Carbon Health's CMO on the company's expansion plans and where it's going next

Steven Loeb · January 17, 2020 · Short URL:

The company just launched its second SoCal location, and has plans to expand into specialty areas

Earlier this week, Carbon Health revealed that it had opened its second clinic in Southern California, located in Pasadena, marking the company's 14th location overall.

Carbon Health is a company that combines virtual and in-person care, offering patients an app through which they can manage appointments, billing, pharmacy refills and lab results from their phone, while also providing them with access to primary and urgent care clinics, which don't require a membership or fees from the patient. 

Along with the new clinic, Carbon Health also made some announcements regarding it's upcoming plans, including wanting to have 100 clinics across the country by next year, while also launching specialty offerings in pediatrics, mental health, and women’s health services.

Dr. Sujal Mandavia, Chief Medical Officer at Carbon Health, spoke to VatorNews about the new clinic, where the company wants to expand to next and how those new areas of focus will benefit Carbon's patients.

VatorNews: Tell me about the new Pasadena clinic. What’s unique about it compared to your other clinics?

Dr. Sujal Mandavia: If you don’t mind, I want to tell you just a little bit about my background because I think it might give you context on why I’m here at Carbon, and what pulled me here.

I’m an emergency physician, and I’m still in practice a little bit, but most of what I’ve been doing, probably for the last like 12 to 15 years, is healthcare administration. I come from an organization that was in the hospital-based world of healthcare delivery, and what really drew me towards Carbon was having a really broad perspective on healthcare delivery. I worked with probably about 120 hospitals and about 2,000 providers, so I got to see a lot of different ways healthcare was being delivered, but I’ll be honest with you, I didn’t necessarily see the way I thought it should be delivered. A lot of that has to do with the constraints of how hospital-based care, or traditional healthcare delivery systems, are built; they were never really built around the patient, they were built more around themselves, or sometimes around the doctor, and the patient ended up having to navigate through that, whether physically or more philosophically, and advocate for their own care. So, what’s been really refreshing is that Carbon is truly built from the ground up, not only around the patient, but also with the provider in mind. Our mission is to increase access to care. 

Now I’m going to get to the Pasadena clinic: what’s significant about the Pasadena clinic is that what we’ve been able to do, reliably and consistently, is deliver that type of care that we think should be the standard, both from an accessibility standpoint, meaning convenience, and also quality-wise, and service-level. The experience you have when you go to the doctor shouldn’t be what most of us get. You’re starting out sick, or at least not feeling well, or something’s not going well in your day, and you don’t have to rub salt in the wound by making the whole care experience difficult to navigate or to get through. We’ve done that really well in Northern California, we’ve been doing it in Nevada, now we’re branching out into a whole new market where we haven't had that same footing. So, this is our chance to show that we can do this in a market where we didn't have a presence before and we can bring the best practice we think we’ve developed and we can leverage the technology we know we’ve developed, and use it to deliver the same type of consistency in a whole new market. 

VN: Why is Southern California a fruitful area for Carbon to expand to? What opportunities do you see in that section of the country?

SM: I'm from Southern California, I’m based there, so I know the market pretty well. It’s not that’s any shortage of what you’d call access points here; it’s a dense marketplace with people, and there are lots of hospitals around, there's a lot of clinics, but there are very few that can deliver the type of service and convenience that we’re aiming to give. What we’re doing is not just about our urgent care or our primary care service, but the fact that we’re really looking to build an ecosystem that’s already expanding. We’re adding pediatrics shortly, we’re adding mental health to our platform, we’re going to have women’s health. We want to take the same type of ecosystem we’re developing and enrich it by increasing the service offerings, so that we can basically take the healthcare to where people are already going. What I mean by that is, either where you’re already going because we happen to be in a more convenient retail location that doesn’t require you taking a day off from work and taking a trip to an industrial part of town, where you wouldn’t have been going otherwise. Now, all of the sudden you can get your healthcare while you’re going somewhere you might have already been heading towards anyway. Or it’s because we’re taking it to where you are virtually. Almost all of my patients are Googling before they come to see me as a physician, and now we have an opportunity to live within that same environment and experience to be able to initiate care, and sometimes even complete care. Some of the things we can do in terms of increasing the scope of what we do in a virtual way are based around the premise of trying to improve the accessibility of getting healthcare  to completion. 

Here’s how I would say that differs from a lot of telemedicine solutions that are out there right now: most of them are delivering healthcare at a very narrow scope. That’s not necessarily their fault, it’s just there’s limitations on both technology and diagnostics. Also, many of them only have a virtual world that they deliver from, so they don't have the benefit of having clinics where they can coordinate the care, or complete the care, that they might have initiated in a virtual fashion. So, a lot of them, you’ll end up spending time with that telemedicine provider, only to discover after 45 minutes that they can't actually resolve what you came there for, and you basically end up having to start all over again somewhere else. That’s frustrating for both sides, to be honest, and it’s not fulfilling for the providers. Because of how we approach care, and because of our technology platform and our intake process, none of the work you might have done in our virtual world is ever lost.  

VN: Is there a different mindset in terms of the people in Northern and Southern California? Do they approach care differently? 

SM: We’re very sensitive to any neighborhood we are setting up a clinic within. As an example, Echo Park and Pasadena have two very different cultural feels to them. They’re very local, meaning that Pasadena is very proud to be Pasadena, Echo Park is very proud to be Echo Park, and I think you could say that for almost every community. So, we’re sensitive to that.

I find that, on a patient level, when people are seeking healthcare, it creates a more agnostic state. When you’re not feeling well, we’re all probably more similar than different, so I think from a patient experience standpoint, and the services and how we provide that service, I don't necessarily see those differences. We want to be a part of that community, and we realize to do that we have to truly integrate with that community. We make sure we’re offering services in a way that fits with both the diversity within that community, as well as what they expect.

VN: Give me some examples. We’re talking about Pasadena, so what are some of the ways that you’ve tried to integrate into that community?

SM: It’s really in its infancy, because we literally just opened the doors of the clinic yesterday, but what we’re doing is a lot of outreach to the community, doing a lot of active listening, so we can understand if there are special program needs that they might want.  

It’s probably easier to give you an example or what we’ve done already in other clinics. For example, in San Francisco we recognized that our community had a need and request for making sure that we could offer PrEP, and it’s something we actually offer in all of our clinics now, but it was initiated out of listening to our community members and having them say, ‘We love your clinic and we’d love it if we could get this service within your clinic.’ So, it’s a program we set up, and we made sure that we’re doing it in a quality way, but also in a way that removed some of the friction of accessing it, making sure we had rapid HIV tests and making sure that we could offer the laboratory work and the services that support being able to prescribe the medications so that now they had a reliable access point for that. 

VN: Carbon plans to expand pretty rapidly: you want to have 100 clinics around the country by next year. Where do you plan to go to next? What are you looking for in the next communities that you’re going to be expanding to?

SM: Some of it will be informed by our awareness of what need is out there. Quite honestly, we still have a lot of expansion and work to do even within California. Even though, when you look at California, as an absolute number it has a lot of access points, or urgent care or primary care clinics, the reality is, when you look at it on a per capita basis, we’re still behind. So, there’s still a need to develop this type of access, even within California.

We think it’s important, just as we saw a difference between operating in Northern California versus Southern California, we think it’s important not only to be aligned with our mission of being able to do this across the nation, and that is our goal, to be a nationwide network and healthcare delivery system, but also be able to do it in different markets. New York is different from Los Angeles which is different than San Francisco, and we have to be able to demonstrate that we can deliver the same type of experience and service we’re used to delivering. So, we’re looking at New York, New Jersey, Dallas; we want to not just go to these larger, metropolitan, highly dense, urban areas, but also places like Kansas City, places where we believe that there’s still a fundamental gap in this type of access point within healthcare. We’re actively looking at those markets. We can’t go everywhere at once, so that’s just a selection of some of the first places that we’ve identified as the first markets we’re going to be expanding into. 

VN: You mentioned you’ll be going into areas like pediatrics, mental health, and women’s health services. Are those going to be specialized clinics, like are you going to have a clinic just for mental health, or are you talking about integrating those services into your existing clinics?

SM: Our ultimate goal is to be able to offer those things no matter where you are, and no matter where you visit with Carbon. What we are doing right now is we’re choosing certain clinics to develop these service offerings in and we’re also, at the same time, really trying to make sure we’re pushing into the virtual world as much as possible with these offerings. The virtual world will allow us to create greater speed to access than if we just try to rely on making sure we were doing it on a clinic by clinic basis.

VN: Why those areas the ones you want to start with? What are the opportunities you see in pediatrics, mental health, and women’s health services that will be beneficial for Carbon and your patients?

SM: All of our decisions are primarily made around what we think is best, as well as what we hear our customers asking for in their comments. So, it’s really informed by the patients themselves.

Certainly, as a practicing physician, I will tell you that, if I were to look at the lack of access and rank those, I definitely think that mental health is the clear number one. There’s opportunity for increased awareness from ourselves as providers, and that’s something we are doing within Carbon: we’re educating all of our providers in looking for where the opportunities are. In defense of healthcare providers, it’s not necessarily what we’ve all been trained robustly on doing, so there’s a bit of catch up that’s needed to recognize where we can offer more support and help. A lot of us have been treating our patients and not even realizing that there’s more we can do, so I’m excited about being able to offer that in a way where now, not can we only educate you more in depth in what these mental health issues are and how they manifest, but, at the same time, give you a tool in your tool belt that allows us to increase access to care. This is particularly an area where virtual will be really important because it provides, not only access, but also a convenience and an intimacy that is difficult to scale in the same way if we were only offering that one a clinic by clinic basis. So, I’m excited about our mental health offerings. 

With pediatrics, we’re looking not only to grow primary pediatric care, i.e. ‘you’re going to trust your care with a Carbon pediatrician.’ Being a parent myself and being a physician, there’s a lot of unmet need and, quite honestly, even anxiety and uncertainty when you’re raising small kids who are so dynamic because they’re changing almost on a week by week basis, and it’s hard to sometimes know, ‘is this normal or not?’ Just having access to our pediatric expertise, and being able to give reassurance, if not guidance and treatment, will be welcomed by our patients.  

Women’s health, that’s another area that doesn't always get the same type of attention or resources. It deserves to have the same type of access, the same type of trusted expertise and accessibility. What I’m afraid happens today is that some women are not actually paying attention to their health because the system has not made it easy to do that. So, that’s what’s driving us to those particular areas to start with. 

VN: What other areas where you’ve seen a similar lack of access and which you eventually want to expand into as well?

SM: Honestly, probably every specialty of care we could put on that list, and not because there’s not existing access, but the consistency and accessibility still has an opportunity. It’s unfortunately too difficult to be able to get to sometimes the specialty care you need and to get that next available appointment, which sometimes is like three months away, so it’s a matter of a lack of capacity. Sometimes you have to compromise because it’s like, ‘I can wait three months to see this provider I really want to see, but I’m going to take this appointment that’s only a month away but it’s not really the provider I want to see.’ Too often our patients are put in that situation and I always tell people, ‘I think it’s the patient’s turn to be first in healthcare because it hasn't been up until now.’ So, I’d love for our patients to be able to get the choices they deserve that I don’t think are readily available to them now. That’s true for almost every aspect of care.  

VN: Is there anything else I should know about the new clinic or the expansion or the new areas you’re going into?

SM: Hopefully you got a sense of where we’re coming from and what drives us. I’ve been doing healthcare for a long time, I still love being a doctor, and I will tell you that many of the situations I’ve been practicing in during that 25 years have not made it easy to love being a doctor. Every time I get to see patients within Carbon, it makes me a better doctor because we’re leveraging our technology to make things better for the patients and the physicians and providers in a way that makes everyone’s day just a little bit better. 

Can I tell you how rewarding it is when you get to take care of somebody, help them with a problem, and everybody actually had a good experience? That builds a momentum that is just incredible that I don't think exists as a default in healthcare delivery. I’m sure you’ve heard of the burnout that’s occurring in the healthcare industry; it’s not because it’s hard work, but I think it’s more often that they’re in a system where they want to do the right things, they want to deliver great care and a great experience, but the system doesn't always make that easy, so the cost has to come from somewhere. Sometimes, even when maintaining that smile and you try to maintain engagement with the patient, sometimes it comes at a cost to yourself and you go home and you don't feel great about your day, but you at least feel a little better knowing that you helped some people. Everybody can win. Everybody should be able to win. 

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