THE STORY OF ZOOM
by Albert DiPiero and Dave Sanders
ⓒ Sanders DiPiero 2018
ZOOM+Care is a cherished healthcare company based in Portland, Oregon that cares for 400,000 individuals and in 2017 delivered nearly 250,000 patient visits.
But the road has been long and winding.
We founded ZOOM+Care 12 years ago.
ZOOM+Care was founded and exists to take on and solve one of the greatest social and economic challenges of our times: how to deliver better access to quality healthcare at a price we can afford.
We both grew up always wanting to become physicians. When we completed our medical training and entered clinical practice we were shocked by the dysfunction we found in the “real world” of American healthcare. We’ve spent our careers trying to fix our sick healthcare system.
ZOOM+Care has always been clear about its place in the world.The Healthcare Establishment has settled into a comfortable pattern of complacency. The world doesn’t need another complacent, incremental healthcare company. Zoom was born to innovate - to disrupt the establishment. Our Promise has long been Twice Half Ten: Twice the Health, Half the Price, Ten Times the Delight. This is more than a slogan. We;ve put everything on the line to make our Promise a reality. This is our purpose and place in society: to point toward a fundamentally superior American healthcare system that leaves behind the last generation of tired, old American healthcare. In turn, we've sought to inspire and catalyze change beyond our own works. The Zoom effect is real. Zoom’s up-tempo modern model is increasingly credited for stimulating consumer-focused change in the Portland healthcare market.
But how did this all start? Here over the next few chapters, we will tell you the full story of ZOOM+Care: the good, the bad, and the ugly.
Do you remember the scene in the year 2005: ipods. No Amazon prime. No Uber. No Lyft. No streaming. No Netflix. No Airbnb, no Twitter. no smartphones. Certainly no iphones .
The web was still in its infancy: ….
But the careful observer could see clues to an emerging golden age of retail and e-commerce that would change the customer experience forever:
Amazon was growing at a rapid rate...
Googling was where you started...
Apple was coming back....
Yet, healthcare remained in the Dark Ages. Most physicians still practiced in small groups in private offices. Remember, to schedule an appointment required calling in by phone and performing a surreal dance with a scheduler:
Scheduler: When would you like to be seen?
Patient: How about tomorrow, Wednesday at 6 PM?
Scheduler: Sorry we close at 5 PM
Patient: Ok what about Tuesday at 9 AM
Scheduler: Sorry that slot is not available
Patient: Ok, Well why don’t you tell me what openings are available.
Scheduler: Let’s see … next open slot is 2 PM July 7, about two months from today
Or you could go to an urgent care, which was appropriately called “doc-in-the-box” - dingy, oppressive, “walk-in-and-wait” facilities staffed by whomever.
Or you could go to the ER and wait for 4 hours and receive a $4,000 bill. And as for technology, there was nothing: Electronic medical records (EMRs) were just rolling out to the biggest systems, but they were (and still are) really just a tool to improve billing and collections.
Quality was a black box. Although the landmark study "To Err is Human" was published in 1999 revealing close to 100,000 deaths annually caused by medical errors, healthcare was still decades behind other industries in quality and safety.
In brief, healthcare was an utter failure of service and business, from every vantage point including quality, safety, financial transparency, cost, and patient experience.
But none of this was really a surprise, because at the core, the entire healthcare system was designed by the doctor and evolved to support the doctor at the center of the show.
There had to be a better way.
Dave and I had a long medical and business history together that revolved around a common theme: in all our businesses, we always put the customer at the center of all experience. This sounds simple. In healthcare there was a surge in recent talk of “consumer-centric health” or “patient-centric care”. But in 2005, the reality was a system with the doctor as the all knowing, all powerful sage on a pedestal. This was the era of the charismatic physician. The entire industry revolved around the doctor and bowed down to the doctor’s pronouncements, schedule, temperament, and expertise.
We had a different vision with a few simple, big, ideas: Place the customer truly at the center of the experience. Everything else becomes secondary to the patient’s needs for time, convenience, location, and control.
First, focus on speed to care: delivering care faster and easier with constant focus on a beautiful experience would produce better care and attract a growing number of customers.
Second, implement true team-based care through standardized protocols and guidelines. The customer would have a relationship with the practice, the Brand. In this context, the providers could be interchangeable, and the team would be the nexus of care.
The provider would be part of a team delivering reproducible high-quality care.
We started touring the country to view emerging concepts of “retail clinics” that were starting to dabble in similar concepts. At that time, a series of start-ups (example: Minute Clinic) were putting nurse practitioners in drugstores to deliver basic urgent care. Dave visited locations around the country. He hung out in these drugstore clinics and observed...
We quickly realized that the “nurse in aisle” 6 would not succeed. First, the economics just did not make sense. The nurse practitioners were seeing a patient an hour and caring for a very limited set of acute conditions. Our back-of-the envelope calculations revealed that nurses seeing a limited scope of care (UTIs, strep throat) with visits every 15-30 minutes could not generate enough revenue to make this a big business, or even a profitable business. The only way this would succeed is if the urgent care visits really served as an entry point to the pharmacy's real business: selling medications and other add-ons that are part of the modern drugstore.
Second, the entire experience of getting care in a drugstore was never going to be appealing to the vast majority of middle American. The settings were depressing, unattractive, and did not feel compatible with high-quality, safe medical care.
Finally, we also met with a wide range of healthcare leaders in insurance, clinical medicine and healthcare businesses in Oregon, Washington and nationally to vet our idea of a modern healthcare system based on ease and speed of access, retail experience, and team-based care. All the experts universally rejected this idea. They predicted that people would not give up their “primary care doctor;” they valued too much the relationship; they would not venture outside of the traditional practice or hospital setting. One physician leader even wrote to us that we would “loose your shirts” (We assume he mean lose your shifts!)
With this feedback in hand, we knew we were on the right path!
Dave Sanders, MD &