The Future Of Primary Care, with Danish Nagda

This video provides an in-depth exploration of the future of primary care, featuring Danish Nagda, founder of Rezilient. Nagda details his company's unique solution—a hybrid "Cloud Clinic" model designed to combat physician burnout, address systemic failures in fee-for-service healthcare, and leverage data and technology to improve patient outcomes. The central thesis is that the current healthcare system is fundamentally broken due to misaligned financial incentives, fragmentation of care, and an outdated analog approach to the doctor-patient interaction.

Rezilient’s model is built on a direct primary care (DPC) subscription framework for self-funded employers, replacing the traditional fee-for-service structure. Patients visit physical "Cloud Clinics" staffed by paramedics (called "presenters"), while the physician interacts remotely via screen. Critically, all diagnostic tools (otoscopes, EKGs, stethoscopes, ultrasound) are connected and live-stream data directly to the remote physician, digitizing the physical exam. This approach unlocks the doctor from a single location, allowing one physician to serve multiple clinics and providing same-day access across a growing network. Nagda emphasizes that this model restores the doctor's time and humanity by removing the need for constant note-taking and administrative burden, allowing them to focus on building trust and accountability with the patient.

The progression of Rezilient involves starting with advanced primary care and then vertically integrating specialty services—a strategy aimed at building a "digital Kaiser." The company is actively expanding into high-cost areas like GI, MSK, Women's Health (maternal care), Psychiatry (substance abuse), and medical weight loss (GLP-1 management). By integrating these services into the primary care setting (e.g., adding a dermatoscope for a remote dermatologist), Rezilient solves the "point solution problem" that plagues employers who struggle with managing 20+ disparate digital health apps. This centralization, combined with the subscription model, allows Rezilient to demonstrate a rapid return on investment (ROI) for employers, often within 12 months, by reducing downstream utilization of expensive, fee-for-service specialists.

A significant long-term vision discussed is the application of artificial intelligence. By digitizing every aspect of the patient interaction—from the physical exam data (eardrum vascularity, heart sounds) to the patient’s personal health data (wearables, habits)—Rezilient is creating a massive, standardized dataset. Nagda posits that this data continuum can be fed into a foundational AI model, creating a "co-pilot" that optimizes individual health, detects anomalies earlier than a human physician could, and provides hyper-specific, evidence-based recommendations (e.g., adjusting protein intake based on lab levels). This shift promises to restore the physician's role to that of an accountability partner and behavioral change agent, supported by AI-driven insights, moving healthcare from reactive treatment to proactive optimization.

Key Takeaways: • Digitization of the Physical Exam is Foundational: Rezilient's "Cloud Clinic" model digitizes the analog doctor-patient interaction by connecting all diagnostic tools (otoscope, EKG, ultrasound) and live-streaming data to a remote physician. This creates a permanent, accessible digital asset (e.g., a recording of a heart murmur or an eardrum image) for longitudinal care and comparison. • Data-Driven ROI for Employers: The subscription-based model targets self-funded employers and must demonstrate immediate financial value. Rezilient achieves this by integrating specialty care, which provides instant savings by avoiding unnecessary outside referrals (e.g., preventing unnecessary biopsies by having a remote dermatologist review a mole). • Significant Financial Return: For employers achieving 20-30% employee utilization, the model delivers an ROI of approximately 3.25x ($3.25 saved for every dollar spent) within 12 months, making it an attractive alternative to the escalating costs of the traditional system. • Vertical Integration Solves Complexity: By expanding beyond primary care into high-cost specialties (GI, MSK, Women's Health, Psychiatry, GLP-1 management), Rezilient addresses the "point solution fatigue" experienced by employers who struggle to manage and integrate numerous separate digital health apps. • AI as the Future Co-Pilot: The ultimate goal is to leverage the digitized clinical and personal health data to train a foundational AI model. This model will serve as a co-pilot for physicians, offering optimized health recommendations and detecting subtle anomalies (e.g., sleep apnea detection from retina scans) that human doctors cannot perceive. • Restoring Physician Humanity: By removing the administrative burden of note-taking and documentation (which AI can handle), the model allows physicians to dedicate their time to building trust, providing accountability, and engaging in root cause medicine (like nutrition and lifestyle modifications), thereby combating moral injury and burnout. • The Need for Transparency: Building trust requires complete transparency. Patients should have immediate access to all their records, imaging, device data, and understand the tasks being performed by their care team, mirroring expectations in other modern industries. • Focus on Root Cause Medicine: The current fee-for-service system incentivizes complex procedures (surgery) over prevention and lifestyle changes. A capitated, subscription model allows providers to focus on nutrition, exercise, and preventative care, which are often overlooked in medical training because they do not generate revenue. • Scaling Through Technology: Unlike traditional regional healthcare systems, Rezilient's technology-first approach allows for rapid national scaling, as the same remote doctor can serve multiple clinics across different geographies, aiming for 10 million covered lives.

Key Concepts:

• Cloud Clinic: A physical location where patients receive care from a remote physician via screen, with a paramedic/presenter facilitating the physical exam using connected, digitized diagnostic tools.
• Direct Primary Care (DPC): A subscription-based healthcare model where employers pay a fixed monthly fee per employee, covering comprehensive primary care services, eliminating co-pays and fee-for-service incentives.
• Moral Injury: The psychological distress experienced by healthcare providers when they are forced to participate in a system that compromises their values and prevents them from providing high-quality patient care (often due to administrative burden and misaligned incentives).
• Digital Kaiser: The concept of building a vertically integrated, comprehensive healthcare system (like Kaiser Permanente) but digitally enabled, where all specialties are centralized and accessible through the same technological spine.