant engagement with the primary care service. We do that and so, for the quality perspective, we hire physicians, they’re all full-time employees here at 98point6. They’re helping build the system and helping create the technology with the technologists here so that’s completely different than anything you’d find in the market. So they’re helping build, because ultimately what they’re doing is they’re helping build the AI to help the automated assistant understand variety of things to include, what questions should you ask a patient, so we care deeply about the physicians who are gonna be delivering that service to the patients, so they’re all around.

– And the reason I’m even here is that you guys are mission driven to actually save medicine on some level, which is primary care, like you said, is in crisis, people are suffering all this moral injury, having to practice in ways that aren’t actually good for patients, aren’t good for them. The question is if you can improve access using technology but then still make it medicine, have it be physician driven, which is what you do, you just said you hire your docs, they’re full-time employees, they’re licensed in all 50 states, they’re part of the company, they spend several hours a week just working on projects to improve the company. So this is a physician-led thing which it has to be because it’s delivery of care. If you’re gonna save a part of primary care and allow people a different career path, the first question is does it work? So when I played with your software, I was a skeptic, dude, I’m gonna be honest. You guys were like, “Hey, this is what we do. “I’m like that sounds like nonsense.” And then you sit down in a room and you go oh, this is what you’re doing. So patient has a chief complaint. They have to 24/7 access even though you, and this is some of this rehash if you watch the original live show that we did, you guys you will see what we’re talking about in some more depth. But to put more points on that, if you sit in a room and you see how this works, patient is a subscriber, say, so maybe the patient is paying an introductory rate or like 20 bucks a year to have access to you guys 24/7 and then later the price goes up a bit but it’s still a flat subscription fee or they’re part of health plan or a health system or an employer that’s getting it for their patients because they want their patients to have access, quality and convenience 24/7, maybe keep them out of the ER, those kind of things. So that’s where the patients are coming from then they’re coming to your app and they’re like I have a problem with a rash on my leg. Okay, there’s the chief complaint. It shows up on your clinician dashboard that the docs are sitting there and there’s a waiting room but it’s not really waiting. It’s a room full of patients that then populate. They have access to the stuff and at that point, your bot starts asking questions. Can you explain how that works because I was very skeptical of this until I saw it.

– You basically get on-demand access to 98point6, the second you access the app, you’re in the clinic and the automated assistant starts asking you questions. So that can be anything that’s on your mind. So we want patients to come in with simple questions instead of going to a search engine as an example because sometimes, as you know, as a physician, there’s so much gold in that, there’s so much information, if someone at 2:00 in the morning is google searching chest or throat burning like we wanna know that data because it’s very valuable data. Sometimes patients don’t always know if it is or not. So I would rather have that within the system than living outside the system. So that acute care medicine, chronic disease management, it really doesn’t matter. The patients can come in. They don’t even really need to discern whether or not it’s appropriate because we want all that to come inside the walls of 98point6. It’s a trusted source. It’s confidential, HIPAA-compliant, secure, you’re going to talk to a physician, after the automated assistant is collected as many questions as it deems necessary, it hands it off to a physician. 100% of the time, every time the physician will take that case and finish it up, physicians could decide to order labs, if necessary, and they’ll send you the nearest and most economical choice to get a lab done in there you live, the same thing goes for prescriptions. They’re gonna send you to the place where you can get a prescription to pick that up. It’s also gonna take into account the cost there as well.

– Now why text and not video? Because that’s a question that came up.

– We’re meeting patients where they are. So one of the big problems with traditional telemedicine is engagement rates are very low and why is that? Because patients don’t particularly like video. We text in our lives, we text our friends, we text our family, we text businesses now in lieu of doing video chats because particularly, we’re just not as comfortable in those video chats. So we went with that direction because we wanted to increase engagement with our patients and we found that to be very true.

– Let’s answer some questions. And again, I was skeptical till I saw a visit play out, until I talked to your doctors. It seems like you get those doctors in a room to tell other doctors how this works and they’re like okay, we get it now. This absolutely works; it keeps people out of the emergency department, gives them care where they need it and when they need it and the best part is you guys don’t even, you’re not even doing nights. So your docs actually have a pretty good lifestyle because they have predictable hours and the documentation is the visit.

– Mm-hmm, exactly; it’s beautiful. Over 20% of our customers on the employer space are in the healthcare space. So it’s great validation. So we have health systems they’re using as employer so they’re very discerning customers. We send our docs in when we need to to make sure they have conversations with the physicians of that health system and that’s always been to the plus, to the benefit. Once they hear how we do it, the quality, we went over those those contracts.

– So Kristin Bertrand asked this specific question. I really wanna know how you partner with existing health systems because it’s something she works on for her organization. So say you’re a health system, why would they use you guys? They have primary care docs.

– So we have a number of different health system relationships and really, what it is, for a lot of these organizations, they don’t have a good front end. They don’t actually have a good digital primary care front end to deliver care so we can essentially give them that and then we can also get some detailed understanding of how to coordinate care within the health system to drive patients to the care that they need. By understanding what resources the health system has, whether its behavioral health as an example, we wanna get the patients the care they need. When something falls outside the context of what a primary care physician is comfortable with, the next step is connecting them with a sub-specialist, connecting with the behavioral health specialists. We can leverage technology to make that a relatively seamless endeavor for the patient.

– So in a way, it’s like a very advanced triage process too.

– Yeah, but if you think about our resolution rate hovers around mid-90s, 90% meaning our physicians resolve those cases and the reason is that we are leveraging technology to try and do as much as we can within the clinic, recognizing that we’ll never be at 100% but then when we’re not able to complete and get the patient what they need, knowing how to get the patient what they need may be able to advocate for them. That’s a tremendous portion of what we’re doing here.

– And the great thing is you’re capturing all this data so the health system now knows what these chief complaints are, what’s going on and can integrate. You can give them that data, they can analyze it, which is important. And the thing is you’re not doing extra documentation because that is your documentation. That’s why text can actually be an advantage, right?

– Yeah, absolutely and it’s also good from a quality perspective because you can actually understand the conversation between the patient and the physician. The vast majority of the work we’re doing is to make the physicians life better. I don’t particularly like documenting. AI can assist in the documentation. AI can assist in the gathering of findings. There’s a bunch of opportunities for accelerating and focusing the physicians and what they enjoy, which is diagnosing and treating patients.

– Yeah, yeah, and then that, again, that’s what I, and talking to Mandy Cuda, I accidentally called her Amy on the show at one point because I had a small lacuna. You guys know that when I do these shows, well, actually, they’ve had done real-time blood pressure testing on me like my BP goes to like 220 and I feel calm. It’s like an unconscious and I’m sure, I’m pretty sure I’m stroking out.

– We’ll keep an eye on you.

– Please do, you’re an ER doc. So let’s read another one, Risa Dubois, super fan Risa, one of my favorite supporters. Text doesn’t lend itself well to effectively communicating tone and can lead to misunderstanding. How do you prevent that?

– Well, I mean we use text every day in the way we communicate with our family and friends and so that’s the foundation for the work we do but we review charts. The physicians are doing peer to peer review all the time. And we were humble in a sense that we understand we’re building something new, building something different and so to do that, we need to review charts and to understand to make sure that things aren’t being missed in the context of how we deliver text-based primary care.

– Yeah, I could imagine, because you end up with an interaction where it’s like when you interact with a human being at like say Cox cable or something, and I’ve done this, I’d like to cancel my service. I am happy to help you here! It’s actually a human. And you end up, they’re not reading your tone, they’re not reading what’s up and you’re getting angry and then this text starts to get ugly. At this point I’m threatening to throw feces, I’m like I will make fun of you on my platform, all right. So are you able then to deconstruct those kind of interactions and learn from them and see what you can do better?

– We do that every day and one of the things that’s really important to highlight is patients come into the clinic and we ask what brings you in today, they can write a word, a sentence, they can write a paragraph. We don’t limit them and the way we’ve constructed our AI is such that we don’t limit them to yes-or-no questions because, as you know, that invalidates the relationship. We want patients to say exactly what they want. There’s so much information in there if you let the patient speak. We’ve constructed a system that’s focused around the patient being heard.

– Laurie Veanu, I pronounced your name right, Laurie. Do you find that your customers are mostly age 50 and under. Could you ever see it expanding to especially such as dialysis, something else like that. And we had talked about this before, people of all ages.

– We do; we have people of all ages. I think our oldest patient may be in the mid 90s, we’ve seen patients in mid 90s multiple times, turns out grandparents text their grandkids all the time.

– Nana, I’m looking at you. That poo emoji you keep sending me, all right, it hurts.

– Cut it.

– Just cut it.

– It’s a medium they’re actually really comfortable with, interestingly, so we see high utilization in that age range just as much as we see in the middle age.

– So this is not like a millennial or Gen Z thing?

– No, and there’s lots of people that are not, they’re not mobile, they can’t walk or whatever the case may be so having a text-based platform that they can communicate and ask questions about their own health is tremendously valuable to that segment of the population.

– Now Carey Bennett asks a question from a standpoint of, by the way, I really like this, going live early, generating all the questions from people who are actually out practicing the stuff and then getting to pitch them at you and making you sweat. Let’s make you sweat about this one Carey Bennett, how do you clock out from the text world. Wouldn’t you get burned out even faster being so connected? So I think Carey may have misunderstood how your shifts work.

– Yeah, it’s a great question. Our physicians are all members of the company, as we talked about, they have equity, they get paid an annual salary, there’s no RVUs or any motivations like that.

– That’s what we did at Turntable as well.

– Yes, it’s fully aligned, fully align the incentives in the appropriate fashion. The other thing we did early on was we decided that because we’re licensing our physicians across the country and they’re integral part of the team, that they will have some time to impact the company’s development and not so, every physician works on what we call here the 80/20 rule. So they work 80% clinical and 20%, they work on non-clinical tasks. So some work in UXR, some work, they wanna work in the AI bot space, some wanna work on recruiting. So we really try to get the physicians where they’re happiest, where they’re comfortable, where they wanna advocate for the company. So we have work to do in all those dimensions but what that allows is that all the physicians just love feeling like they’re actually impacting the company’s growth and development. They’ve been around since the beginning. We have over 45 full-time physians. We’re anticipating being above that within the next few months. These are all full-time docs who are delivering care on the platform.

– This is what they do.

– This what they do when you work for 98point6.

– To me, that was the most compelling thing is like you’re creating another path because right now people in primary care who tell me look, I wanna go into primary care but I’m scared. Everyone’s telling me it’s a disaster and so and so and I tell them I’m like no, no, no, no, you have direct primary care options where you charge a flat fee, that’s a path for you. You’re working in a big health system where you have the support of teams. That’s a path for you. Independent practice, much harder, it’s also a path or something like a 98.6 where you’re employed as part of an organization, you’re building this thing that’s new, you’re practicing in a totally different way that may actually be a better fit for your temperament and you get to do something really, with all your training, that is unique but it helps the world. Well, that’s what we want. We want more of those options in this Health 3.0 environment instead of just trying to shoehorn all the old options into what’s working, it’s not working, we know it’s not working. We have a shortage of primary care. We have people saying they wouldn’t recommend the career to their kids, trying to pay off the loans. Speaking of trying to pay off the loans, are your salaries competitive for docs?

– They’re competitive. Yeah, they’re nationally competitive, we know we have to be to get people that come on full-time. And I think the fact that they get equity is a fairly unique opportunity for physicians to get equity in a company that they’re building. That brings a bunch of physicians to the table who are excited to be part of it.

– That brings Jesse’s, Jesse Anderson’s question; are there pediatric docs in your org?

– We do, we have pediatricians; family medicine, internal medicine, med-peds and emergency medicine.

– Emergency medicine too. That’s like an urgent care type of vibe.

– We wanted people in the organization who understood what a 24/7 schedule was like and how that could impact because that’s really what we are here. So that’s a little bit not consistent for most primary care docs.

– And I wanna back up on one thing because I know that pediatrics, you offer for your health systems and employers and people who are purchasing your product for their, whether it’s their staff or their employees or their patients but right now, you don’t necessarily offer that direct-to-consumer. So if you’re a consumer trying to sign up for pediatrics, you can’t get it just yet?

– Correct, that’s primarily, we started with pediatrics because we launched it at our employer population in February of this year. So now we treat patients age one, all the way up to, I guess 96 now or something along those lines. So that was a change and yeah, so we don’t do direct-to-consumer space. We’ve started with the employers because we can confirm identity of the kids that way to make sure we can protect their medical record data.

– People were asking what about Medicare and Medicaid, do you take those? I think that’s a violation of your model, yeah?

– To really increase access and lower cost, you have to really move away from traditional models. So we’re a subscription-based model. Either your employer’s paying it for it, your health systems paying for it for you or you’re paying a subscription annual fee but there’s no transactional cost there beyond that.

– And I’ll be honest I have no experience with a subscription-based model at Turntable because that’s what we were. And I think it actually aligns incentives really, salary and doctors, aligns incentives very well and then you can work with health systems, health plans, employers and individual patients. So basically, you are like a text-based Turntable Health.

– Yeah, sounds like it.

– And now I’m angry. And I think I’m gonna sue for intellectual property but let’s look at some more comments here, jealous, angry, upset. Also jealous, beautiful place, by the way. You guys definitely check out the live video. So Veronica Moovdee says it sounds like it could potentially reduce the amount of nonsense coming in through ER as long as people use it appropriately, of course. What are your thoughts on that?

– Well, I mean as an ER emergency physician, certainly spent 20 years experiencing the changes in the practice. I’d say that my experience in clinical practice has been, over the years, patients have become much more intelligent about their health plans and aren’t coming to the ED with not urging symptoms as much as they did maybe 20 years ago.

– Really, it’s gotten better?

– Because of high deductible health plans, they’re looking for in the growth of urgent care markets but that being said, it does help, if you think about a health system that has an NAF helpline as an example, the threshold to send someone to an ED is pretty low. I always say that almost every patient that I see in the ED with hypertension is a failure of health system. Like that’s an expensive failure in the health system. So we need to do better at finding ways to manage some of these chronic conditions so patients don’t end up in the ER and sometimes, what all they’re looking for is some guidance and some answers to questions.

– How’s your data so far on how many people you are referring to ER?

– We end up referring about two to 3% of patients to the ED and from my perspective, and this is what I’m talking to health systems, I’m like these are the right patients. You wanna get the right patients to the ED when it’s appropriate, when there’s a physician like at 98point6, evaluating, talking to the patients, saying you know what, you really do need to go an ER, you probably need to be in ER. From our perspective, these are wins. We wanna catch, we’ve had patients come in who are in need of an ED because they’re concerned about stroke, as an example, or I have chest pain, what do you think? That you should be in the ER.

– What if I sent you a text message of this with blood squirting out and I’m like just FYI doc, just curious, do I put a little steroid cream on it? So that kind of stuff, do you get a bit of that where you just start to go this should never have come here.

– We have advocated for patients in multiple different dimensions, calling 911, how we figured out how to do that on a national basis.

– [Zub] Oh nice, you’re in every state!

– We’re in every state. So every state’s different. You have to understand how that works and how you’re gonna support patients for a variety, to include emergencies. We’ve cracked that nut.

– Makes perfect sense. Carey Bennett asks how do you keep from being burned out, being connected 24/7?

– Well, the practice never closes. That’s what makes it beautiful from the patient perspective but again, when you have physicians that are working point8 clinically.

– Point8 FTE.

– Point8 FTE, clinically and they don’t work nights.

– So and you don’t work nights because you’ve set it up that you have, ♪ You got docs in different area codes ♪ Because you got someone in Hawaii. You got someone on the East Coast. They handoff in the time zone so you have 24/7 coverage without people working nights.

– They love it.

– Which is dope.

– So what’s the typical shift, hour range?

– Most of the docs work about eight-hour shifts. Some prefer a little bit longer. We’re always learning about what makes the most sense on our platform to not burn them out. And then we have a place out of Hawaii and physicians are doing usually two, three months stints out there which they love, it’s a different model.

– It’s a good way to not burn out.

– Yeah, so that’s been a really big plus for the physicians. The other thing is they have mobility they’ve never experienced in their careers. One of our physicians recently had a family emergency, had to go visit family and he’s like, I didn’t tell you all because I just kept working my shifts like he’s like I’ve never had that kind of life before. I could just go deal with my life and still keep plugging into the 98point6 where my shift were.

– Just the flexibility.

– Yeah, the flexibility is unique.

– So somebody asked how do we sign up or learn more about this thing?

– You can go to 98point6.com. That has a bunch of information about the company, some demos and videos on how the website works.

– And by the way, definitely check out those videos because they actually show a good flow of how the thing works. It’s actually quite good. And then also, you have an App Store thing?

– We do, you go down to the Android or the iOS App Store, download 98point6, if you’re using direct-to-consumer offering, you can just pay that 20 bucks.

– 20 bucks introductory rate for a year.

– You’re in in seconds.

– I am gonna sign up actually, seriously, right after this show just because I think it’d be fun to use and figure out and I can report back to y’all and be like you know what, they told me I had gout and what I really had was uric acid crystal deposition in my joints which is also gout but you need to test, you need to QA these things. One interesting thing that I realized with text, doctors interrupt patients, on average, like every, what, 11 seconds, 22 seconds?

– Yeah, something like that.

– It’s very hard to do that on text. You see the little three dots like someone’s typing but you’re like I’m gonna go ahead and type anyways. That’s the worst interruption you’re gonna get. So actually, in a way, the text stream is much more patient centric because they can express themselves at their pace, in their way and we’re not just constantly redirecting or interrupting or doing what we do.

– We have a whole UX team here that’s user research around understanding the patient experience, how do we continue to optimize around that, how do we bring technology to the patient in a way that they can understand but also enjoy. That’s a journey in and of itself where we have, I think our product really has the most focused both, we’re able to focus both on the patient and the physician, all at the same time. It’s really unique in that sense.

– Why did you get into this, man? You were in the military, in the army for 15 years, you’ve been deployed, emergency physician, you have a groove. What about this compelled you?

– When I was in the army, I found myself with my first involuntary vacation opportunity in Iraq as a junior emergency physician and the SonoSite 180 was just being deployed in the battlefield. We were working on deploying that across the entire battlefield and I quickly saw this was saving lives. This new portable technology was saving soldier’s lives and that became a focal point for me which was wow, digital healthcare technology hardware devices can scale in a way that we haven’t seen before that can actually impact a large broad audience of patients. That really was a big turning point for me. When I got out of the army, I went to work for a mobile sound company as my first chief medical officer job. It was the first smartphone enabled FDA-approved device in the country, an ultrasound plugged into a smartphone and from there, I just continued working in the space, trying to bring devices technology, to increase access and lower cost, try and help save healthcare.

– We need saving, my brother, I’m just gonna say. I mean that’s great. And the truth is I think it is a combination of technology, human leadership, in terms of physician leadership, clinician leadership, nurse leadership, all of those aspects are what we’re gonna need to build this emergent Health 3.0. So I’m real freakin excited. I also wanna interrupt you every 11 seconds, is that weird? So Samantha Bolin asks how do we interact with insurance? By the way, that was the number one question that Turntable Health got asked. I’m sure.

– How do you pay for this?

– So we’re a subscription-based model. Either you’re paying through direct-to-consumer offering or your employer health system is paying for it, depending on the situation. Really, the only time we’re interacting with insurance is to provide ghost claims, i.e. just zero dollar claims, primarily, to give those visits a marker for health systems that wanna keep track of them but those are zero dollar claims. That’s the only way that we deal with claims from a traditional perspective.

– We had to do the same thing because they wanna keep track of the data but it’s not like they’re gonna charge you. So it’s not a deal where you’re double billing a patient and insurance or your billing insurance and a health system or something like that. It’s off the grid, disruptive, but not disruptive. So in other words, integrated with our existing system. It’s an add, it’s not a we’re trying to replace X and that’s an important point.

– I think to really build a technology solution that’s gonna change healthcare, you need to operate within the existing healthcare space. To think that you can actually build something outside the space that will functionally change the system, it’s just too big.

– I wanna follow up with that because okay, people, a lot of my audience are like burn it down to the ground. I want ashes and I want a beautiful tree to resprout from the ashes of this healthcare system. It’s that broken. I’m gonna tell you guys this, I tried this. You will not be able to make it happen unless you get critical mass, like all of us together. And in the meantime, we need these kind of options where we’re working within the system, maybe on its fringes a little bit, to chip away at the failures of the system until pretty soon, the system blinks and you’re like oh, that’s how we’re doing it now. And I think that is what something like this represents. That’s what something like Suki, which is another company we talked to that does a digital AI assistant from people working with EMR. These are technological solutions to human problems that will help transform healthcare and it has to function within the ecosystem we have because otherwise, what will happen is it will get stomped because otherwise, they have no incentive to play ball.

– I mean the goal of the company is that no one in the world should have to make a financial trade-off for primary care. To get there you have to operate within the system, to get there.

– Yeah, I’m with you.

– Period.

– I’m with you and that doesn’t mean rolling over and saying okay we’ll play the insurance game. No, you can do it without playing that game. Fight the power, people. And also be the power because the power is awesome. I’m kidding, I wish I was the power. Do you ever wanna be the power?

– No, I’m good.

– You’re good, all right. Are people really comfortable getting primary care via technology? What do your patients say?

– Well, we get a lot of great data from our patients, of course. And follow-up after visits. There’s a number of different ways we look at a patient reported outcomes, Net Promoter Score, so our Net Promoter Score is usually around 70-ish, I think, if I recall correctly, right up there was some of the best consumer products in the world.

– So Amazon is 70s. And Net Promoter, just to explain to people who don’t know because it’s a techie thing, how likely are you to recommend to this to your family or friends or what’s your overall size or just one to 10.

– Exactly, we do one to 10 and then there’s a score between I think negative 100 to positive 100 and so we sit right there with giants in the industry who focus on consumer behavior and consumer satisfaction as their paramounts. So like we’re happy with where we’re at right now with that.

– You know where our Net Promoter was at our peak? 90, 90.

– Oh nice.

– But because we had people sitting there in the clinic developing these deep relationships with their health coaches and stuff but it ultimately tapered down in the mid-80s. Well, it was still pretty good. Oh, one thing, and that reminds me, we had a lot of people with substance abuse disorders trying to get narcotics, how do you handle that via text?

– Well, we don’t prescribe any scheduled drugs so–

– Problem solved.

– And what’s interesting is we still explored ways or how can we satisfy patients and also satisfy physicians to give people things that they can actually prescribe patients. So one of our first forays into digital therapeutics prescriptions was we actually have a paper, our first paper was published a few months ago, looking at digital therapeutics and thanks. So we were looking at cognitive behavioral therapy which included smoking cessation but also a pay module. So that, it was a dual satisfier from the physicians who said we can’t do anything, we can’t do scheduled drugs. So now we had something you can prescribe the patient, a cognitive behavioral therapy app and then for the patient perspective, they were coming and saying I’m in pain and you weren’t just saying I can’t give you anything.

– Deal with it!

– We have some options for you and some ideas.

– A cognitive behavioral therapy app. See I’m a huge fan of CBT. I think that it actually works, you know what it is, it’s meditation formalized through the Western process. It’s recognizing feelings and thoughts and emotions and negative thinking patterns, recognizing it for what it is, taking a pause and reframing it. And to me that’s transformative, it’s hard, you have to go work at it. People want a pill. A pill is easy.

– Yeah, so it was an incredibly successful project.

– That’s really awesome!

– So we’re really excited what that means for our patients.

– That’s really awesome.

– Yeah, thanks.

– How are your standards of care different or similar to traditional brick-and-mortar?

– So we have a quality and outcomes team here, a CQA meeting. All of our physicians undergo 100% chart review so that’s pretty heavy lift for the first three to six months. And then we sit at about 60% of peer to peer chart review of all the cases in the clinics, the peer evaluation plus we’ve developed technology that can actually pull out of the visits to understand things like antibiotic stewardship around sinusitis, bronchitis, so we can pull out that data just automatically through AI technology and so we’re gonna continue to build AI-CQA which obviously takes less time. We’re gonna continue the peer-to-peer because our goal is that every single chart gets touched in one way or another. So we can deliver quality at the standard of care or above.

– I love it, that’s great.

– And by above, I just mean that we are in the remover case so it’s no longer that the assertion of the patient or assertion a physician has demonstrated through the note, you actually go back to that chat transcript and see what actually the patient and the physician said to each other.

– Right, and that’s key. You’re not utilizing video much because patients don’t want it.

– Right.

– But it’s there?

– It’s there, it’s an option. Sometimes it’s certain states require it, so we use video when we need to from a regulatory perspective–

– Just for the intro visit, to establish care.

– Yes, exactly but other than that, over 99% of our patients prefer text when we ask them, after their visits, “Hey, would you prefer to video.” No one says oh yeah, I wish we’d done that by video.

– It’s counter to what a lot of like the big telemedicine companies would have you believe. Well, patients want video, they don’t, they don’t. They want to communicate on their terms, whether it’s text or phone or in person but they don’t necessarily want video.

– If you think about how much you use a video in your life versus how much you use text, the market is driven it in the direction of preference.

– Can I tell you something guys, can I complain for a second? People will call me via FaceTime expecting me to pick up on a video call and I’m like you don’t know that I’m in my underwear 24/7 when I’m not outside and 34/7 when I am outside. It’s so intrusive to me, video. And I do video for a living. So I would much rather shoot a text or get on the horn. Because there is something about that. Because you can pace around. You don’t have to worry about body language but you could get some tone but texting is a special kind of communication, I think we’ve gotten better at. But I’m sure, like you said, you’re still working out how do you QA that, how you make that better. How do you contribute, communicate tone and those kind of things. So Brad how did this company start and how was it crafted, with those guys coming together to say we need to do something to save primary care?

– I think that we started, the company was first formed in 2015 and CEO, Robbie Cape, has, from the beginning, felt that we needed to balance the company around four muscles. So we have the technology muscle, the clinic muscle, the legal regulatory muscle and the commercial muscle. So within the first five or six hires, you could see a devotion to filling those muscles in a balanced way. We didn’t wanna be all technology, another technology company coming in to solve healthcare. We certainly–

– Good luck with that, yeah. It doesn’t work.

– We don’t wanna be all physicians who will bring our traditional healthcare experience to the table. You really need a balance. As the company grew, our fifth hire was a physician. Our fourth hire was a full-time attorney because we knew the legal and regulatory environment was gonna be very, very important for us to get mastery over and so we’ve continued that journey from 2015 up to over 180 employees in the office.

– And the regulatory environment is still very antiquated when it comes to this sort of thing. You have to license these docs in all 50 states. Every state has its own fiefdom. It’s crazy and expensive and slow and painful and you do it for your docs.

– We do it for docs and try and make it as painless as possible for them, for the CME, for the relicensure, we have a team, I think of 13 or 14 now, that are doing this for our core group.

– You know Facebook supporters can get CME from my show, I’m just saying, I’m not pitching anything here. I’m just saying if you have a CME problem, yo, I’ll solve it. Check out the hook while my DJ revolves it. I am Vanilla Ice. So all that regulatory stuff, that’s a muscle, that the legal piece, the clinical piece, the technology piece, I met some of your team. They’re coding this stuff, making it work. It’s a real robust technology! When I saw your clinician console on the back end, what the clinician see, it’s pretty robust! You’re watching this visit like a hawk and you’re getting it in a way that’s not overly-cluttered. It’s very usable. We have a great technology team, starting from the top all the way down. It’s growing tremendously, it’s great. Robbie Schwietzer, our chief product officer, he spent years at Amazon Prime helping build that from the ground up so he brings lots a consumer experience from him and what does the customer want, so that’s just, I’ve learned incredible amount from his experience there, Damon Lanphear, our chief technology officer has lots of experience in AI work. So that’s, you need that around here to build what we’re building. It’s a really hard problem we’re trying to solve.

– I imagine you’re trying, you’re always recruiting engineers and tech people and physician talent. How would people reach out to the 98point6.com?

– Yeah, go on the website, 98point6.com, we have a career section. You can see what jobs are currently hiring for. We’re hiring on all those dimensions, all those muscles, really all the time.

– I love it. Now again, guys, look, why would I even like come here and do this thing? I don’t like, you don’t see me doing this with like United Health or something. The reason we do this is because I actually went through this thing with a fellow doctor and I actually think this is a great, great path to a Health 3.0 vision. We ought to support companies and people and doctors and people who are passionate about making things better. We should give them a platform. We should share these videos and tell our friends, and if this isn’t a fit for you, maybe something else is but until we start showing the world what 3.0 can look like, the ecosystem will never change, the legacy players will always have power over us. And we’ll end up doing something silly like destroying our healthcare system even worse if we don’t fix it from the ground up with physician clinician leadership. All right that’s my soapbox. Brother, thank you.

– Thank you. 98.6 and we out! It’s not a fever, I don’t care what you say. 98.6 is not a fever sign. I don’t care what your baseline temperature is. It’s a company, we’re out.

– It’s a company.