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A car shows up when you click a button and groceries arrive by tonight, but a doctor’s appointment takes weeks. Payam Zamani started MY DR NOW while he was still a resident, in a clinic of twelve hundred square feet, and now runs more than eighty of them as founder and chief executive officer. This episode is based on his article “Primary care access is the real problem, not the system,” published on KevinMD. You will hear why he says the eight to five scheduled visit exists for the clinic’s predictability, not the patient’s life, and what changed when his clinics began taking walk-ins every day. He explains how prior authorizations, refills and paperwork were pulled out of the exam room and centralized, and why that made recruiting easier once providers moved to three longer days. He also says the systems copying his extended hours still fail, because the culture was never behind it. You will hear who he counts as his real competition, and why he says the answer is not always more technology.
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at kevinmd.com/podcast. Today we welcome Payam Zamani. He’s a physician executive, founder and chief executive officer of MY DR NOW. Today’s KevinMD article is “Primary care access is the real problem, not the system.” Payam, welcome to the show.
Payam Zamani: Great to be here. Thanks for having me.
Kevin Pho: All right, let’s start by briefly sharing your story, and then we’ll talk about your KevinMD article.
Payam Zamani: Yeah, I’m the founder and CEO of MY DR NOW. We’re an Arizona-based company that’s expanded nationally. The common question I get is, “Why did you start MY DR NOW?” And I usually give the same response, which is, I didn’t start MY DR NOW because I wanted to own a medical practice. I started MY DR NOW because I noticed that the way we deliver health care just didn’t make sense.
I was brought up by a single mom who was forced in a position to raise my brother and I by herself after our father passed away young, and she ended up needing to work two jobs, and we lived a busy lifestyle. She works six days a week. So access to health care was difficult.
And I think over the years what I noticed, especially while I was in residency, is that that problem continues today, and many people have difficulty getting access to health care when they need to see someone. They have to schedule weeks or months in advance. They have to end up taking time off of work. And for many people it just becomes a decision of, do I put food on the table or do I go see my health care provider when I need to go see them?
And again, I started MY DR NOW while I was still in residency, and the concept was really simple. It was: deliver great care, provide a great service, and make health care ridiculously easy for everyone, every single day. And what started as initially a very small 1,200 square foot clinic eventually expanded and grew, really expanded to multiple facilities. It became a system. It became our infrastructure. It became our operating model. Today we have a little more than 80 clinics. We have a thousand employees. We have over 200 providers. And it’s expanded nationally. And that’s really the reason why I wrote the article for your website.
Kevin Pho: All right. So for those who didn’t get a chance to read your article, just tell us briefly, what’s it about?
Payam Zamani: In essence, it tackles the notion that it’s not primary care that’s broken. It’s the health care delivery system. It’s access to health care. It’s the front door.
We live in a world where everything is made simple, it’s made easy, it’s made accessible, it’s made user friendly. Whether it’s, I don’t know, ride sharing. You click a button and a car shows up. It’s retail. You can purchase anything you want online and it’s at your doorstep today or tomorrow. You can move money around. You can order food, groceries. But yet the thing that we believe to be, as physicians, as clinicians, we believe to be the most important, health care, still does not operate in the way we expect of every other industry. It still takes weeks or months to get an appointment. It requires people to take time off of work.
So it really tackles the notion that if we really want to get better outcomes, we want to try to lower the cost of care, we want to provide a service in a manner that consumers are more engaged with, we have to improve the health care delivery system. We have to improve the front door. And in order to do that, you really need to re-engineer the entire model of health care delivery.
Kevin Pho: So give us some of the reasons why that front door is proverbially closed to so many patients. So why is it so difficult to access our health care system?
Payam Zamani: So I think physicians have historically stayed in that eight to five model and needing to ensure that every patient we see is scheduled and planned for ahead of time because of predictability. We want to have a predictable day. We need to know who’s coming in at what time.
And from a family medicine perspective, and by the way, what we provide is, we provide pediatrics, we provide, it’s true family medicine, so it’s pediatrics, it’s adults, it’s seniors, it’s women’s health, it’s behavioral health, it’s anything you go to your family medicine office for, including acute and episodic issues.
And what we did differently was we opened the doors. We said, if you need to be seen today, we’re going to see you today. If you need to walk in, we’re going to let you walk in for anything you go to a family medicine office for. We’re going to give you optionality. We’re going to give you that sense of empowerment for you to decide when it makes most sense for you. If you want to come in on a Sunday after the game ends and get the physical that you haven’t had, you can do that. If it’s that single mom with hypothyroidism who gets off of work at 7:00 on a Thursday and she wants to come in and get her refills, get her labs done, get her annual done, she can do that. If she wants to schedule three months from now, she has the optionality of doing that as well.
And of course, over the years, we layered on other services. We added virtual care. We added home visits. So it’s a true omnichannel platform, where we provide all the services in multiple modalities.
And what we’ve discovered is that the more we find the yes, the more we find ways to serve our patient base, the easier we make health care, the easier it is for people to be compliant, the easier it is for them to follow up when they need to be seen, the easier it is for them to stay on top of their medications and preventative visits and prevent the avoidable ER utilization and hospitalizations and urgent care visits even. And it really just comes down to providing that access and that simplicity to care delivery. We want our patients to walk out the door and think, “Yes, I can do this. I can get my arms around my health care.” We want it to not be scary for our patients.
Kevin Pho: Now, how did you succeed when so many systems have failed? Because, as you know, with so many primary care physicians, they have trouble recruiting primary care doctors. You mentioned things like after the game, you mentioned things at night. How do you staff those positions? Because so many systems, they want what you have, but they simply just can’t find clinicians willing to do the primary care. So how did you succeed?
Payam Zamani: Well, first of all, I think one of my main points early on was re-engineering the health care delivery system. So let’s look at it first from the clinic level. Clinicians, physicians don’t go into health care because they want to push paper around. Nobody goes into health care because they want to do the administrative work. They go into health care because we want to see patients. We want to lay our hands on patients. We want to talk to them. We want to see what’s going on.
So for us, the most important thing was stripping out as many things out of the clinics that don’t need to happen in the clinics. So all the administrative things, whether it’s prior authorizations, it’s the administrative work, it’s even refill requests, we made a big bet on centralization and standardization very, very early on in the process.
Now, of course, in order to make that work, I mentioned earlier I started with 1,200 square feet. You have to be able to scale and grow in order to be able to support those centralized costs, or they’ll overburden the entire organization and none of it will work. But we made that investment early on in the process. Centralizing those things, taking as many things out of the clinic as possible. So our physicians don’t do it, our clinicians don’t do it, our medical assistants don’t do it, our front office isn’t worried about it. They’re focused on the patient that’s directly in front of them. And then as you centralize those things, and we’ve been fortunate enough to be able to now automate many of those functions, it really simplifies the process.
So we made big bets on centralization, on standardization, on workflows that you can replicate, that you can scale, big bets on predictive modeling. If you have certain administrative tasks with certain payers, you can basically, in essence, and for lack of a better term, create care pathways or pathways of how those things are processed, and again take those things out of the clinic, centralize it, and have the administrative burdens removed.
What that also allowed us to do is have our physicians, because we have extended hours, our providers work fewer days per week, but they work longer hours, for example, typically three days a week. So they have more time off work. They do less administrative work, which in essence has really helped with recruitment. The more we’ve grown, I think the easier recruitment has gotten for us, just because the provider and physician experience has been so greatly improved.
Kevin Pho: Now, what proportion of your clinician workforce are physicians versus advanced practice practitioners?
Payam Zamani: So we keep about a 4:1 or 5:1 ratio between physicians depending on the geography.
Kevin Pho: And in terms of where you are located, you mentioned earlier on you’re located in Arizona. There’s less of a problem with recruitment because of the efficiencies that we talked about.
Payam Zamani: Well, there’s less of a problem with recruitment, one because of the efficiencies, because of the work schedules. I think the technology has made a big difference. And a lot of it is just, quite honestly, it’s word of mouth. It’s other providers recruiting other providers.
So yes, we started in the Arizona market initially in the Phoenix metro area. We’ve expanded into a few markets in Arizona and have since expanded into the Texas market as well.
Kevin Pho: Now let’s talk about some of the financial questions. There’s always been that stereotype that it’s very difficult to make money in primary care. As you know, there’s always reimbursement pressures. There’s always a pressure to do more, see more. So talk about some of the financial headwinds primary care faces, specifically in your own model. What kind of financial pressures are there?
Payam Zamani: I would say the biggest one you probably left out, which are inflationary pressures. And yes, of course, reimbursement is always an issue, and dealing with payers, that’s an issue. But luckily I think our model has responded to that fairly positively, because we put a big emphasis on good medicine, good quality care.
I think with the accessibility that we provide, maybe we have a little bit of an advantage as far as keeping cost low. Patients go to emergency rooms less, they go to the urgent cares less, they’re hospitalized less, so our cost of care, our MLR, is more favorable. That has allowed us to have better relationships with our payers.
Additionally, I would say that, and I mentioned this earlier, when you make health care ridiculously easy, what you’re really doing is you’re making it ridiculously easy for patients to do the things you’re asking of them to do. Getting that physical done, getting the cancer screenings done, colon cancer, breast cancer, cervical cancer, etc. Getting their labs done. So I think from a value-based perspective, we’ve performed fairly well and have had great relationships with the payers. That has helped.
The fact that we can always get our patients in. Quite sadly, there really just aren’t many primary care groups that are providing the level of accessibility that we’re providing. That has helped.
We’ve taken an agnostic approach with the different health care systems, hospital systems in our communities. So we have relationships with all of them. I think that has helped. When they have a patient that they need to get seen, a patient that needs to follow up with a primary care provider, they know they can always reach out to us. We’ll get them plugged in. We’ll get them seen. We’ll get them taken care of. We’ll reconcile their medications and coordinate care.
So I think all those little things, being a good partner, has helped us. But again, going back to your original question, I think the inflationary pressures remain difficult for any medical practice. So I think the scale has helped, and being able to reach a certain size, and again being able to double down on technology and automation has probably been beneficial for us.
Kevin Pho: So this next question is related to my earlier one about how you’re succeeding where other hospital systems are not. What’s preventing other systems from doing what you’re doing? How easy or hard is it for them to really implement some of your techniques and make their primary models more successful than they are?
Payam Zamani: Well, theoretically I would say that it shouldn’t be difficult, but we’ve seen a lot of systems try it and not be able to do it successfully.
MY DR NOW started as this model. So it’s ingrained in our culture. It was ingrained in our culture from day one, when I started again as a resident with one team member, that this is what we’re going to do. We’re going to provide great care. We’re going to make it ridiculously easy. It’s going to be available every single day for every patient. So, to be clear, it’s not a concierge model. It’s not a membership model. There are no additional fees or anything associated with that.
So I think from day one, it was a part of our culture. It was a part of what we do. It was a part of what I talked about on a daily basis. And as we grew slowly, responsibly over time, and again expanded that first location and then started adding more locations, that was always a part of our culture. It was a part of what we talked about, and it was about finding the yes and remembering to help that human being that’s standing in front of us.
So I think the problem that a lot of other groups have had and health care systems have had, whether it’s introducing primary care to an urgent care chain, whether it’s trying to take an existing primary care platform and expanding the hours, if it’s not a part of your culture, if you don’t have the right why behind why you’re doing it, you seem to run into some problems.
Kevin Pho: So if I am a hospital executive that’s listening to you on this podcast, what are some of the best ways to turn around a failing primary care system? Is it simply a culture change? What are some steps that you would recommend for other systems to replicate some of your success?
Payam Zamani: So I think, first of all, I would answer that a little differently. The common question I get a lot is, who are the biggest competitors that you have? And that relates to what you’re asking here. And it’s not another primary care group. It’s not an urgent care chain. It’s not another health care system. I think the biggest competition we have are groups like, it’s Uber, it’s Amazon, it’s Netflix, it’s Spotify. It’s all these really leading brands that are setting expectations for consumers on what they expect from every industry that they interact with.
So I would ask the hospital administrators, or the operators, the executives, to take a step back and really put yourself in the position of the patient and what every other aspect, and how every other aspect of their lives function, and ask yourself, how do I bring that into our platform? How do I meet those expectations?
Which means, yes, technology is great. We implement technology. We’ve doubled down on automation, AI, big fans of what’s happening. But the answer is not always let’s add more technology, let’s add more AI, let’s add more scribes, or whatever the new trend is. It’s how do I deliver this service in a way that resonates with the individual, the consumer, the patient, that allows them to want to engage with me, that allows them to want to be compliant and get the care that I ask for them? How do I deliver it in a manner where they walk away from the interaction thinking, “Wow, that was ridiculously easy”?
And that starts from probably the parking lot, where you place your locations, how easy it is for them to physically get there, all the way through the check-in process, all the way through triage and the provider encounter, and even the design and the layout of the clinic, and of course what happens on the back end.
So I really think you need to take a more comprehensive, holistic approach, but really try to put yourself in the position of the individual and try to cater to them in a manner that makes more sense and is more consistent with every other industry we interact with.
Kevin Pho: We’re talking to Payam Zamani. He is a physician executive, founder and chief executive officer of MY DR NOW. Today’s KevinMD article is “Primary care access is the real problem, not the system.” Payam, let’s end with your take-home messages to the KevinMD audience.
Payam Zamani: I think my take-home message is again what we’ve already talked about. It’s that health care doesn’t necessarily need to be reinvented. We need to re-engineer it. We need to think about it from the consumer’s perspective. Patients shouldn’t have to organize their lives around health care. Health care should organize itself around the patients. We have the technology. We have great clinicians. We have the resources. But now we really need to focus on, how do we make it ridiculously easy, make it more accessible, give patients more optionality, allow them to have that sense of empowerment so they can utilize the health care system in a manner that makes more sense for them and their lives.
Kevin Pho: Payam, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Payam Zamani: Yeah, thanks for having me.
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