Armed with a mission to 'remix' primary care, ZDoggMD rode into Las Vegas

Healthcare is in a state of unrest. Increasing quality measures and reimbursement changes, coupled with technology that creates rather than alleviates administrative burden, help to push physicians to burn out. Turntable Health CEO Dr. Zubin Damania, aka ZDoggMD, knows this all too well.

Beginning his stint as a hospitalist at Palo Alto Medical Foundation in 2003, Damania saw the practice change from a partnership of physicians to a larger corporate entity with production quotas. 

“I knew as it evolved, it wasn’t what I signed up for,” Damania told Healthcare Dive. With the team-based care peeling away, he began to feel the effects of burnout. Against the advice of his peers, he began posting rap parody videos about the physician workplace struggles as a coping mechanism.

Years later, he’s become an industry star and a highly sought-after public speaker, using his experience and wit to push patients back to the forefront of the care conversation.

The rise of ZDoggMD

You may have seen Damania's videos. If not, here’s a good introduction:

Or here:

Damania's videos pull no punches. Whether the topic is vaccine truthers or awful EHR tech, his videos aim to skewer workplace inefficiencies and topic ignorance. While recent video "EHR State of Mind" blasts EHR companies for creating unusable technology, companies like DrFirst and athenahealth have partnered with Damania because of his unique critique of the industry.

Entertaining yet educating

However, before the viral success, his videos were met with skepticism. “I was told quite clearly by colleagues, ‘You’re going to ruin your career putting this rap video on YouTube,” Damania said.

Using an alter ego and never mentioning his employer, Damania continued to post videos while continuing to work as a hospitalist. “I think [they] resonated with a lot of other doctors who were feeling burned out and didn’t have a voice,” he said.

Lending heavily from "Weird Al" Yankovic’s parody playbook, the videos aim to entertain and educate. However, when the videos turn to such serious subjects as drug misuse and sepsis-related deaths, some viewers they go a bit beyond the pale.

“We’re at an advantage because we're healthcare providers and we're used to dealing with taboo issues. I think being a bit more provocative and direct helps establish a sincerity and credibility. But anything I do gets some degree of backlash from people who are offended or think we've gone too far,” Damania said.

For example, the video “It’s Beginning to Look a Lot Like Sepsis” — a Christmas-style song about recognizing the signs and symptoms of sepsis — got feedback from individuals who had family members die from the condition and didn’t find the video funny. Damania noted more individuals supported the video.

"If this makes someone laugh and also remember the early signs and symptoms of sepsis, we can prevent a morbidity and mortality and that's worth it,” Damania said. “I've seen people do parody in medicine that does go into the offensive territory, so it is a challenge we're thinking about all the time.”

How Turntable Health’s model works

Damania was still practicing while his videos were gaining traction. His hot takes on practice management helped him catch the eye of Zappos CEO Tony Hsieh. Hsieh made him an offer he couldn’t refuse: Quit his job, take some startup funds and create an innovative care model for Hsieh’s Downtown Project in Las Vegas. The idea behind the project is to get  “productivity dividends that come from cities where people bump into each other and interact -- and ideas are engaged where there's no central command or hierarchical organizational structure telling you what to do,” Damania said. Currently, the Downtown Project owns or invests in more than 300 businesses and entities, including Turntable Health.

Damania and his wife packed their bags for Vegas in the attempt to reinvent, or "remix" as they say, primary care. According to Damania, primary care is currently broken.

"We don’t resource it correctly. We don’t make it team-based and we don’t use the right technology,” he said.

Partnering with Iora Health, the Turntable Health model was constructed: A flat monthly fee for unlimited all-you-can-treat access to care that involves a team with a homegrown EMR. Turntable Health's website touts 24/7 phone access to physicians as well as nutrition and yoga classes as some services. 

The model takes a team-based approach to support collaboration between disparate providers but at its heart, it's a population health model. Patient visits are at minimum 30 minutes and the clinic employs morning huddle times to discuss how to proactively manage, for example, all of the diabetics or all of the individuals with hypertension in the population.

Care givers access and write in the same EHR at the same time. “We don't worry about pissing off an insurance company because we don't care about them because we're not interfacing with your standard insurance company,” Damania said.

Initially, the biggest revenue source came from Nevada Health CO-OP, one of the ACA nonprofit health insurance co-ops that failed and went into receivership. Turntable’s client base is currently expanding to larger groups like self-funded employers and the Culinary Health Fund, a culinary workers union.

Remixing primary care

Using the flat-fee model with a focus on population and primary care, Damania says the model acts as a breath of fresh air for an industry that is largely taught to stay the course and not rock the boat.

“We're not gonna spend tiny amounts on primary care and then hope things work out,” he said. Instead, they are going to spend more on primary care and "imagine the rest of the healthcare pie will shrink. And it does from the preliminary data that we have.”

What he’s seen so far is a 50% reduction in ER and admission rates in the sick population Turntable covers. In addition, he's found prescription drug utilization has increased in a year. “The reason is patients are more compliant with medications because they’re worried the health coach is going to text them and ask them about it. They feel accountable,” he said.

He believes the Turntable Health model can go beyond chronic disease and focus more broadly on wellness but notes it takes longer to show such data. Preventing a case of diabetes, for example, could take three to five years and the results of that won’t be seen for a long time.

“I want people to understand there are different models out there,” Damania said. “I care that other people stand up and do something with a model that's going to make healthcare better. ZDoggMD is definitely one Trojan horse to sneak in the concept of team-based direct primary care. We need more in healthcare, where something/someone credible uses a unique approach to spread the word or legitimize new ways of approaching our problems."

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Filed Under: Hospital Administration Practice Management
Top image credit: Turntable Health