The healthcare industry has been so slow in adopting digital technology to deliver its services that it took COVID-19 for telemedicine to be taken seriously by virtue of necessity. Dr. Daniel Carlin, the founder and CEO of WorldClinic, pioneered the company’s innovative concierge telemedicine model at a time when almost nobody else was doing it. More than two decades ago, Dr. Dan took the challenge of leveraging connectivity to deliver healthcare to people who need it, wherever they are. Through all the challenges, he successfully built WorldClinic into what it is now, a concierge level telemedicine practice that serves families, executives and corporations. During this time of pandemic when everyone is forced to do physical distancing, telemedicine is booming and providers will certainly have a lot to learn from WorldClinic’s best practices. Joining Bob Roark on the podcast, Dr. Dan explains the rationale for telemedicine, its brief history and the future that the post-COVID world holds for it.

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[embed]https://youtu.be/reYEV4ERSvI[/embed]

Pioneering Concierge Telemedicine With Dr. Daniel Carlin, CEO Of WorldClinic

We have a real treat. We have Dr. Dan Carlin. He's the Founder and CEO of WorldClinic. He pioneered WorldClinic’s innovative concierge telemedicine model. He's a national leader in the field of telemedicine. He's a recognized pioneer in the delivery of medical care to distant populations, board-certified emergency physician, and a former US Navy Medical Officer. Commander Carlin, thank you so much for being on the show.

I haven't received that title for years but I still love hearing it.

It's a privilege to have you on the show. For the business owners out there, it's extremely important as you work hard, you have a tendency, or at least most that I know of, to neglect healthcare. When you have a liquidity event, it seems like you wake up with all the things you want to do, and your health condition is not going to support your efforts. For Dr. Carlin to be on the show and talk about what we can do about that, tell us a bit about what WorldClinic is about. How you got into a clinic?

Before I jump in there, I wanted the audience to know that I'm an entrepreneur also. I'm a physician but I'm not in the big white tower of medicine here. I want to talk on the ground level like this is what's going on. I've built a successful practice and a company. These issues I'm talking about are also personal. I want to speak one-on-one around this stuff. Let me tell you about WorldClinic. It's a 22-year-old telemedicine practice. Back in the ‘90s, I was a pioneer trying to figure out how do I deliver healthcare at a distance using the internet. I had a big vision for it. I've seen most of that vision come to pass. It hasn't been easy. It's been a lot of struggles along the way but also a lot of some amazing successes.

In 2020, this is a private concierge level telemedicine practice. We take care of families, executives, corporations. We've gone from superyachts, because my naval background suited me well for taking care of ships, to the families that own those superyachts to the companies in the portfolios of the families. At this point, we've broadened out to taking care of and in some cases, C-Suite executives or an entire workforce. We did that classic marketing strategy thing of start with a niche market and expand and use technology to scale. We still have our original families. Most of them are still with us many years later. They are several generations worth and lots of corporate executives, but I'm happy to report we're on now taking care of a lot of line workers, construction workers, these kinds of things.

It's been a fun, challenging journey. The biggest thing I've seen, I want to close the loop here, is I know a ton of entrepreneurs that put their healthcare, their basic health and wellness as a 3rd, 4th or 5th place issue behind their business and their family. I want to start out with this idea of if you're closing in on that liquidity and transition event, or if you're north of 55, I want to talk to you and start terms about, I need you to treat your healthcare as an asset as important as your business. I want you to be around when that day comes when you step away from the business and you have time to enjoy the broader pleasures of life including family, travel and your legacy.

I even think about the business owner that took and bought a brand-new business. He's looking over the next 3 to 5 years to take in and turn around and grow or scale that business. You look at the workload they're going to be taking on board. I would think that a critical component is the viability of that business owner. I’ve even seen this as a risk management piece for that new business development guy.

I would say in our corporate executive world, which is about 58% of the business, the driver by far is risk management, keeping high-functioning executives healthy. I'll be blunt here. If they're healthy, they're happy. If they're happy, they perform. It's their performance that’s driving so much of the value of the company. Being proactive and keeping them healthy, it's great. The other side of the risk management is you've got to prevent the sudden unexpected event. That's how I make my living. When we get a new executive, the very first thing we do is saying, “Show me your executive physical.” A lot of the executives are like, “What are you talking about?”

I’ll say like, “Where are your medical records?” You look at the medical records and they’re haphazard and incomplete. One of our first things is, “I'm sending you in for a 1 or 2-day executive physical depending on how old you are, what your risk factors are, and what we might be sneaking up on you.” We get that all done. Usually it's one day. If you're older, it's two days. I get all the records at once in a nice tight package and then my partners and I will pick those records apart looking for risk. For example, unrecognized hypertension or borderline diabetes.

We'll see in the records like, “There's a strong family history of pancreatic cancer but you haven't had a CT scan in five years. What's going on?” They're like, “It's inconvenient to get a CT scan.” “Sorry, that is not negotiable. You've got the wrong family history, so we’ve got to get this under aggressive surveillance. If it does emerge, we take care of it before it becomes a life-threatening problem.” We get the executive physical, pick it apart, find the risk, jump on the risk, and get very aggressive in terms of monitoring surveillance and managing.

I think about that business owner. In circling back, when you were looking at starting your business and you're a business owner like the audience is a business owner, did you envision way back when the purpose that your business has evolved into now?

[bctt tweet="Treat your health as an asset, one that is as important as your business." via="no"]

No. I was fortunate enough to be so utterly naïve to not realize what I was attempting to do. In my late 30s, I thought I was smart.

I think about the regulatory hurdle.

I couldn't have conceived to some of the barriers that were coming. What I could see though was the ultimate manifestation of the vision which was as the world becomes more connected, guys like me, my capacity to deliver healthcare at a distance is going to be improved and better. My ability to organize a lot of detailed information is going to get a lot better and there will be huge efficiencies there. What I didn't foresee and struggled with for a while is why the rest of the system, meaning healthcare at large, didn't embrace that vision.

They had a business model built on, insurance paying for end-stage disease. They had no interest in preventing disease or using technology in a new way. They were very happy with the business model as it existed back then. That was tough. It's strange, honestly. COVID has done more to reform the sins of our healthcare system than anything ever in the course of my life. It has shown these huge gaps of, “How do you take care of a person when they can't come to the brick and mortar office?” By the way, there are millions of them. What’s your solution? We don't have one.

What happens if a family member has COVID? Who lives in the basement? How do you take in all of that? Do you or don't you? I was going back and looking at your website. I was looking at your core value statement. I thought that was worth repeating or talking about. How did you evolve into the core values for your company?

To be clear, we have four core values: honor, courage, kindness and curiosity. Some of those are our personal inclinations but some of it is the way I was raised. Some of it was what I acquired in the military. Some of it was own awareness of what it takes to endure. Every entrepreneur, you’ve got to be a tough son of a gun to get through all the crazy things that happen, the obstacles that come along, the knockdown pitches that almost take you out. If you're not clear on who the heck you are and what you stand for, you're doomed. When that knocked-down pitch does knock you down and you're dusting yourself off and you're saying, “How are we going to endure this?” This is what I believe in. I believe in honor. I believe in doing the right thing. I believe in courage. Of all the qualities, I think it is the most important quality and I despise cowardice.

My staff knows this. I'm a doctor. Kindness is critical and kindness includes every variation of that like compassion and listening. Lastly, we're a bunch of physician-scientists who are halfway to Nerdville. Curiosity is a big deal for us. If you had my CTO on this call, he'd say, “Kindness is good but curiosity is better,” because he's always wanting to solve a problem. We give them these crazy goofy things like, “How would we manage hypertension in 4,000 diabetics in Southern Texas?” He said, “I don’t know. How would you?” He wants to pull it apart on the curiosity basis to sort it out. Those four things capture the whole show for us. A lot of entrepreneur knows this. If you're clear about this, you'll attract the right people and the wrong people will have no interest in you.

I think about the benefit of working with business owners and family offices. You think about the back education that you get from your clients. The gift of the show is I get educated by smart people on every episode. It populates your mind. Thinking about your ideal client, what would be a typical or ideal client for the audience out there that go, “Is that me? Is this for me?”

It depends on how old you are. Let me start with some general criteria. The ideal client is someone who doesn't have time to spend on their healthcare. They're recognizing there’s complexity. There’s tremendous amount of inconvenience and they want to hire a physician group to solve their problem set. Here it gets interesting. Sometimes the problem set is simple. It's a young executive, they have good care and they're like, “I want someone to answer the phone when I get sick and when I'm on the road. I want you to know who I am and I want one of your prescription medical kits, but that's all I want.” I’m happy to do that. The typical client is a busy executive who is traveling a lot, who does not have a lot of marginal time in their life for any kind of inconvenient process or procedure.

Healthcare is one of the few things you can't mail in, so to speak, through an assistant or a personal assistant. They're stuck with this problem. How do they make it easier? You hire a guy like me and we step in and say, “Our app is on your phone 24/7. We're going to answer the phone in 35 seconds.” The doctor is going to know who you are because we're a small group. We know everybody in our practice, if you will. There are no surprises. We’ve got all your records. That client is like, “I have no marginal time. I've got a rash. How bad is this? What do I need to do?” An issue has been raised by co-worker or a family member and saying, “Dad, you haven't ever had a cardiac stress test. Shouldn't you have one?” Your dad died of a heart attack at 57. You're 57. Now the executive is like, “I need to transfer a problem. It started in my family but now I’ve got to transfer it to someone who's going to play the handout with me.” We do that.

[caption id="attachment_5451" align="aligncenter" width="600"] Concierge Telemedicine: COVID-19 has done more to reform the sins of our current healthcare system than anything else in the course of our lives.[/caption]

Finally, we have a number of older patients. They have in common, this busyness and said, “I've gotten complex medically. It snuck up on me, but I've got 4 or 5 conditions. My specialists aren’t talking to each other. I don't really have a plan. I don't have an organized, coordinated calendar plan for this stuff like I have in every other part of my life. I've got a plan. It's on calendar and I've got this delegated.” I said, “Can you guys step in here? This is what I've got. I've got diabetes, hypertension, a strong family history of lung cancer or whatever it might be, and I've got osteoarthritis. I still want to play golf so fix it. Get these things organized for me and get me to the goal.” That's very reflective of our client base. We have simple folks.

It's quarterbacking the process and the things that I think about is access to expertise. If you're in a particular area of the country, you may or may not have the best of the best in your locale, where you may be familiar with the best of the best in another location.

That's true. Some parts of the country are medically underserved. That's quite clear. If you are unfortunate enough to have a complex condition like a rare form of cancer or anything that requires sophisticated surgical services like neurosurgery, etc., it may not be available near where you are. We spend a lot of time on this and we do a fair bit of sourcing second opinions for complex conditions like cancer, advanced heart disease, kidney failure, weird, strange almost life-threatening allergy type situations, but these specialists are well-known in the scientific literature. I'll look up a condition like polycythemia vera. This is a disease of the bone marrow.

If it's well-managed, it’s not a big deal. If it's not well-managed, it can set you up for lymphomas, leukemias, these kinds of things. If I've got a patient with polycythemia vera, we'll look at the top 4 or 5 people doing research in the United States, call them doctor-to-doctor and say, “Who's the best clinician you know? Who's the best doctor in practice that's good at polycythemia vera that knows the research you're doing in Chicago or Sloan Kettering in New York?” We start putting that team together and you create a plan around that condition. It's effective, especially if you live in a rural area. I have that as an asset. It's incredibly valuable.

I think of the time saving of that process. For the readers out there, they're going like, “What should I expect in the range of potential expenditures for the range of services that you guys offer?”

A lot of it will depend on age and if you're bringing a lot of conditions to the table but let me give you some general average numbers. Let's start with those healthy road warriors. We call them silver level of service. We charge them around $4,000 a year. They get a medical kit and a medevac policy. We get their records and it's unlimited. The only pre-condition is you got to be more than 100 miles from your home. The next level up is your typical busy executive who wants a doctor to answer the phone but he wants 24/7 no limitations and we call those gold level or executives. We charge them $8,000 to $10,000 a year unlimited.

Some executives call once a year. Some executives call us once a week. We don't care. Every medical practice is like that, seriously. The idea is when an answer is needed right now, you open the app, hit the button and you're going to talk to me or one of my partners. Finally, we have what we call platinums, and they're a little bit more difficult to price. Up to age 65 and if you're not terribly sick or have a major condition, they're between $15,000 and $20,000 a year, but that's a situation where we’re stepping in and organizing every element of your healthcare and with a big emphasis on the preventative side.

These are the guys that we're plugging in to get an executive physical, getting all the results, following up on the results, making sure that things that are supposed to be surveyed and get done on calendar. We do take care of a ton of folks north of age 65. Some of them have very serious pre-existing conditions. At that point, it's a custom pricing. Year one, we make an educated guess. Year two, we have a good handle on what's going on and we can revise the price accordingly. We're fortunate, our typical client renews about 96% of itself every year.

We rarely lose a client. We have a nice longitudinal history with these folks. We're not dependent on insurance billing. I have a very frank conversation with a client saying, “You didn't call us last year. Are you healthy or you just don't like us?” They'll be like, “I love you, guys.” I'm like, “The price is wrong because you're not calling us, so we'll revise the price downward.” Conversely, we have 1 or 2 patients who had a rough year. I'll call them up and say, “Two years ago, you called us twenty times. Last year, you called us 200 times. I’ve got to take the price up a little bit but you're almost done with this journey through prostate cancer,” or whatever the heck it is. You’ve got to make it work.

If you're on speed dial, it's a problem.

[bctt tweet="Leverage connectivity to deliver healthcare to people who need it. #WorldHealth #ConciergeTelemedicine" via="no"]

We have 1 or 2 clients on speed dial.

As we talk about the expense, one of the things that’s fascinating is the economic value of extended lifespan versus the investment in managing your healthcare. If you would, could you explore that economic value we talked about?

The economic value is real and I want to drive this point home. All entrepreneurs are very dollar-savvy and cost-aware in particular. I think that the average male, and I mean that in the most sexist way I can possibly say, will down prioritize health and they’ll look at costs and say that's not worth it. Then he'll look at a tennis court, a car or vacation and say, “I’ll prioritize that,” and spend the money. In my world, I see how this plays out over 1, 2, 3 decades. People that pay attention to their health live 10, 12, to 15 years longer than people that don't. With entrepreneurs, it's very interesting because these are successful entrepreneurs. They've acquired wealth. They're closing in on 65 or 50, whatever it is, but they have a nest egg. Let's say your nest egg earns 10% a year. You engage with a guy like me or great concierge practice that's paying attention to the details, planning, facilitating and enabling the healthcare to happen.

A guy like me is...