David Saltzman: 0:00

What happens when an insurance broker stops just advising clients on healthcare strategy and starts building the clinic model he wishes he could have sold them years ago? We'll find out on this episode of Shift Shapers.

Announcer: 0:16

Change either energizes or paralyzes. The choice is yours. This is the Shift Shapers Podcast, bringing the employee benefits industry interviews with individuals and companies who are shaping the industry's shifts. And now, here's your host, David Saltzman.

David Saltzman: 0:36

And to help us answer that question, we've invited Chris Yarn, who is CEO of Walk On Clinic. Welcome, Chris.

Chris Yarn: 0:43

Hey David, how are you doing?

David Saltzman: 0:45

I'm doing well. Thanks for being here and sharing some of your expertise with our audience. We appreciate you taking the time.

Chris Yarn: 0:51

Absolutely.

David Saltzman: 0:52

So let's level set. How do you define hybrid care or mobile plus on-site clinic models? And do they represent the future of primary care access for employer groups?

Chris Yarn: 1:04

Yeah, I uh I believe so. I think that we've seen the big boom of direct primary care across the nation. I think there's a lot of mom and pop direct primary care practices that are doing good work. Um, but what we've discovered is that patient behaviors are not immune to the retail therapy buying behaviors that exist in the marketplace now, meaning you look at the amount of primary care practices shutting down, being replaced by urgent care centers across the nation and less access. Part of the reason why is the brick and mortar facilities are not being utilized. So when you put those same clinics and those same providers of medicine on site, all of a sudden you get utilization. And it's just the convenience factor. So I just firmly believe the more convenient you make primary care, the more it actually gets used. And that's really what the aim is of most of these self-funded employer groups.

David Saltzman: 2:01

So what are the main barriers, whether technological, regulatory, cultural, all of the above, to getting really good adoption?

Chris Yarn: 2:09

Yeah, I think I think the first one is again convenience. The best kind of story I can tell or example is we have a client in Orlando, a boat manufacturer, 800 employees. We started with them a year ago, and we gave them access to a near-site clinic, brick and mortar facility, 1.3 miles away from headquarters, three days a week. And then we gave them access on-site two days a week in one of our mobile clinics at the same company, same population employees. At the end of a 10-month period out of 800 employees, we had 530 patients that were the primary care home for, but only 15 being 1.5, were using the brick and mortar facility nearby versus the other 515 using the on-site clinic, even though there was less access to that clinic being two days a week versus a near site three days a week. So I think that's really the lesson. I think anybody in direct primary care and the near site clinic industry or even HMO models, all these models that are out there, brick and mortar, what the aim should be is how do we connect to the patient and then can in the most convenient form possible and then continue that relationship through the cell phone.

David Saltzman: 3:22

Do you attribute that to just removing friction? We've seen this in a lot of other consumer fields where people will partake if it's easy and they don't have to get in the car or drive someplace or whatever. Look at Amazon and all the stuff that they sell. Is that part of the what you think drove that trend?

Chris Yarn: 3:39

Yeah, I think I think the convenience has a lot to do with it. I think so much more of it is about in a world where everybody's trying to connect human beings to chat bots or AI tools and all that stuff. What we really do is we connect the patients and employees of companies to human beings they know and that know them. And then we use the same technology not to connect people to chatbots, HIPASCURE portals and chat and text message capabilities. Uh we use the same technology to connect them, but to the people that they see weekly or see monthly, depending on how frequent a flyer the patient is to the clinic. And that's the key. It's keeping the you're it's a lot better telemedicine experience when you're talking to somebody that's also put their hands on you and felt your throat, knows your family history. It's it's common sense. Would you rather talk to somebody on a virtual care system that you don't know? Or would you rather use a virtual care system with somebody that you do? I think, and sorry to keep rambling here, but Dave Chase shared a great post about a year ago about Forward. These guys were putting telemed, it's not just the convenience, right? So that's part of it. But forward was putting these telemed pods on-site at employer groups. I think they had half a billion in funding or 400 million in funding or something like that. They went bankrupt. Why? These amazing telemed pods that had all these measurement tools, and you're talking with a doctor because you don't know the person. And then some people were, oh, they were too early. It's like they weren't too early. It's just it's human behavior. But do you want to talk to somebody you know or a stranger?

David Saltzman: 5:22

It's that speaking of human. I'm sorry. Speaking of human behavior, how did your background as an agent inform your approach to designing clinic services and plan design?

Chris Yarn: 5:32

Yeah, I I started my career property casualty, Liberty Mutual. First account I ever worked was Rosen Hotels. Read the Rosen Employee Handbook, saw the on-site clinic model there, and I saw why it worked for their 6,000 employees. They have a lot of other strategic advantages, a lot of migrant workers, and I don't know if they're on work visas or whatever, but when you're taking folks from another country and then they're employed at a hotel, and then you show them where to access healthcare, of course, you're going to have high utilization compared to somebody that's grown up in the United States and has touched the healthcare systems and all the different options. But I saw that and it stayed with me throughout my insurance career, right? What I didn't see change after the Affordable Care Act is anyone taking that model, that on-site clinic model, and bringing it down market to smaller employer groups. More and more employer groups were going self-funded. They don't have retail space to build out a clinic, or they can't afford to pay some of our larger competitors like Marathon to build out a brick and mortar facility. And so then they do a shared site, which is really just a reinvention of the HMO model. If you're sharing a clinic with multiple employers, that's what's your access to care. We so we look at it, and I said that as a consultant, I want the win is when employees in an employer group have exclusive access on their time to provider that's exclusive to them with their time, not shared with other employers. You're not giving up wait times to other companies or appointment slots to other companies. It's like when the clinic is there, it's there for your employees.

David Saltzman: 7:13

So employer groups, as you very well know, come in all shapes and sizes. How do you decide what model is best for them, whether it's a permanent on-site clinic or a near site shared clinic or even a mobile and fractional clinic presence? Yeah.

Chris Yarn: 7:27

It's got a lot to do with what the claims data looks like. How many employees are on the plan? Um, what problems are the organization trying to solve? The on-site clinic industry 50, 60 years ago, was started in the manufacturing world just as a need and a function to reduce reduce employee absenteeism, right? And keep people on the manufacturing lines. So they they saw a lot of utility in the manufacturing space of just the savings on a lost revenue or lost productivity size, keeping employees healthy and keeping them on the job line, or if they're gone for 15, 20 minutes. So there's a lot of factors that go into that. But the quick answer is depends on the number of employees of an organization, depends on the type of industries, number of locations a company might have, what their geographic spread is, and then also what type of health plan they're on. It obviously makes a lot more sense for a self-funded employer when it's their money being spent outside of the healthcare system to try and contain that and do nurse navigation on site and have a quarterback on your team throwing the passes where you need them to go within the health plan. Because if you don't have that and you're in a self-funded health plan strategy, it's like you're walking, you're walking into the casino in a rigged game. You're going to lose. You can get lucky and have a couple of good years, but if you don't have anybody directing traffic in a self-funded health plan of fill this prescription here instead of there, go get your imaging at green imaging instead of the hospital system, eliminating urgent care access, which is owned by the local hospital system, you you're going you're going to experience a lot of pain and plan noise without the primary care at the forefront of the self-funded health plan design.

David Saltzman: 9:15

You mentioned geographic spread. So here an interesting question comes up. How do you manage logistics and ROI and multi-location or distributed employer footprints? How do you do that?

Chris Yarn: 9:24

Yeah, we have at Walk On Clinic, we have near site facilities. We can build on-site facilities. I'm actually going to be doing one, I think, at the beginning of this year at an employer group. But we use mobile clinics for companies that are geographically dispersed, and it works really well because you put the clinic on site, all the employees see it when they're going in and out of the building at work every day. It's not there, some people have on-site clinics and it's in some break room somewhere down a hall. A lot of buildings are big, out of sight, out of mind. So it's actually an advantage to have the clinic outside, a little more privacy, but it's always seen by every employee of the company. So it's in their awareness subconsciously on their as they pull into the parking lot, or if they're dropped off by a bus at work. It's uh it's really amazing what that does. But you you have to measure how many employees at each geographic location, right? So some locations might make more sense to visit once a quarter, once every 90 days, if there's not a lot of employees there. Our kind of number is 300, 250 to 300. If you're a self-funded employer group with 250 to 300 employees, then it starts to make sense to put a clinic on site one, maybe two days a week. We've seen positive return on investment at two days a week, putting the clinics on site. And then of course they have access all the other days a week, depending on what virtual care option they buy, to use our technology to connect to the same providers the rest of the week when the clinic's not there.

David Saltzman: 10:58

So what metrics or early indicators that can reliably predict whether a clinic deployment will succeed? Is it just utilization, cost savings, employee acceptance? And how do you balance all of those?

Chris Yarn: 11:10

Yeah, I think we do a really good job measuring. I think we do a better job than anybody in the industry, honestly, of measuring return on investment. And that's because we're a kind of a broker and a consultant-built on-site clinic, direct primary care company. I think most people are coming from a background of medicine, not insurance. So they don't really understand the metrics you have to measure to be able to prove return on investment. So what we do is we code every CPT code in the clinic. So we still use the EHR systems and we provide and we report zero dollar ghost claims to the carriers, whether it's TPA or Abuca, Blue Cross United Cigna Aetna, doesn't matter. We report $0 ghost claims, so we have a mechanism at which to track at a Medicare rate what would all of these claims have cost in the marketplace? What would you have paid in a perfect world that only builds you 100% of Medicare? So we know that's not the case, but what we do is we provide the most conservative estimate possible. And then we also take payroll numbers and we calculate like a four-hour or two hour, every organization's different. What's the value of lost time? Typically, most employers are comfortable saying a lot of people take a whole day off work just to playing around a doctor's visit, depending on what the issue is. So they do four hours of whatever the payroll number is, and then we provide that in our reporting system of hey, here's what the here's what the data says, right? And then on other groups, we also can measure how much emergency room utilization goes down. If we have other plug-in plan components like a green imaging, like a pharmacy solution, we can show a direct dollar ROI. It's like here's how many patients we moved from getting their prescriptions filled at CVS or Walgreens to the mail order international solution. So here's your we we can find very often a way to pay for the clinic just on pharmacy spend, as long as we can take over those patients and find who those patients are. Even moving certain patients at income levels on the 340B program, nonprofit pharmacies for medications like HIV and other things that are, I don't want to say plan killers, but it's it used to be pharmacy was 15% of plan spend and 20 to 25% of plan spend now. So it's a that's some of the easy, low-hanging fruit that a lot of companies go after. But this is where I question the industry at whole, unless you're working with an on-site clinic company that understands on the consultant and broker and health plan side everything I just explained, you just have another doctor charging a membership model that really cannot help your individual employer group quarterback properly all the different plan design solutions for every different employer, right? So there's different brokers, there's different employer groups, there's different health plan design. One carrier might have a Lavango solution for managed care, another carrier might have something different. Another broker might think that they've got a better imaging solution or surgical orthopedic surgical solution than another broker does. What we do is we go in there, work with the consultants, and say, what are all your plan design solutions and how can we support that and make sure that these things are actually used? And that's where we, I think, have a our we're constantly renewing groups and like we we don't lose clients because we do a better job of that, I think, than anybody in the industry.

David Saltzman: 14:46

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Chris Yarn: 16:14

Yeah, I think you're asking how do we like help guide the employees through? I just want to make sure I understood the question, how we guide employees through utilizing their other plan design solutions.

David Saltzman: 16:26

You're providing care and the main health plan, whatever it is, however it's designed as providing care. How do you integrate those two so that at some point the employee has an entire picture of what's going on?

Chris Yarn: 16:38

Yes, yeah. So we work with once once we're in there as the primary care solution, the employees in patients still have to choose to come to the clinic, right? So they still have to choose to utilize it. Some people say, I already have my primary care physician. The interesting thing about the marketplace we live in now is a lot of people have a primary care physician, but it's still six to eight weeks to get appointment with that primary care physician. It's again not convenient. Convenience wins in today's world, right? And so what happens is we end up taking over primary care for a lot of folks to get take over their patient charts. And then we are working with each health plan on what the other solutions are. So if somebody's got an endocrinologist, right? And they're with uh like an Imagine 360 plan here in Tampa, we already have a network of all the endocrinologists and cardiologists and dermatology specialists that they already have a direct contract with that they want us to refer to. And so what happens is when those employees come in there to our clinic, we're making sure that they get the fast pass to those specialist practices and there's full communication between us and all the specialists. And it's uh it's really incredible. I think you hear a lot out there about plan noise in the self-funded world, employees not being able to they go to an urgent care hospital or somewhere and they say, we don't accept this insurance because it's some TPA that a secretary's never heard of or a receptionist has never heard of. And that's one of the key differences. Like our patients don't experience that because we're referring them to the places that already know who we are, already know what health plan the employees are walking in with. And so that that's frictionless. And it helps the TPA keep the business much longer and not lose it in a year or two years because there's not a good rollout.

David Saltzman: 18:32

Looking back, what are two or three pivotal decisions, or maybe you want to call them inflection points in walk-on clinics trajectory, good or bad, that shaped where you guys are today?

Chris Yarn: 18:43

I think probably one of the biggest inflection points we've had is walking away from a lot of wellness exam opportunities. I think throughout the years, a lot of consultants that have tried to work with us or wanted to work with us view it as an events-based company because they see the mobile clinics and they think, oh, this is only here a day or once a year. They think like Bloodmobile, and they don't translate the real continuity of care that being on site provides versus near site. Now, then once they see the data, they're shocked. They're like, how do you guys get this much utilization? And it's just it's more convenient, it's more private, and it's just a it's a I just believe it's a better solution. But I think one of the main inflection points came a couple years ago, right after COVID, when I realized a lot of the consultants out there were still viewing us as like an events-based company, even though we're saving companies millions of dollars on the health plan and a full direct primary care membership model. And so really putting a focus more on that, both in the state of Florida and nationally, and letting consultants know and businesses know hey, we can be anywhere in the country in 60 to 90 days with our solution. We've got medical directors ready to go, and every state, let's make it happen for you. I think that's walking more away from the wellness exam stuff and fully funded plans, and we still do some of that, but really trying to make it clear to the consultant world hey, we're here to do on-site direct primary care.

David Saltzman: 20:22

Yeah, it's a problem that a lot of businesses have, especially when they're doing something that's not ubiquitous. It's the main thing is to keep the main thing. And you're right, it's sometimes hard to say no, but it's better long term for building your business. Let's take a left turn.

unknown: 20:36

Sure.

David Saltzman: 20:37

As somebody who's leaned into a, let's call it, creative persona known as Frank Mike Dropper. How do you build visibility? Does that help with branding and storytelling and scaling your venture, or are you just having a damn good time?

Chris Yarn: 20:51

I'm having a damn good time because I grew up as a performer. And uh so this was just a way for me to have that creative outlet, which I desperately need just as a human being. I think and you're a musician. I think anybody that you know is a musician or had that kind of creativity growing up, or it's part of their being, like you have to fill your heart and soul with that in some way, shape, or form. Because if you don't, you're just I don't want to say I'm constantly miserable, but it's uh it's a labor of love. Like I grew up singing jazz, I love singing it. I was in America's youngest jazz band growing up, and so this was a way for me to do what I love and attract awareness for Walk on Clinic as well. So it did work. I've got a lot of followers, a lot of people know the story. I created a fake LinkedIn profile and in a week invited to the World Health Congress, meeting Dave Chase, meeting Nelson Griswold, pretty much got thrown right into the mix just from posting a video singing about self-funded health plans. And I think has that translated into business for Walk on Clinic? Absolutely, it has. It has worked, but I'll go back to I think it also confused a lot of consultants. Is this guy serious or is there serious business? It's like we're a multi-million dollar direct primary care company with hundreds of clients throughout the state of Florida. And I like, I there's like a handful of on-site clinic and DPC practices that have that kind of scalability that we do. And so I think it's teaching those same consultants that know Frank or know Chris, hey guys, if you're talking to Marathon, you're talking to Carrie TC, you're talking to Nextera, you're talking to any direct primary care doctor, if it's a near site solution, you need to be having a discussion with walk-on and just give the client the option. Give the client the option to look at an on-site solution versus a nearsight solution. Because what you're going to find, like the story I told earlier, which is if proof is in the pudding, 1.3 mile away near site clinic, nicer facility than our mobile clinic, like tenfold less utilization. And that's not a knock to anybody that's out there doing phenomenal nearsight clinic work. I love everybody in direct primary care. I just don't think they realize that the consumer behaviors have changed. And if most DPC docs, when you sit down with them and you have a conversation, or even concierge physicians or advanced direct primary care, whatever you want to call it, they will acknowledge that 80, 90% of their patient interaction is taking place telephonically or virtual on the phone because the patient will avoid the hassle of going into their facility. And it's I love Best Buy. I grew up working at Radio Shack. I still buy most of my electronics now on Amazon or wherever it's easier. And I just think people have changed and how they want to access care. And I think the key is get to know the people in person and then give them the ability to connect with you afterwards.

David Saltzman: 23:53

If we look ahead five or 10 years as we wrap up here, what's your moonshot for employer-sponsored care or clinic logistics?

Chris Yarn: 24:01

I would love to, it would be a true blessing to see this company grow to hundreds of millions in revenue, maybe have a one medical exit one day, or keep it private. I I don't know. I think we'll have to bring in a lot of other people to make that happen. I know we will, just the sheer size and scale that some of these companies do. But the beautiful thing about the on-site clinic space and direct primary care space is the work doesn't start until 60 to days, 60 to 90 days after contracting. So we know the model, we know how to scale, we know how to build the clinics, and we know how to provide care. And we can do that in every market across the United States, and we can do it well. And we just need the sales force and the contracts and the opportunities to do that. And then we will scale. Look, people won right here in Florida. They did the Osceola County school system here. I think they had an $8 million first round raise, and then Google Ventures put in another 32 million. But I think they're around, I'm not 100% sure, but I think they're just over 20 million in revenue. And that's a it doesn't take that long to get to those numbers in this space if you're doing good work, and we're doing good work. So we just gotta keep doing what we're doing and grow a little faster, and then we'll we'll get there. All those things will happen.

David Saltzman: 25:23

And that's a great place to end our conversation for today. Chris Yarn, CEO of Walk On Clinics. Chris, thanks for a fascinating conversation.

Chris Yarn: 25:31

Thanks, David. Thanks for having me so much.

Announcer: 25:34

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