Episode #142: How a small group of people are rehumanizing Primary Care, with Dr. Chris Chen, CEO & Cofounder of ChenMed

Friends,

Our dialogue this episode centers on one of the most transformative and divergent clinical care models that I have come across. People throw around phrases like relationship-centered, patient-centered, preventive, personalized, and social determinants of health. In the model we’re discussing in this episode, you’ll see all of that actually being integrated into a coordinated ecosystem of care that delivers continuous, comprehensive, cost-effective and dignified VIP care to older, poorer and sicker Americans.

People refer to ChenMed as one of the iconic, value-based senior care models or Medicare Advantage care models. It is also one of the best examples of a mission-driven healthcare organization. If you’ve ever wondered how a small group of people can transform the American healthcare system, I would suggest you listen very carefully to this interview. I would also recommend that you read the book that Dr. Chris Chen & Dr. Gordon Chen recently co-authored, The Calling – a Memoir of Family, Faith and the Future of Healthcare.

Dr. Chris Chen is CEO & Co-Founder of ChenMed. Since becoming ChenMed’s CEO in 2009, Dr. Chen and his colleagues have built the decades-old, highly successful ChenMed model into a scalable organization with over 100 sites now spanning dozens of cities across numerous states.  ChenMed has been named to Newsweek’s “Most Loved Workplaces” list, Fortune Magazine’s “Change the World” list, as well as earning recognition by the White House, the Department of Health and Human Services, and the U.K. National Health Service. ChenMed was recently named by Newsweek as the #1 workplace in healthcare. ChenMed has also been featured in numerous publications including Medical Economics which named ChenMed, “Best Primary Care System in the U.S.” 

Dr. Chen graduated from the University of Miami’s Honors Program in Medicine. He went on to complete his medical training at Beth Israel Deaconess, a Harvard University teaching hospital, after which he completed a fellowship in cardiology at Cornell University Medical College in New York City.

In this episode, we’ll discover:

• The foundational healthcare vision and mission that this organization adheres to and delivers upon. 

• The pivotal capitation payment model ChenMed has adopted, and how that enables the shift from transactional, volume-driven and reactive care to one that is highly relational, personalized and preventive.  

• The numerous clinical, operational and technologic initiatives and infrastructure ChenMed has launched, which differentiate it from the primary care being deployed in the vast majority of healthcare systems across the country.

• How ChenMed treats its providers with the same respect, dignity and humanity that it applies to the patients and families it serves.

• The analytic and technologic sophistication that ChenMed has invested in, which greatly enable providers and their teams.

• The remarkable business acumen that Chris and his colleagues bring to bear – allowing for a model that is viable, replicable and scalable.

I first met Chris Chen over seven years ago, and I’ve been observing the phenomenal maturation and advancement of the ChenMed model ever since.  Below are 3 reflections.
 First, ChenMed is solving a serious and unresolved problem in our country – affordable, effective and dignified healthcare for older, sicker and poorer Americans. Poverty, overall, in the US is decreasing; but it appears to be rebounding for older Americans. A recent NYT article by Lydia DePillis (An Uptick in Elder Poverty: A Blip, or a Sign of Things to Come, Oct 17, 2022) cites that nearly one in ten Americans over the age of 65 live below the poverty line. One in five Hispanic or Black American Women over 65 live below the poverty line. One in four Americans over 65 years of age make less than 150% of the federal poverty line which is, on average, $19,494 for an individual living alone.  I was surprised, actually shocked, to learn of the high and rising prevalence of poverty amongst our senior population. At this level of poverty, preventive primary care is unaffordable. The ethical imperative is clear. But, what we also know is that the vast majority of the costs of healthcare are attributed to the older, sicker and poorer population. So, there is an economic imperative as well.  

Second, what I have come to learn is how poorly understood ChenMed is amongst healthcare leaders. I’ve listened to knowledgeable experts speak without any coherent awareness of the integrated ecosystem ChenMed has built. I’m under no illusion that I fully understand the ChenMed model, but I continue to be an avid student; and continue to be an outspoken champion.

Third, one thing I’ve observed over and over again with ChenMed is their divergent thinking and approach to primary care, and healthcare in general. They have reframed the practice of medicine to align with the core principles of our profession. There are literally dozens, if not hundreds, of ways that this manifests in their clinical, operational and technological infrastructures; in their processes and protocols; and most importantly, in their outcomes. Chris highlights a few of these differentiating elements in our dialogue.  I’ll share an example below.

Most primary care across the country is based on a volume-driven, RVU-based, transactional framework that does not recognize that some patients require a very different approach. The wisdom, humanity and integrity of the senior Dr. James Chen and his sons is their firm belief that primary care is about establishing a healing and healthful relationship, not about being a visit vendor. They have understood that in order to create healthful relationships in older and sicker patients, visits must be more frequent, longer, supported by a team, and intensely focused on contextual factors, non-clinical determinants of health and lifestyle modifications. They have understood that this requires much greater investment in primary care, sophisticated protocols and technology that is built specifically for this purpose, and ultimately an approach that they characterize as love. They have also understood that top-down, centralized and generic approaches to population health are blunt instruments. So instead, they’ve empowered, deputized and resourced their physicians to essentially be the population health managers of their patients. Another related example is that they’ve reduced the number of patients each provider cares for to 400.  Contrast that to the typical primary care doctor in the US who carries a panel size between 1500 – 2000 patients. This profound decrease in panel size enables ChenMed physicians and their teams to provide the holistic, comprehensive, continuous and personalized care that is required for this segment of the population. It allows them to spend the attention and time that is required to keep these patients healthy, and out of the ED and hospital.

ChenMed is a humanistic inversion of the American healthcare system. It’s approach is an anomaly that, in my opinion, should be studied and applied more broadly across our country. The Chens and their colleagues are missionaries bringing care to the underserved populations in our country: to seniors, to those who have less means and less money, and to those who have more complex and challenging clinical and psychosocial situations. What’s incredible is that the care, experience and outcomes they’re bringing are far superior to the primary care that the vast majority of older Americans receive, and it is far more cost effective.

The ChenMed approach and others that are similarly rehumanizing healthcare are incredibly inspiring and compelling. Over the past few years I’ve been pondering the question of why healthcare systems around the country aren’t adopting or emulating these models of primary care, at least for the underserved populations and communities they serve?  I am sincerely interested in how those of us in leadership roles in healthcare can see models like this and not become immediate advocates and champions. I’m sincerely interested in your thoughts and questions.

Until Next Time, Be Well.

Zeev Neuwirth, MD