Doing justice through for-profit medicine
Jordan Raynor sits down with Dr. Gordon Chen, Chief Medical Officer of ChenMed, to talk about their radical business model that is doing justice in powerful ways, how to embrace and address conflict at work in a God-honoring way, and what Jesus’s work as a physician means for us.
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[0:00:04] JR: Hey, friend. Welcome to the Mere Christians podcast. I'm Jordan Raynor. How does the gospel influence the work of mere Christians? Those of us who aren't pastors or religious professionals, but who work as technicians, lawyers, and fishermen. That's the question we explore every week, and today I'm posing it to Dr. Gordon Chen. He's the Chief Medical Officer of ChenMed. This incredibly innovative healthcare company with a hundred medical centers in 15 states.
Dr. Chen and I recently sat down and talked about their radical business model that is doing justice in some powerful and practical ways. We talked about how to embrace and address conflict at work in a God-honoring way, and what Jesus' own work as a physician means for us. I think you guys are going to love this episode with Dr. Gordon Chen.
[EPISODE]
[0:01:07] JR: Dr. Chen, welcome to the Mere Christians podcast.
[0:01:09] GC: Happy to be here, Jordan, with you. Thank you for having me.
[0:01:13] JR: Oh, man. It's a pleasure. I've been really excited about this. Hey, so I'm really digging this book you guys just put out called The Calling. There's a story in there about the founding of this business, ChenMed. This is very personal for you. The founding of this company. Would you mind sharing the story with our listeners that eventually led to the birth of ChenMed?
[0:01:34] GC: Yeah. This is very personal. Actually, since we've written the book, I've realized that anyone that reads the book that I interact with, they have so much personal detail of my life, that it feels a little bit, it's interesting. It's almost like, “Oh, wow. I guess you know more about me than the majority of people.” How the book starts out, it's about 20 years ago, actually. I was in medical school. I get a phone call from my dad who is essentially trembling on the phone, saying, “Gordon, pick me up.” As a son, I’m going, “What do you mean, pick you up? You taught me how to drive, like what's happening?”
Then I soon discovered that he found out that a simple little numbness over his left lip. He had a CT scan to evaluate it, that he was told that he had a large cancer behind his nose that was going to kill him, fast. Thinking to myself, my goodness I was competitive, relatively worry-free medical student, right? Other than tests and studying, finding out that my dad has two months to live. What do we do? I was engaged. We thought that he would have to have his face removed to get this golf ball-sized mass behind his nose that was encroaching upon the base of his skull and causing kinds of nerve issues.
As a family, we just were broken. We believe we were broken with purpose. We're family full of healthcare providers that finally experienced what it's like to be a patient and to suffer and struggle through a broken healthcare system. So many different doctors and complications, and one hand not talking to the other hand. We really needed to step in and fight for my dad's life and plead to God to spare his life. This is where just we really felt God's presence just carrying us through that struggle.
There were ER visits, neutropenic fever, hospitalizations, many strokes. It was a very difficult six months, but we were so thankful that God brought us through that. My dad made it through cancer-free. That's essentially, what brought us together as a family. We were already brought together through our faith, but that what brought us mentally and emotionally together as a family, the six of us, my parents, my brother and his wife Stephanie, and Jessica and I.
Then from there, we started to not only experience the struggles of being a patient, but then figuring out how to keep my dad's business alive. His business required him to keep his patients healthy for the business to be successful. You could imagine if he's a patient, how he's thinking about his patients, right, and fighting for their better health. Designing technology that supports the ability to take care of patients in a way that not only supports a better health, but then that can help more and more patients.
Then we began to notice as a family, we all are very different. We each had very unique gifts and talents and just being able to work together as a family. It was amazing to see puzzle pieces come together and then be able to then produce something that's beautiful. From those early days, after suffering, we decided we need to do something about this. There's a better way to deliver healthcare. We're family full of doctors. We love technology. We love the Lord. How are we going to design something that can impact more and more patients? Then we started figuring out how to go from one center to two, two to four. Before you know it, we had six to eight centers in South Florida, trying to figure out how to scale outside of South Florida.
Then we went to Virginia. Then we started going to multiple different states. So, today we have over 130 centers, 15 states. We're doubling every two to three years on our size. So, God has just tremendously blessed our family and the organization. We're very fortunate, Jordan, that we can be in a situation where we can be authentic with our faith. It's a private company, so we can be who we are and we can live out our faith through our work, but then we could also have strong business accountability while we have strong mission accountability and they go hand in hand.
[0:06:31] JR: What really caught my eye on your bio. There's a line that says, “Dr. Chen believes doctors can fulfill the moral imperative needed to create a healthcare delivery system that produces social justice through better health.” I really want to hear more about this. I want to learn about how you're solving this problem, how you're producing social justice. But first like, just awaken us to the problem, right? Like, in what ways does injustice manifest itself in healthcare?
[0:07:01] GC: Oh, you see this very often. First of all, the number one reason why people in America go bankrupt are healthcare bills. Okay. We know that everyone knows that if they do, if they have a hospitalization, or if they have an MRI, and then everyone's sticker shocked at the bill. What the heck is going on, right? There's no price transparency. There's financial hardship that hits patients. Now, certainly it's going to hit the poorest patients in the most underserved communities.
Then we also know, because certain communities either don't have access to healthcare, because of the social determinants of health, we know that there's a 20 to 30-year life expectancy gap, just based upon where you live, and perhaps the color of your skin. You can be in New Orleans, in one community and have a life expectancy in the mid-50s, and the tend to be in minority communities. Two to three miles away, you can have a community that is living 25 years longer. Okay. So, whenever you see big gaps in these healthcare disparities or life expectancy, and they're due to differences in social or racial backgrounds, then you got to scratch your head and you got to go, “Oh, why is that?”
What we've discovered is if you go into those communities with the right model, what we call full risk approach, which puts us at risk for the patient's health outcomes and their healthcare costs, and we start working on improving healthcare outcomes in a means to lower medical costs, then we can actually close the gap on the healthcare disparities. We can bring what we're interpreting as social justice by helping people to experience more love and better health in those communities, compared to when we weren't there versus when we're there now.
[0:09:15] JR: You guys are intentional about where you locate these medical centers. I mean, you're rushing into these low-income communities, correct?
[0:09:24] GC: That's right. There are a few reasons why we're rushing in. First of all, the number one reason is that's where our heart is, is helping those that are hurting –
[0:09:35] JR: I mean, I think that's where Jesus' heart is for the record.
[0:09:37] GC: By the way, I mean, our faith, every time you're diving into the scripture and we're called to help the poor, the needy, the suffering, the orphans, the widows, right? The foreigner. We go there, because we feel like that's part of our mission. It's funny, even my mother selects our locations, you know. She's like, she sees too many like wealthy stores in the neighborhood. She's like, “This is not for us.”
[0:10:06] JR: There is a Trader Joe's across the street, move along.
[0:10:08] GC: Yeah. LA fitness, not for us. No, I'm not even joking.
[0:10:13] JR: I love this.
[0:10:14] GC: Then as soon as you go into a neighborhood like, oh, like feeling a little bit, like uncomfortable about safety. We're like, “Oh, this is probably the right location.” Right? What's interesting is we can go in those neighborhoods and there's tremendous healthcare need. That's the other reason first is mission, second is we can grow our centers and attract a lot of needy patients that can help to make that medical center sustainable. Can't have a very expensive medical center that doesn't fill up with patients. It's not going to make it, right?
Then we can fill it up with patients and then the burden becomes on us to take a very sick, complex population of needy seniors in a very poor community and aggressively invest in their health, right? Like detecting their high-risk conditions and aggressively managing them and lowering their hospitalizations, which is the number one like cost burden and the number one determinant of whether or not we can help them to live longer, right?
If we're lowering their unnecessary hospitalizations by upfront, preventative, proactive, primary care, based upon creating trusting relationships with one of our key values of love, then you could heal those patients. You could heal the community and you can bring social justice and you can do it where it's financially sustainable, because you're cutting out the medical waste. If you can invest upfront and prevent the heart attack before it happens, prevent the stroke before it happens, detect the cancer early, manage the chronic conditions before they get out of control. Every hospitalization that you prevent is like 15 to $20,000 in savings.
Then what do you do with that? You invest it back into your people, your technology, your processes, and prevention. Then you invest it into other needy communities and it becomes this beautiful virtuous cycle that it's just like, it's just wonderful to see happen over and over again. That's the journey that we've been on.
[0:12:33] JR: It's such a beautifully redemptive business model, too. You mentioned this term breeze past it. I want to park on it for a second because I don't even think I fully understand this. A full-risk medical practice. What the heck does that mean in practice for you guys?
[0:12:51] GC: Typically, healthcare is called fee-for-service, which means every time you see a patient, you get paid. Every procedure you do, you get paid for it. Every time you order a test, there's some type of transactional payment. That's fee-for-service and that drives the vast majority of healthcare runs on fee-for-service. Every hospitalization you have to pay for, right, or someone has to pay for.
Full-risk means that you're accountable for the total cost of care, so in our current system, if you can prevent hospitalizations, then the full-risk model is actually doing better when the patients do better. Is that make sense? We're aligning our incentives with the patients' incentives to say, “We want a trusting, durable, long-term relationship that produces better health.” When you produce better health, guess what? You have lower medical spending. It just makes sense, right? So, what we've been able to do is to scale this full-risk model. Now, of course, fee-for-service is far from – it's not ideal. It's actually very broken. The full-risk model is, I think, far better than fee-for-service, but it's not a perfect model. There are things to work out.
I think what it does is it aligns from a physician’s perspective or a clinician's or a healthcare provider's perspective. It aligns our interests to think about what we can do to help patients achieve better health, not just perform transactions or not just transfer knowledge to patients, because that's not good enough in our model. It's not good enough to say, “Here's my expert opinion, [inaudible 0:14:44] and it's up to you to figure out. Good luck with that.” Right? That's more of an expert model than a transactional model, where your work is done as soon as you transfer the knowledge.
In our model, we need to see behavior change occur in a way that supports better health. Otherwise, we're not accomplishing our business goals. By the way, when we focus on behavior change, then the people that we attract, it actually accomplishes their mission goals as well, which is producing better health. So, we, as a company, our mission is to honor seniors with affordable VIP care that delivers better health.
[0:15:30] JR: I love this so much. How has God's word shaped your – I was reading in another interview you did a while back. They said that “Being in the word expands your vision” for your work. How so? Talk a little bit more about that.
[0:15:44] GC: My appreciation for scripture has skyrocketed over the last 10 years. I've been a Christian majority of my life. I remember receiving Christ at a very young age, probably five or six, and reaffirming, and rededicating my life to Christ at age 11 in a church retreat. I've been a Christian a long time, but just really diving into the word, but then not only diving in and doing daily devotions but memorizing and meditating on it just has been a tremendous blessing. I've got like my favorite Bible chapters.
One of the things that I did want to mention. I read this book and this is after high school college, and medical school training, where I had to take so many tests. I ended up reading this book called, Unlimited Memory. I thought that I had difficulty like memorizing scripture and other long things, right? I read this book by Kevin Horsley, Unlimited Memory. I use the techniques in the book to memorize scripture. It's been awesome. I've been – for the last six, seven years, just adding to my like repertoire of memorized scripture. Then coming up with a daily and weekly routine to just play it in my head over and over again. When I wake up, when I go to bed when I wake up in the middle of the night. It's just been so meaningful for me. Then it's just the time to just play at my head, but then also keep myself connected to the truth.
[0:17:26] JR: Which of those truths that you've memorized, do you think about the most as you're building this business? You're sitting at your laptop, you're doing site selection, or maybe you're seeing patients like, what passages come to mind most frequently as you're doing your work?
[0:17:40] GC: So many. Romans 12 is probably one of my favorite chapters. Not only does it talk about, “Do not conform to pattern of this world, but be transformed by the renewing of your mind. Then you'll be able to test and approve what God's will is.” Right? “His good, pleasing perfect will.” It just constantly, how do you renew your mind? How do you renew your mind and then, and your heart? Then I had a theme. How do we have our hearts and minds set on the right things, which is on heavenly things, on things of God? That was very meaningful. That continues to be something that just like, I don't think we can get enough of that, right? How do we continue to transform our mind in a way that aligns with Christ? That's been huge.
The other thing is this concept. It's also in Romans 12, but it's also referenced all over Scripture, right? Like, as members of one body, like we all have different functions. You're the hand and you'll be the foot. We all need to realize that we're all part of the body of Christ and Christ is the head. Then we all have different talents and gifts and we need to celebrate that. That's been very meaningful, particularly as a family realizing that we all have different gifts, but we all come together in this unique way.
Then even as you're building your leadership teams, how are you designing leadership teams that have complimentary gifts, strengths? You name it. That has been really beautiful, because it allows us to make sure that we're in check, that not one person can really do it on their own. Ultimately, we have to yield to the head, which is Christ. It gives us and our family a mindset of – and a reminder that we need to humble ourselves and be able to work together and then serve Christ together. =
[0:19:34] JR: Yeah. It's like a recognition of, like mutual submission, right? Like, if Christ is the head, we can eat to submit to each other. Regardless of job title, I mean, obviously, there's functional necessity to some organizational hierarchy, right? But it's a posture, it sounds like, of submission to one another. Am I reading that right?
[0:19:54] GC: That's right. Jordan, I don't want to give anyone the impression that we as a family don't like, “Oh, we submit to each other and we don't have any conflict – just keep in mind, just look at my brother and I, we’re these like, pretty large football player, wrestler, very aggressive personalities, right? We have wrestled physically throughout grown up, but we also wrestle over different topics.
We, as a family, have never shied away from conflict. In fact, we think that shying away from conflict is probably not good, because you're not getting the best answer. You have to engage in conflict, assuming positive intent. Then if the conflict becomes unproductive, then that's a great opportunity to really humble ourselves before God and each other and ask for forgiveness. I think that that's probably been one of the reasons why we've been able to work together as a family, for so long, while building the company.
[0:20:58] JR: Talk more about that. How do you address conflict in a distinctly Christian way, right? Proverbs 27:5 is coming to mind, “Better is an open rebuke than hidden love.” Jesus gave us a framework for conflict resolution. How do you guys think about this within the business?
[0:21:16] GC: Conflict starts out with differing views, right? Now, the question is, when you have differing views, how do you get that all out, so you can find the best answer if you're solving a business need? Then how do you, if it's something that's like whether or not you're debating something moral, then there's more clarity in the Bible. Like, let's go to the Bible if you're discovering what's the best business solution and there are multiple different views. If you don't have conflict, you're in trouble.
Patrick Lencioni has written a ton of books. One of my favorites is The Five Dysfunctions of a Team. As soon as you have that foundation of trust. His dysfunctions are like the absence of trust and or I forget the exact terminology, but once you have a base of trust, then you can have conflict. Then if you don't have conflict that's actually a dysfunction. Now, of course, how do you define conflict? You don't want it to be an unproductive conflict. You want it to be productive conflict, but you're being open and vulnerable in a way where you're engaging in conflict and you're wrestling over different ideas and concepts.
Now, shoot, when you're wrestling, sometimes people get unintended injuries. Then we need to come around and make sure that those injuries, we can all recover from them, right? That's how we approached it. Actually, I think it comes from my parents. I learned so much from my parents. I’m just so thankful for them. They encouraged open debate and positive conflict to find a better solution.
[0:22:56] JR: Yeah. It doesn't sound like these – the way you guys address this is about winning. It's about what's best for the mission, right? Ensuring that if there are injuries, there's repair for the people, right? There's a deep care for all the people involved in debating through these issues, right?
[0:23:14] GC: That's right. There's not only deep care, there is assuming positive intent. We're trying to find the right solution. We're trying to find the best answer. Then also reconciliation. I think, this has been one of our strengths as a family, because we work together, we live together, we vacation together. I think being able to humble ourselves for God and each other. If we mess up, asking for forgiveness and reconciling. I think that that's been a muscle that we've had to work out a lot and I'm thankful for. So, forgiveness is certainly part of it. Then the best that we can do to assume positive intent as we're having animated discussions, we can even get to the results, the right solution in a purely positive way.
[0:24:08] JR: I want to ask you about one more thing before we get to the three rapid fire questions that we round out every podcast with. My wife and I teach fifth graders in our local church on Sundays. We just completed a study through the gospel of Mark. I was just really struck by, you know. It always strikes me when I read straight through one of the gospels. Jesus spends nearly as much time healing as he does preaching, right? Like, it's amazing to me that he isn't described as a doctor by many people. As a physician yourself, what does that mean to you that Jesus spent so much time caring for physical needs and not just spiritual ones?
[0:24:47] GC: It's very meaningful. Ultimately, for myself. I'll speak for my wife, also a physician. Jesus is the great physician, right? Ultimately, you have to love someone enough to help them where it is meaningful for them. Then once you show your love for them and they feel it, the opportunity for them to be open to whatever, to Christ, to biblical truth, to your perspective, it becomes that much more meaningful, right? If you can pour into someone in a meaningful way, and then the most obvious way is if they're hurting or suffering or sick, helping them with that, bringing better health, right? This is back to our family purpose.
Our family purpose is to glorify God by spreading more love and promoting better health and all who come to contact with ChenMed. I love the example that Christ gives and bringing healing and then also bringing truth. I wonder how, as a Christian community, we can do a better job at meeting people's needs and showing love and mercy, and healing before we just rush in to point out the truth. I don't know the right balance there, but there is beauty in searching for that right balance of just really pouring into people to meet their physical needs, maybe mental or emotional needs. Then being able to share your faith and share what Christ means to you.
[0:26:34] JR: That's good. That tangent is a good one we need to be wrestling with. All right, Dr. Chen, three questions we ask every guest on the podcast. Number one, which books do you find yourself recommending or gifting most frequently to others? These can be Christian living books. They can be business books. What's your go to? What are you buying the most on Amazon to send to friends?
[0:26:54] GC: There are a ton of books. Most recently, it's interesting. There've been a lot of people, like searching for answers with their faith and whatnot. I really love Tim Keller’s The Reason for God. That's a fantastic one. Of course, and then it goes along with Mere Christianity, C.S. Lewis. Francis Collins, The Language of God is a great one for anyone in science and medicine. You reference him being a guest. That's a wonderful book. Seeking Allah, Finding Jesus, that has been an amazing book as well. That tends to be the books that I recommend for people if they're in science or medicine that just want more clarity and how to think through, that science-faith relationship.
[0:27:42] JR: Those are good. You know what's funny? Dr. Collins's books were Mere Christianity and The Reason for God. How about that? Great minds, think alike. Great minds, think alike. Dr. Chen, who would you want to hear in this podcast talking about how their faith shapes the work they do in the world?
[0:28:00] GC: A colleague of mine, Faisal Syed, he's a doctor. He became a Christian a few years ago, but has just been on fire for Christ. Actually, he grew up Muslim and came to Christ. He, I think, would be just an amazing person to have on this podcast. We encourage each other in the Lord. He immediately comes to mind. I mean, I think my mom.
[0:28:28] JR: You just say, the way you've been talking about your mom, I’m like, I think I want your mom on the show.
[0:28:31] GC: It would be just amazing to hear her perspective. I mean, she did write a book in record time before Chris and I. It's like, I mentioned to my mom, “I am going to try to write a book on our family story.” She's so focused and she's like, “Okay. Yeah, I may do the same thing.” She like, be this by year.
[0:28:50] JR: That's amazing.
[0:28:51] GC: Her book is just the wonderful testimony of what God's done in her life. I think just having such beautiful, simple faith, there's so much power and just clear, simple faith. It's been interesting is watching the difference between my mom and my dad had to go through all of the intellectual hoops and understand all of the detail. Then finally coming to know the Lord and my mom was just like, God loves us. Christ died for our sins.
[0:29:23] JR: Just like very straightforward.
[0:29:25] GC: Yeah. She has a beautiful way – it's like of just simplifying things. We don't get something that we thought we wanted. She'll say, “If it's not for us, it's not for us.” I'm like, “Okay. Thank you, Mom.”
[0:29:44] JR: That’s a so matter effect. I love that so much. Hey, Dr. Chen, you're talking to this audience of Mere Christians, doing a lot of different things vocationally. We got some physicians listening, we have entrepreneurs, we have, I don't know, foresters, I don't know, retailers. What's one thing from our conversation you want to reiterate to these Mere Christians before we sign off?
[0:30:08] GC: One thing, Jordan, that resonates with me is that it doesn't really matter what job or role that God has put us in. We are all part of the body of Christ. We all have our role and responsibility to serve Christ and serve Christ in a unified way. We have the Bible. How can we really dive into scripture and change who we are? Once we really change and continue to develop who we are every day like how are we changing to be more like Christ every day through scripture? But then when who we are changes, then what we do and how we do it changes.
Then just allowing the Holy Spirit to work through us, I would just love to see us as if the body of Christ, just whatever role that we have, just know that we are all serving Christ together. I actually think even those that are not in full-time ministry. I don't think folks that are pastors or whatnot like are serving God in a better way than anyone else that may be listening to that doesn't have like a pastoral role. I think we can serve God in just beautiful and intense ways right where we are.
[0:31:40] JR: Amen. I think that's why Paul called believers to stay put, wherever they were when Christ called them. Thank you for doing that. Dr. Chen, I want to commend you for the extraordinary work you do for the glory God and the good of others. For reminding us of Jesus' call to go to the margins of our communities and serve the least of these. Thank you for giving us a really compelling case study of what that looks like, not in a nonprofit, but in this for-profit business that is doing justice in some real intangible ways.
Hey, guys, if you want to learn more about Dr. Chen and his family story and the incredible work they're doing at ChenMed, make sure you check out this great book called, The Calling: A Memoir of Faith, Family and the Future of Healthcare. Dr. Chen, thanks again for hanging out with us today.
[0:32:30] GC: Thanks so much, Jordan. Everything that we've done is really by God's mercy and grace.
[0:32:35] JR: Amen.
[0:32:36] GC: Thank you.
[OUTRO]
[0:32:37] JR: You got somebody you'd love to hear on the podcast, I want to know about it. Contact me at jordanraynor.com/contact to recommend a guest, even if that guest is yourself. Guys, thank you so much for tuning in this week. I'll see you next time.
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