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Right now, the medical industry is trapped between the caregiving of the past and the healthcare of the future -- a state of limbo between what was and what could be. That's what Zubin Damania, M.D. thinks. And it's why he founded Turntable Health, a primary care clinic in Las Vegas -- with a twist.
The healthcare of the past -- or Health 1.0, as Damania calls it -- were the days of paper-based medical records and deep human relationships. It was a paternalistic and hierarchical arrangement, and all the power was with the doctor, Damania said.
"The patient pretty much had to do what they were told or go somewhere else," he said. "Clearly a lot of failings there, but the positive was that there was this autonomous physician who had a deep relationship with the patient." This dynamic is what Damania thinks is missing from healthcare today.
"We're in this sort of weird limbo where the technology is expected to do the heavy lifting, but we haven't really transitioned," Damania said. "The human relationship … it's gone."
Furthermore, he thinks physicians and patients have become commodities, and EHRs are a disaster and none of them talk to each other, he said.
"It's increased our workload by an order magnitude and 60% of physicians won't tell their kids to go into the field," Damania said. "The technology should bind us together, provide a loop to encourage the human relationship, and, instead, it's an obstruction, currently."
Coming to the stage: Health 3.0
Where healthcare needs to go is Health 3.0, "which transcends and includes 1.0 and 2.0," Damania said.
Damania believes healthcare should take the deep human relationship aspect from Health 1.0 so that the patient and doctor are partners engaging in a shared decision-making model and then use technology to bind it all together. "But the human relationship is paramount," he emphasized.
In order for this to happen, better technology is required, as are new payment models and new training for doctors. In addition, patients need to let go of the "victim-hood of illness," Damania said. "[Patients] need to put in work, and they need to develop a relationship with someone that clearly will care about them … then use technology to leverage all that."
For such reasons, he founded Turntable Health with the help of Iora Health, a startup based in Boston, using Iora’s collaborative care model, EHR software and mobile application.
This effort echoes what has already begun to happen in retail with the customer experience, wherein a retail sale is largely based on the consumer's personal relationship with a certain store or website. Here, technology serves as the binding factor as well.
"It doesn't mean anything unless it's parsed to a deep, caring, human relationship because so much of our healing is internal, is mental," Damania said.
Turntable brings in the health coaches
At Turntable, every patient gets paired with a physician and a health coach. The health coach texts, emails and checks up on patients to make sure the patient is adhering to the previously agreed upon plan, Damania explained. Not only that, but patients have access to their records and can text, email or call their physician or health coach at any time.
"So instead of: 'We'll see you when you're sick. We'll bill your insurance for that visit,' it's: 'OK, we're paid a flat fee to keep you healthy. We’re going to be in your life in a more involved way and hold you accountable and you're going to hold us accountable for shepherding you through the task,'" Damania said.
Turntable Health charges $80 per month for adults and $60 per month for children. There are discounts for employers purchasing memberships for employees and for health plans as well.
Zubin Damania, M.D.Founder, Turntable Health
With this model, Damania said patient satisfaction is "ridiculously high."
"We use Net Promoter Score, which is very familiar in the tech world, less familiar in the medical world," Damania said. "It means one out of 10 how likely are you to recommend this clinic to family and friends? And in a year we have roughly between 88% and 90% positive Net Promoter Scores."
To put those percentages in perspective, the health insurance industry's Net Promoter Score hovers around 10%.
"So [Turntable's] patient satisfaction is huge, and it's largely because we develop relationships," Damania said.
Not only that, but Damania said they are keeping people out of the emergency department.
"The data we've shown in our trial population is roughly a 50% reduction in in-patient admissions and ER visits over the course of a year," he said. He added that they've also seen improvement in hypertension, blood pressure, diabetes control and more in their patients.
Damania's alternate persona: ZDogg
Damania's way of thinking about health IT is also reflected in his alternate persona, ZDogg. Damania takes mostly well-known songs from all genres of music and parodies them, re-writing the lyrics to reflect his opinions on a certain issue within health IT. The videos accompanying the songs are humorous and over the top.
"I think for me, it was 10 years of working at … Stanford Hospital and just feeling completely voiceless and disempowered in working at such a dysfunctional national healthcare system," Damania said. "Physicians really don't have a voice that's heard at all. So this was a way for me to have a voice, even if it was subtly silly."
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