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Today on This Week Health.

(Intro)  you need more of healthcare to shift over into a mindset of outcomes and promotion of health, not just the resolution of sickness

Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

(Main)  All right, here we are for another keynote episode. Now I'm excited to be joined by Gordon Chen, Dr. Gordon Chen, former Chief Medical Officer at ChenMed, current board member, co author of The Calling, a book I read just last year, thought leader and influencer on physician leadership and transformative healthcare.

Gordon, welcome to the show.

Hi, Bill. So great to be here with you. Thanks for having me.

Well, I'm looking forward to the conversation. There's a lot going on in the space that GenMed is in. There's a lot of stuff going on at GenMed, and there's a lot of transitions going on. For yourself and your family.

Let's start with the transition, just to tee that up a little bit. You recently stepped down as Chief Medical Officer at ChenMed, a company founded by your family that really serves those underserved communities. Can you share what led to that decision and what... your current focus is at at ChenMed?

Happy to, Bill. It's a super exciting time at ChenMed. ChenMed has been near and dear to myself, my whole family. It's really been a big part of, who we are personally and professionally for. Almost two decades now and but still a very exciting time right now.

So we meet recently made the decision as a family to step out of our day to day operating roles. And really what happened is this beautiful opportunity to bring in Steve Nelson initially to lead about a third of our company, which was Gencare, right? And so he was brought in as CEO of Gencare and we were thinking we would Empower GenCare to grow and fulfill its potential.

And the rest of the company would also grow in different geographies, and we'd see how it played out, right? And Steve brought in a wonderful leadership team for GenCare. I had the opportunity to really groom the chief medical officer for GenCare, Gianni Neal. And we prepared her to be an enterprise CMO and really champion that clinical culture while Steve was really moving forward, like leading the culture and leading the outcomes beautifully.

And so we had an opportunity to watch how Steve led for about nine months. And when the time came where we decided as a family, as a board, as a leadership team, not to split the company. Then we had to make a critical decision. He said, well, if we're not going to split the company into, GenCare and the rest of the company, and we're going to keep it as one company, because we think we're going to be stronger and better as one whole company, well, then what do you do when you have two leadership teams, right?

And so as a family, we're watching Steve lead and the team that he brought in, and we said, wow, could you imagine? If he had the ability to lead the whole organization and for us to really take a step back so he can. Feel more empowered to lead the whole organization. And our intent as a family is we need to make sure that this stays a mission driven company and that we maintain this culture that we have, which is, best in class.

Culture, right? We've won, most loved company in healthcare now two years in a row by Newsweek magazine, right? and we still do this change the world approach. We're going to, we're going to transform American healthcare. And so we knew that was so strong in our company and Steve and the new leadership team they continue to champion it.

And so we're very that even as we step back, as day to day operators, that would still be intact. And then we realized that if we stayed in day to day operating, we really wouldn't be empowering our team or Steve to lead to his fullest potential, And so it was a difficult decision because obviously we really love what we do I loved being a chief medical officer for our company. But really it was the right thing for our organization. And I think this move will actually accelerate our growth. and accelerate our ability to achieve our vision. And the vision is still the same vision to be America's leading primary care provider, transforming care of the neediest populations.

first of all I commend you and the family. It's not easy to step back from those day to day roles. It takes it takes some humility to do that, but also takes some vision. and confidence in the team that you're handing these things to. Why is it important for it to grow? Talk about the mission and the vision.

I realize we started talking about the transition and some people who are listening to this might not be familiar with GenMed. I read the calling, I interviewed your brother, and it really is fascinating the way you approach primary care and the areas you choose to do it in. So talk a little bit about the mission and the vision and where ChenMed has been and where it's going.

So if you look across America, the majority of American health care is by this kind of broken fee for service transactional model, a model people refer to as sick care, right? And what we've done is, we've been able to champion more of an outcomes based approach. right, on a foundation of value based care.

And we've been able to scale the outcomes based approach. And so we call that transformative primary care, right, where we can actually scale this outcomes based approach with this focus on talent and technology. And as we've scaled and grown, and back to your question, why is growth important?

We've been able to improve. outcomes, and when I mean outcomes, lower hospitalization rates 30 to 50 percent in the communities that we serve. And we're serving, really needy, poor, forgotten, underserved communities. And so when we go into a community and we can lower hospitalization rates, they live longer.

They live five to seven years longer, sometimes even more. And most importantly they feel. The love and the intention and the support that they need to thrive and do well. And we see it in our patients like day in and day out. Okay. And as we grow, we know we're. increasing their life expectancy, right?

And we're spreading love and we're spreading health. And so for us, it's like a moral imperative that we need to grow when you spread this proven model to communities in need across America. The other reason for growth is growth means improved impact and it also means improved opportunity for our team members.

And so when we're growing and we're transforming care, we want to create this beautiful environment for clinicians for business leaders, for frontline, team members to have both fulfilling purpose and personal opportunity. Those come with growth. As soon as you stop growing, then you, the opportunity goes away.

Okay, so it's one of those things that becomes a positive feedback loop that we grow, we fulfill our vision, which we mentioned before, right, to be America's leading primary care provider, transforming care in the neediest population. And we live out our mission. And our mission is we honor seniors with affordable VIP care that delivers better health.

So if we're doing that, And we're growing, well then we are living out our purpose.

I assume in your residency, you practiced in that fee for service model at some point in

your career? Yeah, all hospital systems are based, not all, but almost all hospital systems are based in this fee for service transactional system.

And you need it to some extent. That's how healthcare is run in this country. You just don't need it to be 90 to 95% of healthcare. You need it to maybe be half at most. And you need more of healthcare to shift over into a mindset of outcomes and promotion of health, not just the resolution of sickness.

Well, it's interesting. I want to take this in two directions. One is the individual and physician, and the other is systems. Let's start with the clinician. So when a clinician, when you hire clinicians, because I assume a fair number of the clinicians you hire come from that fee for service model, talk about and what kind of training, what kind of things are done at ChenMed in order to bring them into this culture, into this different way of practicing primary care.

Well, Bill, I am so passionate about this stuff. This is what Jessica, our former chief clinical officer, my wife, Jessica and I have been doing over the last decade intensively is figuring out how to bring in the right clinicians and physicians and then train them to be leaders, leading themselves, leading others and leading this healthcare transformation.

And we don't get any of this in residency or medical school, very little. And most of our exposure is in this transactional fee for service model. And what we learn in our training is more of the knowledge, the medical knowledge, but you and I both know it's not just the medical knowledge that leads to better health and better outcomes.

We actually need to lead ourselves and lead our patients to the outcomes. Cause ultimately you cannot force patients to change their behaviors. You need to influence them to change their behaviors, and leadership is influence. That's really what leadership is. So, we needed to create this best in class clinical leadership development culture and Chenmei.

And I think we've done a beautiful job, I, like allowing and empowering our leaders to grow to their fullest potential. And here's a beautiful thing. When you give clinicians The time and the permission and the support to grow as leaders, they love It transforms who they are as a person, as a clinician, and as a leader.

And we see this time and time again. So what happens at Chen Medar, a clinician, the day that we start interacting with clinicians, either in the recruitment process, or just getting to know them. That's when their leadership journey begins, and they start to learn more about themselves, who they are, really what they're passionate about.

And if they're passionate about serving the underserved, right? If they're passionate about healthcare transformation. If they're passionate about bringing change to a broken system, well, those are good fits for Chundu. But they not only need to be passionate about that, they need to have the mindset of humility.

You talked about humility before, it's super important. And we call that learning humility and learning agility. Those two things go hand in hand. So if they're aligned with our mission and vision, if they have the learning humility and learning agility, Well, we say, hey, they're a great fit for TrenMed.

And once they start on the journey, they're, it's almost like a fellowship in leadership and value based care and transformed care all together, packaged together for them. It's about intensive training for four weeks before they even see patients on their own, right? They're learning about our organization.

They're learning about themselves. They're learning about what it means to live in a value based care environment. And when we mean value based care, we... We don't mean that we have like a value based care contract. All we do at ChenMed is value, right? And outcomes. We don't do any fee for service. So we have this beautiful ability to then really focus and not practice in a schizophrenic manner, right?

Like some organizations are like. practice in a certain way for some patients and another way for other patients. And it gets very confusing. It's very complex. And that's why we say, hey, really what we're doing is we're scaling an outcomes based care approach. And then their training continues after the first four weeks through the first year in our ChenMed University.

And we have different levels of training, seven different levels of training for them where they can achieve a partnership status. in that year one to two range. The growth continues, obviously people get promoted and continue to get promoted. Gentlemen, it's almost like every one to two years, if you want to go up that that leadership and management track, you can, and you can continue to get promoted and over again.

And so we, we have that culture where 80% of our leaders come from within and they're getting promoted and even to the point, I mean, myself stepping down as chief medical officer is just an example of how intensively we focus on leadership development. And, I was able to promote Johnny Neal into that chief medical officer role and it was a beautiful.

example of how we not only promote from within, but we're really championing that leadership development culture and empowerment culture.

Have hospitals and health systems that are operating in the fee for service model approached ChenMed and asked you about your program, about your approach to primary care with a goal of potentially adopting some of those practices or changing the way they go to serve the communities that they're a part of.

yes, every day hospitals would want to figure out how to partner with us, work with us understand our model for many different reasons, right? Some of the reasons may be they just want to understand value based care more. Some of them are also thinking about, the impact to them when we show up in, in a community.

How do we work together? How do we partner? For a lot of hospital systems, for them to break away from the FHIR service heads in beds model, it's very difficult. Because all of their revenue is based upon that model. And when you're in a situation where you may have margin compression and revenues may be, lower than what they used to be, well, hospitals are less likely to explore things that they're not really good at or they don't know much about.

And so they, they tend to kind of double down on what they know, which is more of that fee for service transactional care, approach that got them to where they are. So it's very difficult for these large hospital systems to really move. out of what they do. think if they are really committed to learning about value or having a part of their organization to focus on value, it almost needs to be this protected, separate part of their organization that's unleashed.

Because what they're going to have to do is that they're going to have to almost challenge their internal approaches, which is to keep the ERs busy, to keep them full, right, and to keep their beds full, like shifting over into a prevention mindset is very different.

we talk about creative destruction and just the whole concept in Clayton Christensen's model and book that he talks about that we talk about in health care all the time, but as you've so eloquently put it when you've built out the infrastructure for one thing, it's hard to make that transition.

I want to transition real quick to analytics. So you talk a lot about outcomes, talk about analytics. What does it, what is a, as a chief medical officer, what does the scorecard look like that you're looking at? What determines the success of the practice, maybe the individual practices or individual communities and then the practice as a whole?

What are the metrics primarily that you're looking at?

So my role when I was chief medical officer was really to drive better outcomes for our patients and to make sure that our medical loss ratio Was as good as it could be. And if you're driving both of those outcomes approach, which is better health, that's like the result of our mission, right?

We need to achieve better health for our patients. And you're doing it in a way where you have a very good medical loss ratio, that's affordability. That affordability, that's what America is trying to get more of for healthcare right now, because if we continue on this path, it's not affordable for anyone.

So we're driving for outcomes, and we're driving for affordability. That was my role every day. So to give you an example, like, the first thing that I would look at every morning would be how many patients do we have in the hospital, right? How many people... That we're caring for overall of those people.

How many people did fell through the cracks and we weren't able to prevent their hospitalization. And I'm thinking, well, we need to we need the right teams in place and the right accountability to get them safely out of the hospital. And then we need to. do a deep dive to figure out what led to those patients falling through the cracks, because we're such a proactive preventative model, we should have caught it early.

Now, this is where AI comes we were using AI before AI was cool. And so we would have this top 40 list where we had all of these algorithms, going all these really smart analytics and data folks that were able to predict which one of our patients were highest risk for hospitalization.

Now, it's not enough just to know who's higher risk, where the rubber meets the road is to take that information and then make it actually applicable and get providers and patients to change their behaviors in a way that leads to better health outcomes. So you take that information, let's say that top 40 list.

And then it shows up on the provider's screen, and we know we need to be seeing this group of patients twice as frequently than every other patient, right, at least. We also need to create alerts for anyone in our organization that sees one of these patients say, hey, we need to check in on them.

Whether or not you're a doctor, clinician, non clinician, anyone that interacts with that patient is on alert that this is a high risk patient. And we need to do everything we can to make sure that they don't fall through the cracks.

And the amazing thing was, I remember in the interview last year, I asked about the EHR, what you guys are using and whatnot.

And the answer back to me was, Essentially, ChenMed has built their entire tech stack almost from the ground up, essentially. So you have very tight integration between all those systems. Therefore, the data flows, the getting the information back into the workflow, into, in front of the clinician at the point of care.

is something that's just built into the entire model. Do I have that right or am I overstating it a little bit?

No, I think you have that right. We have our own technology company called Curity that enables and supports all of our ChenMed systems. And so what happens in healthcare especially, right, healthcare is really just connecting providers and patients together in a productive way that produces better health.

And technology's role in that is not to replace, it's to enable, support, and simplify. And if technology can do that, then what you're doing is you're creating more meaningful touch points, you're creating more face time between providers and patients, and then you're creating ultimately more behavior change.

So we view things in our organization, particularly technology, as an enabler of what we do in providing, the care for patients. That may be different in other organizations if you have too much separation between, the people that are developing the technology and the people that are delivering the care.

For us, we're able to say, hey, this is what we're trying to do with patients, how can our development teams, our technology leaders and team members help us. in doing that. We would consider technology to be like the lightsaber of a Jedi and the Jedis would be like our frontline team members and the would be the technology for their Star Wars fans out there, but really it's in the Navy. That's what it

is.

  📍 📍  We'll get back to our show in just a minute. We have an excellent webinar coming up for you in November. We had an excellent conversation about AI in September with three academic medical centers around the topic of artificial intelligence.

It really was exceptional, and we released it on our podcast channel so that we could share it with a wider audience. I wanted to explore that topic a little bit more, and I asked a couple of additional health systems to join us to explore the use of generative AI and other forms of artificial intelligence to see if we can identify some pragmatic approaches to how health systems are looking at taking advantage of this technology.

The webinar is on November 2nd, 1pm Eastern Time, 10am Pacific Time. You can reserve your spot on ThisWeekHealth. com and one of the things we love is that you can submit your questions in advance and we can make sure that we, answer those questions and keep the webinar relevant to the things that you're looking to talk about.

So, please join us November 2nd, 1 p. m. Eastern Time, 10 a. m. Pacific Time. Now, back to our show. 📍   we're going to transition the first half of this interview. We talked about Chenmed. So You know, you've moved into the board role, you'll still be actively involved, but the leadership team is going to take it and move it forward. Clearly you were passionate, clearly you enjoy doing it.

And I think the second half is going to be what's next. So, what are your passions? What are your things that you're excited about in the industry has your attention right now in something that. You think, man, that might be an area. I assume you're going to stay in healthcare, and I assume that you have passions in healthcare.

What are you looking at?

Well, Bill, I'm in this beautiful phase of learning, reflection, and exploration right now. And my first priority really is just, allowing whatever I can do to support ChenMed's vision and mission and to allow ChenMed to see through its fullest potential. And the first step in that is, is me taking a step back and empowering my team.

Cause I realized I'd been pouring into the clinical leadership team for one to two decades, literally. And they've seen our explosive growth and they have been coached and developed. To really lead without myself or Jessica there day to day. And we're still, available for coaching and mentorship, but they're ready, They're ready to go. And then having the ability to, get someone like Steve Nelson and the team that he brought in. I mean, Steve, was the CEO of United Healthcare. He was He knows. How to build the right systems for scale. He knows how to scale the right culture.

And so we're really excited about just empowering Steve and that new leadership team to really see through that vision. So they want to go from, 130 centers and communities. To 700 by the end of the decade. I mean, that's a tall order. So my first responsibility, as a board member is to say, hey, whatever I can do to support you in that journey, I'm going to do.

And maybe that's more, of an external focus. Right, not like doing podcasts or maybe it's creating the right relationships or helping in any way that I can help. So very excited about that. The other thing that we're really excited about is learning the impact of the whole community on health, right?

And so when we talk about transformative care, I define that as the pursuit of health and wellness. For everyone involved. That means caregivers, patients, community members, whoever it is, you're promoting health and wellness. And there's really five drivers of health and wellness. a personal, a community, a nutritional, a physical, and a spiritual.

And I believe you're driving towards health and wellness with these five key drivers, then healthcare has a role in it, but I think it's actually broader. And we're learning about that right now, how communities are set up how cities are set up. You're learning about it when you study the blue zones, like communities that have.

Longevity that exceeds typical communities in your setting, you're saying. What is special about those communities that allow so much health and wellness to their residents and to their community members that they're outliers, like, in the world? And so, Jessica and I are really studying that right now, and this interaction between community and healthcare needs to be explored further, so healthcare is not on an island.

I mean, you've given me so many directions to go here, so the five things were personal, community nutrition fitness, and spiritual. It's

spiritual. Personal, community, nutritional, physical, and spiritual. Physical and spiritual. Those are the five that you... Any community that you study, whether or not, it's like those blue zones or when we've been able to go into communities and really transform care, or even in, in our mission work to Nicaragua, right?

We've gone on, probably at this point in time, Almost a hundred different types of mission trips with different teams or whatnot to Nicaragua, and maybe not a hundred, maybe a hundred is overstating, but many mission trips and studying the impact of health and community and that relationship and these five components continue to stand out for driving health and

wellness.

It's, I've seen this, I've moved around the country. And when we lived in certain areas, there was not a propensity to, there wasn't access to workout and that kind of stuff. You had seasons and whatnot. And then I moved to Southern California for work and and all of a sudden realized that I stood out.

I was overweight and... And there is a, there, there is a community sort of, push towards, Hey, everybody's working out. Everybody's at the beach. Everybody's outdoors. Everybody's working. There is a community aspect to it that happens. And you can see that it's interesting to to find all five would be interesting to me.

I'm now in Southwest Florida and I was, I told someone I just started a personal health journey. for me. I realized 55 years old I want to be healthy for when grandkids are around and those kinds of things. I want to be able to get on the ground and whatnot. So I start that journey and this is going to pain your heart to hear this.

I didn't start with my primary care physician because I don't have... Since my, my parents had a doctor, Dr. Polliner, who was my doctor from birth until I graduated from college. Like, I saw Dr. Polliner, he knew everything about me, he knew everything about my family, and he was invested in our family. In fact, he was invited to family gatherings and those kind of things.

It was a part of my life. Since then, I have not really thought of my primary care doctor in that way. And so here I am in Southwest Florida, I begin a health journey. I find a fitness coach, I find a nutrition coach, I find, I find all those different things outside of the healthcare system per se.

Because because I, I'm not sure that the healthcare system, the way it's designed today. Would really lend itself towards keeping me healthy. And so I didn't even go to the healthcare system to help me with that journey. I'm not really asking questions. I'm just sort of relaying my thing.

I mean, what. What would it take for communities in the U. S. to transform and be really communities around wellness? And where does this start? Does it start at the, does it start at the government level or does it start somewhere else?

Bill, first of all, super excited that you're on this health journey, and that you've taken the initiative yourself, even though it wasn't, like, led by your doctor or primary care, provider, whoever but you've taken the initiative, so just want to call that out, proud of you, right, way to go, and keep it up.

And then what we've really done at ChinMip, Physicians, clinicians are not trained on how to drive health and wellness. They're not. And in fact, when you look at these five drivers of health and wellness, right, just the physical component and not even the nutritional, like I'm trained in internal medicine, cardiology, got very Little nutritional training, but just the physical component and the, particularly as it relates to medicine, not even promoting, activity and function and that kind of thing.

It's just the body component, right, that, the, and the medicines and the interactions with procedures. That's what healthcare focuses on and not any of the other components. So it's not a surprise to me that you didn't get that through, your typical PCP or whatnot. What we've done at ChenMed is we've asked our PCPs and care team members to champion all five of the drivers of health and wellness, which is probably the reason why we see the amazing results we do.

And we reduce loneliness and isolation just because we have a high touch. Relationship focused model, right? And that's so key. My, my dad would say this all the time, part of the reason why we're having the impact that we're having is because we're meeting with, these seniors monthly, and we're telling them, we care about you, we want the best for you we're going to hold you accountable for your healthcare decisions, and we're going to work with you, and then they do better.

It's, it's no wonder. The medicines help, but just having that Connectivity and almost like these mini health promoting communities that we've been able to scale. I mean that is impactful and that's why I want ChenMed to continue to grow and make a broader impact throughout the U. S. Now, what are other ways that we can promote health and wellness that don't have to go through a primary care physician or a clinic?

There are so many other beautiful ways that we can create these communities of health and wellness. And that's what Jessica and I are exploring

right now. heard the phrase that sitting is the new cancer. I heard that for the last decade. it's the new cancer.

When people become isolated, that's when bad things happen. And it's, again, living in Southwest Florida, you see a lot of people who are over the age of 60, 70 even 80. And their worlds get smaller and smaller until their worlds are so small that they just isolate themselves.

And a mental health aspect of that. There's also a physical health aspect of that. And I'm curious as you think about, I mean, you mentioned how important it is to have. The physicians have that encouraging conversation with them and actually be excited to see them. Hey, welcome back into the office.

It's great to see you. How are things going? Talk a little bit about isolation and it's. impact on health.

So this is something that is very close to home. Jessica, my wife's grandmother, she's 90 years old and throughout COVID she was really isolated. She was lonely and you can see her really not thriving.

Her health was deteriorating. Her memory wasn't quite as good. And then all of a sudden we got her into the right senior living environment and she took off. She had, social connections, friends. She was able to, go to church services together in their community. She had people looking after her.

All of a sudden we would ask her, we would say, Hey, you want to do something? And her calendar was so full that we had to And so she was so engaged, you could almost see her come back to life. And so we see this as well. Recently, I heard a stat that loneliness can take 15 years off of life expectancy.

Yeah. I don't believe, Bill, that we were created to be isolated. I believe we were created to be in community, to be encouraging each other to be shaping each other to have those really important relationships that allow us to grow and thrive and live with purpose.

Now, I know you're going to make this decision with your family, with your with your wife, with your kids, but I want you to project out 10 years from now.

So, we're in 2023, getting ready to go into 2024, 2034. What would you, I mean, if you could just, sort of paint a picture or write a screenplay between now and 20... 34. What would you like to accomplish? What would you like to see happen?

I would love for ChenMed to really see through its vision to be America's leading primary care provider, transforming care of the neediest population.

So every needy community that needs a ChenMed center to transform the care of the neediest population there. I want to see that through any way that I can help. The second thing is I would love to take a broader look at how we can drive health and wellness, not just from the healthcare standpoint, but maybe in creating these environments or communities.

Where we can bring the right people together in the right structure, in the right environment, where they're eating well, where they're, physically active, where they're on the move, so to speak, right, where they're living with purpose. and they have deep connectivity with their community.

And that, I believe, will help people to live not just five to seven years longer. I think people can live 10 to 15 years longer, if not more, in the right environment where they can thrive. You see, right now we, we send old people to nursing homes to die, right? But what if we flip that on its head? And what if there are these communities?

that people go to thrive and live to their fullest potential, and it was designed for them. That would be a beautiful

dream. That would be a beautiful dream. Gordon, I want to thank you for your time. I want to thank you for the work of your immediate family and the work of your father in Really going after this challenge of serving the underserved in our community.

it's so funny in, in, in healthcare itself, we talk about payer mix and there's areas almost to be avoided and you guys just went right into those areas and are caring for for those communities. And I just want to thank you for that. I want to thank you for your time.

Well, Bill, thank you so much.

And, I just thank God for this opportunity that we've had to, to influence American healthcare and to lead in this transformative care space. And I'm so optimistic for the future and these 700, medical centers and the million, patients that we're trying to take care of by the end of the decade.

If folks are interested, please look out for ChenMed coming to communities close to you. Fantastic.

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