People Needing Access to Care Shouldn’t Have to Do Battle to Get It

I recently sat down with Brad Younggren, MD, Chief Medical Officer of 98point6, the growing medical technology platform providing text-first, primary care consults with a physician, 24–7, through each patient’s smartphone.

Brad has served in leadership roles at EvergreenHealth, Cue Health and Shift Labs. His 20 years of experience as a doctor, ongoing work as an emergency physician and medical director of emergency preparedness, trauma and urgent care make him uniquely qualified to envision the quality of service for those seeking immediate care need.

Saving lives is a survival instinct for Brad. He earned a Bronze Star and Combat Medic Badge for his service in Iraq as a United States Army physician, and those experiences have enabled him to think about healing a fragmented system of care to make it far more responsive to patient needs.

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Gil Bashe: You and I both served in an army medical corps, you as a surgeon with the US Army, and I as a frontline paratrooper combat medic. We both had dramatic experiences in providing care. I went out with our soldiers to treat them where and when they were wounded. Fast forward, you served during the Iraqi War, when great technological advances in medical care were available. You saw that medical personnel were deployed piecemeal, and care was fragmented and provided by scrambling to get to patients. Tell us a little bit more about how those experiences framed your vision for patient care?

Brad Younggren: I completed my residency after September 11 (2001) and then joined the US military. Suddenly, I found myself transported to the middle of a major conflict as a squadron surgeon for a reconnaissance unit along the Syrian border.

When I arrived, the doctors and physician assistants were stationed in different places along the front. I couldn’t understand why. I thought: “We have helicopters, portable ultrasound machines, and video calling capabilities. Wouldn’t it be more strategic to position ourselves in Tal Afar, which would allow us to get to soldiers more quickly?”

Bashe: So, you saw the capability to use resources more effectively to treat patients faster to save lives. You recognized that you also had the technology to connect to the front-line instantly. What did that realization inspire you to do?

Younggren: When I saw critical time wasted and providers pushed to the point of injury, that launched this notion to use technology to save soldiers’ lives. When I returned stateside, I dived into technology visualization procurement for the Army. If we have devices that are durable enough for deployment that can extend our reach, we shouldn’t need to risk doctors’ lives by stationing them in Baghdad. Why not place them strategically in locations where they can sustain and save lives using technology at major medical centers such as Walter Reed Medical Center?

In 2010, I got out of the military and went to work for a company that developed the first Food and Drug Administration (FDA)-approved mobile-phone device. Now, we take for granted that a cell phone has better visualization than a hospital monitor. At that time, that wasn’t the case. That’s when I got my first taste of just how great an impact technological evolution could have on patient care.

Bashe: Can you expand on your decision to join 98point6? You saw the potential of technology to transform military medicine. Is the civilian world of urgent care very different? Why do you feel those in the healthcare profession must use technology to bring the primary care physician closer to the patient?

Younggren: As an emergency physician, I saw several failures within the healthcare system. During my time in the military, I saw how technology accelerated and could be leveraged to meet urgent medical needs. I recognized the need to build a technology platform that provides on-demand service at the point of care that also would reduce physician variability in practice.

Instead of repeatedly trying to get doctors to do something with an off-the-shelf digital plan, the only way you can impact change and care is to put technology tools and data directly into the hands of the doctor. Then they can make the best clinical decisions when they need to, in real-time.

Bashe: We both know how hard it is to change the healthcare system. You may need to push new ideas while old ones are still firmly in place. Tell us how the 98point6 platform is working to effect changes that will eventually transform the system?

Younggren: One of the primary reasons I came to 98point6 was to be the first point-of-care company in the room during every single patient visit. Almost all of our patient cases are handled via text (with support for photo/video as needed for diagnosis). We can capture all of the conversational information that occurs between doctor and patient, which informationally and procedurally, is incredibly powerful. If you want to understand how to impact the care delivery system, you need to fully understand the interaction: you need to be in those rooms.

Our Chief Product Officer Robbie Schwietzer helped build Amazon Prime. His acute understanding of consumer engagement played an integral role in the development of our platform. We are committed to providing a pleasurable experience that gets people the care they want and need.

That’s key to the transformation of care, and we have patients tell us all the time how easy-care is for them now. They’re on a bus or in a meeting when they’re engaging in care, and that’s the beauty of it. You don’t even need to be on video: you can access care from physicians in an incredibly convenient, nondisruptive way. And that’s going to change how consumers want to get care, and how they expect to access it.

Bashe: Most certainly, you are familiar with Dr. Eric Topol’s book “The Patient Will See You Now?” Is 98point6 the transformation from question mark to exclamation point to the polemic he raises?

Younggren: Yes, I’ve read the book and considering Eric’s view that the smartphone is the agent for transforming care, and digitally empowered patients can take charge of their health care, I hope that he would believe that we are the kind of “bottom-up” care that he envisioned.

Ultimately, we’re a technology-driven, care-delivery platform where every case is backed by a doctor. We’re leveraging our technology and physicians to deliver better patient outcomes because that’s truly where the magic happens.

Bashe: Tell me about the 98point6 physicians. Do they take on 98point6 work in addition to their private or group practices? Or are they dedicated to pioneering this sort of connective technology with patients?

Brad Younggren: It’s the latter. I spent a lot of time looking at the market and found that physicians are on the outside looking in. To build an AI platform where the AI is learning from the behavior of the physicians, and to deliver care in 51 jurisdictions on demand, we needed a cadre of dedicated, on-staff physicians.

With these goals in mind, we couldn’t rely on locum doctors, which most of our competitors do. We needed to train our doctors to properly use technology. Originally, we started with seven and now we’re up to approximately 50 full-time, board-certified physicians. We augment the full-time physician team with part-time, directly employed board-certified physicians who meet the same hiring bar and receive the same training.

Bashe: Going back for a minute to our shared past in military triage, how do you deal with the triage of specific health needs within the 98point6 system?

Younggren: We have a whole team that’s devoted to continuously improving virtualized or AI-based triage, and one of the angles we’re taking is how to triage based on acuity and immediacy of need, which is very similar to being an aide in an emergency department. We’ve already built AI-based tools to help identify suicidal patients and pull them up to the top, so you can locate the patients that need care most immediately. Even though we’re aiming to provide on-demand care for all patients, it still requires a bit of clinical triage.

We do employ some doctors part-time who can help fill in gaps as needed from a capacity perspective. Ultimately, we want all the doctors we employ to work for us forever, so any work we can do to make their lives better from the perspective of preventing burnout is really important to us. At the heart of it, we’re a physician-forward organization. We track their satisfaction scores and constantly ask what we can do to make their experiences better.

Bashe: Describe the relationship between the primary care provider and the patient from a technological standpoint. Do you feel that 98point6 has maintained a relationship there or is it more functional than anything?

Younggren: Our theory at the beginning was based on research in computer science that shows patients can develop relationships with technology. Because we’re on-demand, it’s basic to our system that patients develop a relationship with 98point6 versus our physicians — it’s simply unrealistic for each of our doctors to work 24–7. We constantly strive to provide a peerless experience for patients that builds a level of trust with the brand, regardless of the physician on duty.

Bashe: In this country, 90 million people are pre-diabetic, but only 1 in 4 know that are trending toward diabetes. If 98point6 has a relationship with the customer, and you see that they’re pre-diabetic, do you simply say your blood glucose is a little high, you should be more mindful? Or do you preemptively engage that patient/customer?

Younggren: At the most basic level, we’re focused on invoking the standard guidelines of preventative care. So, let’s say a patient is 45 years old with a family history of colon cancer. We can catch that and recommend a colonoscopy, especially if they’ve never had one. There’s still a lot more work to be done in making preventative care more effective, as well as care navigation, chronic disease, behavioral health and we’re constantly looking to improve these areas.

Bashe: How do you feel about empowering faster engagement and the use of artificial intelligence, or even a medical chatbot to do so?

Younggren: There are a lot of symptom-based chat boxes on the market, and this technology isn’t inherently connected to a doctor. Even if a chatbot supplies the top four diagnoses to a patient, when a physician comes into the picture, they still have to backtrack to understand what has happened in that technology experience to build trust, provide an accurate diagnosis, and determine the next steps. That takes additional time and effort, and patients feel that.

I believe you need physicians trained to use technology that is fundamentally connected to the practice of medicine. In that case, technology is extending the reach of a physician’s hands and it’s a pretty cool, proven approach.

Bashe: I noticed that you’ve been tapped by major corporations as their medical service partner of choice. What’s the driving force behind these partnerships?

Younggren: One of the great things about working with employers is that we make a real concerted effort to understand their challenges and the problems their employees face. For instance, when the pandemic hit, we had to figure out a way to support employers with COVID testing in several different contexts.

Large employers trust us to give them high-quality care, but it goes beyond that. We’re having meetings regularly to better understand what their pain points are and where we can use technology to make the greatest impact. Many times, patients don’t know the extent of their medical benefits, but we know exactly what their plans are, and can recommend other services they might need, whether it be substance abuse support or behavioral coaching, that they’re not even aware they can access.

That additional ability to increase the utilization of other services these employers are paying for is a win-win for employers and their employees, who can further improve their health and enhance their quality of life.

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As an experienced combat physician and trauma care specialist, Dr. Brad Younggren — applying technology to accelerate access to care — demonstrates the digital transformation occurring in the health ecosystem. He is centering medicine around the patient and selecting to reinvent care, not by planting technology into a system seeking to keep it away at arm’s length, but rather by inviting physicians who select to be on the frontlines of care to use innovation to improve people’s wellbeing.