Datica Podcast

May 5, 2020

Working in Healthcare: Vasanth Kainkaryam

In this episode of the 4x4 Health series “Working in Healthcare”, co-hosts Dave Levin, MD and Geeta Nayyar, MD talk with Vasanth Kainkaryam, MD founder of 4 Elements Direct Primary Care. Dr. Kainkaryam has held a variety of roles as a community physician and regional medical director in a large health system, as a medical director of a healthcare startup, and as a Chief Medical Officer of a federally qualified health center.  

Dr. Kainkaryam, a board-certified Internist and Pediatrician and holds a Masters in Health Informatics, delves into the ways 4 Elements Direct Primary Care is “bring[ing] back the focus on the doctor-patient relationship, and removing artificial barriers to care.”

Dr. Dave Levin: Welcome to 4 x 4 health sponsored by Datica. Datica, bringing healthcare to the cloud. Check them out at www.datica.com. I'm your host, Dr. Dave Levin.

Dr. Geetha Nair: And I'm your cohost, Dr. Geetha Nair. Healthcare is one of the largest sectors of the US economy and one of the most intensely personal aspects of our lives. But few of us have insights into what it's really like behind the scenes. Who are the people who make healthcare tick? What do they do and why? What observations and advice do these insiders have?

Dr. Dave Levin: In this special 4 x 4 health series working in healthcare, Geetha and I talk with doctors, nurses, administrators, IT professionals and others to get insights into their personal journey and the wisdom they've acquired along the way. Today we're talking with the Vasanth Kainkaryam, founder of 4 Elements Direct Primary Care. He's held a variety of roles as a community physician and regional medical director in a large health system. As a medical director of a healthcare startup. And as the chief medical officer of a federally qualified health center. He started 4 Elements Direct Primary Care to quote, "Bring back the focus on the doctor, patient relationship and remove artificial barriers to care." He's a triple threat, board certified internist and pediatrician and also holds a master’s in health informatics. He's devoted to creating a healthcare experience that's truly focused on building rapport and trust, making access to care easy and helping patients get affordable care. We're grateful he's here today to share his experiences. Welcome to 4 x 4 health Vasanth.

Dr. Vasanth Kainkaryam: Thank you both.

Dr. Geetha Nair: Alright, Geetha, why don't you kick us off?

Dr. Geetha Nair: Sure. So Dr. Kainkaryam, my goodness, you've had such an amazing journey in healthcare. Can you just kind of give us the nuts and bolts about yourself, your organization, and what gets you going in the morning?

Dr. Vasanth Kainkaryam: Sure. So I'm what they call a direct primary care physician. And I’ll tell you a little bit about that in a second. But by training I'm board certified both in internal medicine and pediatrics. And, after I finished my training, I did what I thought all doctors do is you work for a large organization and you deliver good care. So I work for a large health system here and became a regional medical director shortly afterwards. And then I got introduced to sort of the disruptive way of thinking about healthcare. And I became a medical director for one of a healthcare startup company called Iora health. Excuse me. And we launched a practice here in Connecticut that was actually in the direct primary care model, which was fascinating. And by direct primary care, what I mean is there are no third-party payers. And so for the primary care part of it. So it is, think of it like old school medicine where the transactions don't involve a payer, but with modern technology and with an almost like a membership base, like a Netflix membership or a gym membership. So indirect primary care practices, there are no copays. You get to think out of the box because you're really focusing on what the patient needs and you really get to innovate because all the artificial barriers of what a payer will pay for or not kind of all off the table. So I got my first foot in the door with Iora and really got to build a practice from scratch, work with thinkers across the country. That's actually how I met Geetha right here on this podcast.

And so it was a fantastic experience. And then after that I went more along the leadership route and became chief medical officer of a health center, spending 14 sites. And I was there for about two and a half years before I realized, I love this DPC model. And I wanted to start my own. So, that's really where 4 elements direct primary care came from. But the truth is there was actually, I don't know if you, have either of you heard of icky guy. Have you heard of that concept?

Dr. Geetha Nair: I have not, but sounds like Dave. Dave sounds like the icky guy.

Dr. Dave Levin: I have been referred to as an icky guy, but I don't think that's what he's talking about.

Dr. Vasanth Kainkaryam: So there are four circles and I am just going to briefly touch on it cause that's really what I spent months last year staring at. So there's four circles. One represents what you love, the other represents what the world needs. One represents what you can be paid for and one represents what you are good at. And so when a lot of these overlap, it becomes, for example, what you're good at and what you love is your passion, what you love and what the world needs is your mission. And it's hard to find where all of that comes together. When all of that comes together. That space is your icky guy or your reason for being or your sense of purpose. And that's really how I got to where I am now is by really doing some soul searching and figuring out what is it that brings all of this together.

Dr. Dave Levin: That's really fascinating. So then you wanted to put it into action, I presume?

Dr. Vasanth Kainkaryam: Correct. Yeah. And so that was sort of you know, so I created this concept and direct primary care is not a new concept, right? It's been around for years across the country. There's so many people who are taking the concept, making it their own. And so I opened my practice in November which has been a fantastic journey since then and trying to figure out how do I want to make it my own. So as a doctor, we all have our practice styles, we have our beliefs. I am very open to Eastern philosophies of care and acupuncture and I'm also trained in acupuncture. And so I’ve incorporated that in my practice. So really trying to be able to say, what are all the things I love to do that I believe in and how do I bring it all together. The nice part was with Iora, I had a chance of building a practice from scratch. So some of this was not new to me. I've gone to fairs, I’ve done my own marketing, I’ve been at tables. And so that piece was, it was a lot of fun.

Dr. Geetha Nair: So, I have to ask about this, especially as a rheumatologist, people always ask me about acupuncture, allopathic medicine. So my curiosity, I know there's plenty of folks out there that want these services. How do you bill for that? Is it that because you're a direct primary care, you're able to do this now in a way that you wouldn't be able to in a traditional practice? Or what does that look like?

Dr. Vasanth Kainkaryam: So think of it this way Geetha. At the end of the day, as doctors who writes your paycheck, it's the insurance company. If you really think about it. So you bill, the insurance company writes your paycheck and based on your agreement with them or the company's agreement with them, they will pay you for what you do, or they will not. In my case as a DPC doc, I work for my patients. So if my patient is willing to pay for it or if we have some sort of membership set up that it's included, then I don't bill, I don't code anything I do. I don't worry about lengthy documentation that is trying to satisfy a biller or coder out there for reimbursement. Everything I do is clinically based in what the patient needs. So if the patient needs acupuncture, if it's in my scope of practice, if I'm trained for it, if I can offer it, then we make it happen.

Dr. Geetha Nair: Wow. That sounds like a dream. Sounds like the way medicine is supposed to be.

Dr. Vasanth Kainkaryam: Well, but so it's no surprise. That over the past few years, maybe about three years ago, the number of direct primary care docs in the country was about 300, now there's over about 1,200 DPC docs in the country and forget primary care. It's actually expanding into specialty care. So you're having, direct access docs for endocrine, you're having them for rheumatology.

Dr. Geetha Nair: Let me know, maybe you would need a partner. Maybe we need a new partner here.

Dr. Dave Levin: So Vasanth I think this is really interesting and you describe it really well. I guess there's this other Venn diagram of what we're good at, what the patient's needs and what will be paid for. And so you've altered that to some degree. The pushback that you sometimes hear about this approach is that's great for the folks that can afford the kind of subscription model that you're describing. But what about the folks that can't? Cause as we know, we've got, we have a number of different challenges in healthcare in the United States. Certainly quality of care, cost of care, but access is also an issue as well. And I'm not trying to put you in a spot here, I'm just curious about how you think about those questions when you consider your model.

Dr. Vasanth Kainkaryam: Yeah. And that's a great question. Because there's this misconception about direct primary care model. And a lot of people have heard of concierge medicine, which is sort of a close cousin to it. But the fundamental focus of DPC is actually making it accessible to everyone. So membership fees are not very expensive. So, on the low end and they're typically age-based is $35 a month. And at the high end, if you're above 65, my costs are a hundred dollars a month, which is still, if you think about it, there are zero copays. So video visits, you're not paying anything additional, in person visits, you're not paying anything additional. So that's one piece is that the membership rates themselves are significantly lower. And secondly, there are other benefits. So I, in Connecticut physicians can actually dispense medications right from their practice. So I actually order medications from wholesalers and I'm able to provide it to my patients at the point of care, at wholesale rate medications. So now we're talking the same medication, instead of paying $30, $40 bucks at the pharmacy, they're getting it for like $5 or $2. So, for patients who are on medications already with just one medication, you might be saving your membership fee. That's one piece.

Then you've got labs. So an A1C that's billed through a third-party payer typically might go for about $40. My cost for the exact same A1C test for my patients is $3. So with one lab test, you have made a difference of 40 something dollars. So I would actually argue this is, this makes primary care more affordable for people. And I’ve got patients who are on Medicaid, I have patients who have no insurance, I have patients who have private, some patients have gone through health shares or cost sharing communities. So I think that's why the things I love, cause with the work I have done, part of my quest has always been how do I make this accessible to everyone? And I don't feel like DPC is a compromise on that.

Dr. Dave Levin: Well, I got to tell you that's one of the best answers I’ve heard to that question in a long time. And I think I see a little hint of the Amazon strategy in what you're doing as well. Amazon is famous for looking at supply chains and figuring out what all the waste is in the middle between the two end points and your description of what doing around pharmacy and lab I think kind of mirrors that in a way that benefits you and your patients as well. If we could stay on this for one more minute, what happens with the patient when they need to go to an outside lab or go for an imaging study or god forbid be admitted to the hospital for care there? How does that part of this work for them?

Dr. Vasanth Kainkaryam: Yeah, so part of my goal, is it typically as doctors, we stay away from the money piece of it. But the reality, if we look at what determines your health, the number one reason for bankruptcy in this country is medical bills. So, as a doctor, I'm not doing my patients good service if I don't bring in the discussion about money. We too often just focus on what is the best care. But we don't actually think about, well, is the cost going to be a barrier for this best care and is it okay to offer them option number two, if they're more likely to go through with it? I think that's where the DPC doc really find strengths. So my job is to help my patients find options. So let me give you an example.

Sleep study. So I contacted local sleep centers for a patient who needed a sleep study. They're all quoting the prices of $600-$700 for in home sleep study, I was able to find a vendor that other DPC docs use for $150 including shipping and interpretation of the sleep study. They can get a two day at home sleep study. So part of the thing is, so when my patients need imaging, I have cash-based imaging partners. So instead of a cat scan, instead of paying $1,300, you will pay about $500 $400 for cat scan. So, that's really where the value comes in of being able to do that. Now, there are certain things, let's say you get admitted to the hospital that is outside my purview. But I can still help care coordinate. I visit my patients who are admitted in the hospital as a social visit to help coordinate their care. And if you think about it, a lot of the waste is because of a lack of coordination. Unnecessary labs we can redraw, and information not being shared. So those are all the ways I can help bring down costs. And lastly is giving options of health cost sharing communities because that will cover some of your larger catastrophic expenses and people just don't know enough about those options.

Dr. Geetha Nair: That's all really helpful Vasanth. One of the things that strikes me is what Dave mentioned about, Amazon sort of figuring out where there's fat and how do you trim it. What do you think has largely been that success for you? Is your infrastructure different? Is there a technology you are using that perhaps in a traditional practice you were not? Or, is that not the case? What do you think is the basic infrastructure using that's different than a regular traditional practice?

Dr. Vasanth Kainkaryam: So I think the first, number one, your payment structure and who you work for is different, which then fundamentally changes your overhead. So in a direct primary care practice, the goal is to keep overhead very, very low. And by low I'm talking maybe 20%, 30% at max compared to organizations that have overheads of, 50%, 60%. And to do that, part of it means as a doctor you flex yourself. So I draw my own labs, I answer the phone. And patients love it, I do the vitals. So all that extra time that we spend having other folks do the work for us in a sense. I get to do myself and the patients enjoy that experience and it also keeps my overhead low. Technology is a huge piece of it. My patients are the texting platform integrates with the EHR, which integrates with the membership management. I get reminders if there is a bill that's unpaid, patients get automated texting that tells them that their credit cards due for expiration. So all of those things. So there's a lot of DPC docs. Until you have about 300, 400 patients, don't hire any additional staff because you don't need to. And that's, I think fundamentally that difference.

And I think the last piece is thinking about, we are always taught to work to the max of our license. I've learned to fundamentally disagree with that because I think working to the maximum of your license actually fragments the care. Because you're like, well, this is below my license, I'm going to outsource this to this person. Versus saying, let's forget the license piece and focus on the patient and let me do as much as I can for that patient. So I think conceptually those are what make it very different than traditional care.

Dr. Dave Levin: Man, you are completely blowing my mind because I’ve spent a good part of my career working in large systems, designing and supporting large systems of care. And you are questioning some of the basic principles there, which I think is terrific and you're conducting the experiment in the real world. So it's not just the theory on a piece of paper. It'll be interesting to see how your thinking and your model evolves as it scales. And it may be that some of these other principles about teamwork care and maximum licensure and other things will may have a different impact at scale. But I want to be really cl ar,I love what you're doing. And again, you're testing your ideas in the real world. Before we leave the tech part of the conversation, you use an expression that really caught my attention. You said member management. And I think I caught a whiff of CRM there, the notion of customer relationship management, but rather than me project my own thoughts here, what do you mean when you say member management? And what are you doing about that?

Dr. Vasanth Kainkaryam: So, when I say member management, when you think about a direct primary care practice, so your patients are your members. They are members of your service. And so part of that it means the software you have, has to be a little different. Because it's not your typical billing, coding, transaction based. It's ongoing, It's ongoing relationships. So in terms of the frequency of communications, the notification, alerts, ease of use, all of those things are key pieces. And there is software out there built for direct primary care practices. So the nice part from a technology standpoint is all of this stuff is out there and there are new ones constantly coming up. So we're in a unique piece where we can actually pick and choose what resonates with us and then apply that platform and the interoperability between these various platforms is fantastic. So I mean, like I said, the texting feeds right into the EHR. I'm not, a chart is created once in one platform and that goes across all my platforms. And it minimizes the amount of work which is great.

Dr. Dave Levin: I think you're describing the dream that many of our clinicians are seeking right now and that we have yet to deliver. This is one of my sort of interesting hobby horses, I think there's a huge role for CRM on healthcare. I think we're relatively clueless about how to manage relationships over time as you've described it and in behavior change. And there's some real interesting lessons to be learned from our colleagues in the field of marketing and behavioral economics. And of course CRM is an engine for modern marketing techniques, and I think it has clinical potential as well. So it's very interesting to me to hear you talk about this and even the language that you use to describe it, that shift in mentality from, this is basically a bill collection engine to this is about managing a relationship over a period of time and influencing health behaviors. So just again, applaud you for the thought process and the approach and again, the willingness to not just talk about it, write an article. I got the courage to do that. You've got the courage to actually, step out into the real world and apply it. So good for you.

Dr. Vasanth Kainkaryam: If I could share Dave for a second, and that was sort of as I named the practice that was one of the key pieces as to how do I capture what I'm trying to do? And so that's where the 4 elements come in. And I don't know if I’ve shared this with you Geetha before. Is that the 4 four elements are the four e's, engagement, education, empowerment and encouragement, those are the four elements.

Dr. Geetha Nair: Wow. I love that.

Dr. Dave Levin: Yeah, that's just beautiful. It's just such a completely different mindset and philosophy. And again, I think Geetha agree with me badly needed and probably more satisfying to everyone, clinicians and patients as well.

Dr. Geetha Nair: Besides, now that you can practice across state lines, Maybe I'm going to join your practice after this. Our family can use a doc like you. That's great. They're sick of me. They don't want me to be managing this stuff.

Dr. Vasanth Kainkaryam: But you know, it's funny you say that. I'm going to just do a quick plug in on technology. And so there are practices out there, DPC docs that have actually gone to virtual DPC. And interestingly enough you say that is I'm actually licensed in other States and we'll be starting virtual direct primary care practices, including in Florida. So I think this is where technology has shifted, especially recently how can we deliver care differently across the country?

Dr. Dave Levin: Sounds like a franchising opportunity to me.

Dr. Geetha Nair: The other E is enterprising.

Dr. Dave Levin: That's right. There you go. Five E's now. If you just joined us here, you are listening to 4 x 4 health and we're talking with Vasanth Kainkaryam, a physician and founder of 4 elements direct primary care. So Vasanth, I'm so enjoying this conversation. You're clearly an extremely bright, talented, thoughtful, visionary guy. You probably could have done a lot of different things with your life. Why did you choose to go into healthcare?

Dr. Vasanth Kainkaryam: Yeah, it's an interesting question, cause I say that to myself; I could have done a lot of things and I could have been happy. And I think I'm one of those people, really looking at that icky guy where I feel like life points us in certain directions and I'm very open to listening to them. So, my love for science has always been there. But I’ve also liked doing things that were multipurposeful. So, even with high school, for example, I went to a brand-new high school class. So here I am, an immigrant kid in this country and you all hear, Oh, high school is important. I'm getting into college and I tell my parents, Hey, there's a new high school that isn't being built yet, it's in this old garage and I want to apply, and I don't know what it's going to do for my future, but that's how I'm going to do.

And so I got in and so it was a class of 60, and it was focused on health sciences. So I got my sort of intro to doing that, but also thinking out of the box. So we wouldn't write book reports when we read books. We would actually make films. And we would be able to say, well, why did you choose this costume? Why did you change your plot this way? And, so much of it was how do you think out of the box. But I started off college with a biology major and then added a linguistics major. But my first year I got diagnosed with cancer. And I think like many folks, we have sort of our inspirational stories and the same doctors who took care of me when I was 17 are the same doctors who I see now. And part of it was I got fantastic care and I was very lucky. But I think more than anything you walk in the room and there's certain people who come in and you just feel better. And that's what I wanted to do and that's where I sort of felt I needed to do. So I think, there was sort of the cerebral side of it, but then there was sort of the, you know what, I think this is what I need to do, cause I have a second chance of doing it. But I also want to do it in a way that I put my own style and my ideas on it. So at the end of the day, I say medicine is not my destination. It's my journey. And part of that is bringing in so many other things as part of that experience. And that's what I get to do now.

Dr. Dave Levin: That's really phenomenal. You said something in there that struck me really deeply about the great clinician and it could be a doctor, it could be a nurse, it can be anybody really. They have an air about them, a manner that inspires calm and confidence as you said, they can walk in the room and you feel better. And I find observations like that so fascinating because, much of Western medicine has been about deconstruction, right? Getting things down to the molecular level and there's great power and value in that. I don't mean to demean it, but it's not, but the more we deconstruct, the less holistic we are. And the way you've talked about the work and the way you approach it in your background speaks to a kind of marrying of those two things.

The companion idea for me is I think great clinicians can walk in the room and pretty much instantly tell if the patient is really sick or not. And I observed this in my days of training and in practice. I suspect both you and Geetha would agree with me. It's not, I don't know that that's a skill you can learn. I think either folks have it or they don't. And to me it's also just sort of a marker of the science is important and we need that. And I want to know what you're creatinine is and your CBC and all the rest, but there's this other communication observation that goes on. That's frankly, I think more humanistic and more holistic and is part of great clinicians and great relationships in delivering healthcare. I'm sorry that turned into a speech and I didn't really mean it to...

Dr. Geetha Nair: That was Dave being inspired.

Dr. Dave Levin: Yeah, exactly. Exactly.

Dr. Geetha Nair: I don't always agree with Dave, but on this one I will.

Dr. Dave Levin: Geetha rescue me here, get us back on track.

Dr. Geetha Nair: Yeah. So thanks for inspiring us Vasanth. It really is so nice and refreshing, I think is the right word to hear you and your passion and also your personal journey. So there's a lot you're doing, there's a lot you're managing. Help us understand what a day in the life is like for you. How does it begin? Where does it begin? You're going into an office, you're using technology. Now you're practicing in Florida, what does it actually look like day to day for you?

Dr. Vasanth Kainkaryam: Well, I think as many of us in this country currently, between being full time doctor, full time parent, teacher, entrepreneur, I think we don't, we're all finding a new norm and it's a little hard to say, but I think there are discrete moments. So let me talk about those moments. So the discreet moments where I am purely a clinician, where I am delivering care either in person or via telemedicine. There are discrete moments where I am functioning as a care coordinator, making phone calls to offices for appointments for my patients. Following up on records, there are discrete moments where I'm functioning like a nurse or a phlebotomist. I'm drawing my own blood for my patients. But then there's also the hat of being a community advocates. So part of my days might be sitting in meetings in the community. I work very closely with the chamber of commerce. I'm actually on the board of directors of the chamber of commerce here. Looking out for small businesses, helping them. There's a whole sort of networking element of my day where sometimes half the day is just spent getting to know people, sharing services, understanding what their needs are. Because, some of my members are employers. So that's sort of a different way of thinking about care where an employer will buy a membership for their employee and say, Hey, one of the benefits we offer you is copay free primary care. I mean, what would that do for retention and satisfaction. So I think every day is different, but there's sort of these discreet functions that I perform throughout the day. As time goes by, a lot of the typical DPC journey is that you end up getting certain moments of your day carved out. So maybe two or three hours of just emails, texts, communications, and then you might see about 8 to 10 patients a day in a busy, direct primary care practice. So think about that, where each of your visits are maybe 30 minutes to an hour. But the point is you're not bringing patients in unnecessarily just because that's how you get paid. The point is you bring them in when it's clinically needed, and you use technology and other methods of managing them over the continuum and not episodically. So my days are evolving.

Dr. Dave Levin: So we talked before we began recording that the pandemic is having an impact on everyone and we did not want that conversation to dominate our discussion today. I think this day in the life gives us a little bit opportunity to look at that. So without getting too deep into it, Vasanth I'm curious, how has the pandemic altered what you're doing, your approach. What advice do you have for others in primary care as they try to navigate this as you said, the new normal?

Dr. Vasanth Kainkaryam: For me, it hasn't affected me that much because the solutions that people have been implementing since the pandemic started were part of the solutions that direct primary care offered to begin with. So, we did a lot of things remotely. We do a lot of things virtually. Not everything has to be in person. So, I think when it comes to that technology, it was very easy for DPC docs to just continue saying, you know what, we're going to do everything remotely for the next few weeks. And patients were already comfortable with that and they already were used to that and they know that that exists. So, it hasn't really made as challenging of an impact as it has for a lot of people. I think on the flip side, a lot of people who've lost healthcare benefits can still get access to care. And that's one of the things that I have also tried to do is outreach to folks who, just cause you don't get benefits doesn't mean you can't get good care. So know that that care exists. And that's been another way DPC has actually been doing well through the pandemic and there's a lot of DPC docs across the country who are actually doing COVID testing clinics themselves. So people have been thinking out of the box how to help communities. And that's one thing I think what I love about direct primary care is, people who go into it are very community based and are looking to help find solutions for their communities. And that has been a great privilege to be a part of.

Dr. Dave Levin: Well, that's terrific. There's a theme in there, I think it's been interesting to watch. Organizations that have been embracing technology and been, if you will more out on the leading edge. And I think this is across a lot of different industries are finding it easier to make this pivot into the virtual world, I think. I don't mean that to sound critical of others cause I think there's, look there's other industries where it's just not possible. Or that it hasn't happened for other reasons. Simply observing that, it appears there has been a group that is more easily been resilient and adapted to the current environment. Rather that's a digital health company that was already practicing a lot of flexible working arrangements and basically just turn that up all the way or the way you've described your practice, which was already greatly digitally enabled. So I think that's really great. Geetha you want to bring us home today?

Dr. Geetha Nair: Sure. So, Vasanth we've taken a lot of your time, you've definitely given us a lot to think about. My last question too is really, we're clearly in a new normal, going back to a new normal. I think there's going to be a new normal of health care as we think about what the crisis has done to all of us as individuals and as physicians. So I'd love to hear from you where you see the future of healthcare and where do you see DPC fitting into that? Will this be where we gravitate, or do you see something else for the future?

Dr. Vasanth Kainkaryam: I think the future of healthcare will have a very large digital component to it. I think that there's no going back to what was pre coded in some ways. I think that the reimbursement structure will ultimately determine how much of that reverse pivot we make. Right now folks are getting, the payment for a virtual visit is the same as a video visit, but at some point, patients are going to be like, wait a minute, why am I paying the same amount? So that may pivot a little bit, but I think, the digital world is here to stay. The next piece I think will really be about remote examination. I think there's great technology coming out there in terms of, and I’ve actually been exploring it myself as part of my virtual DPC practices. How do I now begin to examine patients remotely? And so I think that is the next step to where it's going. I think DPC is a fantastic model. It's not for everyone. But I also think that, one argument made against DPC is if every doc went into DPC, the physician shortage would get exacerbated because our panels cap at 500 to 700 patients. So as it is, the numbers and statistics are based off of panels of 2000 and 3000, maybe even more. But at the same time, it's going to take folks to challenge the system, to force the system to come up with a different solution. So I view DPC as similar to an enzyme or a catalyst where, things have to change. Physician burnout is so high. And folks who do DPC love what they do. Once again, not for everyone, cause you've got to be willing to wear those multiple hats. But it's good care for patients. It's great lifestyle balance for the physicians. And it financially, look you don't go into DPC to make tons of money, but you will be satisfied financially.

Dr. Dave Levin: That's a really terrific summary. I understand that in addition to everything else you're doing; you have a podcast. So let's wrap by you telling us about this podcast, what's it about and why are you doing a podcast?

Dr. Vasanth Kainkaryam: Yeah. So part of that, my icky guy is really about how do I help educate people? And so my podcast is called the 4 elements of healthcare. Sort of a nod to those themes and it really looks at healthcare from the lens of the patient. So we talk about things like health shares or cost sharing communities. We talk about technology from the lens of the patient. We talk about different ways of making behavior change on such as hypnosis, such as Reiki, medical qigong. So it's really supposed to be versatile but looking at various issues and not looking at from an analytical, scientific perspective necessarily, but how does the patient take this information and what is their call to action with what they do next? So I decided that as part of my healthcare journey and teaching people to have choices, that's where the podcast came out of.

Dr. Dave Levin: Well, it sounds like clinicians also have choices. Having listened to you today, and to just connect this back to what you were saying earlier, you're right. If you look at a conventional model and you apply those assumptions to what you're doing, then panel sizes and economics start to look kind of screwy or squirrely. But what you're really saying is I'm not doing the same thing on a smaller scale. I'm doing it differently. And I think the podcast is an element of that. It would not surprise me if you're not already doing it at some point that some of your prescriptive advice might involve listening to a particular podcast, joining a particular group, adopting a particular digital app. These are just, these are new ways of thinking about how we partner and care for patients. And, as you said, the old models and the old analysis may not map particularly well to this.

So again, I would just like to recognize your, your creativity and your courage in being able to not just sit on the sideline and think about these ideas, but really put your time, your elbow grease into making them a reality and figuring out what really works. What's mere theory from what's real practical working advice. So thank you for that. And I, for one, I'm going to continue to follow your career with great interest.

Dr. Vasanth Kainkaryam: Thank you very much for having me.

Dr. Geetha Nair: Thanks Vasanth. I'm going to be subscribing to your podcast. Thanks so much for making the time. We really enjoyed this.

Dr. Dave Levin: Yeah, me too. We've been talking with Vasanth Kainkaryam, physician and founder of 4 elements direct primary care. Vasanth, thanks so much for joining us today.

You've been listening to 4 x 4 health sponsored by Datica. Datica, bringing healthcare to the cloud. Check them out at www.datica.com. I hope you'll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I'm your host, Dr. Dave Levin.

Dr. Geetha Nair: And I'm your cohost, Dr. Geetha Nair. Thanks for listening.


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