Zubin Damania is a Stanford-trained physician working to develop a new model for primary care clinics. But if you cared to, you could also find him on YouTube, rapping as ZDoggMD.
Damania, assuming the persona of ZDoggMD, began making music videos in 2010. He parodied songs by Notorious B.I.G and the Black Eyed Peas, in so doing addressing some of the serious problems he noticed while treating patients in the hospital. He has since made more than 60 PSA-style videos that have amassed close to 1.2 million YouTube views—from “Immunize: the Vaccine Anthem,”—which plays off the Travie McCoy and Bruno Mars song, “Billionaire,” and urges vaccine deniers to “get your shot on”—to “Pull and Pray,” which explains “ST to the Ds” and other dangers of unsafe sex in graphic detail.
With ZDoggMD at the mic, Damania says he was able to be more vocal about the problems of the healthcare system than he would as “just a regular doc.” One of his most widely watched videos is a take on Jay-Z’s “Hard-Knock Life.” In it, ZDoggMD and his sidekick, Dr. Harry, a pediatrician in Redwood City, California, break it down from hospitalists’ perspective:
“It’s the hard doc’s life for us/Hospital doc’s life for us/Specialists, they got it made/We do the work while they get paid.”
Damania’s humor is grounded in deep frustration over a “devastatingly dysfunctional” healthcare system that, he says, “fails miserably at prevention and focuses instead on the treatment of disease.” The costs of treating chronic diseases like diabetes, heart cancer and cancer represent 75 percent of the staggering $2 trillion spent annually in the U.S. on health care according to a 2012 Institute of Medicine report. Most chronic disease can be prevented.
According to Damania, this approach reduces medicine to “doing something to patients instead of for patients.” This is particularly true, he says, in fee-for-service models—the foundation of most private insurance and public entitlement programs in the U.S.—that reward physicians for quantity of care over quality of care. He estimates that most primary care physicians’ salaries depend on them seeing as many as 30-40 patients each day. “You can’t treat a patient in 10 minutes so you refer them out and probably never see them again,” Damania says.
In a TEDMED talk he delivered earlier this year, “Are zombie doctors taking over America?” Damania made the case that patients are not the only victims of the episodic and fragmented nature of healthcare in the U.S. Pointing to the sobering statistic that fewer than half of all doctors would choose medicine again if given a chance, Damania compares primary care physicians to the undead—their lives devoid of the very interactions that inspired them to become doctors in the first place. What’s worse, he says, is “they feel powerless to do anything about it.”
“The frustration patients have about not getting enough time with their doctor is the same frustration doctors have with not having enough time to spend with their patients,” he explains. “Spending hours on the phone haggling with insurance companies and buried in a crushing amount of paperwork is not why we got into medicine.” According to a recent study by personal finance site NerdWallet, an estimated 25 percent of a doctor’s day is spent on administrative tasks.
Damania’s outspoken views on the healthcare system attracted the attention of Tony Hsieh, CEO of the online shoes and clothing emporium, Zappos.com, who offered him an opportunity to transform his critique info action. In 2012, Hsieh recruited Damania to head up healthcare development of his Downtown Project. Damania’s charge: changing the way medicine is practiced in Las Vegas, a city that the Commonwealth Fund ranked 268 out of 306 localities for its quality of healthcare.
“Zubin is a great communicator and passionate about getting healthcare right. But most importantly, he believes that to get healthcare right, you first have to get the culture right,” Hsieh says.
Hsieh’s Downtown Project is an ambitious revitalization effort to transform the oft-overlooked Fremont East district just north of Las Vegas’ strip into a vibrant, connected, and livable urban core. Bringing the $350 million plan to life has required Hseish to pull from his own deep pockets—he sold Zappos in 2009 to Amazon for $1.2 billion—to invest in everything from arts and education to small businesses and high-tech start-ups.
“One of our goals for Downtown Project is to help make downtown Vegas a place of inspiration, entrepreneurial energy, creativity, innovation, and discovery… as well as help create a place where everything people need to live, work, and play are within walking distance,” Hsieh says. “We believe that helping make downtown Vegas healthier will play an important role in all of this.”
Part of Downtown Project’s $50 million investment in arts, education, and health will be given to Turntable Health, a primary care clinic founded by Damania that shuns assembly-line style medicine for one-on-one, “relationship-based” care. The goal, Damania says, is keeping people healthier by focusing on preventative care and reducing trips to specialists that can result in costly and often unnecessary procedures.
Turntable Health will run on a membership model—patients will pay a monthly fee that is auto-debited from their checking accounts, “like a gym membership,” said Damania, for access to unlimited primary care access. Prices have not been set yet, but Damania estimates the per-month cost would be under $100.
Because patients are paying cash for care, the clinic has a financial incentive to keep people healthy, as opposed to insurance-based models, under which providers have a financial incentive to see more patients, make referrals and order procedures without regard to outcomes, he says. Should patients require treatment beyond the scope of primary care, clinic staff will help coordinate referrals and specialty care.
Though the clinic does not eliminate the need for traditional insurance, Damania expects it will bend the cost curve downward and decrease the cost of wraparound insurance plans for specialty or emergency care. He is currently finalizing talks with the Nevada Health Co-Op, a new non-profit insurance company created under the Affordable Care Act. The co-op will offer Turntable Health as a primary care option for patients on its insurance.
Turntable partnered early on with Iora Health of Cambridge, Massachusetts, to oversee the clinic’s day-to-day operations. The seven-year-old company is known for developing innovative care models, such as insurance plans geared toward freelancers and a clinic that serves hotel and restaurant workers with severe or chronic illnesses.
Turntable will be staffed by a team of physicians, nurses, and health coaches who will work together to treat each patient. Each morning the staff will “huddle” to discuss each patient they are scheduled to see that day. Damania calls this a "non-hierarchical" approach, where patients get the attention they need but time and money is preserved by realizing that "not everything has to be done by a doctor.”
Turntable will use technologies such as email and video chat to constantly engage patients even when they are not sick, a strategy the Damania says will boost wellness and prevent illness and disease in the long-run. In addition, the clinic will offer free classes on everything from cooking and nutrition to yoga and chronic disease management to help people stay as healthy as possible.
Damania and Hsieh say that if it works, the model could be expanded to other parts of the city, including places where low-income residents currently have little access to compassionate and effective primary care.
At full capacity, Turntable could serve about 5,000 patients, a cap that will allow clinic staff to develop and maintain a personal relationship with each patient. Some of Turntable Health’s first patients will be Zappos’ employees, who will have the option to purchase a membership at a discounted rate. In addition, the clinic is working with community organizations to get the word out.And of course, so is ZDoggMD, with a suite of new videos. "Vegas," he says, "prepare to turn and cough. Because it is on.”