The Duty of Care

By Andy Butcher

As she neared her Medicare enrollment age, Nadine McCrea began to research the best way of ensuring good health care in her later years. The answer: the ChenMed Senior Medical Center in Hollywood, Florida.

With free transportation for those who need it and monthly doctor’s appointments, the center is one of around 100 similar ChenMed operations in 15 states that is upending the health care system. “They make money when people get sicker,” says Chief Executive Officer Dr. Chris Chen of other providers. “We make money when people get better.”

“An ER visit is a failure in our system, because we should have picked that up earlier,” says Chief Medical Officer Dr. Gordon Chen, who with his CEO brother now leads the family-run, Miami-headquartered business founded by their physician father, Dr. James Chen.

By assuming responsibility for all care of Medicaid Advantage plan members—one way seniors can top up their basic Medicare coverage—instead of charging fees for service, ChenMed is incentivized to keep its clients well. Through regular visits with doctors who act more like coaches than clinicians, ChenMed patients have a third fewer ER visits and half as many hospitalizations as normal. To make the high-touch care that produces such positive results possible, ChenMed patient lists are capped at around 400—a fifth the usual size. Patients are given their doctor’s cell phone number for 24/7 contact.

“My doctor calls to talk and listen to me,” says McCrae, who is not on any meds. “She educated me on the importance of getting my rest, exercising, vitamins and eating right. They check up on you to see if you are OK and ask you do you need anything? My other doctor never did that.”

“We call it transformative care,” says Chris of the ChenMed mission. “Not because it's transforming health care. Because it’s transforming the people who receive it.” That’s contrary to the general health care system which “prevents you from dying,” he says. “It’s all reactive. It’s a bunch of mechanics that can’t wait for you to come back and break down and want to replace your transmission every time you come in.”

While many in the medical world have long agreed with that assessment, acknowledging that America’s health care system is broken—often leaving the most vulnerable least able to get the care they need—there has been skepticism that a values-based approach like ChenMed’s can work on a large scale. But the Chen family is proving the doubters wrong.

THE ART OF INFLUENCE

The Chens’ approach has been cited as an example of how to provide effective care to high-need patients in a 2017 report by the National Academy of Medicine. It has also earned the company a place as the only health provider on Fortune’s Change the World list of leading-edge innovators and the No. 1 health care provider on Newsweek’s most-loved workplace list.

That last recognition underscores the way ChenMed’s approach resonates with health professionals too, like Dr. Faisel Syed, who wanted to practice medicine from as far back as he can remember. “There’s just something about helping people,” he says, recalling how as a teen in small-town Orefield, Pennsylvania, he would round up fast-food restaurants’ throwaways and take them to the homeless.

But good intentions can be stymied by bad systems. Syed first became aware of how American health care failed people during his medical training. “I saw that people with little to no insurance were oftentimes using the emergency room for most of their medical care,” he says.

Not only did that mean people were putting off seeking care until more serious health problems had developed, but it was costing them and the system more when they did finally seek help. Even after becoming chief medical officer of one of the largest community health centers in the country mostly serving those without health insurance, Syed felt there had to be a better way of helping those in need.

Since joining the company five years ago—he’s now national director of primary care—Syed has grown to admire the ChenMed model, which centers on doctors developing what he calls “the art of influence” which is so essential to good preventive health care. Consider medications as an example: it’s one thing to write a prescription, but that’s no guarantee of an effective outcome when only half the drugs prescribed in the country are taken at the right dosage or frequency. ChenMed’s relational approach opens the door to finding out someone’s motivations for their choices, and helping them make better ones, says Syed, rather than “just labeling them as, oh this is a difficult patient.”

On the question of whether ChenMed’s approach is really scalable, the answer seems to be yes. Currently employing 500 physicians and with a total workforce of around 5,000, the company is growing at 40% a year.

If the ChenMed way is a revolution, it is one born out of a family crisis. In 2003 their patriarch, a primary care doctor since the mid-1980s, was diagnosed with cancer and given just a few months to live. Even with their inner knowledge of the medical world, it was an overwhelming scare as they tried to navigate the system to get him the best help possible. Remarkably, the initial diagnosis turned out to be wrong and Chen Sr. made a full recovery. Relieved, the family made a vow to make sure others did not have to go through the sort of experience they had.

Over the years, the ChenMed’s values-based approach has come to be defined as the LAP way; practices driven by love, accountability and passion. “Love” doesn’t sound very measurable, on first hearing. Indeed, they were urged to drop the language by colleagues who thought it sounded “too kooky,” Chris recalls, but he wouldn’t budge. And, in fact, ChenMed has developed a way to monitor its love level, much like you’d take someone’s pulse. It’s done by tracking four metrics gauging how patients feel about the care they are receiving.

“It’s not soft,” says Chris of the company’s commitment to tracking performance. “It’s very hard. We meet monthly with each employee to give them feedback.” That connects to the second value: accountability. Or “what you do,” Chris goes on. “Tell us what you're going to do and do it; be truthful about it.”  

INTENSIVELY HUMBLE

Given the emphasis on establishing a new mindset toward health care—thinking of staff more as medical influencers than just medical practitioners, if you will—ChenMed invests a lot of time and effort in leadership development. New hires go through a four-week orientation course familiarizing them with the ChenMed philosophy, and there’s a seven-stage “black belt” program that drills down into the values over the following year.

One of those steps focuses on becoming what they call a “humble healer,” which includes having another doctor sit in on patient visits to offer feedback and advice. “We have to be intensively humble in terms of what we know and open to what we don’t know,” Gordon says. “We have to learn from each other, and we have to create a culture where that’s possible.”

The alternative ChenMed way is reflected in the company’s language. Those dubbed “walk-ins” elsewhere (meaning, interruptions to the schedule) are called “patients in need” at ChenMed centers. “Suddenly, the response is very different,” says Syed. “Everybody is, ‘What can I do to help?’” The language matters, Syed explains, “because most of our health care delivery is this transactional system.”

The COVID pandemic forced ChenMed to pivot quickly to ensure patients were still seen regularly, even if not in person. The centers switched to virtual sessions within two weeks, delivering tablets to patients who did not have the technology they needed, to make sure they kept their appointments. The ChenMed patient mortality rate was 40% lower than typical.

Because so much of the ChenMed approach is based on offering suggestions for ways patients can improve their own health, rather than just writing scripts to fix a problem, there’s a lot of emphasis on how to develop trusting relationships. “Physicians don’t generally know how to influence,” says Gordon. “You need to teach doctors how to think ahead, how to prevent, how to earn, trust, how to get patients to actually change their behavior. That requires a whole lot of leadership development.”

ChenMed has probably invested more in physician leadership development than any other health organization “because it matters so much to us,” says Chris. “If physicians can’t lead themselves or lead their patients or lead other physicians in our model, we can’t grow and scale,” adds Gordon.

A UNIVERSAL FORMULA

In pursuing their values-driven approach, the Chens have drawn on a wealth of outside business wisdom, including Patrick Lencioni and Stephen Covey, but most notably John Maxwell. Gordon references Maxwell’s 5 Levels of Leadership as foundational. Yet, for him, Maxwell’s influence has been as much from personal example as it has been the principles he shares in his books (Developing the Leader Within You and The 21 Irrefutable Laws of Leadership also get a shoutout).

He recalls the time they first met, when Maxwell said he had been praying for Gordon and his brother and asking God how he might add value to their lives. “Recognizing someone that accomplished feeling that kind of passion for pouring into other people—that, probably more than almost any other content in his books, was just for me beautiful, and it inspired me,” says Gordon. “I’m constantly thinking, how do I pour in and add value to others around, and help them to grow and develop into their fullest God-given potential?”

In his foreword to a new book in which Gordon and Chris tell their story (see sidebar), Maxwell describes the way ChenMed is challenging the health care status quo, drawing deeply on some of his leadership principles, as “remarkable and courageous.”

The Chens have also sought and embraced best-practice advice from other outside experts, including leaders from Ritz-Carlton and Chick-fil-A who are part of the ChenMed board. “We recognize that seeing patients is not like making a chicken sandwich,” says Gordon. “But what they have done is they’ve transformed an industry; they’ve taken fast food and they put it on its head, and they’ve created an environment where you can get amazing service.”

ChenMed’s LAP values hint at a second driver behind the mission. It’s not just the Chens’ shared health crisis and passion for medicine. It’s also their faith. In talking about the company’s values, Chris references John’s Gospel describing how Jesus came “full of grace and truth.” “We said, that’s a universal formula,” he recalls. “We’re going to build a company based on that.”

John Maxwell helped them understand “how ministry is intended to work,” he says. He recounts how Maxwell told him you can’t just go out and “beat people over the head with the Bible. What does Jesus do? He heals them first. He goes and spends time with them… Once I’ve given them something of value, their hearts are open.” Developing trust “opens the door to everything else,” Chris continues.

There’s a secondary impetus for the focus on seniors (which acknowledges the respect for the elderly that is part of the Chens’ Asian heritage). In many of the underserved communities where ChenMed is based, single moms are often working multiple jobs to keep their home together. “Who’s raising the kids?” asks Chris. The grandparents, he notes—who are also often the backbone of the local church. “If you want to make a difference and bring light to the darkness—the city on a hill—you start with the people holding up that community. And if you don’t have people taking care of seniors in those communities, those communities will fail.”

MOVING UPSTREAM

ChenMed’s quiet mission field isn’t just patients but medical professionals too. “No one is ministering to physicians like a mission field,” says Gordon, noting the high rates of burnout, depression and suicide among doctors. But “if we’re pouring into our physicians, connecting them with their Creator and their purpose; oh goodness.”

Not surprisingly, the ChenMed model has spawned some copycats. A couple dozen companies have adopted a similar approach and are seeing success, which Chris is pleased about. “We’re really excited about the opportunity here,” he says, “because if we continue to do what we’re doing, we might reach 5% of the available need.”

If the ChenMed mission was born out of one challenging personal family experience of how the health care system fails people, their drive to model a different approach was accelerated by another: healthy triathlete Chris ended up in intensive care after contracting COVID. Lying there “with nothing; just God,” contemplating his own death, made him even more determined to make a difference.

The brothers agree that the pandemic, which stretched the health care system, and the economic fallout which impacted many people’s ability to pay for health services, served to underscore just how broken things are. “There’s never been a better time to disrupt health care and to think of it differently,” says Gordon. “We’ve passed breaking point. It’s time to figure out a better way.”

While ChenMed’s current focus is seniors, the company has its eyes on other health sectors in the future. “We believe that 80-90% of the methodology entirely translates to every population.,” says Chris. “It’s really about moving upstream. It's about saying stop taking care of people [only] once they're about to die.”

Still active in her community, with two grandchildren and what she calls “hundreds of community children, McCrea personifies the ChenMed model. Noting that “the price of some meds is exceptionally too high for a large number of seniors,” she believes ChenMed “has some of the answers” to the problems of the health care system. “They provide you with the resources and team to succeed in-house and out.”

A Family Affair

The ChenMed mission is truly a family affair. Born in mainland China, Dr. Jen-Ling James Chen came to the United States to study chemistry and then medicine. He opened his first primary care center in Miami’s North Shore in 1984, with the help of his Taiwanese wife, Mary, who is now ChenMed’s Chief Market Development Officer.

Both sons followed into medicine. Chief Medical Officer Gordon graduated from the University of Miami Miller School of Medicine and specialized in internal medicine and cardiovascular disease. Chief Operations Officer Chris also graduated from the Miller School and completed his medical training at Beth Israel Deaconess, a Harvard University teaching hospital, before becoming a cardiologist.

The brothers both met their wives while participating in medical outreaches in Nicaragua, where the family has established the Nicaragua Medical Mission. Dr. Jessica Chen (married to Gordon), Chief Clinical Officer, graduated from the University of Miami Miller School of Medicine and completed her training in internal medicine at the university’s Jackson Memorial Hospital. Stephanie Chen (married to Chris), Chief Legal Officer and Culture Officer, is a graduate of New York Law School.

Chris and Gordon teamed up to tell the ChenMed story in the recently published The Calling: A Memoir of Family, Faith and the Future of Healthcare (Forefront Books).