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ZoomCare Has Its Eye on Expansion

It’s no secret that Dr. Dave Sanders has far-reaching plans for ZoomCare, which he cofounded in 2006. Determined to become a global trend setter, he’s convinced our current standard of care will become passe – along with those ivory tower hospitals.
January 30, 2014

It’s no secret that Dr. Dave Sanders has far-reaching plans for ZoomCare, which he cofounded in 2006. Determined to become a global trend setter, he’s convinced our current standard of care will become passe – along with those ivory tower hospitals.

“ZoomCare’s going to change the way healthcare is being delivered, neighborhood by neighborhood,” he told The Lund Report. “It’s a phenomenal time right now. With state and federal reforms anything is possible. We’ll look back and remember those days with the old insurance companies and hospital systems. We have a vision for being a dynamic modern delivery system and are investing in that.”

Everything about ZoomCare is transparent – its prices appear on its website where people can find a clinic in their neighborhood and make an appointment on line, often for the same day, while wellness and preventive care are foremost.

That neighborhood clinic model is expanding into northern and southern California later this year, with new clinics opening in Portland, Boise and Seattle – there’ll be 37 in the three-state region – not including California.

“We’ll be in all the great neighborhoods,” said Sanders who intends to open clinics throughout Oregon, and move beyond the Portland and Salem communities.

But just offering primary care doesn’t satisfy Sanders’ ambitions -- surgery centers are on the docket for Portland. More specialists are joining ZoomCare who’ll circulate among the clinics, with their fees based on a case/flat rate.

“There’ll be real breakthroughs in specialist care this year, and we plan to create new models around specialist services,” he said.

If someone require hospitalization, concierge desks are located at all the Portland metropolitan hospitals, and ZoomCare has a contract with First Choice Network, which has contracts with those hospitals as well as for specialty services such as anesthesiologists, to coordinate that care.

Sanders also linked his first contract last November with a self-insured employer – DSU Trucks – and is convinced he can lower their healthcare costs by as much as 40 percent – while he’s been having conversations with CMS so he can begin accepting Medicare and Medicaid patients. Right now documents are being exchanged with high level officials from Region X about the ZoomCare patient care model, but there’s no firm timeline.

And, within the next few months, ZoomCare expects to have its own insurance license, with the Oregon Insurance Division reviewing its application, according to a state official.

Sanders encouraged former Governor Ted Kulongoski – who earlier was the state’s insurance commissioner and revamped Oregon’s workers’ compensation system, and Dr. Bart McMullan, the former president of Regence BlueCross BlueShield of Oregon, to join ZoomCare’s for-profit board.

Both men will help guide ZoomCare’s entry into the world of health insurance during the months ahead, but Sanders says isn’t seeking insurance licenses in other states.

Recently Tim Nesbitt, who’s been an adviser to Governor Kitzhaber and Kulongoski, sang Sanders’ praises in an op-ed article that appeared in The Oregonian, saying, “If private insurers don’t learn from innovators like ZoomCare, they may as well sign up for single-payer."

While Sanders wouldn’t comment on the single payer movement, saying he’s focusing his attention on the growth of ZoomCare, it’s pretty obvious he thinks the current healthcare system is a thing of the past.

The First Self-Insured Contract

Now that DSU Trucks is officially part of ZoomCare Direct – its self-insured entity – a clinic’s been opened at its Swan Island site, while employees can also visit a neighborhood clinic. All told, 400 employees and their dependents now have ZoomCare coverage, and Sanders has meetings with other employers to encourage them to join. In Portland, roughly 33 percent of all employees work for a self-insured company so there’s plenty of room to grow.

Sanders credited his 250 employees – a phenomenal group of people who work really hard on the front lines – for his success and, as a benefit, is offering them stock options in ZoomCare. While an IPO isn’t on the table yet, “we’ll definitely cross that financing bridge when we get there.”

Believing that education is critical, Sanders created ZoomCare University. Every clinician – be they a physician, nurse practitioner or pharmacist – is required to take monthly courses taught by faculty members so they stay updated about the latest technology and clinical care, while they receive a benchmark score based on their performance which is compared with state and national standards.

“Our goal is to move toward a culture of accountability so we teach and measure; we’re a data driven and learning based culture,” he said.

Sanders is known for taking on hard challenges. That’s why he refused to accept the Epic system as the platform for electronic health records and instead built his own technology – a system that produces a wellness score for every patient, taking into consideration their physical and mental status and lifestyle.

When he started ZoomCare, other healthcare leaders tried to dissuade Sanders, saying no one would want that kind of care, and now, with news that Providence intends to open a similar clinic in Bridgeport – the site of his first neighborhood clinic -- he’s not surprised. “We expect competition; other health systems will try to catch up.”

Telehealth Legislation

Convinced that neighborhood health clinics are the future, Sanders has another expansion project in mind --- telemedicine. Next Thursday, Senate Bill 1560 is being introduced at the Oregon Legislature that will require insurance companies to pay for online interactions between patients and their providers.

“It’s really a beautiful elegant bill and the premise is simple – the care is the care—today we charge 20 percent less for telemedicine and don’t incur the overhead,” Sanders said.

Not only will this reduce healthcare costs, with insurance companies negotiating for lower fees, it will also help drown out the fee-for-service payment model which relies on in-person care and needs to fall by the wayside. Currently, 20 states require insurers to pay for telemedicine. “We’re trying to modernize Oregon,” Sanders said.

India Beckons

Intellectually curious about other cultures, Sanders took his family to India last month to find out what makes their healthcare system work -- particularly when treating cataracts which has caused needless blindness. An ophthalmologist who goes by the name Dr. K has created an extraordinary delivery system – starting with an 11-bed hospital in southern India, he’s been able to perform – with the help of clinical staff – cataract surgeries – and was able to bring telemedicine into the villages to diagnose and manage eye care. From those rural beginnings, now 400,000 cataract surgeries are performed each year in five hospital settings.

“I saw firsthand how telemedicine was being used in advanced ways,” he said.

When Dr. K started, in the 1990s, the cost of the intraocular lenses – better known as IOLs was prohibitively expensive – and had to be imported at a cost of $200 each. But, with the ingenuity, the medical community created their own lenses, built a factory, and now export them to over 84 countries. That’s meant thousands of people – many of whom live in poverty – have benefited from such surgeries and have had their sight restored.

That same spirit led the medical community to begin treating their own tap water and turn it into saline solutions after the price of such sterile water became too costly.

Sanders came away impressed with how India focuses on outcomes and training and uses physicians judiciously without being concerned about pedigrees.

Since going to India, he said, “I’ve renewed my commitment to question everything and take nothing for granted. This is a phenomenal time right now. For the first time I have a sense that anything is possible.”