We’re really good at complaining about what’s broken in healthcare, but what about solutions and bright spots that can lead us to Health 3.0?

I may be a bit biased, but I think our Turntable Health clinic experience is just such a sign post. It was REALLY hard, and that’s why it’s worth doing. We can fix primary care, and thereby fix pretty much all of medicine by getting prevention, care coordination, and the patient relationship right first. 
 
Learn more by watching some of our prior videos featuring Turntable Health here.
 

Hey everyone, it’s Dr. Zubin Damania, AKA ZZDoggMD, anyways, listen, people have probably noticed that I love to complain about what’s broken in healthcare. So what about the bright spots? What about things that actually work?

Well, we have plenty of those too and I want to tell you guys about a clinic that I ran for three years in Las Vegas called Turntable Health. A lot of people have heard about this but they don’t really know what we did and why it’s such a bright spot, and a sign post for where we can go in medicine that will build what we call Health 3.0, which is reconnected, repersonalized, technology enabled healthcare where we get paid to just do the right thing for patients. Heaven forbid.

So Turntable Health, the concept was, if we get primary care right, if we fix it, the rest of the system will actually fall into place because our specialists will be able to practice at the top of their game, our hospitals will do what they do best, which is acute care, and we’ll be able to prevent people from actually getting into trouble in the first place.

So we focused on primary care. And we funded it differently. We said we want a flat fee, for an all you can treat access to the buffet of care. ‘Cause this was Las Vegas, right? And so we said listen, for this flat fee of somewhere between $50 and $80 per month, you get unlimited access, with no copays to a primary care team. Now, individuals could pay that fee, or an insurance company could cover patients on a plan that sits on the federal exchange, where you can get federal subsidies to actually have amazing primary care and in return they expect from us to actually lower costs, improve outcomes and make sure patients have an experience that makes them feel listened to and cared for, right? Doesn’t mean you give ’em dilaudid and a turkey sandwich, it means you listen to your patients, and that means you need time.

So, a team of primary care people, doctors, nurses, we call them nurse innovators because they pretty much ran the clinic, health coaches drawn from the community that they’re actually serving hired based on our elephant reaction, our emotional reaction, and I’m like do we want to give them a hug, do we want to tell them you know, our life story, do they come from the community they’re serving, speak the language and then we kinda train them up for skills.

So they’re hired for empathy but trained for skill and they do the heavy lifting. Motivational interviewing, looking through shopping lists, texting, emailing, Skyping, anyway the patients want to connect and communicate. Teaching classes in a teaching kitchen. Doing that heavy relationship that doesn’t require a doctor. And this is gonna cause some butt hurt in the medical community, what do you mean doesn’t require a doctor? Doctors, you know this is true. A lot of what we can do can be done by someone with a lot of empathy and compassion really, and can be trained up to do the other stuff, then we come in the room and do that high level intuitive medicine that no machine will ever replace, and that can only be done by us.

Well, that’s a beautiful team. Then you have a licensed clinical social worker who focuses on one of the biggest problems in primary care and throughout which is mental health. Behavioral health. So, depression, anxiety, substance abuse, all these things that are the symptom of our very broken way of being in the world currently, where we’re focused on social media and we’re stressed and it’s just…

Why not incorporate that into the model as part of a team, have a yoga, meditation studio where that, those sort of personal resiliency tools become part of the care, all of it, included in that one flat fee, which means there’s no copays, nothing to prevent you from coming in, when you’re well so we can keep you well.

Now the technology piece, if I’m staring at a computer the whole time instead of a patient, even though our visits are minimum 30 minutes, often more like an hour, I mean that gives you the time to get to know the unique hopes, dreams and fears of the patient in front of you, which means it’s gonna take, it’s gonna be a relationship instead of a transaction, which means you cannot use an electronic cash register, which is what, and most EHRs are, they’re a glorified billing platform with some patient stuff tacked on as an afterthought.

Had to build our own with our partners Iora, it was all about team based care. Where everybody could write in the note at the same time, it was problem based, and guess what, patients could read and write in their own chart. It’s your chart! We are just the stewards of it, right? Put the screen between the patient in a circle like this, so that we’re looking together at the screen, and at each other instead of oh hey, what are your allergies and medications? Make it tie us together with technology, and help us enable the human relationship. That was the heart of the Turntable Model.

You incentivize good care, you do well financially by doing good for patients, you make it a team based enterprise, you focus on prevention and relationships instead of transactions and widgets, that we do now, and you tie it all together in a space that feels more like a community center than a hospital or a clinic.

And guess what? It worked. We dropped costs by 12%, dropped admissions by 50%, outcomes with hypertension, obesity, smoking, depression screening improved and yet, we’re out of business in three years. Why? Because we were too ahead of the game. Insurance companies weren’t willing to pay this up front to have the savings, and people had the notorious short term thinking that is kind of not unique to Las Vegas, right?

So in the setting of that though, well so what happened? Is the dream over? No! It turns out now these bright spots are rising up around the country. Our partners like Iora Health, doing it in Medicare Advantage, ChenMed, Oak Street, CareMore, there are ideas all around the country where the primary care revolution is happening, including the direct primary care community where individual docs can have a variant of this because they control it, not the payors, the government, the employers, etc.

So, here’s what I hope you guys do. If you want to go deeper on this stuff, hey come and join us in the Supporter Tribe, but if you don’t wanna do that, share this video, tell us your bright spot experiences in the comments, and please spread the word about what Health 3.0 has to be. We have to get there. We have no choice, because this system is not gonna work for us. For us or our patients. All, right guys? I love you, we out.

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