Dr. James Wantuck: “Pay more for primary care”

…Eliminate tax breaks for employers when they buy employee health insurance and give the tax break to individuals who buy their own health insurance. This is the whole reason that employers got involved in the very personal business of their employees’ healthcare. Wouldn’t it be better if your employer simply handed you a pile of […]

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…Eliminate tax breaks for employers when they buy employee health insurance and give the tax break to individuals who buy their own health insurance. This is the whole reason that employers got involved in the very personal business of their employees’ healthcare. Wouldn’t it be better if your employer simply handed you a pile of cash to buy your own health plan? You could even keep the same plan if you moved or if you changed jobs — your healthcare wouldn’t skip a beat. We could make this work with some changes to how health insurance is bought and paid for and would have the most dramatic effects on the quality of care we receive.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dr. James Wantuck the Chief Medical Officer and co-founder of PlushCare, a leading virtual health platform that offers primary healthcare and virtual doctor’s visits to patients in all 50 U.S. states. Dr. Wantuck treated many patients who traveled long distance to see him, and this along with his frustration of the lack of modern technology in healthcare helped plant the seed for PlushCare to be born. Dr. Wantuck received his undergraduate degree from the University of Pittsburgh and went on to get an MD at Vanderbilt University School of Treatment in 2010. He completed his residency at Stanford University Medical Center, and is board certified in internal treatment . Dr. Wantuck grew up in Rochester, NY and currently resides in San Francisco, CA.

Can you tell us a story about what brought you to this specific career path?

It was really my father who inspired me to go into treatment. He had some health issues when I was in my impressionable phase of youth, and he was always talking about how much the doctors he saw helped him and what a big difference they made in his life. I watched that happen, and watched him go from being immobilized on his back to playing golf again after several surgeries. As I progressed through school I latched on to the rational, fact driven, side of treatment, but have tried never to forget that there are people behind the biology, that treatment is both an art and a science, and by leveraging both we can change the world in a very big way.

Can you share the most interesting story that happened to you since you began leading your company?

Early on, I cared for a patient that came to me worried he had bronchitis. His story didn’t quite fit as a textbook case, and I probed deeper. He shared some more symptoms that had me worried enough to send him to get a chest x ray done. I got a call a few hours after the study from the radiologist, who saw a large tumor in the man’s right lung. I called the patient, and over the next few days helped to orchestrate the confirmation of his diagnosis and his initiation of treatment with surgery and chemotherapy. I looked at this as simply my duty, something I had done for many patients before him. But I did it all from across the country — I never met the patient in person, and had never been to his small town. When he told the story to the local hospital, they were awed by the fact that this diagnosis was made via telehealth. When we got started, virtual treatment seemed like a great way to diagnose minor ailments — but this story and others have made me realize that virtual care can be incredibly powerful, giving access to those who need it, catching illness early, and establishing a vital connection to healthcare providers for patients who otherwise might not be able to go in. We have never looked back and can see a future where everyone has this type of comprehensive and relationship-driven care.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

When we first started, our CEO Ryan McQuaid was answering the phone, and I, as the doctor was seeing the patients — there were only two of us. When we got our first funding, a startup competition that we had won, Ryan had to travel to Stockholm to accept the award. We didn’t want to stop seeing patients and so initially I was serving as customer service AND as the doctor — I used a (very bad) British accent when answering the phone, and would “check” my own schedule to see if I was available to see a patient. Because of that situation, we hired an outsourced customer service center to take calls — a huge mistake. We fired them the next day as we realized that customer service was an absolute core competency. Ever since we have maintained an NPS of 90 and believe strongly that we need to WOW our members with great service in order to keep them.

What do you think makes your company stand out? Can you share a story?

We absolutely go above and beyond for our members. We have an NPS of 90 and encourage every single member to reach out to our support team via phone, email, or chat. We see our associates and our clinicians not as a cost center, but as the most important members of our team. This means that we encourage forming relationships with our members — which can lead to some unique and unusual conversations — we have had customers call in and spend an hour on the phone talking to our support agents — that can be therapeutic for those who are lonely and it also builds trust and lifelong members.

What advice would you give to other healthcare leaders to help their team to thrive?

Make it about patients. We have all been patients at one point in our life, and reminding yourself every single day that it is people just like you that we are here to serve is critical. If that doesn’t motivate you, then you shouldn’t be in healthcare. We talk a lot about our core values, about who we are trying to serve, and start discussions with that being the north star — how can we solve this problem in a way that improves patient’s lives. This viewpoint brings into focus what is truly important.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

  1. It’s disjointed. Nothing has proven this more true than the global pandemic. In the US we have seen testing, clinical care, and communication vary across regions, states, counties, and cities. No one is on the same page in the US healthcare system. This has to change. At the same time, a uniform approach won’t work for every geography or for every person.
  2. The healthcare system is full of waste, corruption, and fraud. The mission of healthcare attracts those who are our most altruistic citizens. The money in healthcare can have the side effect of attracting the most exploitative. With taxpayers footing the bill, and with little incentives built in to combat waste and abuse it is not surprising that so much money goes to waste.
  3. There is something about American culture and the American attitude that I don’t think we can overlook. We have a culture of overdoing it. In healthcare this plays out in our focus on treatment and not prevention, our aggrandization of life-saving surgery rather than the humility of primary care, and our desire to try the latest thing rather than the things we know will work. This leads us to be pushing the frontier of treatment ever further, but causes us to forget about serving the basic healthcare needs of our population.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

  1. Eliminate tax breaks for employers when they buy employee health insurance and give the tax break to individuals who buy their own health insurance. This is the whole reason that employers got involved in the very personal business of their employees’ healthcare. Wouldn’t it be better if your employer simply handed you a pile of cash to buy your own health plan? You could even keep the same plan if you moved or if you changed jobs — your healthcare wouldn’t skip a beat. We could make this work with some changes to how health insurance is bought and paid for and would have the most dramatic effects on the quality of care we receive.
  2. Make healthcare data interoperable. We have come a long way when it comes to digitizing and storing health information, but we are a long way away from a doctor a mile down the street being able to access records or images from a the first doctor you see. A friend recently came to me, having recently been diagnosed with cancer. I recommended a second opinion (something that could save her life), and she was reluctant only because she knew how difficult it would be to transfer her records. This is a travesty, and compounds the disjointed nature of our system.
  3. Mandate pricing transparency. Healthcare is perhaps the second most expensive thing that you will ever buy (besides housing), but you often have no idea what it costs. It’s not about letting consumer shop around, because you don’t have enough information or time to decide whether to go to emergency room A or emergency room B, but not even the doctors know what things cost. If you ask me what the treatment I am prescribing will cost, I have a rough idea, but I frankly can’t tell you. Even the pharmacist doesn’t know until they submit a claim to your insurance, and even then all of the middlemen involved in the transaction are hiding their prices from each other.
  4. Pay more for primary care. The panel of doctors that the government uses to advise on what we pay doctors for their services is made up of specialists, even though most doctors are primary care doctors — it makes no sense. Of course, the advice they give always seems to suggest increasing installment for their specialty surgeries, procedures, and treatments. However, primary care is underpaid, and thus not very attractive to medical students when choosing a specialty.

Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

  1. People can call their congressmen, or vote for candidates who espouse these views. The changes that need to be made often require a legislative fix. I would also advise that more people go into healthcare as a career choice. If you want to make an impact, get informed and get involved. You don’t have to be a doctor to make a difference. We need the brightest minds in all fields.
  2. Corporations have a great deal of power. They can push on the insurers and push on the healthcare systems in their communities to make changes. They can lobby politicians and have the ear of government officials. They are drowning in the costs of a system they didn’t create — unfortunately every business is a healthcare business because of it. This needs to change.
  3. A grassroots community effort to encourage the changes I suggest above, to elect politicians who will actually make these changes, and to educate the population about how the system works is a necessary part of effecting change. If people speak, the government must listen.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

The separation of mental and physician healthcare is an embarrassing product of our own creation. Because we don’t understand the brain as well as the rest of the body we all too often put it in a separate category. However, we know for a fact that mental illness is not only interwoven with illness elsewhere in the body, but it is just as (or perhaps more) impactful on people’s lives and livelihoods. Today we often see health plans that limit the number of mental health visits, or pay differently, or put mental health in a different category than other healthcare and this is a mistake. How would it feel if your oncologist could only see you 8 times in a year and after that it was determined your plan didn’t cover the rest of your cancer care! Psychiatrists, psychologists, and other behavioral health workers need to be treated the same as other healthcare workers when it comes to reimbursement, and we need to invest significantly in educating and training more of these people.

How would you define an “excellent healthcare provider”?

Having interviewed hundreds of physicians and hired and worked alongside hundreds more at PlushCare, I have seen just about every type of clinician. While there is no one approach, personality type, or skill set that defines excellence, there are common threads. There are table stakes items like solid education, thorough training, and wealth of experience that come through on a resume. However, the best of the best are the ones who can communicate. Communicate clearly to colleagues, work fluidly with other team members, and talk with patients in a way that resonates with them. The best clinicians can do this with any patient who they come across. Finally and above all, they must be great listeners and make patients feel heard. If you read our most raving reviews, they all talk about how the physician listened to them like no other clinician had before. This is how you build trust, and without that you can’t be effective at taking great care of patients.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” — Margaret Mead. Perhaps a bit cliché, but I first heard this in college and it has stuck with me ever since. As a very small group of people in the largest sector of the US economy and trying to change the way that 20% of our economy functions, this quote always rings true.

Are you working on any exciting new projects now? How do you think that will help people?

Something I am very excited about is our new effort in mental health. We have a tremendous deficit of mental health care in this country and PlushCare is helping to solve that problem. We have seen the number of patients coming to us for help with depression and anxiety skyrocket since the COVID pandemic began. People are home, isolated, and scared and this has made underlying problems worse, and resurfaced prior struggles people have had with these conditions. Our primary care doctors are on the front lines caring for these patients, and we have made great strides in streamlining the patient experience and adding new features to enable them to take better care of our members’ mental health needs. We have some exciting new developments on the way to make this part of our membership even better, I am excited to put the word out that we are hiring mental health professionals rapidly so I encourage your readers to join the team.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I’m a big believer in reading books both in and out of your field. I straddle the worlds of technology and healthcare and so I read quite a bit within those areas. I also read a lot of other non-fiction and find ideas that help me solve problems by getting me outside of my usual wheelhouse.

Flow by Mihaly Csikszentmihalyi is one of my favorites of all time. The fundamental principle is that those who are doing the thing they love and the most happy, and that you should try hard to find a job that doesn’t feel like a job, one that allows you to get into a flow state, where you lose track of time and are simply in a rhythm. If you aren’t doing something you love, do something else.

Building a Story Brand by Donald Miller. As a doctor, you don’t learn a whole lot about marketing in medical school. This book was one of many books on marketing I have read to get me up to speed, but the central idea — putting the customer (patient) at the center of the story and making them the hero, and your organization as merely their guide in their journey, really resonates with me.

Algorithms to Live By. A book about how computer science problems pop up in everyday life. Read it and you will never think about parking meters the same way again. Many of the problems you solve in life and in business can be categorized, deconstructed, and solved in the same way that computer scientists approach problems. This opened up my eyes to a whole new way of thinking.

The Emperor of Maladies. I would be remiss not to mention one of the greatest healthcare books of all time. Reading this book is like a journey through our healthcare system over the past hundred years; from scientific breakthroughs to stories of suffering it is a profound introduction to the kind of impact that individuals can have when they apply themselves. You cannot lead people somewhere if you do not know where you have been, and this book will illuminate the shoulders of the healthcare giants you stand on.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.

Always help those who ask for it. I have tried to live by this ethos and highly recommend it. Even if the person asking you can’t help your cause or your success, it will always pay back dividends. If everyone did this, we would all be better off, not just because we will have helped so many people, but because the benefits and personal satisfaction from helping those who need it are tremendous — you will be better at other tasks simply by having helped someone in need.

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