Creating Higher Expectations for the Healthcare Experience - Bhavdeep Singh, CEO and Co-Founder of HealthQuarters

SHIV GAGLANI:Hi, I'm Shiv Gaglani and today on Raise the Line, I'm happy to be joined by Bhavdeep Singh. Bhavdeep is the CEO and co-founder of HealthQuarters, which is developing a model of providing healthcare that combines physicians with other types of providers in one location, with an emphasis on wellness. Prior to that, he was the CEO of Fortis Healthcare one of the largest providers of health care in Asia. He brings many years of experience in the retail sector to his healthcare work. Before we get started, I'd like to thank our advisor and investor at Osmosis, Akhil Paul for the introduction to Bhavdeep. So, Bhavdeep, thanks for taking the time to be with us today.

BHAVDEEP SINGH:Thank you. Thank you. It's a pleasure to be here Shiv and I look forward to this conversation.

SHIV GAGLANI:So, can you start by telling us a bit about your background and then getting your career started in retail?

BHAVDEEP SINGH:Sure. Well, I grew up in White Plains, New York and like many teenagers looking for a part-time job -- I wanted to buy a car, which I did -- but you have to earn your way to do things like that and at the end of high school just starting college, I got a part-time job in a grocery store. Like any mother, mine was horrified that her son was going to work in a supermarket. I assured her, no, no this was just going to be for a few months. I just wanted to do something to stay busy. So I was stocking shelves, unloading trucks, cleaning bathrooms…everything that you do in a grocery store. I didn't actually leave for quite a bit of time. I ended up staying a good 15, 20 years and eventually I became president of the company.

And that was quite a journey because I had the opportunity to do just about everything you can do in retail. I had the good fortune of working with some really good leaders, whose lessons stayed with me until today. So I stayed in retail for a while. I'm originally from India, born there, but I came to the U.S. when I was very young. So I had this vision about working in India and my friends and family said to me, "Why can't you just read about it like everybody else? Why do you have to go there?" But I wanted to go there. I wanted to literally get the feeling and understanding, "What's it like to work there?" 

Well, I learned a couple of things. One is it wasn't that different. Two was that I started teaching myself Hindi because I figured I'd have to learn to speak Hindi otherwise I'd be lost. It was interesting when I got to India and I'd be sitting in meetings in boardrooms -- there'd be 10 people around the table -- and there's one guy speaking Hindi. Me! Everybody else was speaking English because everything is in English. English is a medium and that's how things are done and quite honestly, it just wasn't that different. So I was in India, I ran Reliance Retail which is now one of the largest retailers in the world. We had over a thousand stores and I had the good fortune of running Reliance Retail, launching it and running it, for about three years. 

Shiv, one day I got a call to be a CEO of a healthcare company and I almost hung up on the recruiter. I said, "You’ve got the wrong Singh." Singh is in India what Jones is here, Smith is here, there's just millions of us. And he said, "No, no, no, hold on. The board is looking for somebody who understands multi-unit brand customer/patient care." Quite honestly, I talked to the board for a few months and after a while, I just thought to myself, "Let me just try it. This could be interesting." So I ended up joining Fortis Healthcare and I became the CEO. It was interesting because the initial time period, the initial couple of months, I was completely lost. I had no idea what was going on. Absolutely clueless. I was convinced that I was going to get chucked out in a matter of no time at all. But I'm studious and I spent a lot of time understanding medicine, understanding healthcare. I spent a lot of time talking to doctors and just really understanding what were the pain points in healthcare and how could we improve things?

And what's interesting about Indian health care is that while India lacks investment -- we don't always have the infrastructure we need -- but the clinical work taking place in India is outstanding, as good as any place else in the world. I had the good fortune of doing that for a couple of years. Family tragedy brought me back to the U.S. I went back into retail and I ran U.S. operations for Ahold, which is the parent company for Stop & Shop and Giant. In 2015 healthcare came knocking on my door again, and I went back to India for four years. So I've done a bit of a tangle with healthcare, been in healthcare now for about seven, eight years. I joined Redesign and HealthQuarters in August of 2019, and that's what I've been doing for the last year and a half or so.

It's been interesting. What I've learned, Shiv, at the end of the day is that patient-centric and customer- centric isn't that different. People want to be treated well, they want to be treated with respect. They want to know that you're competent, that you know what you're doing and that you care enough about them and they want a good value proposition. Whatever I've just said now applies just as much when you're buying a house, or paying for a dinner at a restaurant, or going to see a doctor. The metrics, the key prongs of a value proposition aren't that different. And so that's why I've had the good fortunate and kind of be able to go back and forth.

SHIV GAGLANI:That's a really, really interesting background, not only because you've gone between retail and healthcare, but also the U.S. and India and more broadly, Asia. So what are some of the things that you're most proud of during your time at Fortis? That’s a massive healthcare system. Do you mind actually describing it to our audience who may not have heard of it? We do have a global audience, but those in the U.S. may not be as familiar with Fortis as those of our users in Asia, for example.

BHAVDEEP SINGH:Sure. So, first of all, I think as a background, it's helpful to know that for many, many years, healthcare in India was mostly provided through government hospitals. The government hospitals are still there and they do a great job. The private healthcare systems have come up more in the last 20, 25 years. Fortis Healthcare is the second largest health system in India. I think the third or fourth largest in Asia. 3000 beds, a significant tertiary care program, over 30 hospitals. Really doing some outstanding clinical work. At one point we had done some work with multiple hospitals in the U.S. looking at cardiac work. We started tracking clinical outcomes for cardiac work, oncology, liver and renal transplants as well. There are some outstanding physicians there.

I think the only thing that quite honestly a place like India has lacked has been infrastructure and investment. And with that happening over the last five, 10, 15, 20 years, Indian healthcare has come quite a long way. Now, India is still dealing with many challenges from a healthcare perspective. Disease burden of something like dengue, for instance. Dengue happens every year in India, from July/August until about October/November. It's a challenge every year. But at the same time, look at what's happening with COVID. Many, many people predicted a worst-case scenario in terms of what might happen in India. The reality is that India has actually handled this quite well. Initially, the testing process was being criticized because you couldn't get a test, which is no different than what was happening here. If you and I were going to go get a COVID test, if we went in on a Monday, we'd get our test results on Wednesday.

I'm telling you that today in India, you can get a test taken at 11:00 AM and get your result by 6:00, 7:00 PM and they'll come to your house to do it, by the way. They're becoming that efficient at it. I think from a vaccination perspective, I think when it's all said and done, we're going to find that India was able to produce a good deal of a huge amount of quantity of vaccinations, and actually helped not just the citizens in India but beyond that as well. So, I think it's a healthcare market that's changing, evolving quite a bit. I think the brands like Fortis have had a big say in what's happening from a clinical perspective. I think it's just a matter of time between the infrastructure and investment catching up with the intellectual capability that's there. But I would say in the next five to 10 years, you're going to hear about India rivaling the very best clinical platforms in the world.

SHIV GAGLANI:That's incredible. That's something obviously to look forward to, and hopefully we can learn a lot from that experience. Especially, the dream of being able to get same day results and they have at least three, if not four times, as many people to vaccinate as we do in the U.S. 

So, going into your work at HealthQuarters, it had been an online business, but you just opened up a location in New York City which will bring Mount Sinai physicians together with independent practitioners in a variety of specialties, including wellness practitioners. What is the specific problem you're trying to solve? And where do you fit in this pretty fragmented healthcare ecosystem?

BHAVDEEP SINGH:You hit the nail on the head -- it's fragmented. I tell people very often that when we were growing up, any one of us, when we were growing up healthcare for the most part started and ended with either your family doctor -- depending on how old you are, what childhood looked like -- or the primary care physician. You went to the primary care doctor, or you went to the family doctor for just about everything you had -- whether you scraped your knee playing football, or if you had a stomach problem, whatever it was. What's happening is that healthcare is changing and evolving.

If you think about young families today, certainly they have a primary care provider, but they also have the various specialists they see. Then they have their chiropractor, they have their acupuncturist, they have their dermatologist, they have their therapist, they have their nutritionist. There's so many things happening in healthcare today that it's no longer that conventional clinical path that people have taken. And this doesn't in any way shape or form take away from the clinical path. It's just that people are looking for alternative treatments, they're looking for other ways. The scenario that I'm describing quite honestly with COVID is just going to get even further intensified because this whole notion of an underlying condition is something that's very quickly become second nature to all of us in this country.

The idea of comorbidities, underlying health conditions, all the things that are related to that. So I think that you're going to see a big, big focus around wellness. HealthQuarters is, as you rightly said, in New York partnering In a physical space with Mount Sinai. They're just tremendous, tremendous partners. Mount Sinai is our partner and our branding is to the outside, the sign outside is HealthQuarters with Mount Sinai doctors. Mount Sinai brings in primary care physicians, they bring in specialties based on what that area requires, depending on the geography. So we happen to be in NoHo. This is an area of the city where you actually have a lot of very health-conscious people. So of course, medicine is something we're looking at for a market like that. If you're in a different part of the city or a different part of the country it might be a different type of specialty.

We also have other practices under the same roof. As I said, your Mount Sinai primary care, some specialties, you have a wellness platform. We have a chiropractor, we have acupuncture, we have dental which is Invisalign teeth straightening. We have dermatology, we have nutrition, we have mental health. We have all of these things under one roof, so that's on the main level. If you go to the lower level, we have a full physical therapy set up, we have orthopedics, we have physiatry, sports medicine. So the idea, Shiv, is bringing it all under one space. When we did our research, we were thinking about this idea: almost 80% of patients felt that one of the biggest challenges they had was that if you had to go to the doctor, if you had to go to the dentist, if you had to go to the chiropractor, that Monday you were going this place, Friday you we're going someplace else and, oh, by the way, it took three weeks to get an appointment somewhere else.

It would take potentially six weeks, maybe longer, maybe shorter to actually get that done. We're actually saying that when you come into HealthQuarters, you can go see your primary care provider, go see a specialist, get a root canal done, get your physical therapy done, and maybe even get an acupressure treatment while you're having a cup of coffee all under the same roof. And being coordinated in such a way that it's the best use of your time, bringing in some really great providers, great practitioners and giving patients the best possible experience. 

When people ask me, "What's the difference between what you're doing and what somebody else might be doing?" I think the big difference is that typically in a clinical healthcare environment, when somebody comes in, the first question is what's wrong? How can we help you? What's wrong? Shiv, we're asking a different question. We're asking how are you feeling? And the two questions -- they sound identical -- but they're so dramatically different. Not only that, the actions that come out of the response to that question are completely different as well. 

So when you come to HealthQuarters -- apart from having a very COVID friendly space in terms of how seating is set up, how you're welcomed in the space, we have to a great extent a touch-free facility -- we have water, we have coffee, we have comfortable seating. We have some consumer goods that we brought in that are all approved by Mount Sinai, so where they have a clinical stamp of approval. And the idea is to make what otherwise is such a challenging, sometimes painful experience for people – it can be so uncomfortable, you're so vulnerable at that point – into something where people are comfortable, respected, and they walk out saying, "Well, that wasn't so bad. They took care of me and at least I know what I'm doing, and I feel better about it." It's not about making it a great experience because I don't know if you can actually ever do that in a health environment.  

SHIV GAGLANI:Absolutely. It's what you were saying earlier…your retail experience forces you to be very consumer-centric or patient-centric and clearly this is a way to do that, to make it super convenient for the patient. We've had another guest on the podcast, Marcus Osborne, who runs Walmart Health. He talked a lot about omni-channel engagement and the convenience of scheduling and putting everything under one roof, including grocery shopping. What are some of the innovations you all have done besides bringing everyone under one roof? It sounds like a very big logistical challenge to get someone scheduled in with all these different providers in the same day. But for instance, telehealth…can you talk about some of the other things that HealthQuarters offers to be as consumer-centric as possible and to truly differentiate.

BHAVDEEP SINGH:I think there are two or three things. I think that it sounds fairly straightforward and maybe even obvious. One of the things that's happened in our society, Shiv, is that we associate technology with innovation, and very often that's true, very often that's true. But very often we also have technology that's just technology for the sake of having a couple of shiny buttons on the wall. So our first innovation is actually about giving the patient a far superior experience. I was in a doctor's office recently talking to them about what we're doing and how we're doing it. They said, "We don't get any complaints. We've been doing this for 20 years and nobody ever complains. The system works just fine." Part of the reason is it's a bit like when cell calls used to drop after 30 seconds, when we first all had cell phones. Nobody complained about it. We were just happy that we can make cell calls. So the whole idea is to dramatically change the expectations around what happens when you walk in a doctor's office. 

From my retail days I can tell you people spend their money, people shop based on the mindset and the frame of mind they’re in at that time, which is why people always tell you “don't shop when you're hungry.” They always tell you that because that's when you're likely to make some bad decisions on what you're purchasing.

I can tell you every grocery retailer in the country at least has tried selling things like apparel and clothing because it's higher margin. Basic groceries you make 25%. Clothing you can make 40%. So we've all tried to sell clothing. None of us ever succeeded because the reality is when you go to a grocery store to buy milk, juice and eggs, you're not going to buy a pair of jeans, no matter what brand they are, how much they cost, because when you walk out, they're going to be in some grocery store brand bag.

So there's something to be said about mindset. A huge innovation here is to build a mindset around healthcare, build a mindset around wellness, get people to proactively think about how do you take care of your health in this crazy world that we live in? The whole notion of improving the experience is one big thing.

I think the second thing from an innovation perspective, is we're moving forward and we're doing this in phases. We're in 1.0 right now. Essentially we have functional technology in terms of doing basic billing, booking, et cetera, things like that. Where we are headed is being able to provide a telehealth platform for the clinical piece and the wellness piece as well. Having one platform where you can actually talk to multiple providers -- whether it's clinical, whether it's a nutritionist, whether it's a mental health specialist. Being able to actually do that on one common platform in a way that's simple in a way that's easy and in a way that mirrors the experience that the patient would have when they came into the space. And that's really important. Can you actually pick up that experience and mirror it with respect to that? 

And then the final piece is that we're working on multiple engagement platforms to continue to be connected with the patient life cycle across geographies, across medical specialties, across disciplines. Because we are not the provider; we create a platform for providers. It's about linking those providers. Somebody was asking me earlier today, “What attracts health systems to come and partner with you. Why would health systems want to do that?” It's because of the ability to bring together people who look at medicine and health in different ways, from different angles, bring them all on one platform. As one of our partners said, healthcare is a team sport, and that's what really starts to bring it together.

So our innovation, our solution, what are we solving for is the fact that we have this really fragmented environment. You have this scenario where people have just come to accept bad as being acceptable and improving it in a significant, significant manner. And we think there's a huge, huge upside to that.

SHIV GAGLANI:That makes a lot of sense. I want to go back and ask you about the timing. You started working on this in the second half of 2019, the first half of 2020. Obviously COVID hit and it's been almost a year. You open up a physical office in 2020 and maybe even more recently than that in January. What has your personal, and then HealthQuarters experience been navigating the pandemic?

BHAVDEEP SINGH:You know when the pandemic first hit, Shiv, like everybody else I had the deer in headlights kind of look. Like what happens now? What do we do? So a couple of things. One is just our take on the pandemic in terms of what's happening around us. Two what does that mean? So what does that mean for HealthQuarters? And so working backwards, I read somewhere recently that the word immunity is being tossed around and used in the English language today like it's never been used before. What does immunity mean? What does wellness mean? What does underlying conditions mean? We are a wellness platform. You don't come to us when you're sick. If you're sick we would refer you to the hospital, the doctors, some critical care facility. We are a wellness platform.

And what we've realized, and what we firmly believe, is that coming out of COVID, there will be greater awareness of wellness and prevention. I'm sure we've all seen the data that while people are debating the value of masks or not, the reality is that influenza has been at really low this year. We all believe that masks have played a big role in it. And so the idea of people thinking about wellness, the idea of people thinking about prevention, the idea of people thinking about, “What can I do to stay healthier? What can I do to make sure that I don't get sick? What can I do to make sure that I build my immune system? What can I do to make sure that I'm working on these things?” I think that the impact on our brand and our platform is that this is a huge, huge opportunity for us. Health systems are telling us the same thing. 

When COVID was at its high, people were literally terrified of going to the doctor's office, they were terrified to go into the hospital because of the whole idea of infection. We think that if anything, COVID has opened up additional doors for us…that we actually get to be a part of the solution in response to what COVID has presented in terms of the challenges. And today’s COVID tomorrow could be something else. We all know that's possible as well. So the implication for us is that the demand has gone up. The interest has peaked quite substantially. And you're right, we just opened our first location. The number of patients that are coming in…we’re probably about 250% of our profile projections coming out of the gate. Very, very strong. People want to be able to come to the same place and I think especially in a COVID environment, in terms of how we built the facility, the fact that in terms of physical space and how we've made it COVID safe as well, I think it's very attractive to people.

I think more broadly just in terms of COVID, we look at this as anybody else in the health ecosystem is: that this has been a major challenge we were not prepared for. We weren't prepared for it as a community, as a society. I think going forward, I believe that brands like ours, platforms like ours -- and I'm sure Walmart would tell you the same thing -- we actually have an opportunity to help the country, help the communities we're in prepare for this type of thing. Help educate people. Our platform is not strictly about getting people in and charging them and they leave. Our platform is about wellness, it's about educating, it's about partnering, it's about collaborating. So we see COVID as the big challenge that it’s been for all of us, and we see it as a huge opportunity to actually start being a part of the solution, and actually to start to become part of the answer when people look at where things are today.

SHIV GAGLANI:Absolutely. It's certainly been an accelerant for a lot of things that we've been talking about for many decades now, telehealth being the obvious one, but there's certainly a lot of other things. The social determinants of health, health equity, all of those things have come to the forefront as a result of COVID. I know we're coming up on time so I have two other questions for you. The first is given that our audience comprises a lot of current and future health professionals or people who are considering careers in the health professions, what advice would you give to them about meeting the challenges of the COVID pandemic and beyond?

BHAVDEEP SINGH:I've always adopted the position -- especially when I joined healthcare and I was new to healthcare -- I've always adopted the position that as a healthcare administrator my job is to serve those who serve the patients and who serve the guests. I think there's a massive, massive need for healthcare professionals, business professionals, business leaders, administrators, who can actually help the ecosystem. I am so impressed. I've seen this in Asia. I've seen it here. Just the passion, the dedication, the energy that doctors work with, that nurses work with but the ecosystem around it. So if you're in the healthcare profession where you're a doctor, a nurse provider, whatever it might be, good Lord, our job is to support you. Our job is to support you. We work for you. 

I can tell you right now, Shiv, if you said to me before the session started, "Make sure that your phone is off” I'm telling you right now -- and say this with the utmost respect -- if one of our doctors called, I would say, "Excuse me, excuse me. I need to take this call because I work for the doctor.” Why? Because the doctor works with the patient. And I think that there’s a crying need for professionals with that service mentality who will actually play that role, who have that kind of approach, who understand that we're in this for the patient. I learned a long, long time ago in retail and it's exactly the same in healthcare as well: start with the customer. Start with the guest. Start with the patient. Build an ecosystem around them, and part of that ecosystem is professionals, providers, administrators, whose only job, who the only thing they think about is to think about the customer. Think about the patient. Build your processes around it, do it efficiently, do it in a manner that makes sense. A, you'll have a much healthier population, B, you'll have a very profitable business, and C, you'll have an organization that's actually adding value to everybody around you.

SHIV GAGLANI:Excellent advice. Is there anything else that we haven't covered about you, about HealthQuarters or anything else that you wanted to be able to share with our audience?

BHAVDEEP SINGH:I think that healthcare delivery has to change. I think that we've been sitting with this for way too long. When you go to a doctor's office, you sign in, you sit down, read the Highlights magazine that's on the wall or the Reader's Digest or whatever might be. You’re not sure exactly how long you're going to wait. Eventually they call you in. Once you get in the examination room, somebody comes and takes your vitals, temperature, blood pressure, weight, et cetera and then you sit and you wait again, and then you wait. Then eventually the doctor comes in and the doctor spends five, seven, eight minutes with you. That's pretty much what's required. And then the doctor leaves and then you wait again. And then you go out to billing and then you have to make a follow-up appointment. And you're not sure exactly when that's going to be, and then you go home and you call and then you have a bill. 

So you have all these things that happen, Shiv, and what's interesting is the best part of that entire experience is the five to seven minutes with the doctor. Because we have great doctors, who just do an exceptional, exceptional job. It's the rest of the ecosystem, and that's what we're solving for. That's what we're solving for. That's why we're partnering with healthcare systems, that's why we're partnering with doctors because there's nothing that Bhavdeep or HealthQuarters or Shiv is going to do by themself, it's in partnership and collaboration. And I think that healthcare delivery needs to be fixed. We've got great doctors, we just need to give them the right ecosystem to work in.

SHIV GAGLANI:Those are some inspiring words to end on. So Bhavdeep thanks so much for taking the time to be with us today, and more importantly, for the work you've been doing for many years to raise the line and improve health care capacity, both in Asia and in the US.

BHAVDEEP SINGH:Thank you Shiv. My pleasure. Look forward to chatting again soon. Thank you.

SHIV GAGLANI:And with that I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.