OR – Jeffrey Kang: Video automatically transcribed by Sonix

OR – Jeffrey Kang: this mp4 video file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
Hey everybody! Saul Marquez with the Outcomes Rocket. So excited you tuned back in to our podcast today. Doctor Jeffrey Kang is the CEO of WellBe Senior Medical, a global risk home-based geriatric care medical group. As a geriatrician, he has extensive experience in global risk and primary care for the frail, elderly, and disabled population. He most recently was president of ChenMed and in the past has served as Executive Director of Urban Medical Group in Boston, where he pioneered advanced practice provider, team-led-based care, and he’s done a lot of different projects and been a part of many different initiatives to improve this area of geriatric care. So I’m excited to have him here on the podcast. Jeff, thank you so much for being with us.

Jeffrey Kang:
Thanks, Saul. Pleasure to be here.

Saul Marquez:
Yeah. And so look, you’ve done so much. Is there anything that maybe you want to highlight from your past and the things that you’ve done that maybe I didn’t touch on?

Jeffrey Kang:
Well, maybe, maybe kind of spend some time just telling you a little bit about how I got into all of this, because kind, it’s kind of an interesting story. You know, maybe first I’ll talk about why a doctor. This is kind of a little cultural thing, but I actually, when I was 20 years old, I had the opportunity to visit my grandparents in China for the first time, 20 years old, first time ever see them, okay. They, of course, asked me, Well, Jeff, what do you want to do? And I said, well, I’m going to be a lawyer. They say, why be a lawyer? Be a doctor because the human body is the same everywhere you go in the world, and you come back and serve the motherland, you know, because it was all about China back then. And when you make, when you think about it, it makes sense. You know, laws are different country to country, right? But the human body is the same, so you can be useful kind of anywhere you go, so I changed. And then maybe that’s medicine, maybe the other thing is kind of why geriatrics? So this is a cultural thing a little bit also. First of all, I really was very service-oriented, and when you get into medicine, I found myself as an internist taking care of a lot of colds, sore throats, but that’s not why I went to medicine. I went to medicine to take care of sick people, you know, to really make a difference, so that’s. But second, the cultural thing is, you know, the Chinese culture, you kind of, are taught to respect your elders and to revere them and to honor them because when you think about it, they’re the ones that, you know, your parents, your grandparents, they raised you and invested you and cared for you and taught you and educated you, and so I just feel like we owe this great debt back to the seniors. And so that’s kind of why medicine and why geriatrics.

Saul Marquez:
You know, your grandparents had a deep impact on you, it sounds like.

Jeffrey Kang:
Yeah. Well, you know, maybe one other fun fact here, my last name is Kang, but that character in Chinese actually means health. And so when I see a Chinese patient, I’m Dr. Health.

Saul Marquez:
It just made sense, it should have happened, and I’m glad it did. My family, I was one of the first ones to go to college, and when I was about to leave to go to college, my grandmother told me, Son, make sure that you don’t forget that there’s a difference between being smart and intelligent. And so, go get booksmart, make us proud, but don’t forget to be intelligent, and I’ve never forgotten that from my grandma.

Jeffrey Kang:
That is the way, that is the wisdom that comes from the elderly. There is a difference. That is the wisdom that comes from it.

Saul Marquez:
I totally agree with you. And so today’s very important topic is how do we care for our elderly? And so what you’re doing with your company, WellBe Senior Medical, talk to us about the focus.

Jeffrey Kang:
So I want to give you a mental image. You know, all of us have had a grandparent or an aunt or an uncle or something. And think about it, 6 to 7 chronic disease, multiple specialists, 12 medications, maybe some arthritis, so they just can’t get out of the home, you know, maybe some dementia because they’re a little confused or whatever, and it is really hard for those people to navigate the healthcare system. And so the real solution, and I’ve been a geriatrician for 35 years, the real solution for those people is, instead of taking them and asking them to go to that, navigate the healthcare system, you know, go see this doctor, go see that doctor, you know, go to this clinic or whatever, is actually to bring the care to the patient in their home. And, you know, for your listeners, one of the things you just kind of step back and think about it, just look at what happens in a doctor’s office, and you begin to realize that about 90% of that could be done at home. You know I can take a history. I can do a physical exam. I can draw a blood test. I can do an electrocardiogram. I can even do an ultrasound. There is, and so it just makes sense from a patient’s perspective, especially it’s really, you know, that complicated, frail kind of grandmother kind of image. Just bring the care to them. Don’t, don’t bring, you know, don’t make them navigate the healthcare system. In fact, the WellBe, you’re too young actually, but WellBe is a play on words. There, in the 70s and 80s, there was a TV show called Marcus Welby, MD, and that was spelled W e l b y, so we’re W e l l B e, and he did home visits. He took care … from your own home. So, and that was basically, when I try to explain what WellBe does to a senior, I just say, remember Marcus Welby, MD, the TV show? And they were like, That’s us.

Saul Marquez:
You’re so good at telling stories and connecting that it’s fantastic, and we could learn a lot from you there. You know, from a marketing perspective and from the business of healthcare side getting, getting the care to where they are, how do we do it? And how are you guys doing it in a way that’s better or different than what’s available already?

Jeffrey Kang:
Yeah. So I think, actually, it turns out, if any of your listeners kind of know the home care space, there are a lot of what I would call point solutions in the home care space. So there are companies that provide skilled services, they’re called home health agencies. So that’s a nurse or a physical therapist. And you know, you’ve had a hip fracture, and you’re out of the hospital, they’ll help you, okay. Then there are other companies called home health, I mean personal care agencies, that’s, they’ll help you with bathing or eating or, you know, what’s called, the activities of daily living, okay. There are third, other companies that do durable medical equipment. So they’ll get your wheelchair and your, you know, your canes and your walkers. And there are community service organizations that will do Meals on Wheels or, you know, help with adult kind of activities to keep you from being depressed, you know, just keep you active, right? So there are a lot of these things that are trying to do things in the home, and they’re all great. But from a patient’s perspective, it’s very confusing. Who’s coordinating all of that, and who orders all of that? In fact, all, most of those services require a doctor’s order. Basically, think about those as subs, but WellBe is like the general contractor. So we’re the physician who’s ordering those services, coordinating everything on behalf of the patient. So just, just kind of that image, right? You’re trying to, let’s say you build a house, right? You got electricians, you got plumbers, you got, you know, concrete masonarers and everything, but who kind of pulls all of that together? You got, you hire a general contractor. We’re basically that general contractor, and we pull everything together. Does that make sense?

Saul Marquez:
It makes a lot of sense, and you mentioned a lot of things. Like all the resources, right? Like, the personal care, the home care, the durable medical, the, all of these different things, the community organizations, and half the time, we don’t know what the options are. You know, half the time, we don’t know all of the resources, incomes. WellBe, and now you have all of the resources at your fingertips, and you could get access to them based off of what you need. I think that’s brilliant, and the way that you guys have aggregated all of these options. And so, then, as far as a business model, are you guys focused on Medicare Advantage? Are you going broader? Are you doing …

Jeffrey Kang:
So right now, it’s Medicare Advantage, 100% Medicare Advantage. We’re actually in seven states with over 100,000 people we’re caring for. And now, interesting enough, 20% of those people are already in Medicaid, they’re dual eligible. So it’s a lot, it’s a very poor kind of population. We will, at some point, we’ll probably get into Medicaid only, and then eventually we’ll think about Medicare, traditional Medicare, Medicare fee-for-service, that’s ACOH, that’s another target, but right now, we’ve started off with Medicare Advantage.

Saul Marquez:
Talk to us about some of the wins, right? Like what have you seen that has kept you going with this?

Jeffrey Kang:
So this is interesting. We started just three years ago. So we’ve ran out of clock. That was in the middle of COVID before any vaccinations, so July of 2020, that’s when we started. And I just had to just take it back. Remember, everyone was locked down, they were afraid that, the sick people were afraid to go see a doctor, you know, it was called deferred care back then? We came along and said, Look, you don’t have to go out and see your doctor and take a cab and, you know, run into 100 people on the way to the doctor’s office. We will come into your home, in the safety of your own home, just one person, and we’ll take care of you. It was, it was really rewarding, actually. In many ways, we tried to accelerate because of COVID is because it was a huge need, and the doctors were closing their offices and everything, and we’re like, Well, wait a second, these people need care. We just take the care then to see them. Well, I think the other thing, which is really fascinating, the reason it was really, I couldn’t believe this, actually, but doctors were literally closing their office. And I’m saying, But wait a second, this isn’t their time of need? You should be like, take care, so we were like, but we were very careful, you know, remember all the PPE, you wore masks. So between that period when we started, and we, when first vaccinations, right? Everyone got, all the seniors got vaccinated first. Between that period, it’s about maybe eight months, we’d seen about 12,000 people encounters, and we did not have one single case of occupationally transmitted COVID.

Saul Marquez:
Nice.

Jeffrey Kang:
Because we were careful. So I mean, there was all this fear, but boy, you needed people, and you just took, they took the right precautions, and we got the care to them, and you know, you kept them healthy as you possibly can, and you didn’t transmit COVID.

Saul Marquez:
Yeah, for sure. That’s a huge win, right? You sort of ran to the fire and said, What are we doing here, people? Like our seniors need care. So you went over, and you did it. And then fast forward to today, which huge kudos to you, by the way, and I can’t believe all those encounters, thousands of encounters, and not a single occupationally transferred COVID case. I mean, that’s a huge win in my eyes. And today, you know, what are you seeing that is helping you say, Man, I’m glad I’m doing this?

Jeffrey Kang:
Well, geez. You know, if you had five hours on this podcast, like, we have so many patient stories on a daily basis, I mean, it’s unbelievable. In fact, we took some guests out recently the home to do a couple of home visits with us. I guess maybe the, maybe, it’s amazing that you can take care of the medical issues by just being both convenient and responsive. So someone who has an exacerbation of emphysema, we can go into their home. We can actually, we have this interesting mobile paramedic program where it’s, you think about an ambulance, but in an SUV, all the equipment with a paramedic. And let’s say you have shortness of breath and you have emphysema. We send that in, the truck in, and they can literally give you a nebulizer treatment right there. Or let’s say you’re dehydrated. They give you, you know, intravenouses, right? So what’s, from a medical perspective, just being very convenient and responsive. Convenient is like, in the home, right? And then responsive is, I get there in 30 minutes. You can really improve people’s outcomes and actually treat them in the patient’s home, right? So that’s kind of the medical side of the story. Then there’s this, you’ve probably had guests on that keep talking about the social determinants of health, right? Not enough food or whatever. Boy, if you really want to understand the social determinants of health, you go into someone’s home, and you know exactly what’s going on. You know, when you see someone in the office, what they do is they dress up, you know, and they’re like, you know, and they’re kind of on their best behavior and whatever, and you ask them, do they have enough food, and they say, Yeah, I got plenty of food. Then you go into their home, all you have to do is open the refrigerator. And it just tells you a completely different story.

Saul Marquez:
The power of digital cannot be ignored. It’s part of what we do, what we have to do, but at the same time, presence is key to make a difference.

Jeffrey Kang:
I agree with that 100%. You probably, so presence for a whole variety of from like that social determinants of health perspective, you get the full picture. You know, digital or remote patient monitoring. Is it showing you that there’s a tear in the rug and someone can trip over it? It’s not showing you that, right? But that’s kind of, but that, boy, that’s a fall waiting to happen, right? And so you ought to do something about it. The other thing, from a pure telemedicine perspective, let’s say person has abdominal pain. You can’t examine someone, you know, put their hands on their abdomen, and actually, and push, right? You just can’t do that. That’s a, unfortunately, the technology can’t do it. So there’re really limits to this. To your point, there are limits to this digitization, remote patient mining technology, and presence. I love the way you said that, presence, right, in the patient’s home is, really gives you so much more information and color around of what’s going on.

Saul Marquez:
Thank you for sharing the philosophy, the method, how you aggregate all of these things, and some of the wins that you guys are getting. You know, how about the, you know, when we think about the quadruple aim, Jeff, we think about the clinician, right? And there’s a lot of burned-out clinicians. Talk to us about that. Are you guys employing clinicians? Are you guys offering opportunities to clinicians that are looking for something new?

Jeffrey Kang:
Yeah. Boy, I can go on on this one. So first of all he says an interest…

Saul Marquez:
Another five hours?

Jeffrey Kang:
Yeah. So it’s interesting because, I’ll come at this a couple of ways. One is, we as clinicians, as professionals, we all, most, actually clinicians, just like my story, go into medicine because they want to care and they want to serve and they want to make a difference, okay. What happens though, in the fee-for-service system is we beat that out of them. You know, we say it’s not about caring patient, it’s about seeing 30 patients a day, you know. You go in to see the doctor’s office and they’re like, frantic, they’re going in 30 patients a day, right? That’s the volume-based medicine. WellBe Senior Medical is, you know, you mentioned global risk, we’re basically, we’re in a, we’re in the value-based world, which really means that our economic incentives are to keep people healthy and out of the hospital. So we actually allow our clinicians, not allow, require, I guess, to practice medicine the way it should be practiced. Take care of the patient, spend the amount of time that’s needed with the patient to be empathetic, to be compassionate, to talk to the patient. Right now in the home, typically in the fee-for-service world, in the, to make it work in the fee-for-service, you have to see 8 to 12 patients a day. We’re about 4 to 5 patients a day. And it’s not about the number of patients, it’s about spending the time with the patient that you really, that they really need. Back to your question about how do we recruit people? It’s because we’re in this value-based world. We’re basically offering the primary care clinician something that they’ve been looking for, and they’re not getting in their current job. In their current job, it’s just a volume game. In our job, it’s about doing the right thing, you care for the patient, and in our model, we actually, it’s not about money, but at the end of the day, you can’t make money, you can’t be sustainable, right? So in our model you actually, we make more money, we keep people healthy out of the hospital. Isn’t that something you would want? You would want a doctor that that’s what they care about is keeping you healthy, and not…

Saul Marquez:
It should work. Yeah, that’s the way it should work. No, I love that. And folks, if you’re a clinician and you’re looking for … there’s options out there for you. WellBe Senior Medical is one of those options. You know, and so as you’ve built this, I mean, and you guys have grown fast. I mean, it’s been three years. What’s been one of the, yeah.

Jeffrey Kang:
So just before, just one other proof point, because I strongly believe I’m building a clinical culture that supports our clinicians, that doesn’t treat the clinicians as like a cog in the wheel or a, you know, piecemeal worker, right so? So we’ve only been in existence for three years. We just were recognized last night, modern healthcare, best places to work. 66th in the country.

Saul Marquez:
Nice. That’s amazing.

Jeffrey Kang:
Out of all providers in the health plan. So 66th in the country.

Saul Marquez:
Out of all providers in health plans?

Jeffrey Kang:
Out of all providers in health plans.

Saul Marquez:
And you’ve been in the game for three years. That’s huge.

Jeffrey Kang:
Yeah. So I’m like, but it’s about creating that culture and supporting the clinicians to really let them care for the patient. It’s not about, and if you really look on what’s going on medicine in that fee-for-service world, number of people, when was the last time you saw a doctor?

Saul Marquez:
Let’s see, two months ago, and, well, actually, it was a virtual visit. And then I went in to go do the blood work. Like, I went to the lab to do the blood work.

Jeffrey Kang:
How much time did you get to spend with that doctor?

Saul Marquez:
It was, it was a 30-minute thing, but it was like a concierge thing.

Jeffrey Kang:
Oh, okay. Well, now that’s a different thing. So if you’re, in fact, WellBe Senior Medical field’s very similar to concierge program.

Saul Marquez:
It feels that way to me. Yeah, what you’re telling me.

Jeffrey Kang:
Yeah, you get, you can get, but now you have to pay for that, right?

Saul Marquez:
I do, yeah, yeah.

Jeffrey Kang:
But in our situation, it’s all covered by the health plan. And basically, people get convenient access to their clinician 24/7, 365 days a year. That’s what it’s about, it’s about convenience and responsiveness. That’s what you’re paying for in concierge medicine. I get my doctor. Versus when you’re not in that you call whatever, you know, your doctor at whatever, Friday night, and what you get is an answering service that says, If this is an emergency, hang up and go call 911. You can’t get a hold of anyone who will talk to you, you know, after 5:00.

Saul Marquez:
In the states that you work, you guys deploy this service as an option for everyone?

Jeffrey Kang:
Yeah, so short answer is yes. Maybe to give you the visual, the reason why it works, I’ll give you Atlanta as an example, so we’re in Atlanta. Right now we have three trucks with three paramedics, and they’re just sitting around like the fire station ready to be deployed. So you know how the fire station they’re sitting around, and they’re playing pinnacle or whatever it is, you know? But then when the fire happens and the call comes, they deploy immediately. So that’s exactly what says, we have three trucks just sitting around. Then call the cars, we dispatch them, and then to your point or, the doctor that knows the patient is on the other end. The doctor who knows patients sent them and says, the paramedic evaluates them and then together as a team make a decision is what the right thing to do. But what’s really key is the person that the physician or clinician that knows the patient is the person who’s actually supervising what that paramedic is doing. Versus in the 911 world, an ambulance goes in, they don’t know the patient at all. So they have no background. They don’t understand, Is this the first episode of Chest Pain, or is this the 50th episode of Chest Pain? They don’t have any of that. And so, your podcast is about outcomes, right? So the, we’ve measured the outcome, right? With this program, we’ve had a 33% reduction in emergency room visits. So probably that, let’s say that emphysema patient, that would have cost from the WellBe with the paramedic and everything, maybe $500 to $1000. But then we, that patient ended up in the emergency room, it would have been probably $5,000. So, and, but because we’re at risk or we’re essentially the payer for that emergency room visit, that difference, let’s say it’s a $4,000 difference that actually turns out to be, “profit” for us. And so that’s kind of like we, you know, I hate to say because again, it’s not about money, it’s about care and about doing the right thing, but in this situation, we just made more money by keeping that person, you know, treating him at home and keeping that emergency room.

Saul Marquez:
Yeah, it’s the right thing. I love it. I can tell just from the stories you’ve been sharing, there’s a lot of more options. I think you wanted to say something else. So want to … you up for that.

Jeffrey Kang:
Just give me another, just another thing because people can relate to this. The, you know, we’ve all had a loved one who is getting cancer treatment, unfortunately, right? And they’re getting chemotherapy, and they’re nauseous, and they’re vomiting, and you know, they’re dehydrated. So it’s just a simple thing with our paramedic program, right, that’s occurring. We just simply go to their home, we can give them an injection of IV Zofran, that’s for the nausea, and give them IV fluids. That’s pretty straightforward. Now it’s the same thing that would occur in the hospital. But if they went to the hospital or an emergency room, first of all, it’s uncomfortable, you know, you’re in a cold or whatever, and second of all, it would have cost, you know, five times more.

Saul Marquez:
Fantastic that you guys are doing this, aggregating it all in a way that makes it simple for everyone and the family, right? I mean, like, like we talk about stakeholders, the family, it’s hard work as a caregiver, and if you have somebody on your team like WellBe Senior Medical, boy, talk about relieving the stress.

Jeffrey Kang:
Absolutely. In fact, the, one of the first things we do with this frail band, let’s say they’re demented, is we figure out who the caregiver is, let’s say it’s a daughter or a sister or something, and then we actually form a therapeutic alliance with that person and say, Hey, look, you know, here, call us first. Tell us what’s going on, whatever. So that we, we think about that, it’s interesting, we think about that caregiver as extension of the team, and then to your point, it’s the other way around. The caregiver thinks about us as that valuable asset that can kind of really make it all work.

Saul Marquez:
Totally. I Love that. So then the, as a caregiver, I would be able to have access to the platform as well, and kind of be part of it?

Jeffrey Kang:
Absolutely. Absolutely.

Saul Marquez:
That’s great. That’s great. Well, look, this has been informative, Dr. Kang. I know that we, we should probably visit again in the next six, seven months. I’d love to hear how things are going and get inspired by the type of care that you guys are delivering. If you had one thing you wanted to leave the listeners with today, what would it be?

Jeffrey Kang:
Yeah. So, you know, you actually kind of said it, but I’m just going to reemphasize.

Saul Marquez:
Okay.

Jeffrey Kang:
I think it’s, it’s our responsibility to make healthcare easy. That’s our promise, is to make healthcare easy. We, in general, have made healthcare so complicated. It’s been fragmented, you know, multiple different providers every time, or doctor, the patient is like, sees one doctor for prevention, one doctor for chronic disease, one doctor for palliative care. You wonder why people are confused and just that. We basically think about us as the navigator or the, and the advocate, you know, who’s working on your behalf. You know, I’ve said the general contractor also, I mean, a couple of ways to think about it, but the goal is to make healthcare easier.

Saul Marquez:
Well said. Let’s make it easier, folks, on ourselves, our loved ones. Check out the work that Dr. Kang and his team, WellBe Senior Medical, are up to. In the show notes, we’ll leave links to their company, and if anybody wants to get in touch with you or anybody on your team, Jeff, how do they do it?

Jeffrey Kang:
It’s very simple. Go to WellBe.com W e l l B e, and there’s a contact place for that.

Saul Marquez:
Amazing. So take action folks. That’s how you get outcomes. And Dr. Kang, I want to thank you for taking action and being with us today to share the message that you and your team are up to.

Jeffrey Kang:
Saul, thank you very much. And just remember, it’s not about being smart, it’s about being intelligent.

Saul Marquez:
Yeah, I appreciate that, Dr. Health.

Jeffrey Kang:
Thank you.

Saul Marquez:
See you later.

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