At X=Primary Care, we like to explore a variety of ideas as we solve for X. Part of our exploration involves speaking with innovative individuals leading progress in the primary care space. We sat down with Zak Holdsworth back in July at the DPC Summit in Kansas City, MO to discuss his views on the future of primary care.

Zak Holdsworth is a health tech entrepreneur who co-founded and is the CEO of Hint Health. Prior to this Zak was a Vice President at WellnessFX, a direct to consumer clinical diagnostics and telemedicine company, and a venture capitalist at Voyager Capital. Zak completed his MBA at Stanford University and has an Electrical Engineering undergraduate degree from Canterbury University in New Zealand. Zak loves kite surfing and adventure sports.

Hint Health powers direct primary care (DPC) clinics by giving clinicians the technology they need to operate their practice efficiently. HintOS, Hint’s Direct Care Administration Platform is the first solution that gives providers the tools they need to scale this model with consumers and employers, enabling a better healthcare experience for everyone. Their membership and billing platform for direct care practices is trusted by over 2,500 clinics and enterprises, and integrates with EHR and EMRs to automates billing, eligibility and more. They recently launched Hint Connect is a national DPC network curated by Hint that, unlocking a plug-and-play DPC benefit for plan sponsors, provider-led networks and employer groups across the country.

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Below is a transcript of the video (edited for clarity).

TRANSCRIPT

Dr. Kenneth Qiu (KQ): Hi, I'm Dr. Kenneth Qiu. I'm here with Dr. Paulius Mui. We are here at the DPC (Direct Primary Care) Summit, talking about the future of primary care. So, Paulius, do you want to kick us off?

Dr. Paulius Mui (PM): Ya, sure, so Zak, what are your thoughts on the future of primary care?

Zak Holdsworth (ZH): That's a tough question to jump right into. I think the way to think about it is that, at a systemic level, if we don't transform primary care, the healthcare system is going to remain broken. Let's keep that as an axiom. The incentive structures of today's healthcare system and most of the innovation we see sits on top of the insurance fee for service infrastructure. I don't think that it's going to be possible to make large scale step change improvements to healthcare unless we figure out alternative approaches to paying for care and also just administering it at scale. The way I tend to think about the future of primary care is: can we kind of reorganize the healthcare system around a high functioning primary care system that is not beholden to the traditional insurance fee for service infrastructure? And I'll go so far as saying that I think that, to the extent we are able to do that, then I think primary care can play a role in completely transforming the US healthcare system.

PM: What types of partnerships do you see emerging that maybe don't exist now, whether between physicians and technology or the pipeline and the landscape that we're trying to create?

ZH: Primary care should be central to really high functioning healthcare and we shouldn't just build everything on top of the stuff that we know is broken, especially with partnerships relating to primary care. If you fix primary care, what's the next thing? Fix all the referral pathways coming out of primary care, remove their perverse incentives, remove the kind of the stuff that's broken there as well. If you can establish price transparent, open networks that are not built on top of antiquated infrastructure, remove those incentives and bloat; and if you do so around a functioning primary care system, then that's where all the impact can happen.

The way I tend to think about technology partnerships and integrating natively more things with functioning primary care, then it starts to get really interesting. What are the referral pathways to downstream care? Are we able to start pulling imaging, lab, specialists, even some potential surgeries? Then put these referral pathways back in the control of the primary care doc, but without the perverse incentives of the existing system. As it relates to technology, there's a lot we could cover there, but I think at a high level, most of the technology innovation that's happened in the last few decades has been around how do we optimize around either submitting claims or trying to reverse engineer getting these doctors to meet various different quality scores to satisfy the requirements of a risk-based deal. If we can pivot away from focusing on optimizing for top-down bureaucratic stuff and optimizing around restoring the integrity of the doctor-patient relationship, and restoring the spirit of medicine, then that's a major step forward in the right direction.

We're able to passively, in the background, collect the data needed to allow the clinical teams to actually understand data at scale so they can improve outcomes or use technology to better scale the awesome care they're delivering. They can also use it to aggregate information in such a way that it helps them quantify their value upstream to, say, an employer who may have a direct contract with them. That to me is the way I tend to think about the innovation needed in healthcare. It all centers around kind of restoring the integrity of that relationship, which I think is something that is missing in today's healthcare system.

KQ: That's right. One of the things with direct care is we're bringing in an innovative payment system. We see a lot of innovations in technology, and it doesn't seem to be catching up in today's world because they're still stuck in this antiquated system. DPC has brought innovation in payment model and Hint is really powering this new innovative payment model. Tell us a little more about Hint and what you guys are doing with the direct care community.

ZH: So back to the mission. You know our vision at Hint is to basically redesign the healthcare system to enable easy access to high quality, affordable care. When we started the business 8-9 years ago, we identified this direct primary care community as, from our perspective, one of the only truly working manifestation of a care model that we thought achieved the objective of restoring that patient physician relationship, but also doing so in such a way that was working economically as well for the system. There was clear data that it was actually saving money and doing so in such a way that improved patient satisfaction as well. So when we started the business, we thought, what's the core underlying innovation here? And from our perspective, the innovation is actually not clinical, it's really a business model innovation. And so we thought, why don't we build the kind of infrastructure and payments layer that can power that new business model, which allows the innovation to flow, right? If you have the correct incentives in place, then things like telemedicine, you don't need a code for that. It's just the logical thing for a doctor to want to do if it's where the patient wants to be met. You don't need to incentivize that, it just will happen naturally. You don't need to incentivize doctors to create great clinical notes, for example, because it's what they need to do to actually provide great longitudinal care for that patient. The traditional model where there's [insurance] incentives in place, you don't need any of that. So that was one of the things that attracted us to the DPC community.

We've essentially built the payments and billing and operating system that powers the enrollment processes, from employer direct contracts to membership management payments. And then we have APIs out to a bunch of other core innovative companies that have really awesome clinical tools and communication tools.

KQ: And it's kind of paying off for you, right? Because now after some years with the DPC community, you just completed a new round of funding.

ZH: Yes.

KQ: Do you want to tell us a little bit about that and what you plan to do with it?

ZH: Yeah, well, aside from throwing a really great Hint summit party. We raised [funding] with groups called Banneker Partners and Frist Cressey Ventures. The goals for the company haven't really changed a lot. We still have the same mission, we're still chasing the same vision, and our investors have strong alignment on that, and it's one of the reasons they invested with us. I'd say the primary thing we're going to be doing differently is just going a little bit faster. So we're starting to look at ways to continue investing in technology and products that help meet the needs of our community. One of the things we've done that's a little bit new is we've launched a product called Hint Connect, which is a really interesting way of connecting our community at scale to either other networks that are forming or employers that want to access direct primary care. We'll be accelerating the go to market on Hint Connect. We should be in close to 50 states within about 18 months or so. That’s a big investment, and then we're really, I'd say, doubling down on our thesis that if we can help scale this movement, we can help scale fixes to the broader healthcare system. Because if you fix primary care, that’s the sand with which the pearl can form around in terms of broader healthcare transformation.

PM: So as you talk about these networks that are growing, what kind of individuals do you see are part of the networks and is it more of the individuals who are fed up with the way things work currently, or is it the new kind of fresh trainees that are entering practice in a new way and they're just starting to do it with Hint from the beginning?

ZH: I'd say it's both. Where we’ve started is any DPC doctor can join Hint Connect, assuming they agreed to certain minimum requirements, which most of these doctors will go “Yeah, no problem.” While that’s open to everyone, we've really started with our community of groups that are running on Hint, and so that's been a lot of our more established practices. What’s interesting actually about connect though is that often if you start to say look at a local employer, if they are just purely local, then it's not inconceivable for you just to manage that relationship directly. So they've got a few hundred employees and you've got capacity across a couple of clinics, you can just serve that employer. But as soon as that employer has even a single employee out of state, or even out in the next town, or even half a dozen employees where there isn't a clinic, now you're in the situation where you're saying to the employer, “we can look after most of your employees, but not those seven.” And so we're actually getting quite a lot of interest from other DPC networks who are actually running on Hint, as well as just individual clinics saying, “hey, is it possible for us to tap into Hint Connect to actually serve this local employer we have where we are, but we were not able to kind of reach the edge of their network from a requirements perspective?” So the way I tend to think about it is it's really about connecting the ecosystem and helping grow the movement broadly speaking. If you're a new resident getting into [Hint Connect] is also great because it can help jumpstart your practice as well.

PM: Do you think that physicians specifically playing a role in this transformation is a welcome thing from the industry or it's more of everybody should stay in their lane, the tech folks innovate the tech and then we take care of patients?

ZH: I'd say my general view is that I think it takes a community of people working together to transform something. I'm also somewhat of a generalist myself, so if there are physicians that are tech minded and want to get into tech, then from my perspective that's great. But, I do think we need a lot of primary care physicians. We need a lot of good ones that are willing to take a little bit of a leap. Sometimes I find it's almost a shame that in some cases they’re scared away from primary care. But if it's under something like tech that's enabling colleagues, then great, and I think we should just all collaborate and work together with the shared vision of really truly transforming healthcare versus more incremental improvements that at the end of the day aren't going to really move the needle.

KQ: So it sounds like there's kind of a mix of innovation between payment models, direct primary care being the main one, and then you powering both the movement on both an individual and then grander scale with the employers. Going back ending with our first question, the future of healthcare. If you could sum it all up into maybe one sentence:10 years down the line, primary care is…?

ZH: Summing it up is hard. But I'd say if we can reorganize the healthcare system away from the traditional, antiquated business models and refocus on really awesome, high integrity primary care without any of the negative incentives that we see in the current system, that's how I tend to think about the future of primary care. I think it can play a transformational role in scaling great healthcare across all dimensions of health care. I will just finish with this: I don't think insurance is bad, I just don't think it should be used to pay for 60, 70, 80% of care in the healthcare system, I think we should reorganize the system around price, transparent, open networks, and have insurance be used for unpredictable, catastrophic risks, which is really what insurance is designed for.

KQ: That's right. Well, Zak, thanks so much for joining us and answering our questions. Great again to hear about Hint and what you guys are doing, and really looking forward to seeing what else you guys have coming for us.

ZH: Yeah, sure. Thanks for having me.

Thanks to David Lu, PharmD at Axon Video Strategy for video and audio of the interview

Hint Health CEO on the Future of Primary Care