Part II: A PCP NewCo Designed for Indian-Americans
Each part of the experience is tailored to our community’s preferences
In Part I of this series, I outlined population characteristics of the Indian-American community, and how those characteristics translate into what that community might want from their healthcare experience.
In Part II, here, we explore what the initial operational rollout of such a service would look like.
Where would you put the clinics, to start?
The suburbs of large metropolitan areas with high Indian-American populations. NYC, DC, Chicago, LA, SF, Dallas. Personally I’d start in Jersey City. I say the suburbs, not the cities, because the suburbs is where so many Indians live — need to meet the consumers where they are. Plus the real estate is cheaper. Spend the cash on offering the right services, not being in the right location. Once word gets out, Indians will travel to you to get the right care and the best deal for their money.
What clinical services would you offer? How would you staff the clinic?
Set up a small multi-specialty group — this is the expensive part. There are three types of talent needed:
- Nurses, NPs and PAs serve provide most of the care and serve as PCPs
- Specialties: Cardiology and Endocrinology are a must, on-site, as employed physicians. The panel size ratio will have to be lopsided here, at the beginning.
- Other: Certified nutrition coaches with a background in holistic medicine / modern Ayurvedic applications
This is just to start. As the company gains traction, you bring more services in-house, over time. See “What about the network?”, below.
Who would fill those roles?
Ideally you would recruit Indian clinical talent, and tailor that talent to the language needs of the region. E.g., in New Jersey, you need your employees to speak Gujrati. Outside of SF, Telugu. And so on. Hindi is a great baseline as well, they at least must understand it. Also this language pre-req is probably the only way to not discriminate during hiring.
How about the network and other physician services?
Build a custom-network of other Indian doctors in the area, whose specialties you don’t have in-house but are core needs of any population. OBGYN, Women’s Health, Mental Health are top of mind. The key is to recruit in-network docs whom you would eventually want to be a part of your practice. The goal is to get big enough in concentrated geographies to employ that clinical talent in-house someday.
What other services would you offer on-site?
Tutoring. Have a room where smart high-school students sit and can teach any off-the-shelf subject to kids who are brought along with their parents. Use free Khan Academy courses of a laptop, just need paper and pencil. This is a massive hook to get the parents into the doctor’s office.
What is the look/feel of the clinic?
It needs to look nice so you can attract the fancy, richer clientele…but it can be located in less-posh places. This is the attempt to addresses the bifurcated income distribution that is the Indian-American community. Again, you’re betting that once they are in the door, the product/service is good enough to keep them coming back.
How would an average visit work?
Every visit has four suggested parts. Before anything starts, the menu of prices are shown to the consumer and they pay up-front for what they want. Also, align the language preference of the patients with the staff who treat them, whenever possible.
- Step #1: 15-min diet breakdown. Tell us what they normally eat, we plug it into a spreadsheet/system (assuming they are under-clubbing by 25%), and spit out a dietary profile with strengths/weaknesses.
- Step #2: 15-min general physical, done by Nurse/NP/PA.
- Step #3: 15-min specialist visit. Cardio or Endo, whichever is more relevant.
- Step #4: 15-min next steps with the Ops team. Based on your preferences/needs, they physically help you with the technology on your phone, explain how to use that technology to get care (e.g., download the CVS app and get your medication, or book your next appointment). They also tell you your recommended next step, based on your clinic visit today. It’s at this point you can opt-in to the subscription service (e.g., access to your data whenever you want it, access to care-team within 24hrs of request, and best next-step notifications)
Testing, labs?
Do the minimum necessary in-house to keep the costs low and still be effective (e.g., rapid cholesterol and glucose testing). Anything you have to send out for, like labs, needs to have an up-front price given to the consumer.
What is the preferred technology stack?
Choose the clinical stack (i.e., EMR) based on what integrates with the consumer-facing tech stack. The big idea: the consumer should be able to operate their entire medical life from WhatsApp. They should never have to go to another app/site, unless for a HIPAA/security reason.
So building backwards. You need an API layer for WhatsApp integration, like Twilio, and a CRM that can pull from EMR and push to WhatsApp. Not sure if this last part exists. The hack-y way to start is to have humans be the integration point between the EMR and the CRM, then the CRM has logic to automate outreach, communications and coordination.
If you need an app layer for security reasons (i.e., viewing patient data), then have a lightweight secure mobile-first site website, don’t need a dedicated app.
Couldn’t this all be done virtually?
The fully-virtual model isn’t feasible at-first because it takes away from the sense of the community that is brought on by the in-person experience. Seeing people like you at the clinic is the whole point — it makes you as an Indian-American feel seen and it makes you want to come back. For members with 3+ visits or paying subscription, sure virtual can work. To start the clinic, if we want to reduce Capex, I would argue for a hybrid model like so:
How will you go get lives?
Customer acquisition is expensive. To not pay that premium at first, you need to go to the heart of the community, and have community leaders advocate on your behalf at their events. This means partnerships with: (1) local temples (pay for a bus to shuttle folks over on weekends), (2) community affiliated groups (e.g., BSNA, Bengali Association), and (3) business groups with majority Indian affiliation (e.g., Asian American Hotel Owners Association).
Forget the 12–18 month sale cycle to insurance companies. Your true “sale” is to religious, community, and trade/industry groups, which takes let’s say 6 months if they have to take it to their board. They likely don’t. If you win them over, they’ll funnel patients your way through marketing and promotion at their events.
Ok but are there other models to get lives?
Yes, you can partner with or become an insurance plan, but this is a very capital intensive and rigorous approach that takes time. However, it’s nice to see that community-targeted care delivery is a real thing. Take a look at this hispanic-population focused company that is beating Oak Street in most care categories and EBITDA %:
I wrote the above as I’m exited by how a new healthcare trend may help my community — as always, would love your feedback/comments. Find me on twitter @Rsiddhanti.
