How a Calling Has Led to the Evolution of Primary Care in the US

Brian Urban:
[00:00:30]
Yes, this is the Healthcare Rethink Podcast. I'm your host, Brian Urban, and today
on our show we have joining us the chief medical officer now board member of
ChenMed, Dr. Gordon Chen. Gordon, thank you for joining our show.
Dr. Gordon Chen: So good to be here with you, Brian.
Brian Urban:
[00:01:00]
This is going to be so much fun. We've gotten to know each other a good bit here
and there before our episode here, and we're going to be getting into this book,
one of your first, I think, probably of many books that you have, The Calling. But
before we touch the book, we're going to get to know Dr. Gordon Chen before the
MD, before ChenMed, before all the lives you've helped and the mission trips
you've done globally too. Let's go back to the early beginnings to get our audience
familiar with you. Take us through it. Who is Gordon Chen and how have you come
to be here leading an amazing primary care health center across the US?
Dr. Gordon Chen:
[00:01:30]
[00:02:00]
[00:02:30]
Well, I'm the son of immigrants, my parents came from Taiwan and I could spend a
whole hour talking about my parents and just how amazing they are. We grew up
in South Florida, in sunny South Florida. Now growing up in South Florida as a
Chinese boy, you're like a minority of minorities. And especially my brother and I,
we came out as six foot four, pretty big Chinese guys and we love sports and so we
didn't really have our own, whatever, community other than the folks that we
played sports with and the community that we created. And so we loved sports.
We knew we wanted to go into medicine at young ages because we had already
been doing mission trips to Nicaragua and really before the MD, I was pretty much
a student athlete. I loved to compete, played football and wrestled in high school,
then went on to play football at Brown. I was 260 pounds, if you can imagine that.
Brian Urban: Man, you don't look 260 anymore.
Dr. Gordon Chen: Yeah, I've trimmed down quite a bit since then. And then from Brown came back to
Miami to do medical school, it was like the family tradition, and then launched off
into medicine.
Brian Urban:
[00:03:00]
[00:03:30]
There's so many parts in between we're going to get into there because your story
is so rich, individually but family as well, as the book dives into at a pretty good
depth, The Calling. Thank you again for sending this to me, it's just so thoughtful.
Our conversation got delayed a few times, so I'm so glad we got to reconnect here.
I want to dive into so many things you just listed, but I've got to start with the
ChenMed story because so many folks now cross healthcare and even outside
healthcare are becoming familiar with your family story, your father's story, even
your mother's business that she had as well developing a restaurant, multiple sites
for restaurants, and then you're moved to Florida.
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[00:04:00]
Let's start there. It's such a beautiful story, The Calling, and the humble beginnings.
I'd love to know how your father got into the US and went for multiple high
degrees, and ChenMed got started out of a very big health scare that he had. It
seems like it oriented off of that, and he's obviously since recovered very well, but
can you take us to those humble beginnings of why you decided to start ChenMed?
And I believe it was because of your father's diagnosis and health scare nearing
over a decade now.
Dr. Gordon Chen:
[00:04:30]
[00:05:00]
And so my father came from Taiwan. He was actually an incredible student and was
the number one ranked student in Taiwan going into college, in National Taiwan
University. They actually rank the students there. And then he came over to the US
to get his PhD in biochemistry. He got that at the University of Wisconsin. And then
he got into this competitive two year medical school program at University of
Miami for PhD candidates. And so you can imagine with my brother and I going to
medical school, we could never complain about medical school doing it in four
years. He did it in half the time. And so we're a very tight family, just my brother
and I and my parents. And while I was in medical school, I was in the middle of my
third year of med school, I get a call from my dad and he was really shaking, you
could tell. And he said, "Gordon, I need you to come pick me up." And I'm like,
"What's going on? Something is really not right."
[00:05:30]
[00:06:00]
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And he told me he had a mass behind his nose, a five centimeter golf ball size mass
behind his nose, and it was terminal cancer. They thought it was a squamous cell
carcinoma and he was given two months to live. And at that point in time,
everything just slowed down. I was in the hustle and the bustle of school and tests
and whatnot, and none of that mattered. And we were thinking, " What do we do
to help my dad, help save his life, prolong his life days, weeks, months if we can,
and help him to fight this cancer?" And my fiance at that time, Jessica, she was a
classmate in med school, we were already engaged and we said, "Let's get married
because I don't know if my dad will have a face. I don't know if he's going to be
around." And so I called her on a Friday and then the next day we got married, and
it was emergency wedding and families flying in from all over the country and even
internationally.
[00:07:00]
And students are all showing up to show us support because they knew what we
were going through. And at the wedding we hear back from MD Anderson's
pathologist for a second opinion, that the diagnosis that we thought it was, was
actually a B-cell lymphoma that was potentially curable. So best wedding present
ever. I'm giving my dad a big hug, and my brother, they were my best men. My
pastor at that time, he pulled me aside, he said, "Do you still want to go through
with the wedding?" I'm like, "Yeah, let's continue to go through with the wedding."
Brian Urban: That's a good question. You never know. Yeah.
Dr. Gordon Chen:
[00:07:30]
So Jessica and I, we've been married, that was 20 years ago, and we know that
because we're about to celebrate our 20-year wedding anniversary and 20 years
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[00:08:00]
[00:08:30]
from when my dad had this cancer fight, and thank God he's alive. But from that,
we really suffered at the hands of a broken healthcare system. We had ER visits for
neutropenic fever, seizures, even a stroke. And we were experiencing what it's like
to be so incredibly vulnerable and feel like the system is working against you. And
we realized with all this education, connections, resources in the field, my dad
barely survived. And what about all the people that don't have doctors in the family
or connections or resources, how are they making it? And we realized many of
them don't. And so people fall through the cracks all the time. And that became our
why. We need to fix this as a family. We've experienced what it's like to be on the
other side. We know the medicine component, how do we create a better system
that actually takes care of those that need it the most and how do we start to think
about healthcare differently?
[00:09:00]
[00:09:30]
And so once my dad got healthy, we went from that one medical center that he
was initially running and we figured out how to get it to two, then to three, then to
six. And then we were pouring into our patients with this outcomes- based, what
we call transformative care approach, which is like an extreme version of value-
based care, and then we learned how to scale to other states, Virginia, then
Kentucky, then Louisiana, then Illinois. And we were growing all over the map and
we're realizing that the need was just so tremendous. We'd go into these
communities that have no access to care and once we were there, we would start
pouring into them from a relationship and trust and a health standpoint.
[00:10:00]
And then the ER visits would come down, the hospitalizations would drop 30 to
50%. And we're doing this in a very replicable manner where we could plan a
center and know in one to two years the health outcomes would be dramatically
better, and it was a financially sustainable model because we're taking the savings
from the reductions in hospitalizations and we're pouring it upstream into
prevention and proactively going after health outcomes.
Brian Urban:
[00:10:30]
[00:11:00]
I love that. And I love now that you've taken this and you've actually put this into
how-to content that you've distributed on YouTube, aside from ChenMed's main
website as well. I think it's also an amazing use case of how things can function and
work in a value-based care model and how you're taking things upstream, like you
said, that then have better downstream impacts in terms of health. The currency of
trust is incredibly difficult to build in healthcare ecosystem nowadays. And you've
gone into the right places at the right time to help the people with the highest
social health needs, not just healthcare needs. So the story of your experience with
your father, your educational blend, has all played out to an amazing startup that's
now no longer a startup, it's quite a mature business, ChenMed. I love the story in
The Calling that you walk through there.
[00:11:30]
Let me bounce quickly into your athletic days. So there's one thing the book didn't
cover, and I should have looked this up beforehand, but by far probably the biggest
Chinese guy to ever play football at Brown University, let alone break records of
many kind. And I remember in the book your father had mentioned after a big
snowstorm that you had seen in Rhode Island of a foot or more of snow, maybe
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[00:12:00]
you can come down to Miami and finish medical school here and you jumped down
there. But take me around that time at Brown and your experience there, because
Brown is a leader not only in medical and public health sciences, but a leader in
diversity and community health too, I think. So what was your experience like at
Brown and take me back to the football days for a moment here before we dive
into ChenMed again.
Dr. Gordon Chen:
[00:12:30]
[00:13:00]
All right, so I grew up in South Florida, used to the sunshine, the heat. I love sports
and I loved the opportunity to go to Brown where they had a combined eight-year
medical school program. And so I knew that I could play football there and I didn't
have to be 100% pre-med hustling and bustling and trying to get into medical
school because I had a spot at Brown. And so it was amazing to be able to go there
and be a part of a team. We won an Ivy League championship my junior year, which
was the second one in school history. And Brown had been around for a couple
hundred years, right? So a huge history without many football championships and a
whole lot of losses. And we went on to have the winning-est record at that time in
Brown history, which by the way, it was only 30 and 10, but it was still a great
record for Brown standards.
[00:13:30]
[00:14:00]
I had a wonderful opportunity to get to play as a sophomore when somebody got
injured. And I started as a sophomore junior, we won the championship. Senior
year my roommate and I were captains together. My roommate Drew Inzer, he was
an offensive lineman, and we had a wonderful four years there. He continued to
the NFL and he got a Super Bowl ring with the New England Patriots as they were
just getting started. And of course I loved Brown, loved being able to take medical
school courses during undergraduate, but it was very cold for me. So I did take the
opportunity to apply back to Miami and University of Miami were kind enough to
give me a scholarship for medical school. So I came back home. And we have this
long legacy, my father, my brother, two of my uncles were all UM medical school
alums. And so I came back to South Florida to finish my medical school training.
[00:14:30]
Brian Urban:
[00:15:00]
I love to hear that. I'll be up there in January in Providence, so I'll let you know how
the temperatures feel versus South Florida. But I love that story. Didn't know your
roommate went on to the NFL. I mean, what a cool connection and culture that you
experienced in both places, in New England and then of course back in South
Miami where ChenMed got its early days. So I had to get back into those days
because such a great athletic background, yourself and your brother have and then
share. So I just wanted to hit that real quick. But let me jump back into ChenMed
here. So you operate in a value-based care model, very successful, I'll say early
adopter of that if you think about the whole healthcare ecosystem from the
bottom to the top. And you've made it work. You've shown large healthcare
systems how this model can work not only for the patient, not only for the
payment system, the business side of healthcare, but also for the community as
well.
[00:15:30] So I wanted to dive a little bit deeper into that fostering patient relationship side.
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What has it meant to you and what has it meant to your brother, Chris, too, Dr.
Chen, to develop these community-based relationships and actually see health
change center by center, state by state, location by location? Take us through what
it's meant for you personally.
[00:16:00]
Dr. Gordon Chen:
[00:16:30]
It is amazing to see the impact that our model can bring to communities. And when
you go to the neediest communities, you have so many different ways that you
impact. Number one, you're taking care of the sickest of the sick, and all of a
sudden the family members don't need to do that as much and they're relieved.
Their loved ones are actually living longer and spending more time at home with
their loved ones rather than in the ERs and in the hospitals. You're investing into
the poorest communities. And what we often see is we often see these
communities get re-gentrified because we're investing in them, we're providing
jobs, and then we're pouring into our employees who come from those
communities and we're training them and we're teaching them how to build
relationships and trust in situations where you have to earn it back because there
isn't a lot of trust with healthcare in a lot of these communities.
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[00:17:30]
[00:18:00]
And once we're there, we have the relationships and have the trust, you literally
see these communities just thrive and blossom. And what we have as a vision for
each of these medical centers, we want them to be like a city on a hill. We want
them to bring light to the darkest communities across America and start to break
the negative cycle of sickness and disease and despair and start the virtuous cycle
of health that actually brings more health and renewal as you invest back into
primary care. But a lot of that has to happen with the right financial infrastructure,
what we call full risk model. That allows us that if we can prevent a hospitalization
and we know that 40 to 50% of hospitalizations can be completely prevented,
erased, and then you take those savings, that could be like a $20,000 savings, and
then you pour it back into primary care or into going into needier communities or
whatnot, then you're getting upstream.
[00:18:30]
And when you get upstream, healthcare is a lot cheaper and you're stopping bigger
problems from occurring by catching them early. So that's just been very powerful.
What we've learned along the way is if you can get the right talent and train them
into behavior change and accountability for outcomes and really empower them to
live out this beautiful mission and connect with their purpose, then you can
unleash that potential and you can transform American healthcare.
Brian Urban:
[00:19:00]
That right there, if that doesn't inspire our listeners a lot through healthcare
technology, researchers, advancing health equity leaders, I don't know what else
can because you've proven it. A couple of things you said I wanted to pull out, re-
gentrifying communities, that has got to be one of the most challenging things to
do is working through perhaps a very impoverished community and helping reverse
the cycle. Folks that were pushed out, bringing them back in. I think that says so
much about not only the economic impact, but the love, the trust impact, as well as
what your purpose base, your foundation, has done with your business as well. And
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[00:19:30]
[00:20:00]
the other side, the financial infrastructure, I think this is so gratifying. It has to be
for your family, for your providers, for your whole operation, to show that this
model works. That you can have these savings that you're generating, that you put
them back upstream and then you can have a better reinvestment and a better
focus on attracting the right talent that are teachable and trainable and that can go
into these communities and be able to appeal and connect to diverse populations.
[00:20:30]
[00:21:00]
It's so amazing that this has just worked and I love it in a healthcare system in the
US that really doesn't allow for this traditionally. So I love what you said and I want
to go into the Chen culture a little bit more now, Gordon. So you built a culture
with your wife, Dr. Jessica Chen, again you said you had done some schooling with
back in the day, as well as being married at the same time as your medical
academics. Your brother, the CEO, Dr. Chris Chen and sister-in-law as well, the chief
legal and culture officer... love that title by the way... Stephanie Chen. And of
course your parents, Dr. James and Mary Chen. How do you balance the demands
of business and family? I think a lot of individuals would see this as, man, how do
you work with your family? Is the business going to fail? It hasn't, but how have you
been able to balance the family and business relationships and that dynamic while
you're growing ChenMed?
Dr. Gordon Chen:
[00:21:30]
[00:22:00]
Well, Brian, I mean there are so many different aspects of this. Let me see how I
can kind of piece it together. First of all, I mean, you may know that as a family
we've been pushing really hard together for a long time. And just recently, just over
the last month or two, when we've identified just amazing leaders that we thought,
"Hey, they're ready," we've actually had the opportunity to take a step back out of
our day-to-day operating roles and work in a more strategic way to figure out how
we can get the organization to that next level. So we're functioning more as board
members and trying to work on strategy. And we've got operators and I have a new
chief medical officer in Gianni Neil who's taken the reins with just grace and
strength and love, and she's doing a fantastic job. And same thing for many of our
other new executives.
[00:22:30]
[00:23:00]
But as a family throughout this journey this has been, and continues to be,
something that we're deeply passionate about. And we're deeply passionate about
this because we were homeless. We were dirt poor. We understand what it's like to
be a minority or just suffering at the hands of a broken healthcare system. And we
understand just the amount of need that's out there and the amount of rebuilding
of relationship and trust that needs to occur. And so when you hear things like
social justice or healthcare disparities and that makes folks just upset, it's not right.
You shouldn't have to have a shorter life expectancy just because where you grew
up, like growing up on the wrong side of the tracks leads to 20 to 30 years of lower
life expectancy. I mean, that's not right. Anyone can just hear that and see that and
get upset by it.
[00:23:30]
But at ChenMed, we give folks an opportunity to apply that passion in a very
constructive, beautiful way in the neediest communities where you can take that
passion and turn it into love in action. And so that's been part of, I think, this
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[00:24:00]
movement, this healthcare revolution that we as a family have had the privilege of
starting, of kindling. Now, back to your question about how do we make it work as
a family? Let me just say it hasn't been easy but it's been very meaningful and
rewarding. And what has brought us back time and time again is really our faith.
And I don't want to push my faith or my belief in God, I don't want to push my
beliefs on anyone, but I will say that having an aligned faith and having a continued
ability to humble ourselves in the side of God and each other when egos flare and
we realize, hey, it's not about us.
[00:24:30]
[00:25:00]
It's about how can we serve others better and how can we pour into others? And
then whenever our egos would get out of check, having the same aligned values
and the ability to just ask for forgiveness or reconciliation, and then understand
that we all have the same goal. Life is short. I mean, almost losing my dad was very
real. And also we almost lost my brother to Covid. So life is very short, how do we
make each of our days count? And that's how we came up with this family purpose.
And again, not to push my beliefs on anyone, just to be authentic with what we're
trying to do as a family with our purpose, and our family purpose is to glorify God
by spreading more love and promoting better health in all who come into contact
with ChenMed.
[00:25:30]
Brian Urban:
[00:26:00]
It's so true to your faith and your philosophy with family. You've taken that
replicable model and you've put it out to the world through healthcare, literally,
with the ChenMed centers. So being able to hear how you've done it and knowing
that it was tough and it's not perfect and never is perfect, is really humbling of you
to say. And I think it's great for our audience to be aware of as well. In terms of
major US healthcare systems, you've said it, a lot of other leaders that we've talked
to on the show have said it, we're stuck in a sick care system in which you're sick,
you exacerbate conditions, you come in the ER, urgent care, hospitalizations, and
then you do it again. There's no prevention upstream, no lifestyle health science
injected in medicine right now. But with your model, do you think ChenMed is a
blueprint for how large healthcare systems can drop down to serve communities
better?
[00:26:30]
Dr. Gordon Chen:
[00:27:00]
There are really, Brian, three things that we do that's very transformative, and what
we do is we focus on patient and clinician and caregiver behavior change. So we're
really a behavior change organization. That's number one. The second thing that
we do is we bring accountability for health outcomes. And so we know what we're
focused on. We're not focused on sickness, we're focused on health outcomes. And
the third thing that we do is we pour into clinicians and non-clinicians and business
leaders alike, and we teach them how to lead themselves and lead others together
in a way that produces better health. And if you call those three things a blueprint
for the future of healthcare, well, that's what we are.
[00:27:30]
Brian Urban: And I hope it's taken up, I hope it's listened, I hope it's replicated for the good of
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[00:28:00]
what you've done and to be able to spread that across the US healthcare system
and the lives that are being served too. So thank you for that breakdown, all of this
is extremely insightful. I actually want to take a moment to talk about your medical
humanities as well. So mission trips to Nicaragua has been a part of, I think, your
routine for maybe a couple decades now. Can you take us through your journey
with mission work and how that's maybe influenced your approach to the lives
you've served as a practicing physician, let alone a healthcare strategist and
business leader as well?
Dr. Gordon Chen: We've been going down to Nicaragua for almost 30 years.
Brian Urban: 30, wow. I thought it was just 20.
[00:28:30]
Dr. Gordon Chen:
[00:29:00]
[00:29:30]
In high school we would go down and do mission trips and repaint schools and
build basketball courts, and we would go with our church. And then in medical
school we started Nicaragua Medical Missions and we would go down there and
see patients and really give free care, we'd raise money for supplies and
medications, and we'd bring hundreds of thousands of dollars worth of supplies
and medications down to Nicaragua and those medicines would serve those
communities. And that was very rewarding, but we realized that there needed to
be more partnership with the folks in Nicaragua. And so working closely with a
group for the last decade and a half, called AMOS, a Ministry of Sharing, they are
working tightly with the Nicaragua government and the Ministry of Health. And so
together they're trying to figure out how to bring much needed care to some of the
poorest communities across Nicaragua. So we've partnered with them. We
continue to take medical mission teams down there, both with ChenMed, a couple
of trips per year, one led by Chris and Steph, and one led by Jessica and I.
[00:30:00]
[00:30:30]
[00:31:00]
And then we also have the University of Miami Medical students have been going
down there for almost two decades now. And so we continue to build this long-
term relationship with the communities there. The main community is in Nejapa,
which is about 40 minutes outside of Managua. And what we do when we go down
there, when we realize that we do, I think, help the communities down there, but
who really gets transformed every time we go there are the people that go. We go
down there and we realize how precious life is, how joy doesn't come from things,
it comes from relationships, it comes from inside. And many of these trips are great
for relationships. They're also great spiritual awakenings as well. When I go down
there personally, I feel like I can just connect with God and others in such a deep
way without the noise, without the hustle and the bustle that we have in the
states, and you can get that clarity of purpose. And so that's what it's meant for
me.
I know that many people that go down there also have the same experience. Now
also, in addition to these things, both Chris and Stephanie and Jessica and I, our
relationships before Jessica and I were married, and right when we started dating,
that all came from these Nicaragua medical mission trips. And so there's a part of
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[00:31:30] us that were like, "Wow, these trips helped me find my wife." Chris and Stephanie
can say the same thing. And so there's a little bit in our hearts that is attached to
what happened and how our life trajectories changed by going on these trips.
Brian Urban:
[00:32:00]
It's such a beautiful beginning, not only to marriage but also to your philosophy in
medicine. And also it's a continued repetition that you have in your life and you've
passed down to your children as well now. It's amazing. It's a uniter, and I hope
everyone can find that type of meaning in mission trips or purpose-based giving,
things like that. I love that, Gordon. That's so cool to hear. Do you think that's
directly impacted your view on US health equity and advancing health equity in the
US?
[00:32:30]
Dr. Gordon Chen:
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[00:33:30]
It's been so precious as we've been building ChenMed and then continue to take
these mission trips to Nicaragua and learn how simple healthcare can be if you
break it down into its core components. And so when we talk about transformative
care, what it really is is the pursuit of health and wellness for everyone involved,
both the patients and the caregivers. And if you think about the drivers of health
and wellness, whether or not you're in Southside Chicago or in Atlanta or in South
Florida or in Nicaragua, there are really five key drivers of health and wellness that
anywhere you go, it's the same. There's a personal driver, a community
component, there's a physical, certainly, and we see a lot of that with healthcare
but it's only part of the story. There's a nutritional and clearly there's a spiritual,
which ties back to bringing meaning and purpose back to people's lives. And if
these five drivers, personal, community, physical, nutritional, spiritual, if we're
thinking about those things in a cohesive way to drive health and wellness, then
we're going to be on our way towards transformative care.
Brian Urban:
[00:34:00]
[00:34:30]
I think that breaks it down to how simple health and achieving health and wellbeing
can be. Man, I could talk to you for hours. I know you don't have that sort of time,
but this has just been just fascinating. I want to take a look into the future, Gordon,
here. So in terms of contributions to the healthcare ecosystem, what do you think
all of your work with ChenMed will amount to over the course of the next several
years? Is it going to be change in processes, policies, healthcare business models,
the way large systems become more community-rooted more than ever? What do
you think ChenMed's legacy is going to be? What's the big contribution you think is
going to be there over the next several years?
Dr. Gordon Chen:
[00:35:00]
[00:35:30]
So we have this beautiful vision to be America's leading primary care provider,
transforming care of the neediest populations. And that's why we go into the
neediest communities, and that's why we set such high expectations for ourselves
to be the leader, to actually transform American healthcare. I think it can be done
and it needs to be done through primary care. And my hope is in the future, in the
next five to seven years, that we can see that through. Our new president, Steve
Nelson, has set out a goal for the whole organization to reach 700 communities by
the end of the decade and take care of over a million of the most vulnerable senior
patients throughout the country. And if we can do that, and you know how the
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Pareto works, right, if you're taking care of the sickest of the sick, then you're
having a huge impact on the broader healthcare ecosystem.
[00:36:00]
And if you can do that in an efficient and effective way and pour those resources
back into new communities' growth and get further upstream, that's how you
transform American healthcare.
Brian Urban: I can't wait to continue to follow the impact ChenMed makes, not only across the
healthcare ecosystem, but the communities, the lives that you'll be serving. Just a
truly informative and inspiring conversation today. Gordon, thank you so much for
being on our little show.
[00:36:30]
Dr. Gordon Chen: Brian, thanks so much for having me, and hopefully we're encouraging our listeners
that this can happen. We don't have to be stuck in this sick care model. And if they
want to learn more about ChenMed they can go to chenmed.com. If they want to
check out the book they can find it on Amazon. It's The Calling, A Memoir of Family,
Faith, and the Future of Healthcare. Or they can follow me on LinkedIn. That would
be great. Thank you very much, Brian.
[00:37:00]
Brian Urban: Thank you, Gordon. The book is amazing. I highly encourage everybody to learn not
only your story, your adventures, but the impact you're making. It's just so, so
amazing to get to know you more, Gordon. And for more exciting insights and
excerpts, please visit us at finthrive.com