URGENT MESSAGE: Zoom+, which operates 28 walk-in clinics in the Pacific Northwest, has long been a technological innovator, launching web registration, scheduling, and telemedicine in its markets. In the past year, ZoomCare has evolved further to create Zoom+, integrating urgent care with insurance, primary care, wellness, specialists, and ancillary services. As Zoom+ refocuses the future of urgent care around the needs of its community, there is much that other urgent care operators can learn in attaining revenue growth from a “maturing” business model.

Alan A. Ayers, MBA, MAcc is Practice Management Editor of JUCM—The Journal of Urgent Care Medicine, a member of the Board of Directors of the Urgent Care Association of America, and Vice President of Strategic Initiatives for Practice Velocity.

The rise of “urgent” care has put healthcare delivery on notice: A new, disruptive model, born of consumer frustration and standing as a viable alternative for minor medical episodes. The outdated access paradigm of long waits for primary care appointment and lengthy, expensive ED visits was under siege, and would give ground to “urgent care,” which promised shorter wait times, extended hours, lower prices, and a retail-like customer service orientation. Over the last decade, the urgent care model thus gained momentum, spread like wildfire, and became the darling of physician entrepreneurs, hospital systems, venture capitalists, and private equity firms looking to cash in on the “next big thing” in healthcare.

But within the still-novel urgent care space, further innovation was occurring. To wit: ZoomCare, a Portland, OR-area urgent care operator, was hard at work reinventing the incumbent model via its comprehensive integration of mobile technology throughout its patient service model. Self-touted as the world’s first “neighborhood clinic and smartphone-based healthcare delivery system,” ZoomCare successfully leveraged its mobile online scheduler feature—an industry first—to take the burgeoning concept of on-demand healthcare to unprecedented levels of brand differentiation and consumer loyalty in the Pacific Northwest.

zoomcare
ZoomCare to Zoom+
In spite of the surging popularity of the various urgent care models, traditional primary care proponents held firm to their longstanding admonition: The urgent care model offered neighborhood convenience, extended hours, and faster service, but it also served to fragment care, hinder preventive medicine, and undermine the concept of a “medical home.” ZoomCare, by way of innovating further, came up with a resounding answer to that criticism:

Zoom+.
The original ZoomCare, based in Hillsboro, OR and founded in 2006 by Drs. David Sanders and Albert DiPiero, had already introduced several on-demand healthcare innovations, including:
• Full-featured, easily navigable, mobile-ready website – listing clinic locations, service offerings, provider rosters, and company press releases
• Online clinician profiles – including full headshot photo, educational credentials, and field of specialty
• Mobile online scheduler – allowing patients to select, from available time slots, the provider they trust, the provider recommended by friends and family, or a provider of the same gender
• Late-night operating hours – in some locations, as late as midnight, a boon for midday workers and students who can’t miss work or school
• In-clinic medication dispensing – helping to provide faster patient relief, improved compliance to care instructions, and fewer prescription errors
• Telemedicine – Skype-based online consultations and evaluations within the State of Oregon
• In-house medical specialists – reducing the need for outside referrals and helping to facilitate longitudinal care relationships
These and other offerings such as naturopathy and mental health services positioned ZoomCare as an urgent care operator that truly understood the power of innovation, as evidenced by its leveraging of web and mobile technology in ways that the on-demand healthcare space hadn’t really seen. The result was a thriving company that garnered rave reviews and popular acceptance in the Portland area.
Then, in May 2015, ZoomCare—largely through an infusion of private equity cash—rebranded/relaunched as Zoom+. Whereas ZoomCare merely built upon the already popular urgent care model, Zoom+ has positioned itself as a comprehensive health system, complete with its own insurance, based on the idea of maximizing health and performance rather than merely treating sickness, or even pursuing wellness. The company’s new motto of Twice. ½. 10 means “Twice the healthcare, at half the cost, with 10 times the delight.” Twice. ½. The “10” represents the de facto mission statement of Zoom+ founders Sanders and DiPiero, who set out with the idea to deliver care that’s affordable, accessible, and delightful through structural and cultural innovation. In sum, Zoom+ is proving that the urgent care model can indeed be the complete, on-demand medical home that PCP proponents have declared impractical.

Zoom+ Notables
Rather than branching out and extending its primary care footprint geographically, Zoom+ opted to go vertical, and built up from its preexisting neighborhood clinic platform by investing in infrastructure, technology, and people. The result is a complete healthcare system designed to be used every day to achieve maximum human performance. The Zoom+ model is highlighted by several innovative features, including:
• Performance Health Insurance
Performance health insurance is the linchpin of the Zoom+ model, as it’s designed to enhance human performance rather than merely treat sickness. The Zoom+ founders encountered inherent friction when attempting to deliver complete care through the status-quo insurance model; hence their development of a new insurance carrier. Built from the ground up, Zoom+ insurance functions like traditional insurance but adds performance-enhancing services that other plans simply aren’t designed to offer.
• Packaged as Zoom+ Plans, this insurance provides total healthcare coverage with unlimited primary, urgent, and specialist services via the following payment tiers:
– Zoom+ Zero – a zero deductible plan
– Zoom+ 100 – patients fully pay for their own care until they reach their maximum deductible, then Zoom+ pays
– Zoom+ Gov – federally mandated, this option includes Gold, Silver, and Bronze plans
• Note that Zoom+ accepts other private insurance plans, but does not take Medicaid or Medicare.
• Zoom+ Mobile – Healthcare that’s 100% accessible by smartphone; Zoom+ members can schedule appointments, access and manage their health records, and book coaching sessions online. After creating an online account on the Zoom+ website, members gain access to a menu portal that allows them to view records, submit questions, see test results, and even speak face-to-face with a provider through their mobile device.
• 28 neighborhood clinics – Zoom+ is comprised of 28 neighborhood clinics located in the Pacific Northwest. With 23 clinics in Portland and five in Seattle, Zoom+ segments its primary, urgent, and specialist care services into individual Zoom+ studios to form a small footprint neighborhood “health campus.”
• Culture fit – Zoom+ understands that for such a radical healthcare model to flourish, it must approach its hiring process with great care in regard to culture fit. Hence, Sanders and DiPiero place a premium on candidates who are flexible, adaptable, and can thrive in a dynamic environment. Zoom+ even goes so far as to eschew the traditional job interview and instead has applicants shadow their potential coworkers throughout a typical workday, even roleplaying actual on-the-job scenarios. This process is deliberate and fluid, and designed to weed out applicants who aren’t a great fit with the Zoom+ brand and ethos.
• What, When, Where – Zoom+ has simplified its scheduling system by replacing its Schedule a Provider feature with an intuitive “What, When, Where” web module. On the Zoom+ homepage, a patient can select the service they want (What), the time they want it (When), and the location they want to receive it (Where) from a simple dropdown menu, accessible through a smart phone or mobile device. Based on the inputs, the system then displays the best matches. Note that for urgent care visits, Zoom+ guarantees a PA/NP visit within 15 minutes, and an ED doctor visit within 30 minutes.
• Zoom+ Gurus – Performance Health Insurance members get access to their very own Zoom+ Guru, or personal health assistant. Through these gurus, Zoom+ members can request help and advice in areas such as scheduling care, benefits disbursement, and the coordination of follow-up care.
• Flat and transparent pricing – There are no surprises in the Zoom+ pricing model, as every service and procedure has a clearly listed price. Deductibles will depend on individual insurance plans for nonmembers.
ZOOM+ Places
Zoom+ Places is the umbrella under which Zoom+ provides its specialist, urgent, and primary care with the help of its partners, including the Oregon Science and Health University. For Performance Health Insurance, most services are free of charge. Zoom+ Places employs a team of MDs, NDs, PAs, and NPs to deliver care through its Zoom+ Advanced, Zoom+ Care, and Zoom+ Primary platforms, which are detailed as follows:
• Zoom+ Advanced
The Zoom+ Advanced platform provides on-demand access to medical specialists through Zoom+ partnerships with OHSU and Portland-area hospital systems.
– Zoom+ Specialist – Offering 100+, same-day, no-wait appointments with board-certified specialists in areas such as:
 Cardiology
 Dermatology
 Endocrinology
 Audiology
 Ear, nose, and throat
 Gastroenterology
 Neurosurgery
 Pulmonary
 Podiatry
 Allergy/asthma
 Neonatology
 Nephrology/dialysis
 Oncology & hematology
 Ophthalmology/optometry
 Pain management
 Rheumatology
 Speech therapy/occupational
 Urology
– With Zoom+ Specialist, there is no need for a referral, and procedures and evaluations can be scheduled via smart phone or mobile device. The approach is designed to move away from one-on-one specialist care to a more collaborative, team-based approach to care and wellness.
– Zoom+ Surgery – Coming soon, on-demand surgery scheduled from a phone or mobile device.
– Zoom+ Hospital – Also coming soon, blue-carpet access to OSHU and Portland-area hospital systems
• Zoom+ Urgent Care
The Zoom+ Urgent Care platform allows for over 500 on-demand, no-wait, injury, illness and wellness visits each day. The platform is broken down as follows:
– Zoom+ Care – The standard urgent care solution, staffed primarily with PAs/NPs, and featuring on-site prescription medication 365 days a year. Basic urgent care for on-demand injury and illness treatments. Also includes immunizations, vaccinations, labs, and physical therapy at each clinic.
– Zoom+ Super – Zoom+ Super was created to bridge the gap between urgent care and the ED. Zoom+ Super treats 80% of cases that would ordinarily result in an emergency room visit, but in a fraction of the time and a tenth of the cost. This dramatic reduction in the use of expensive and unnecessary ED resources helps drive down healthcare costs. Cases like fractures, serious infections, kidney stones, and intense headaches can be treated during a Zoom+ Super visit. The entire visit, lasting around 60 minutes, includes x-ray, CT, and ultrasound, as well as a comfortable Super room complete with TV, Wi-Fi, and space for accompanying family and friends.
– Zoom+ Video – The Zoom+ telemedicine solution, Zoom+ Video enables unlimited, worldwide on-demand video visits for minor illness and injury. With the proliferation of mobile devices with HD video capabilities, Zoom+ Video is a fast, no-hassle option for minor issues such as rashes, ringworm, pink eye, cold sores, etc. Additionally, for nonmembers, the $35 video visit fee is deducted from the final bill should the clinician need to refer the patient to a Zoom+ clinic for in-person treatment. Zoom+ Video is free for Zoom+ members, and most separate insurance plans cover video visits due to the passage of Oregon state law SB144, which requires all video medical visits to be reimbursed by insurance companies.
• Zoom+ Primary
– Zoom+ Primary is the all-inclusive platform for Zoom+ primary care services. The stated mission of Zoom+ primary is to use “food, movement, and medicine” to both attain maximum performance and eliminate most lifestyle diseases, such as heart disease and diabetes. Zoom+ primary is based on three components: cloud-based medical care, Zoom+ Health classes, and health coaching. The platform is divided into five categories of service, with each housed in its own separate studio.
– Zoom+ Brain – Zoom+ Brain not only consists of mental health services, but also includes performance brain training to enhance cognitive function and mental focus. Mental health services include treatments for OCD, anxiety, ADD/ADHD, insomnia, and depression.
– Zoom+ Performance – Zoom+ Performance is focused on athletic performance, creative energy, and mental acuity. On-site naturopaths take assessments of a patient’s baseline cellular, brain, and athletic benchmarks, then devise a commensurate food, movement, and relationships plan to help patients reach their potential. When beginning a Zoom+ Performance program, there is first a comprehensive Baseline Performance Assessment, then subsequent Performance Sessions based on individual need. The initial assessment and follow-up sessions are free for Zoom+ Performance Health Insurance members, while nonmembers are afforded transparent pricing and the option for their insurance plan to cover the fees.
– Zoom+ Prime – Zoom+ Prime was designed to be a radical departure from the status quo of prescription drug and reactive—rather than proactive—care for chronic illness. Zoom+ Prime instead teaches that the modern Western lifestyle and diet is responsible for a majority of chronic illness, and espouses exercise combined with a plant-based diet to prevent and reverse disease. To that end, Zoom+ even offers a program called Prime 90, designed to help members “Get Off Your Meds in 90 Days,” based on plant-based eating, movement, lifestyle coaching, and digital education through video and email support.
– Zoom+ Smile – Described as an “Apple Genius Bar for your teeth,” Zoom+ Smile aims to make the traditional dentist appoint as leisurely an affair as a trip to the coffee shop. Zoom+ Smile features Healthy Clean White 57—an on-demand dental care package that includes an exam, cleaning, and whitening, all in 57 minutes or less, scheduled from a smart phone. And if the dentists encounter a problem, they can refer the patient to the Zoom+ Smile team for a follow-up visit. Every Zoom+ member receives one free annual Healthy Clean White 57 service.
– Zoom+ Kids – The Zoom+ pediatric care system is Zoom+ Kids, and is touted as a program that artfully merges “Montessori and modern pediatrics.” The program delivers complete pediatric care designed to help parents raise healthy, happy kids. Features include a 24/7 parent hotline, personalized parent coaching, and movement studio/demo kitchen where kids and parents can take healthy lifestyle classes together. Zoom+ Kids currently sees over 2,000 kids a month.
• Zoom+ Meds, Labs, and Imaging
Supplementing and supporting the Zoom+ Places platforms, and Zoom+ members toward achieving their health and fitness goals.
– Zoom+ Labs – On-demand labs, although the timetable for results varies depending on the specific type of lab.
– Zoom+ Meds – Zoom+ clinics dispense medications at each of their 28 locations, with home delivery available for Zoom+ members.
– Zoom+ Imaging – On-demand x-rays, CT, and ultrasounds. Results are delivered immediately.

Disrupting and Advancing the Urgent Care Model
Although the urgent care industry has made huge strides toward helping to usher in a better, improved access paradigm, as a whole it’s barely scratched the surface of what’s possible. An urgent care operator such as the former ZoomCare, for instance, was already pushing the proverbial envelope with its widespread integration of mobile-friendly technology throughout its platform. With Zoom+, however, it took the concept of disruption to a new level in the unveiling of the nation’s first complete, on-demand, neighborhood health system. Offering such a comprehensive platform of services and features, coupled with personal health gurus, collaborative care teams, and performance coaches at the ready, Zoom+ undoubtedly can be considered a de facto medical home. Hence, for an innovator like Zoom+, the old PCP admonition about the allure of urgent cares serving to undermine complete care was effectively rendered moot.

Admittedly, the Zoom+ model has the massive advantage of investor capital and its own health insurance, two things many independent urgent cares don’t have access to. The lesson from Zoom+, however, may be more than just plugging in investor capital to overcome obstacles. Rather, it seems to be more about reimagining what’s possible, and devising radical new solutions for old problems. Furthermore, adopting that sort of disruptive, pioneering ethos almost always goes back to culture, as Zoom+ notably seeks out business trendsetters and innovators to fill its nonclinical executive roles. With Sanders and DiPiero at the forefront, Zoom+ and its disruptive care team are attempting to show what a healthcare system can be when it sets out to transform basic urgent care into an inviting human performance campus—all while capturing the high-tech, welcoming vibe of an Apple Genius Bar, or neighborhood Starbucks.

Conclusion
So what’s the takeaway for urgent care operators everywhere? Even when faced with the burden of the status-quo insurance model and limited financial capital, you can still seek ways to push the envelope and reimagine what’s possible with your service model.

As technology prices fall, are you exploring ways to implement telemedicine into your practice model, for example? Does your clinic offer education for patients on how food and movement can be medicine, thereby lessening their reliance on the prescription pad? Can you find a way to implement mobile-friendly health records and self-scheduling through your website? Is it possible for a UC owner-operator association to form its own insurance in the pursuit of human potential, rather than merely treating illness?

The possibilities are numerous; the challenge seems to be taking a hard look at your own status quo, and figuring out novel and innovative ways to advance your practice and your business.

Remember, the urgent care model itself was once considered a novelty. Today, with close to 10,000 clinics nationwide, the industry is still ripe with new possibilities for those willing to imagine.

Portland’s Zoom+: An Integrated Health System Built on Urgent Care

Alan A. Ayers, MBA, MAcc

Chief Executive Officer of Velocity Urgent Care, LLC and is Practice Management Editor of The Journal of Urgent Care Medicine
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