Mary Chen of ChenMed: 5 Things We Must Do To Improve the US Healthcare System
An Interview With Luke Kervin
Close the medical education gap. Medical schools and residency programs are designed to meet the needs of the fee-for service machine. Medical education certainly is moving in the right direction, but we can’t begin to change to a value-based care system if we are not training physicians in value-based care. There is a huge gap between what is currently taught and what doctors need to excel in influencing and coaching — the foundation of an outcomes-based system.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Mary Chen.
Mary Shao Mei Lee Chen is co-founder of ChenMed, where she serves as the organization’s Chief Market Development Officer. A woman of strong Christian faith, she created the company, along with her husband, Dr. Jen-Ling Chen, as a mission-driven healthcare organization caring for the most fragile and underserved senior citizens in America. Despite serving thousands of seniors in 15 states, Mary is proudest of the title bestowed on her by her eight grandchildren, who affectionately call her Nai nai, the Mandarin word for “Grandma.” Her belief in God, and how He directed to her, provided for and protected her and her family, and gave them a family purpose beyond what they ever asked for or imagined, drove Mary to share her story with believers and non-believers alike in her new book, The Chronicles of Nai Nai: Beyond What Was Asked for or Imagined [Morgan James Faith, March 8, 2022]. Her goal is to inspire others to embrace a God that loves and protects His people.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
I am delighted to be here with you. If you would have told me when I was a girl growing up in Taiwan that one day, I would be sitting here talking to you about my life and I would have never believed you.
I wish I could tell you that my husband Jim and I had all this figured out from an early age, but I can’t. We’ve always trusted in God to show us our path and take care of us.
Early in our marriage we were doing pretty well. I opened a couple of Chinese restaurants in Wisconsin while Jim attended graduate school. I was so focused on making our restaurants successful I stopped attending church and Bible study. Jim wasn’t happy with me and told me if I didn’t return to our faith, he would pray to God to take the restaurants away. I remember saying to him, “But Jim, the more money we make the more we can give to the church.” Jim responded, “God doesn’t want your money, Mary. He wants you.”
I promised I would cut back my time in the restaurants, but I didn’t. So, Jim prayed to God to take the restaurants away from me and within a few short weeks a blizzard and the flooding from the melting snow destroyed both restaurants. Even though we were broke I wasn’t angry at Jim. I wasn’t worried or upset, either. I knew God would put us on the path he wanted for us and He did.
Can you share the most interesting story that happened to you since you began your career? –
When we opened our first medical center our responsibilities were clear. Jim took care of the patients, and I took care of the business. But I had no experience running a medical office. I knew nothing about healthcare payers or insurance plans.
At first, I was scared to pick up the phone. But I hired and trained employees, researched the rules and regulations, and figured things out. I was a natural with numbers, so I also dove into the payments we received from healthcare plans and I noticed they made a lot of mistakes.
Every time I found a mistake, I called them. I called them so much I didn’t even have to identify myself when they picked up the phone. Everyone knew me. It got to the point where I was training them on how to reimburse medical providers! They didn’t like making mistakes either. It took a lot of time and effort to fix errors.
When ChenMed began to expand, we hired managers to interview doctors and staff. A lot of prayer went into every new hire. Our employees needed to have the same commitment to our patients that we did. That is how I ran the office side, and it wasn’t long before my husband lovingly reminded me, “Mary, you’re supposed to be working for me. When did that change?”
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
My son Gordon, who is also ChenMed’s Chief Medical Officer, tells me I quickly forget what doesn’t work. He is correct, and I’ve found “forgetting” is both a blessing and a curse. The blessing is I don’t dwell on failures. The curse is when we are sitting around the table in the ChenMed boardroom with all the leaders and I think I have the perfect solution to a problem. The other leaders let me talk and eventually someone will start smiling. That’s my signal that I’ve already made that suggestion and we didn’t get the desired outcome; so, I stop talking. We all have a good laugh before we move on to consider ideas that we haven’t tried yet.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“If I rise on the wings of the dawn, if I settle on the far side of the sea, 10even there your hand will guide me, your right hand will hold me fast.” Psalm 139: 9–10 NIV
Throughout my life, God has always shown me my path and protected me (and my family). My faith in Him and his plan for me are unconditional and absolute.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider is someone who improves health and helps patients live happier lives.
So much of healthcare today is focused on sick care, volume, and billing. We must shift the focus to well-care so patients can live longer and celebrate those special moments that bring us joy — like the birth of a grandchild, or maybe a golden or diamond wedding anniversary.
At ChenMed we practice full-risk, value-based healthcare.
Since ChenMed is full-risk, that means we get paid a set amount and assume full responsibility for patient care. We are incentivized to keep our patients healthy and avoid costly hospitalizations. This approach benefits both our patients and doctors. The two work together to set realistic goals that focus on improved health. Then our doctors act as coaches to help the patients achieve their goals. Doctors and patients track and celebrate progress together.
Our model creates better health outcomes. ChenMed patients have 33 percent fewer hospitalizations and ER visits — and a renewed sense of passion and purpose in our doctors.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
My favorite book is the Bible. It has been since I was a little girl.
I remember attending Church and memorizing Bible verses. Of course, I memorized them in Chinese, and even today, when I play them back in my head I still hear them in Chinese. These verses have stayed with me my entire life and have helped me through some very difficult times.It doesn’t matter if I apply these verses to my life as a wife, mother, grandmother or business woman. They always lead me in the direction God wants for me.
Are you working on any exciting new projects now? How do you think that will help people?
ChenMed is growing so quickly. We are opening approximately 30 new medical centers this year. Each one is an exciting, independent project that will help more seniors live healthier lives and transform a new community.
We are also opening our first youth center this year in Fort Lauderdale, Florida. The center will offer free, academic, personal support and athletic training to students ages 6–18. It will be a safe space to ensure they have a place to meet, grow and thrive. Students are our leaders of tomorrow and the youth center will help them maximize their potential.
I’ve also just written my first book, The Chronicles of Nai Nai: Beyond What Was Asked for or Imagined, which tells the story about how my family got to where we are today through God’s mercy and grace, and how ChenMed was created. Through the book, I want to inspire others to put their trust in a God who will love and protect them; as well as put them on the right path. All our success bringing better health to ignored, marginalized and often forgotten seniors is all through His mercy and grace.
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
You know, a lot of people say healthcare is broken in the United States for exactly the reason you stated. America spends more on healthcare than the entire economy of almost every other nation on earth. More than $4 Trillion. But, we are dead last among developed nations for outcomes. We get so little for our money. But here’s what people don’t realize –
- The fee-for-service healthcare system in America, which is the dominant healthcare system in America, isn’t broken. It works perfectly. The system is designed to make money from sick care.
- Physicians inherently want their patients to make positive changes towards better health, but the business leaders and hospital administrators don’t. They don’t mind when patients use ERs for their mainstay of care. So they set up a system where doctors are responsible for thousands of patients and barely have time to learn a patient’s name. They can’t get to know a patient well enough to build trust and use influencing skills to convince the individual to make lifestyle choices that can lead to better health.
- A clinician’s huge patient panel combined with the paperwork that goes along with seeing 25–35 patients per day is burning out good doctors. We are already seeing a shortage of primary care physicians in America and the situation is going to get a lot worse unless physician burnout is addressed.
- Since revenue and profit is the driving factor in the fee-for service world, it also makes sense that medical providers will follow the money to wealthier, more affluent neighborhoods where patients can afford expensive deductibles and copayments. This leaves a large portion of the population outside those neighborhoods without healthcare — especially people who are older, poor, and suffer from multiple and complex medical conditions.
- Student loan debt is forcing residents into high paying specialty fields rather than primary care. We must elevate the PCP’s compensation and prestige to the level of their specialist colleagues to address the upcoming PCP shortage.
As a “healthcare insider”, If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
All Americans deserve access to better healthcare, so the five things we must do to improve healthcare are:
- Shift to value-based care from the predominant fee-for service model. The fee-for-service system means every sickness has to be seen as revenue and a disincentive for change.
- Close the medical education gap. Medical schools and residency programs are designed to meet the needs of the fee-for service machine. Medical education certainly is moving in the right direction, but we can’t begin to change to a value-based care system if we are not training physicians in value-based care. There is a huge gap between what is currently taught and what doctors need to excel in influencing and coaching — the foundation of an outcomes-based system.
- Address economic inequities. There are zip codes in this country where life expectancy of residents is 20–25 years less than the life expectancy of people living in more affluent zip codes a few miles away. Addressing the social determinants to better health — housing, food, and education challenges — found in these less affluent neighborhoods will bring better health to people who typically suffer at the hands of traditional healthcare providers.
- Access to transportation. Nearly four million people in the United States do not seek care for health issues because they don’t have access to reliable and safe transportation, according to a 2017 report from the American Hospital Association. “Access to healthcare” includes more than just visiting a doctor’s office. Transportation is required to visit a pharmacy to fill a prescription, obtain imaging or laboratory services, or even visit a park or other green space to safely engage in exercise. Transportation-disadvantaged patients are at risk for a host of downstream health challenges. Delaying or missing appointments with a primary care provider can affect how well patients with chronic disease manage those conditions, as well as reduce the chance that a serious disease can be diagnosed early. This is a particularly significant issue for patients in low socioeconomic circumstances, whom research has shown have a higher incidence of chronic health conditions. This can lead to more costly emergency room visits and hospitalizations for these patients.
- Place a larger emphasis on training in influencing patient lifestyles and diet.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Clinicians must play a greater role in shaping the future of healthcare. They can be the change they want to see, but they must develop the influencing skills necessary to become leaders of their industry. This won’t come easy for them. They are trained in, “I am the doctor so listen to me” influence.” That response will only get them so far. They must develop their influencing skills, demonstrate results, and then develop other clinicians to do the same thing. When you can scale great results and combine it with a culture of professional development, you can spread better health throughout America.
We also must get more active in our communities — especially the communities where adequate healthcare services are lacking. ChenMed volunteers’ partner with 40 local foundations to improve the quality of life in surrounding communities. The company has reached out to sponsor literacy programs, health education programs, food collection and distribution, transportation, housing, and basic needs (even laundry services!) for the neediest in the communities.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
COVID-19 exposed every crack and weakness in the fee-for-service system. When the goal of the system is to generate revenue, and people stay home rather than go to the Emergency Room or schedule expensive elective procedures, the revenue dries up. We watched hospital systems lay off doctors and smaller medical practices close their doors because COVID-19 robbed them of their ability to generate revenue.
But full-risk, value-based care providers didn’t face the same challenges as our fee-for-service colleagues. We had the flexibility to meet our patients’ needs where those needs existed.
For example, the minute America began shutting down, we switched more than 90 percent of our in-person visits to virtual visits in one week.
We also prioritized our sickest patients and gave away free blankets to get them to come in. We picked them up, saw them under the safest conditions possible — plenty of PPE equipment — and brought them back home.
We handed out tablets and instructed patients on how to use them so they could have video visits. We called them weekly to make sure they had everything they needed. We delivered their medication so they wouldn’t have to leave the home. If they needed groceries, we went shopping and delivered them. If they needed toilet paper, we found out who had it and delivered that too.
The flexibility of our full risk model to meet our patients’ needs where they existed balanced the scales that have been unbalanced by society. The fee-for-service network could have prevented a lot of pain and suffering if it approached COVID-19 like we did.
How do you think we can address the problem of physician shortages?
Like so many of the diseases we treat, a national primary care physician shortage is highly preventable.
It starts with addressing student loan debt and the uneven compensation between PCPs and specialists. Doctors come out of residency programs hundreds of thousand dollars in debt. They will naturally gravitate to the higher paying specialty jobs to pay off the debt faster. We must make medical education more affordable and level the compensation playing field between PCPs and specialists.
We must also remind doctors why they entered medicine in the first place. They didn’t become doctors to spend their time writing notes and generating billing codes..
Doctors want to practice medicine the way it was meant to be practiced. They want to be healers. They want to prevent suffering. Bringing primary care physicians to underserved communities, creating environments where they can make a real impact on their patients’ lives, and surrounding them with personnel and technology resources that can help them practice more efficiently is the solution to the United States’ primary care crisis. This will not only attract more young professionals to primary care but also entice them to remain in primary care, averting the dire, doctorless future so many have predicted.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
I am already involved in a movement to transform primary care in this country.
The predominant fee-for-service system is designed to generate profits through sick care. This profit-driven model leaves many Americans, especially older senior citizens with multiple chronic medical conditions living on fixed incomes, with no place to go for primary care. In addition, a focus on sick care rather than well care does not produce better health.
The movement to provide transformative primary care through a full-risk, value-based care model is growing. Full-risk means full responsibility. Providers who assume full responsibility are incentivized to keep their patients healthy and out of the hospital. Clinicians meet patients’ needs where their needs exist — and that includes food, housing, and transportation necessities. Everyone competes to improve health rather than bill more. In the process, we inspire others towards a much more ethical healthcare delivery system.
How can our readers further follow your work online?
Connect with Mary Chen on:
Official Site: www.marychenbooks.com
Facebook: www.facebook.com/AuthorMaryChen
Twitter: https://twitter.com/MaryChenBooks
LinkedIn: www.linkedin.com/in/marychenbooks/
Connect with ChenMed on:
Official Site: www.linkedin.com/company/chenmed
Facebook: www.facebook.com/ChenMedFamily
Instagram: www.instagram.com/lifeatchenmed
Twitter: https://twitter.com/ChenMed
Thank you so much for these insights! This was very inspirational, and we wish you continued success in your great work.
About the Interviewer: Luke Kervin is the Co-Founder and Co-CEO of PatientPop, an award-winning practice growth technology platform. PatientPop is Kervin’s third successful business venture. Prior to co-founding PatientPop, Kervin co-founded and was President of ShopNation (acquired by Meredith Corporation) and was the first executive hire at StarBrand Media (acquired by POPSUGAR).