Illness (not wellness) drives the U.S. healthcare delivery system. But some are trying to flip the status quo upside down, building models designed to keep patients out – not in – hospitals and clinics. In this episode of the Oliver Wyman Health Podcast, Sam Glick, a partner in Oliver Wyman’s Health & Life Science practice, chats with Dr. Gaurov Dayal, ChenMed’s President of New Markets and Chief Growth Officer. ChenMed is a primary care group caring for a specific population subset – low-to-moderate income seniors from underserved areas who have both Medicare Advantage and chronic health problems. ChenMed opened three decades ago as a single physician practice in Florida, and by the end of this summer, ChenMed will have expanded to 60 clinics serving seniors in 8 states. ChenMed is now one of only a few primary provider groups and healthcare systems that’s expanded nationwide – and continues to expand – successfully across multiple markets. Sam and Gaurov discuss what makes ChenMed’s model unique, scalable, and one where patients say, “Wow, this is really cool.”
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- “Dr. James Chen [one of our founders] started [ChenMed] as a solo practice in Miami. Over time, James started realizing there were a lot of members who had chronic conditions. [This was] around the time when initial rollouts of capitation around Medicare members were happening. He jumped into it very early on. There was a significant learning curve, but … the company in initial iteration went from one to two to three practices and was a very Miami-centric company for the better part of two decades.”
- “[ChenMed’s] ‘secret sauce’ is to put the patients’ needs at the middle of everything we do and build a clinical care model that actually does two things: provide exceptional clinical care so we can manage their chronic diseases, but at the same time provide exceptional customer service.”
- “For example, we pick up patients from their homes. If a patient calls us at, say, four o'clock on a Friday afternoon and says, ‘Doc, I'm not feeling good,’ we tell them to come in. We welcome people walking into our clinics, we spend a lot of time with them, and we work around their convenience. We provide their Part D generic drugs in our clinics so we don't have to give them [a prescription]. Lot of things we do are honestly very logical, but what’s amazing to me is how unique these things are, because of the lack of logic and aligned incentives across the U.S. healthcare spectrum.”
- “At our core, we are exceptionally standardized. … The clinical care model is extremely standardized around chronic heart failure management, and diabetes management. On the operation side, every clinic [looks] identical in some way. It's a bit discombobulating. I'll be in Jacksonville one morning and then Philadelphia that evening and you're a little lost because everything looks the same.”
- "[ChenMed’s] success in every market is ultimately driven by how patients perceive us. We can sell as much as we want and so can the plans, but patients have to walk out of this experience saying, ‘Wow, this is really cool. I feel good about my doctors, my clinical care team, myself, and how I feel after coming to a ChenMed clinic.’”
- “Our healthcare delivery system is based on illness, not wellness. Models like ours are still somewhat unique because we're one of the few that actually gets compensated for keeping people outside of the hospital and keeping them healthy.”