Disruptive Innovation, ZDogg Style

While in Las Vegas for the Integrated Healthcare Forum and EMS World Expo in September, we had the unique experience of visiting a disruptive healthcare innovator and rap mogul all in one afternoon.

Typically healthcare innovators and rappers reside on opposite ends of the cultural spectrum, yet we had the strange fortune that the rap mogul and innovative healthcare icon were one and the same: Dr. Zubin Damania, or, as most of the world knows him, ZDoggMD. He’s the doc who, through his rap parodies and acquired following, has wittily demonstrated how our healthcare system can at times be disturbing, illogical and even hilarious.

We learned of Damania after reading an August 2015 USA Today feature about an upstart healthcare gamble in Las Vegas. We were fascinated and decided to take a gamble of our own, so we rolled the dice and asked ZDogg if he could find time between patients and music videos to share the Turntable Health experience with us. He graciously and enthusiastically consented.

From the street, Turntable Health looks much like most other storefront clinics that can be found in Anywhere, USA. But that is undoubtedly where most similarities end. Entering what could only be described as a cross between an upscale bar and a new-age gym, we were greeted warmly by a 20-something lad looking up from his Mac while sitting at a small, round, bar-height table.

After checking in, while waiting for Damania, we took the liberty of wandering the grand lobby of this fantastic facility. To our left was a kitchen complete with a glass-front refrigerator filled with healthy drinks, signs advising the health benefits of particular foods, dates and times for upcoming meal-preparation classes, and the contact information for various grocery escorts—not the typical Las Vegas escorts, but those who go grocery shopping with their clients to help them make healthy food selections.

As we traversed the vast space, we passed a merchandise rack selling Turntable Health t-shirts and explored a futuristic-looking curved door that slid circularly on glides mounted top and bottom. The door opened with a gentle push to reveal a small, circular room with a matching door on the other side. That, we would later learn, was used for meet-and-greets with patients, their families and their care providers. There were customers waiting in the lobby as well sitting comfortably on chairs or beanbags, watching Sleepless in Seattle on a big screen and sipping coffee, while others were reading books.

A glance at the bookshelf revealed titles such as Decisive: How to Make Better Choices In Life and Work (complete with a hologram of a Magic 8 Ball that revealed different answers as you moved the cover), The Green Pharmacy, Righteous Dopefiend and The Death and Life of Great American Cities, as well as the most current version of the game Cranium, “the game for your whole brain.”

As conflicting thoughts confounded our brains (This is a medical clinic?), we turned to see the outstretched hand of a 5-foot-4 yet larger-than-life man wearing jeans, sneakers and an untucked button-up collared shirt with sleeves rolled to the elbows. With welcoming brown eyes and a big smile, he said, “Hi, I’m Zubin Damania. You must be the IHE people.”

Drastic Change

Damania’s presence elicited in us a bit of a “rock star fan” response. Having watched as many of ZDoggMD’s hilarious music videos on the silliness of our healthcare system as we could get our hands on, we’d developed a considerable level of adoration. In one he’s clad in fur, wearing radical sunglasses and rapping about readmissions (a parody of R. Kelly). In another he dons cowboy hat and boots and uses a blood tube as a guitar slide (“I’ve Got Friends With Low Platelets”). His touching Eminem rap parody “Ain’t the Way to Die” imagines the patient’s perspective on the lack of end-of-life instructions. It’s a good thing neither of us were wearing Holter monitors, or staff members might have had to come running, IV propranolol in hand.

During our initial discussions, Damania explained how he came to be in fabulous Las Vegas. During his 10 years as a Stanford-educated physician working in the university’s hospital and frequenting the emergency department, he became increasingly frustrated with the revolving-door delivery model of emergency care. His steady stream of highly popular rap parodies and associated music videos led to a call from Tony Hsieh, CEO of the online shoe and clothing empire Zappos.com.

Hsieh explained the vision for his “Downtown Project,” a $350 million plan to enhance culture, arts and healthcare for Las Vegas. With about 16% of Nevadans without health insurance, Vegas ranks as the seventh-least healthy metropolitan area in the nation. Further, the service sector workers, a large portion of Las Vegas’ population and undoubtedly the backbone of its convention and entertainment industries, represent some of the most underserved by their current healthcare system. Hsieh knew Las Vegas needed a drastic change in its delivery of care and that Damania was the guy to make it happen.

While we toured Turntable Health that afternoon with Damania, he shared his “Seven Pearls of Wisdom of Healthcare Revolution” with us. He explained that until just a few years ago, our healthcare systems were operating in “healthcare version 1.0,” that now some have upgraded to 2.0, and that his clinic successfully uses healthcare version 3.0. The transition has unfortunately been painfully slow because, in Damania’s words, “In healthcare sometimes change happens one funeral at a time—the next generation can be our best hope.

The Seven Pearls of Wisdom

1. Make it holistic—Turntable Health starts with the foundation of nutritional health by providing food selection and preparation classes, and offering health coaches to help with grocery lists and shopping assistance. The clinic’s own yoga studio offers traditional and hot-yoga classes for low-impact exercise, complete with funky rolling chairs designed to build the body’s core. They also conduct disease-specific classes where patients can share their experiences, fears and strategies with other patients while still learning from instructors. All classes are free for members.

2. Make it personal—At Turntable Health, the minimum appointment block for primary care visits is 30 minutes, with many lasting more than an hour. During visits, patients and their families can have meaningful dialogues with their care team, discussing every aspect of their health and care plan. There are consultation and exam rooms, but no provider offices. Clinical staff work in large, open work rooms designed to encourage collaboration around patients and their needs. Clinic providers have “huddles” each morning to discuss each patient on the schedule for that day, as well as identify other at-risk clinic patients who may need additional attention and resources. This care coordination helps ensure everyone on the clinical team is familiar with and involved in the care plans for all patients.

3. Make it accessible—Patients enrolled in Turntable Health have access to a physician 24/7, whether in person or by phone, e-mail, text or FaceTime/Skype. Health coaches regularly check in on patients using those media as well. Because of the daily huddles, the physician answering the patient’s call will be aware of the likely issues and how to best resolve them.

4. Make it affordable—Members of Turntable Health pay a monthly membership fee, like a gym. The fee covers unlimited visits, phone calls, texts, etc. It also covers other services offered through the clinic, from primary care appointments to grocery escorts to fitness and nutrition classes. When services beyond those offered at the clinic are necessary—for example, lab work—they are offered to the patients at a wholesale rate negotiated by the clinic in advance. Far from concierge care just for the rich, employers can also purchase discounted Turntable memberships for their employees. The Culinary Workers’ Health Fund covers memberships for all of its 100,000 union members in an effort to improve their health and productivity while lowering downstream specialty and hospital costs.

5. Make it transparent—The staff at Turntable Health are remarkably frank when visiting with their patients. The charting is done on large computer monitors in the patient exam rooms with the specific intent of allowing and encouraging the patient to see what is charted. Before each entry is finalized, the patient is asked to review the documentation for accuracy and confirm they understand and agree.

6. Make it fun—Everything about the environment at Turntable Health is upbeat, exciting and fun, starting with the founder himself. It’s Damania’s infectious enthusiasm that lies at the foundation of all that is Turntable. Examples of this include the interior colors, the caricatures of all the staff members hanging on the walls, the unique layout of the clinic and, most of all, the attitudes of the staff. They all have an affable demeanor that disarms the most cynical of personalities.

7. Make it real—Turntable Health is real. The concept is cutting-edge and patient-centric. The patient’s experience is paramount, and the outcomes are exceptional. This is healthcare 3.0, and major healthcare systems have been taking notice. Iora Health, a primary-care startup that makes its money by keeping patients out of the emergency room, is partnered with Turntable Health as the “intel inside” that runs clinical operations. Iora works with employers and unions already paying for healthcare coverage to help keep their populations healthier through encouraging and facilitating better access to high-quality primary care. Iora recently raised $40 million from venture investors to expand the model countrywide.

Conclusion

After meeting ZDoggMD, we overcame our intimidation. At his core, Damania is a passionate physician who devotes his time making the lives of patients better. Whether it’s face to face in his clinic, by e-mail with a nervous parent, in front of a ballroom full of healthcare providers who cling to every word looking for change, or through the rap parodies and music videos watched by thousands of followers, he and his Turntable Health model are the personification of “disruptive innovation” in healthcare.

By the way, for those of you who are now at the end of this wondering, What about the whole “turntable” thing?…

As we were leaving, and in a final example of things old and things new, of foundations and innovations, Damania showed us the turntable, proudly showcased center stage in the lobby. He explained that it is a fully functioning vinyl player, needle and all. And yet, what’s on the lid, plugged into the clinic’s sound system, but an iPod programmed with the staff’s favorite music.

It seems having a strong foundation of a classic delivery model is great, especially if it can be used as a platform for a newer, more personalized delivery model!

Sarah McCrea, EMT-P, RN-BSN, is EMS quality improvement coordinator for Las Vegas Fire and Rescue (LVFR). Hired by LVFR in 1998, she has served in various roles throughout her career, including firefighter, paramedic and EMS instructor.

Matt Zavadsky, MS-HSA, EMT, is public affairs director at MedStar Mobile Healthcare in Texas. He has helped guide the development of several innovative programs that have transformed MedStar fully into a mobile integrated healthcare provider.