Solving the Primary Care Shortage Challenge
Episode 373

Bradley Younggren, Chief Medical Officer at 98point6

Solving the Primary Care Shortage Challenge

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Solving the Primary Care Shortage Challenge

Episode 373

Recommended Book:

Cutting for Stone

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Solving the Primary Care Shortage Challenge with Bradley Younggren, Chief Medical Officer at 98point6 | Convert audio-to-text with Sonix

Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.

Saul Marquez:
Welcome back to the podcast. Today I have the privilege of hosting Dr. Brad Younggren. He is part of the executive team at 98point6. Started there at 2017 bringing nearly 20 years of experience working as a physician. Most recently serving as Chief Medical Officer at Cue. He also served as Chief Medical Officer at Shift Labs and Mobisante. Brad still practices as an emergency physician at Evergreen Health and as a medical director of Emergency Preparedness trauma and urgent care. He received his B.A. from UCLA and his medical degree from the Uniformed Services University of Health Sciences. He has earned both a Bronze Star and a combat medic badge for his service in Iraq as the United States Army physician. Brad enjoys traveling through Central America with his twin daughters and is passionate about designing Global Health Solutions. As you can hear he's served both our country health system and health care economy with gusto and it's a true privilege to have Brad on the podcast today. Brad, thanks for joining.

Brad Younggren:
Thanks for having me so I really appreciate it.

Saul Marquez:
Absolutely. Now that I leave anything in your intro out that you want to share with the listeners?

Brad Younggren:
No I think that was plenty, thank you.

Saul Marquez:
Excellent. So I'm excited about our conversation today. And just hearing your thoughts around primary care and the solution that you guys are working on at 98point6. I know a lot of people are probably thinking "why 98point6?" We'll get into that in the why and also some of the ideas behind Brad's work there. But before we do Brad, I'd love to hear what is it that got you into health care to begin?

Brad Younggren:
I was really interested in global health and in particular disaster medicine that drove me to the military to go to the military medical school to specialize in emergency medicine and start my early career in the army focused on both emergency medicine but also humanitarian and disaster medicine.

Saul Marquez:
And so the focus and you got straight to it right. I mean if you want disaster preparedness, emergency medicine there's no more dynamic place. And what you chose and you fast forward to the things that you're doing today. Brad what would you say is a hot topic that needs to be on health leaders agenda and how are you and the team at 98point6 taking care of it?

Brad Younggren:
I think that for me the hot topic right now is figuring out ways to leverage technology to address the physician experience or in more to the point physician burnout. We've seen lots of solutions which really have had a negative effect on the physician experience. And we're seeing enormous rates physician burnout and health care and we need to address that by creating technology that supports the physician experience as well as the patient experience.

Saul Marquez:
And it's definitely a big deal. And so I'm curious a little bit more on 98point6. Why 98point6, what are you guys doing there that's different to improve outcomes?

Brad Younggren:
So I think we can start maybe with our approach to the physician side of the clinic. 98point6 is delivering on demand text based primary care across the entire country now 50 states plus Washington D.C.. To accomplish that goal we approached it quite differently from other traditional analog telemedicine companies. We decided that we wanted the physicians to be intimate members of the team. And so from the ground up we built a system that involves the physicians in every aspect of the company. So the physicians, they're all employees of 98point6 we do not use locum tenant's physicians to deliver the care they get is critically important. The physicians to be deeply invested in the clinic. And so they're all members of the company they all work on both the clinical care as well as every physician whose core position of the business also has time carved out to work on other aspects of the company whether it be technology development recruiting new physicians really trying to get physicians into work administrative work if you call it that really resonates with them and excites them. That combination is really unique in the market. It allows physicians to really participate in the process and feel like they're making an immediate impact. Half of our technologists at the least if not probably more than half of the technology in the organization are focused on the physician facing side of the technology and coming from original health care where physicians really isn't the customer. They're trying a medical record. This is a significant change for the physicians and a great satisfy for their experience here at 98point6. That itself translates into a fundamental difference around how the care is delivered. The physicians are building the practice, the policies, they're deeply invested in the 98point6 experience and we think that that is the correct approach to delivering high quality medical care with at an affordable price with access has never seen in the market.

Saul Marquez:
That's really insightful and yes as people try to tackle the physician burnout problem. This is a great approach that you and the company are taking. Empowering physicians to be part of the entire solution and making a product that is focused on the physician ultimately results and better care for patients. So I'd love to hear from you. Brad maybe an example of an outcome that you guys had that you're very proud of.

Brad Younggren:
Right. We there's a number of different ones we're really proud of. I think that for us quality of care delivered is paramount to the 98point6 experience. This is this translates in multiple ways again from this foundation of building a position corps that's deeply invested in the work we're doing here at 98point6. Concrete example would be looking at our antibiotic stewardship. The physicians have built deep policies in this are very aware of the literature that is out there regarding the use of antibiotic prescriptions and traditional telemedicine. And we've tackled that head on with the support of technology for us to better understand how to be good stewards of antibiotic use in the context of really care across United States but ultimately globally.

Saul Marquez:
Well I think when you take a look at the impact that you can have with your technology, it's impressive. And so it doesn't always come together without any any hitches. So I'd love to hear from you Brad maybe one or two items that didn't work out so well that you guys learn from and now you're better for.

Brad Younggren:
I think my biggest experience at 98point6 would be just trying to figure out what the appropriate time to leverage the workforce to give a 24/7 ubiquitous service to the patient. That's a pretty heavy lift not only from the delivery care side but also from the technology side. We essentially provide on demand primary care for our patients. They can access the app anywhere in the country now. We deliver pediatric care. It is one enough for our employer customers. And additionally we're soon moving to 24/7 and that's been an extremely heavy lift. And so we've had a couple sort of stop starts stops it related to the delivery of that and for us falling back and realizing that the most important thing is to do it when we have the physician workforce in a position to do so. And from my perspective being I'm an emergency physician by background so I understand the impact that night shifts have on physician lifespan, quality of life, behavioral health issues related to the delivery you know to being a provider in that space. So as we approach this it took a lot of critical informed thinking to figure out how to properly deliver that while still being true to the core values of the company. So what we've done is we actually have just flown out a few providers into Hawaii actually to help us cover the 24/7 schedule while we have a few physicians we've just hired in Hawaii that are actually organic to that location and as physicians will be able to hand off the clinic to the early hours down to the physicians on the East Coast. So now we have a 24/7 clinic that allows for ubiquitous service for the patient while still respecting the quality of life of the physicians in the service and in fact because of this approach that we've taken it's just increasing the number of inbound physicians who are looking to work at 98point6 full time.

Saul Marquez:
Well you guys are quickly becoming an admiring place to work. So kudos to you and the team there Brad for being able to do this. You know in a in a very traditional market where physicians just go work at a provider organization you guys are creating another place where people could perform what they do best in a more fulfilling way.

Brad Younggren:
Thanks Saul, I appreciate that. It's really our intent and we have physicians who are interviewing through the process. We have medical directors now that are managing some of that but I still get the opportunity from time to time to talk to them during interview process and I encourage them to talk to as many of our physicians as they want. We have over twenty five full time positions on staff now we're hiring four to six a month right now. And so with that growing core clinician we still try to be very transparent and offer the opportunity for those who are looking at possibly working with us to really just talk to the physicians about what is it like to work here.

Saul Marquez:
What would you say Brad separates a physician that works at 98point6 from an average physician?

Brad Younggren:
I think that the difference is not really on the physician side. I think in general the problem with primary care is we're really in a primary care crisis so we're near a shortage of 20,000 primary care providers in the U.S. health care system currently. And so the physicians are doing their best to shoulder this primary care lift capacity of options. Really our focus is taking the physicians who all have deep motivations to patient care to improving. Outcomes in helping them get back to the core functionality which they enjoy which is communicating with patients. Diagnosing medical disease and treating patients and what we're endeavouring to do is remove all the other kinds of tasks that it really driven patients or physicians away from that relationship with patients over the last 40 years.

Saul Marquez:
Love that. That's a great call out and and yeah it's a big issue and you've got you've got folks trying different things. So you know you've got the direct primary care groups doing their thing and I think technology is an enabler. And I think you guys are doing a wonderful job and and say working with employers and health plans I imagine would be the focus. Which is the most exciting project you guys are focused on today?

Saul Marquez:
We started back actually working with self-insured employers. We also have a direct consumer offering. So we have both channels open. The health system and health plans came honestly quicker than I initially thought in terms of their interests. We've formally announced a deal with being right now which we'll be starting soon was announced a month or so ago which we're extremely excited about because it's our first opportunity to work with this joint venture between it and Banner Health in the state of Arizona large population that we're gonna be able to work with these organizations in this joint venture to really impact outcomes. Really connecting our virtual primary care experience value the resources that this organization has within the state of Arizona.

Saul Marquez:
I think it's brilliant. And what would you say is what was one of the most difficult thing to go from an idea to this is now working?

Brad Younggren:
I think that was really addressing some of the scalability issues at least from my perspective as a chief medical officer. A lot of my core function work initially was building this idea around what the physician culture would be how these physicians when or interact with the technologist figuring out this sort of deep interweaving of technology and health care in a way that hasn't been done in the market before. And then figuring out how to operationalize some other functional issues that we know we're bound by state licensure lines so if you want to deliver ubiquitous care and you want the physician quality to be the same then that means we've invested in licensing all of our physicians in every state across the United States. This in of itself is probably our podcast but we've internalized this whole process. We have a team of nine people that manages the medical group through this licensure process and realize it's because it's such a heavy lift and we don't want the physicians themselves to really have to do any extra work in regards to that but that was our approach to sort of getting past the state boundaries for delivery of care and we continued with that approach to this day is that it requires us to find physicians who are sort of all in on the 98point6 ethos. We certainly have a front end process that is for the physicians which is honestly no different than it is for the technologist or anyone else in the company for that matter in a rigorous interview process. And part of that is to make sure that we're having a deep deep relationship with physicians we want to make sure that the right ones for the business.

Saul Marquez:
Well that's fascinating I'm glad I asked that because you're right. You know I've had conversations with other folks wanting to scale and especially with you know I know you guys are mainly tech space but you know you think of tech space even telemedicine the state licensure boundaries really are prohibitive. And so I can't imagine the session you guys had where you made the decision and said or licensing these guys and gals across the nation. That must have been a day and you're like wait a minute do I have to drive this?

Brad Younggren:
To our CEO Robbie Cape credit. He was all on board from day one with this.

Saul Marquez:
Amazing.

Brad Younggren:
Then really amazing as far as building this culture here at ninety point six. And you know there's a bunch of product left around that we don't want the physicians having to be responsible or understanding the subtleties of the different regulatory environments in these states. So for us to go live in a state as we went stepwise across the country we had a cross-functional team to make sure that product supported the physicians in those states.

Saul Marquez:
Amazing. Yeah kudos to everybody involved that 98point6 and other than the you know obviously the temperature right that's the normal temperature. Is there any other significance to 98point6?

Brad Younggren:
I think that the name selection predated even me in the company and I was..

Saul Marquez:
Ahuh

Brad Younggren:
…early but yes I think it's just the I don't think it has additional significance beyond that.

Saul Marquez:
Cool. No worries I was just I was just wondering if there was there every now and then you get a cool story. But it's something that everybody can identify with. 98point6. So we all know that's the normal body temperature and you want to stay healthy and these are the people you could connect with whether a consumer an employer or a plan definitely check them out. Brad getting the lightning round here I've got I got a couple questions for you followed by a favorite book for the listeners. Are you ready?

Brad Younggren:
Sure.

Saul Marquez:
All right. What's the best way to improve health care outcomes?

Brad Younggren:
Start with measuring the right things.

Saul Marquez:
What's the biggest mistake or pitfall to avoid?

Brad Younggren:
Not involving providers in the conversations.

Saul Marquez:
How do you stay relevant as an organization despite constant change?

Brad Younggren:
You have to leverage technology to stay ahead of the market.

Saul Marquez:
What's one area of focus that drives everything in your organization?

Brad Younggren:
No single individual in the United States or really the world should have to make a financial trade off for receiving Primary Care Medicine.

Saul Marquez:
Love that and I've got two new ones that I've been asking. These are more on a personal note for the listeners to get to know you. What's your number one health habit?

Brad Younggren:
I run and do yoga on a regular basis.

Saul Marquez:
Nice. Good for you. And what is your number one success habit?

Brad Younggren:
Getting enough sleep.

Saul Marquez:
Mm hmm. Important, very important. I tried doing yoga, Brad, and it was just hard for me to do it regularly. I admire your commitment to that.

Brad Younggren:
Thanks it was an early decision related to a lot of the stresses of runs in medicine looking for sort of opportunities to create focus outside of the job because it was pretty and it's a pretty intense job.

Saul Marquez:
It is. Good for you and you still do it right? You're still practicing?

Brad Younggren:
I still practice a few shifts.

Saul Marquez:
That's great.

Brad Younggren:
To stay connected to the, you know stay connected to patient care.

Saul Marquez:
I mean that's so great that you're doing that. What book would you recommend to the listeners?

Brad Younggren:
I love Cutting for Stone by Doctor Verghese. I think it's a great fiction book and I just really enjoy listening to really anything that he puts out or speaks to.

Saul Marquez:
So what's what's Cutting for Stone about?

Brad Younggren:
It's a sort of fictional account that sort of layers and lots of realities of medicine. I think that obviously Dr. Abraham Verghese got a deep sense of knowledge of health care plus he's an amazing writer. So that combination especially for someone in medicine is just it's worth a worthwhile read.

Saul Marquez:
Love that. What a great recommendation. Folks, for our Lightning Round a full transcript of our discussion as well as links to resources we've discussed, go to outcomesrocket.health and in the search bar type in 98point6 and you'll find that there it's been a true pleasure connecting with you Brad. I'd love if you could just leave us with the closing thought and then the best place for the listeners could continue the conversation with you and the company.

Brad Younggren:
For listeners I think just to reiterate the focus at 98point6 is to address three main issues which are burdening health care globally which is cost quality and access. And we're attempting to deliver on all three of those while at the same time addressing and building technology that involves physicians and is equally focused on the physician experiences and the patient experience. You can reach me at the Brad at ninety eight point six dot com is probably the easiest way.

Saul Marquez:
Outstanding. There you have it folks. Brad just want to say thanks again. Really enjoyed the conversation and I'm thrilled for the work that you guys are doing for for the U.S. population and health care and definitely want to give you guys encouragement to continue doing the amazing work you've done.

Brad Younggren:
Well thanks I appreciate you having me on the podcast.

Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration, and so much more.

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