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Zac Ziegler: Rural Oregon is in a health care crisis. Most parts of the state do not have enough appointments with primary care doctors to meet the needs of residents, and for some rural communities, seeing a doctor requires a drive of somewhere between 20 and 60 Minutes. Given the field's current condition, it may sound unusual to hear that there's a company that has opened six clinics in rural locations around Western Oregon in recent years, and it's looking to grow. That's where Orchid Health finds itself today. Its locations range geographically from Oakridge to Sandy. Its CEO and founder, Orion Falvey, joins me in this episode. My first question to him, How did he find himself getting into opening rural healthcare clinics?
Orion Falvey: So about 15 years ago, I was a student at University of Oregon studying social entrepreneurship. It was kind of a newer program at the time in the business school, focused on using business as a force for positive social change in the world. And so that sparked my my personal interests, my values, wanting to be my own boss and make a difference. So, this field of social entrepreneurship interested me, and I was in Eugene for a summer between my junior and senior year, and there's an opportunity to form a U of O team to present at the first Social Business Challenge, which was taking place up in Portland. So at that point, I didn't have really any interest in healthcare, although I had been a patient myself, and I grew up in a rural community up in Alaska- Haines, Alaska, and I knew that there was a lot of need for creating a better system that served the key stakeholders in healthcare. But I didn't envision myself at that time going into healthcare in any way, but my team and I, we met. There were about five or six of us. We met twice, brainstorming what kind of solution did we want to present at this social business challenge. And we brainstormed ideas from like, environmental sustainability, food waste reuse, and then healthcare came up as well as like, this is a major need in our country. And I spoke up and said, I think if we focus on healthcare, let's look at rural communities where people don't have the same access to quality care. And oftentimes- as it was for me- it was a small sea plane or a small flight to Juneau, oftentimes, to get health care.
Ziegler: Okay, so now the question, because obviously it's worked, you're here because you're running a company like this. Now, how did the professors grade you on on this? Do you get to look at them and go, "ha!"
Falvey: A little bit of that. So we, we had an incredible U of O professor as our team sponsor who helped us. And he was Professor Ron Severson. He was such a great support and really encouraged us to to go for something big. He really encouraged us. And then when we went up to Portland and presented at the contest, we got second place.
Ziegler: Is first place an existing company?
Falvey: I don’t think so, yeah. But the thing is, they committed that they would fund the first place idea, some commitment of funding, and our funding required half a million dollars versus the one that won was $10,000 startup. Maybe that's why they got the number one spot. But overall, it was such an incredible experience. I would love to see that happen again. I don't think that social business challenge has happened since that was in 2012 or 2013. Afterwards, we did win a little bit of startup money, and we also got free advising sessions with the Portland State University School of Entrepreneurship as well. That was kind of the next step we took. So after the contest was at the end of the summer, my co-founder and I were both coming back to school, and we had a decision: do we just kind of focus on schoolwork and college life, or do we keep pushing this idea forward and researching more and seeing kind of what the next steps should be?
Ziegler: I'm guessing there's been plenty of towns or communities that have just been beating down your door, like, 'Can we at least pitch you on why your next spot should be here.' How do you choose where to open a clinic? Because, if you could get to everywhere that has this need, you'd be running some like massive conglomerate right now.
Falvey: Yeah, that's a really tough kind of dilemma and tension internally. Is not only kind of where do we go next, but what rate of growth is healthy for Orchid and we feel our organization and myself personally, feel a strong responsibility for our current employees and patients and communities, and we don't want to grow too fast and sacrifice the amount of kind of attention and care we can offer. Oftentimes, when companies grow too fast, they're losing their culture or what kind of what made them special and successful in the first place. And so there's that, also we feel our responsibility to these other communities that don't have local healthcare and to clinicians and caregivers that are serving in large corporate systems that are totally burning them out when we've worked really hard to create a model that really puts clinician and employee well-being as the priority, based on this idea that if our caregivers aren't cared for, how are they going to best care for patients in the communities. And right now we're seeing an epidemic of burnout in healthcare that's kind of over the last five or so years that has been our primary focus at Orchid, working with thought leaders from around the country, really, in terms of well-being and preventing burnout at kind of a structural level. How do we design our organizations to not burn clinicians out so much? Oftentimes, when we see well-being initiatives at play, it's layered on top of a broken system. It's like 'Oh, if everyone just meditates for 10 minutes a day-, which meditation is awesome- but that's not going to fix the structural issues that are causing the burnout. And so I guess going back to your question, to fully answer your question, how do we choose where to go and even kind of what rate to grow at... we first kind of look at data of ZIP code level data, looking at what is the current healthcare ecosystem look like in those communities. Are there other clinicians, other clinics open that are accepting patients? Or was it like the only clinic in town just closed down, leaving 5,000 people without any access to care? And then we also look at for Orchid internally, is this a community that we're going to be able to be successful in based on the geographic location. If we have existing partnerships with, for example, the coordinated care organizations or other community based organizations in the region or the area that we can leverage, is there a clinic facility that's recently shut down that's kind of turn key that would make Orchid's entry into that area easier? We also look at health equity and inequities, and so, for example, if there's a clinic in town but it's not accepting Medicaid patients, OHP, will kind of rate that higher because people that really need care aren't getting it locally.
Ziegler: I'm guessing that that level of growing leads you to hiring those medical professionals you need. Healthcare is one of the few industries that is really going strong in Oregon right now. You're trying to recruit people to areas that- if they're from out of state- they maybe aren't looking to move to these areas. They're moving to the places that get all the attention, like Portland or Bend. How do you entice people to come work for one of your clinics? I'm guessing what you were talking about with putting staff at the center of it and your clinicians at the center of the practice that probably, I'm guessing, has a lot to do.
Falvey: Yeah, and we made that a priority early on, that employee well-being is our number one priority at Orchid, followed by trusting patient relationships, followed by community health outcomes: being able to kind of show the data and actually improve outcomes. And then financial sustainability kind of follows after that, and that feeds back into our ability to take care of our caregivers. So, we call it our well-being first flywheel that starts with employee well-being, and then it kind of feeds into each of those areas. And once we identified this core strategy of putting employee well-being first and building an organization under this flywheel, we've been able to, like I mentioned, achieve some great outcomes and achieve good financial sustainability and reinvest in our company. And our kind of secret sauce for recruiting has been our culture and our work environment and word-of-mouth really,
Ziegler: Let's go to a topic that actually involves how I got to meet you. We were both at an event that was hosted by Oregon's US senators and some other politicians from the area, talking about the impact that Medicaid cuts could have on the medical industry. Medicaid tends to be a little more outsized in rural, small communities. How would the idea of Medicaid getting scaled back affect your company's ability to do what it does?
Falvey: Yeah, we're trying to answer that question, and there's a lot of concern across the board from healthcare stakeholders, including people working in rural communities and at Orchid, we're still a pretty small organization. We're just under 100 employees, and we have six clinics, but in terms of our lobbying power or how active we can be in shaping policy, we haven't taken much of a front seat in the past. But with this large threat and all the changes that are looming, we've been trying to be more active in having conversations with other rural health stakeholders, and writing into our representatives, et cetera. I think it's like about half of our revenue comes from Medicaid at Orchid and a lot of that comes from, like I mentioned, when we are able to keep people out of the hospitals and healthy and that kind of value-based care and payment. And we really would hate to see cuts to that kind of value-based payment, because it's only going to result in greater payments when more people end up in the hospital.
Ziegler: Yeah, if you're if you're nipping the problems in the bud, if you're catching someone with high cholesterol, that's going to do a lot before it turns into a major heart problem or even a stroke.
Falvey: And kind of with these funding threats looming, Orchid is just part of our well- being first operating model is we're very transparent with information across our organization. And so each of our clinic teams knows our financial health and projections and what leads to increased revenues, and so we have this strong local ownership. It's a model called self-management. So our Oakridge team is actually a self-managed clinic where they we believe, like our clinics are our company, not our corporate office, or it's like that's where the work's happening. And oftentimes, most of the time, our local clinics know best what's needed to deliver exceptional local care and be successful financially. And so we've really kind of decentralized our decision-making authority and information. And so each of our clinics really knows what's what's going on and has a big part of the overall success of the company.
Ziegler: There's a lot of possibly negative things that can be talked about with the healthcare. We've hit on some of them... burnout, for people who are working in the industry, concerns about payment from insurance or Medicaid. What are some of the bright sides in healthcare right now? Let's end on what we in the news industry like to call the kicker at the end of the at the end of the newscast here.
Falvey: Yeah, I appreciate that question, and there's so much incredible work happening. One of my favorite parts of my job is visiting clinics, going out to our Fern Ridge clinic right after this to just take people out to lunch, have conversations with what works taking place on the ground and around Oregon and around the country. There's incredible kind of new models and advancements happening in whole person, community-based care, and that includes integrated behavioral health services and oral health services, and making sure there's social services and wrap around care happening. We're seeing more partnerships, more organizations coming together to make sure that we're all working as a team to care for patients' needs. There's work happening in the communities to ensure there's more opportunities for people to come together, and more social interactions, and with loneliness and social isolation being concerns, and we're seeing more and more kind of community events become key opportunities for people to get out of their houses and get healthy, build new friendships and social connection and confidence. We believe that keys to living a healthy life are having social connection, feeling confidence in your ability to kind of carry out and live a healthy life, and then feeling like you have control over the things that happen to you, and there's a movement happening to shift how we approach healthcare, from what's the matter with you to what matters to you. It's like an interesting shift in kind of, if you come in to see your doctor, instead of it just being 'What's the matter with you, let's quickly write a prescription,' solve the issue to what matters to you. Like, what do you want to achieve? Why are you here? What does your community look like? What are your strengths?
Ziegler: What's the thing in the quality of life that you need to make sure you keep going?
Falvey: Yeah, and let's focus on that so there's real advancements happening in kind of whole person care, relationship-based care models. It's great to see.
Ziegler: Well, thanks for taking some time out of your day and coming in to chat with me.
Falvey: Yeah, thank you for having me. It's been a pleasure.
This transcript has been edited for clarity.
