Part I: Q&A with Turntable Health Founder Zubin Damania
There are two kinds of disruption in the medical world: the kind that comes in alongside existing processes and makes them more efficient, and the kind that turns the entire model on its head.
Turntable Health represents the latter. This Las Vegas-based startup is creating a health and wellness ecosystem, offering members a primary care experience that’s focused on preventative care. Founded by Zubin Damania, a former hospital doctor at Stanford University Medical Center, this clinic’s team includes everyone from physicians to wellness coaches—for little more than the price of a monthly gym membership.
To learn more about Turntable Health’s plan to bring wellness to the people, Arnab Sarker – a healthcare consultant and medical/business student at the University of Virginia School of Medicine and Darden School of Business – spoke with Damania about why he thinks his company is just what the doctor ordered. In this two-part series, Damania discusses everything from his elevator pitch for Turntable Health to the Affordable Care Act. Read on for part one of Arnab Sarker’s (AS) interview with Zubin Damania.
AS: Could you give the quick pitch about Turntable Health, and why it makes so much sense for the climate in healthcare today?
Zubin Damania: Sure! The idea behind Turntable Health is that in order to disrupt a very regulated industry such as healthcare, you have to really rethink it entirely and do it in a way that hasn’t been done. Not only do you disrupt the business model, you disrupt the care model and you disrupt the technological model all at once. I think you need all three of those to succeed in true healthcare innovation.
The next component is—if you are doing a clinical enterprise like we are—it has to be led by physicians. It can’t be led by government, and it can’t be led by industry.
The first innovation is that first we strip away fee-for-service medicine entirely from primary care. Turntable Health is a primary care clinic that focuses on prevention. For a flat membership fee, similar to the gym, you get all-you-can-treat access to a buffet of care. The focus is not on episodic treatment of acute illness, but on longitudinal treatment of a person’s entire life. We like to get involved when people are well; we like to get involved when people are sick.
When you use a membership fee, instead of fee for service, you are incentivized to do things to people instead of for them. It turns out that the flat fee can be paid for by individuals, it can be paid for by health plans/insurance or it can be paid for by employers. There are no limitations of who can use us.
The second innovation, is that instead of a one-doctor and one-patient relationship, where the doctor is overwhelmed and can’t do a lot of things that the patient needs, we go for a team based holistic approach. We have a physician who is working with a nurse, a licensed clinic social worker (who also happens to be a yoga instructor and licensed medical instructor) and then these entities called health coaches, who are drawn from the community. They are screened based on the their ability to show empathy and build a story. They do the heavy lifting in chronic disease management: They call patients, they text patients, they go shopping with patients. They also teach the classes included in the membership.
We think this team dynamic is the new age of healthcare. During our “morning huddle” where the entire care team meets to discuss patient cases, we don’t just talk about the people who are coming in that day. We talk about the people who haven’t come in a while, to see how we can reach out. In that way, we’re doing true population management.
The third piece is the technological piece. There is no existing electronic health record that can cater to a team-based approach to care. The existing solutions are sustaining innovations that are essentially just glorified insurance billing platforms. Clinicians need to develop their workflow around the EHR. We decided to partner with Cambridge, MA, startup Iora Health, which has built its own EHR designed solely around team-based care with no insurance billing. It’s entirely transparent to patients, and we even keep a screen on the wall in each room where the patient can see what the physician is writing. The whole software is centered around the patient.
AS: Having dealt with a number of Internet-based startups, “going viral” is on everyone’s minds. What is it going to take for Turntable Health, a company based on primary care clinics, to go viral?
ZD: Our partnership with Iora Health is a big part of helping this scale. What we’re really going for is an “Iora Inside” model. They provide the technology, providing the care model along with hiring clinical staff like physicians and health coaches. Turntable Health provides the “hardware”. We provide the marketing, brand growth, the physical clinics, specialty networks and hospitalist networks. This allows us to scale the direct primary care model that Iora Health has created to a variety of different market segments.
Turntable Health provides a very specific brand. We’re going for an edgy, innovative, and a bit younger (audience). We chose the name “Turntable” because we wanted to generate the same feeling you get from holding a vinyl record in your hands—analog, warm and filled with a collection of tracks that fit in a cohesive way. In a system where everything is fragmented and crappy, we’re bringing it back to that intense relationship. So, all in all, we’re taking a core model developed by Iora Health, using the Turntable Health infrastructure to make it relevant to our market, and backing everything up with real patient feedback. Our initial data shows patient satisfaction in the 95-percent Net Promoter Score range, which is unheard of in healthcare.
AS: At the moment, it seems that you’re working with patients who are a bit sicker, maybe a little bit older. I’m interested to see how well the younger generation, who value convenience, buys into the Turntable philosophy?
ZD: Yeah, it’s kind of interesting because a lot of our population is young, sort of tech-savvy urban dwellers, and the feedback we’ve gotten from most of them is that this is amazing. It’s like an Apple product, they didn’t know they needed it, but once they have it, they can’t believe it. Particularly the classes and the engagement of the health care – but then there’s a small subset that says, “You know what, I need shorter appointments, I just want in and out, I just want a prescription.” Those guys are going to be less thrilled with our model because it is more time-intensive and involved in your life. So what we’re hoping to do is expand our thinking to include those patients and not alienate them. I think we’re getting there.
Arnab Sarker is a healthcare consultant and medical/business student at the University of Virginia School of Medicine and Darden School of Business. He is the former Director of Operations of K Street Capital and regularly advises on issues related to health IT strategy and venture funding.