November 4, 2025 • 25 mins
What if the clinic your team actually uses is the one parked outside the office? We sit down with Chris Yarn, CEO of Walk On Clinic, to unpack why on-site and mobile primary care crush near-site options on utilization, trust, and measurable savings—often with fewer clinic days. The story begins with a simple truth: convenience wins. When clinicians are visible and familiar, employees engage more, follow through on care, and keep the relationship going virtually with the same people they see in person.
We break down a standout case: a near-site clinic three days a week just over a mile away versus a mobile clinic two days a week on-site. After ten months and 800 employees, 515 chose on-site, only 15 went near-site. That utilization shift powers tangible outcomes: lower urgent care and ER visits, time savings measured against payroll, and pharmacy strategies that can offset clinic costs. Chris explains how zero-dollar ghost claims at Medicare rates create conservative ROI models, and how plan-aligned referrals remove the “we don’t take your insurance” friction that derails self-funded plans.
You’ll hear a practical framework for choosing the right model: headcount thresholds, geographic routing for distributed workforces, and which plan designs benefit most. We also explore how a broker’s mindset shaped Walk On Clinic’s approach—quarterbacking imaging, specialty, and pharmacy decisions so plan assets get used. Along the way, Chris shares lessons on branding and visibility, from creative content to educating the market on why hybrid care—on-site plus virtual continuity—outperforms stand-alone telemedicine.
If you’re a benefits leader, broker, or operator hunting for real-world ROI and a better member experience, this conversation is a playbook for turning primary care into the true front door of the plan. Subscribe, share with a colleague, and leave a review with your biggest question about building on-site access at scale.
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
David Saltzman (00:00):
What happens when an insurance broker stops
just advising clients onhealthcare strategy and starts
building the clinic model hewishes he could have sold them
years ago?
We'll find out on this episodeof Shift Shapers.
Announcer (00:16):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift ShapersPodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industry'sshifts.
And now, here's your host,David Saltzman.
David Saltzman (00:36):
And to help us answer that question, we've
invited Chris Yarn, who is CEOof Walk On Clinic.
Welcome, Chris.
Chris Yarn (00:43):
Hey David, how are you doing?
David Saltzman (00:45):
I'm doing well.
Thanks for being here andsharing some of your expertise
with our audience.
We appreciate you taking thetime.
Chris Yarn (00:51):
Absolutely.
David Saltzman (00:52):
So let's level set.
How do you define hybrid careor mobile plus on-site clinic
models?
And do they represent thefuture of primary care access
for employer groups?
Chris Yarn (01:04):
Yeah, I uh I believe so.
I think that we've seen the bigboom of direct primary care
across the nation.
I think there's a lot of momand pop direct primary care
practices that are doing goodwork.
Um, but what we've discoveredis that patient behaviors are
not immune to the retail therapybuying behaviors that exist in
(01:27):
the marketplace now, meaning youlook at the amount of primary
care practices shutting down,being replaced by urgent care
centers across the nation andless access.
Part of the reason why is thebrick and mortar facilities are
not being utilized.
So when you put those sameclinics and those same providers
of medicine on site, all of asudden you get utilization.
(01:48):
And it's just the conveniencefactor.
So I just firmly believe themore convenient you make primary
care, the more it actually getsused.
And that's really what the aimis of most of these self-funded
employer groups.
David Saltzman (02:01):
So what are the main barriers, whether
technological, regulatory,cultural, all of the above, to
getting really good adoption?
Chris Yarn (02:09):
Yeah, I think I think the first one is again
convenience.
The best kind of story I cantell or example is we have a
client in Orlando, a boatmanufacturer, 800 employees.
We started with them a yearago, and we gave them access to
a near-site clinic, brick andmortar facility, 1.3 miles away
from headquarters, three days aweek.
(02:29):
And then we gave them accesson-site two days a week in one
of our mobile clinics at thesame company, same population
employees.
At the end of a 10-month periodout of 800 employees, we had
530 patients that were theprimary care home for, but only
15 being 1.5, were using thebrick and mortar facility nearby
(02:51):
versus the other 515 using theon-site clinic, even though
there was less access to thatclinic being two days a week
versus a near site three days aweek.
So I think that's really thelesson.
I think anybody in directprimary care and the near site
clinic industry or even HMOmodels, all these models that
are out there, brick and mortar,what the aim should be is how
(03:14):
do we connect to the patient andthen can in the most convenient
form possible and then continuethat relationship through the
cell phone.
David Saltzman (03:22):
Do you attribute that to just removing friction?
We've seen this in a lot ofother consumer fields where
people will partake if it's easyand they don't have to get in
the car or drive someplace orwhatever.
Look at Amazon and all thestuff that they sell.
Is that part of the what youthink drove that trend?
Chris Yarn (03:39):
Yeah, I think I think the convenience has a lot
to do with it.
I think so much more of it isabout in a world where
everybody's trying to connecthuman beings to chat bots or AI
tools and all that stuff.
What we really do is we connectthe patients and employees of
companies to human beings theyknow and that know them.
(04:02):
And then we use the sametechnology not to connect people
to chatbots, HIPASCURE portalsand chat and text message
capabilities.
Uh we use the same technologyto connect them, but to the
people that they see weekly orsee monthly, depending on how
frequent a flyer the patient isto the clinic.
And that's the key.
(04:23):
It's keeping the you're it's alot better telemedicine
experience when you're talkingto somebody that's also put
their hands on you and felt yourthroat, knows your family
history.
It's it's common sense.
Would you rather talk tosomebody on a virtual care
system that you don't know?
Or would you rather use avirtual care system with
somebody that you do?
I think, and sorry to keeprambling here, but Dave Chase
(04:47):
shared a great post about a yearago about Forward.
These guys were puttingtelemed, it's not just the
convenience, right?
So that's part of it.
But forward was putting thesetelemed pods on-site at employer
groups.
I think they had half a billionin funding or 400 million in
funding or something like that.
They went bankrupt.
Why?
These amazing telemed pods thathad all these measurement
(05:09):
tools, and you're talking with adoctor because you don't know
the person.
And then some people were, oh,they were too early.
It's like they weren't tooearly.
It's just it's human behavior.
But do you want to talk tosomebody you know or a stranger?
David Saltzman (05:22):
It's that speaking of human.
I'm sorry.
Speaking of human behavior, howdid your background as an agent
inform your approach todesigning clinic services and
plan design?
Chris Yarn (05:32):
Yeah, I I started my career property casualty,
Liberty Mutual.
First account I ever worked wasRosen Hotels.
Read the Rosen EmployeeHandbook, saw the on-site clinic
model there, and I saw why itworked for their 6,000
employees.
They have a lot of otherstrategic advantages, a lot of
migrant workers, and I don'tknow if they're on work visas or
whatever, but when you'retaking folks from another
(05:54):
country and then they'reemployed at a hotel, and then
you show them where to accesshealthcare, of course, you're
going to have high utilizationcompared to somebody that's
grown up in the United Statesand has touched the healthcare
systems and all the differentoptions.
But I saw that and it stayedwith me throughout my insurance
career, right?
What I didn't see change afterthe Affordable Care Act is
(06:17):
anyone taking that model, thaton-site clinic model, and
bringing it down market tosmaller employer groups.
More and more employer groupswere going self-funded.
They don't have retail space tobuild out a clinic, or they
can't afford to pay some of ourlarger competitors like Marathon
to build out a brick and mortarfacility.
And so then they do a sharedsite, which is really just a
(06:40):
reinvention of the HMO model.
If you're sharing a clinic withmultiple employers, that's
what's your access to care.
We so we look at it, and I saidthat as a consultant, I want
the win is when employees in anemployer group have exclusive
access on their time to providerthat's exclusive to them with
(07:01):
their time, not shared withother employers.
You're not giving up wait timesto other companies or
appointment slots to othercompanies.
It's like when the clinic isthere, it's there for your
employees.
David Saltzman (07:13):
So employer groups, as you very well know,
come in all shapes and sizes.
How do you decide what model isbest for them, whether it's a
permanent on-site clinic or anear site shared clinic or even
a mobile and fractional clinicpresence?
Yeah.
Chris Yarn (07:27):
It's got a lot to do with what the claims data looks
like.
How many employees are on theplan?
Um, what problems are theorganization trying to solve?
The on-site clinic industry 50,60 years ago, was started in
the manufacturing world just asa need and a function to reduce
reduce employee absenteeism,right?
And keep people on themanufacturing lines.
(07:47):
So they they saw a lot ofutility in the manufacturing
space of just the savings on alost revenue or lost
productivity size, keepingemployees healthy and keeping
them on the job line, or ifthey're gone for 15, 20 minutes.
So there's a lot of factorsthat go into that.
But the quick answer is dependson the number of employees of
(08:07):
an organization, depends on thetype of industries, number of
locations a company might have,what their geographic spread is,
and then also what type ofhealth plan they're on.
It obviously makes a lot moresense for a self-funded employer
when it's their money beingspent outside of the healthcare
system to try and contain thatand do nurse navigation on site
(08:30):
and have a quarterback on yourteam throwing the passes where
you need them to go within thehealth plan.
Because if you don't have thatand you're in a self-funded
health plan strategy, it's likeyou're walking, you're walking
into the casino in a riggedgame.
You're going to lose.
You can get lucky and have acouple of good years, but if you
don't have anybody directingtraffic in a self-funded health
(08:51):
plan of fill this prescriptionhere instead of there, go get
your imaging at green imaginginstead of the hospital system,
eliminating urgent care access,which is owned by the local
hospital system, you you'regoing you're going to experience
a lot of pain and plan noisewithout the primary care at the
(09:12):
forefront of the self-fundedhealth plan design.
David Saltzman (09:15):
You mentioned geographic spread.
So here an interesting questioncomes up.
How do you manage logistics andROI and multi-location or
distributed employer footprints?
How do you do that?
Chris Yarn (09:24):
Yeah, we have at Walk On Clinic, we have near
site facilities.
We can build on-sitefacilities.
I'm actually going to be doingone, I think, at the beginning
of this year at an employergroup.
But we use mobile clinics forcompanies that are
geographically dispersed, and itworks really well because you
put the clinic on site, all theemployees see it when they're
going in and out of the buildingat work every day.
(09:45):
It's not there, some peoplehave on-site clinics and it's in
some break room somewhere downa hall.
A lot of buildings are big, outof sight, out of mind.
So it's actually an advantageto have the clinic outside, a
little more privacy, but it'salways seen by every employee of
the company.
So it's in their awarenesssubconsciously on their as they
(10:06):
pull into the parking lot, or ifthey're dropped off by a bus at
work.
It's uh it's really amazingwhat that does.
But you you have to measure howmany employees at each
geographic location, right?
So some locations might makemore sense to visit once a
quarter, once every 90 days, ifthere's not a lot of employees
there.
Our kind of number is 300, 250to 300.
(10:28):
If you're a self-fundedemployer group with 250 to 300
employees, then it starts tomake sense to put a clinic on
site one, maybe two days a week.
We've seen positive return oninvestment at two days a week,
putting the clinics on site.
And then of course they haveaccess all the other days a
week, depending on what virtualcare option they buy, to use our
(10:49):
technology to connect to thesame providers the rest of the
week when the clinic's notthere.
David Saltzman (10:58):
So what metrics or early indicators that can
reliably predict whether aclinic deployment will succeed?
Is it just utilization, costsavings, employee acceptance?
And how do you balance all ofthose?
Chris Yarn (11:10):
Yeah, I think we do a really good job measuring.
I think we do a better job thananybody in the industry,
honestly, of measuring return oninvestment.
And that's because we're a kindof a broker and a
consultant-built on-site clinic,direct primary care company.
I think most people are comingfrom a background of medicine,
(11:31):
not insurance.
So they don't really understandthe metrics you have to measure
to be able to prove return oninvestment.
So what we do is we code everyCPT code in the clinic.
So we still use the EHR systemsand we provide and we report
zero dollar ghost claims to thecarriers, whether it's TPA or
Abuca, Blue Cross United CignaAetna, doesn't matter.
(11:53):
We report $0 ghost claims, sowe have a mechanism at which to
track at a Medicare rate whatwould all of these claims have
cost in the marketplace?
What would you have paid in aperfect world that only builds
you 100% of Medicare?
So we know that's not the case,but what we do is we provide
the most conservative estimatepossible.
And then we also take payrollnumbers and we calculate like a
(12:17):
four-hour or two hour, everyorganization's different.
What's the value of lost time?
Typically, most employers arecomfortable saying a lot of
people take a whole day off workjust to playing around a
doctor's visit, depending onwhat the issue is.
So they do four hours ofwhatever the payroll number is,
and then we provide that in ourreporting system of hey, here's
what the here's what the datasays, right?
(12:38):
And then on other groups, wealso can measure how much
emergency room utilization goesdown.
If we have other plug-in plancomponents like a green imaging,
like a pharmacy solution, wecan show a direct dollar ROI.
It's like here's how manypatients we moved from getting
their prescriptions filled atCVS or Walgreens to the mail
(13:00):
order international solution.
So here's your we we can findvery often a way to pay for the
clinic just on pharmacy spend,as long as we can take over
those patients and find whothose patients are.
Even moving certain patients atincome levels on the 340B
program, nonprofit pharmaciesfor medications like HIV and
(13:21):
other things that are, I don'twant to say plan killers, but
it's it used to be pharmacy was15% of plan spend and 20 to 25%
of plan spend now.
So it's a that's some of theeasy, low-hanging fruit that a
lot of companies go after.
But this is where I questionthe industry at whole, unless
you're working with an on-siteclinic company that understands
(13:44):
on the consultant and broker andhealth plan side everything I
just explained, you just haveanother doctor charging a
membership model that reallycannot help your individual
employer group quarterbackproperly all the different plan
design solutions for everydifferent employer, right?
So there's different brokers,there's different employer
(14:07):
groups, there's different healthplan design.
One carrier might have aLavango solution for managed
care, another carrier might havesomething different.
Another broker might think thatthey've got a better imaging
solution or surgical orthopedicsurgical solution than another
broker does.
What we do is we go in there,work with the consultants, and
say, what are all your plandesign solutions and how can we
(14:29):
support that and make sure thatthese things are actually used?
And that's where we, I think,have a our we're constantly
renewing groups and like we wedon't lose clients because we do
a better job of that, I think,than anybody in the industry.
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(15:52):
I know one of the conversationsthat oftentimes you have in
different kinds of plug-insolutions or additional
solutions, is how you approachintegrating your clinics with
the existing healthcareecosystem.
You talked a little bit aboutthat.
What are some of the thingsthat you talk to employers and
other and the base plan,assuming it's whether it's
self-funded or whether it's afully insured plan?
Chris Yarn (16:14):
Yeah, I think you're asking how do we like help
guide the employees through?
I just want to make sure Iunderstood the question, how we
guide employees throughutilizing their other plan
design solutions.
David Saltzman (16:26):
You're providing care and the main health plan,
whatever it is, however it'sdesigned as providing care.
How do you integrate those twoso that at some point the
employee has an entire pictureof what's going on?
Chris Yarn (16:38):
Yes, yeah.
So we work with once once we'rein there as the primary care
solution, the employees inpatients still have to choose to
come to the clinic, right?
So they still have to choose toutilize it.
Some people say, I already havemy primary care physician.
The interesting thing about themarketplace we live in now is a
lot of people have a primarycare physician, but it's still
six to eight weeks to getappointment with that primary
(17:01):
care physician.
It's again not convenient.
Convenience wins in today'sworld, right?
And so what happens is we endup taking over primary care for
a lot of folks to get take overtheir patient charts.
And then we are working witheach health plan on what the
other solutions are.
So if somebody's got anendocrinologist, right?
(17:22):
And they're with uh like anImagine 360 plan here in Tampa,
we already have a network of allthe endocrinologists and
cardiologists and dermatologyspecialists that they already
have a direct contract with thatthey want us to refer to.
And so what happens is whenthose employees come in there to
our clinic, we're making surethat they get the fast pass to
(17:43):
those specialist practices andthere's full communication
between us and all thespecialists.
And it's uh it's reallyincredible.
I think you hear a lot outthere about plan noise in the
self-funded world, employees notbeing able to they go to an
urgent care hospital orsomewhere and they say, we don't
accept this insurance becauseit's some TPA that a secretary's
(18:04):
never heard of or areceptionist has never heard of.
And that's one of the keydifferences.
Like our patients don'texperience that because we're
referring them to the placesthat already know who we are,
already know what health planthe employees are walking in
with.
And so that that'sfrictionless.
And it helps the TPA keep thebusiness much longer and not
(18:26):
lose it in a year or two yearsbecause there's not a good
rollout.
David Saltzman (18:32):
Looking back, what are two or three pivotal
decisions, or maybe you want tocall them inflection points in
walk-on clinics trajectory, goodor bad, that shaped where you
guys are today?
Chris Yarn (18:43):
I think probably one of the biggest inflection
points we've had is walking awayfrom a lot of wellness exam
opportunities.
I think throughout the years, alot of consultants that have
tried to work with us or wantedto work with us view it as an
events-based company becausethey see the mobile clinics and
(19:05):
they think, oh, this is onlyhere a day or once a year.
They think like Bloodmobile,and they don't translate the
real continuity of care thatbeing on site provides versus
near site.
Now, then once they see thedata, they're shocked.
They're like, how do you guysget this much utilization?
And it's just it's moreconvenient, it's more private,
(19:26):
and it's just a it's a I justbelieve it's a better solution.
But I think one of the maininflection points came a couple
years ago, right after COVID,when I realized a lot of the
consultants out there were stillviewing us as like an
events-based company, eventhough we're saving companies
millions of dollars on thehealth plan and a full direct
(19:47):
primary care membership model.
And so really putting a focusmore on that, both in the state
of Florida and nationally, andletting consultants know and
businesses know hey, we can beanywhere in the country in 60 to
90 days with our solution.
We've got medical directorsready to go, and every state,
let's make it happen for you.
(20:07):
I think that's walking moreaway from the wellness exam
stuff and fully funded plans,and we still do some of that,
but really trying to make itclear to the consultant world
hey, we're here to do on-sitedirect primary care.
David Saltzman (20:22):
Yeah, it's a problem that a lot of businesses
have, especially when they'redoing something that's not
ubiquitous.
It's the main thing is to keepthe main thing.
And you're right, it'ssometimes hard to say no, but
it's better long term forbuilding your business.
Let's take a left turn.
unknown (20:36):
Sure.
David Saltzman (20:37):
As somebody who's leaned into a, let's call
it, creative persona known asFrank Mike Dropper.
How do you build visibility?
Does that help with brandingand storytelling and scaling
your venture, or are you justhaving a damn good time?
Chris Yarn (20:51):
I'm having a damn good time because I grew up as a
performer.
And uh so this was just a wayfor me to have that creative
outlet, which I desperately needjust as a human being.
I think and you're a musician.
I think anybody that you knowis a musician or had that kind
of creativity growing up, orit's part of their being, like
you have to fill your heart andsoul with that in some way,
shape, or form.
(21:12):
Because if you don't, you'rejust I don't want to say I'm
constantly miserable, but it'suh it's a labor of love.
Like I grew up singing jazz, Ilove singing it.
I was in America's youngestjazz band growing up, and so
this was a way for me to do whatI love and attract awareness
for Walk on Clinic as well.
(21:32):
So it did work.
I've got a lot of followers, alot of people know the story.
I created a fake LinkedInprofile and in a week invited to
the World Health Congress,meeting Dave Chase, meeting
Nelson Griswold, pretty much gotthrown right into the mix just
from posting a video singingabout self-funded health plans.
And I think has that translatedinto business for Walk on
(21:55):
Clinic?
Absolutely, it has.
It has worked, but I'll go backto I think it also confused a
lot of consultants.
Is this guy serious or is thereserious business?
It's like we're a multi-milliondollar direct primary care
company with hundreds of clientsthroughout the state of
Florida.
And I like, I there's like ahandful of on-site clinic and
(22:16):
DPC practices that have thatkind of scalability that we do.
And so I think it's teachingthose same consultants that know
Frank or know Chris, hey guys,if you're talking to Marathon,
you're talking to Carrie TC,you're talking to Nextera,
you're talking to any directprimary care doctor, if it's a
near site solution, you need tobe having a discussion with
walk-on and just give the clientthe option.
(22:38):
Give the client the option tolook at an on-site solution
versus a nearsight solution.
Because what you're going tofind, like the story I told
earlier, which is if proof is inthe pudding, 1.3 mile away near
site clinic, nicer facilitythan our mobile clinic, like
tenfold less utilization.
And that's not a knock toanybody that's out there doing
(23:01):
phenomenal nearsight clinicwork.
I love everybody in directprimary care.
I just don't think they realizethat the consumer behaviors
have changed.
And if most DPC docs, when yousit down with them and you have
a conversation, or evenconcierge physicians or advanced
direct primary care, whateveryou want to call it, they will
acknowledge that 80, 90% oftheir patient interaction is
(23:23):
taking place telephonically orvirtual on the phone because the
patient will avoid the hassleof going into their facility.
And it's I love Best Buy.
I grew up working at RadioShack.
I still buy most of myelectronics now on Amazon or
wherever it's easier.
And I just think people havechanged and how they want to
access care.
And I think the key is get toknow the people in person and
(23:48):
then give them the ability toconnect with you afterwards.
David Saltzman (23:53):
If we look ahead five or 10 years as we wrap up
here, what's your moonshot foremployer-sponsored care or
clinic logistics?
Chris Yarn (24:01):
I would love to, it would be a true blessing to see
this company grow to hundreds ofmillions in revenue, maybe have
a one medical exit one day, orkeep it private.
I I don't know.
I think we'll have to bring ina lot of other people to make
that happen.
I know we will, just the sheersize and scale that some of
(24:21):
these companies do.
But the beautiful thing aboutthe on-site clinic space and
direct primary care space is thework doesn't start until 60 to
days, 60 to 90 days aftercontracting.
So we know the model, we knowhow to scale, we know how to
build the clinics, and we knowhow to provide care.
And we can do that in everymarket across the United States,
(24:42):
and we can do it well.
And we just need the salesforce and the contracts and the
opportunities to do that.
And then we will scale.
Look, people won right here inFlorida.
They did the Osceola Countyschool system here.
I think they had an $8 millionfirst round raise, and then
Google Ventures put in another32 million.
But I think they're around, I'mnot 100% sure, but I think
(25:05):
they're just over 20 million inrevenue.
And that's a it doesn't takethat long to get to those
numbers in this space if you'redoing good work, and we're doing
good work.
So we just gotta keep doingwhat we're doing and grow a
little faster, and then we'llwe'll get there.
All those things will happen.
David Saltzman (25:23):
And that's a great place to end our
conversation for today.
Chris Yarn, CEO of Walk OnClinics.
Chris, thanks for a fascinatingconversation.
Chris Yarn (25:31):
Thanks, David.
Thanks for having me so much.
Announcer (25:34):
The Shift Shapers podcast is a production of Shift
Shaper strategies and may notbe reproduced or quoted in whole
or in part without our expresswritten permission.
Copyright 2020, all rightsreserved.
What happens when an insurance broker stops
just advising clients onhealthcare strategy and starts
building the clinic model hewishes he could have sold them
years ago?
We'll find out on this episodeof Shift Shapers.
Announcer (00:16):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift ShapersPodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industry'sshifts.
And now, here's your host,David Saltzman.
David Saltzman (00:36):
And to help us answer that question, we've
invited Chris Yarn, who is CEOof Walk On Clinic.
Welcome, Chris.
Chris Yarn (00:43):
Hey David, how are you doing?
David Saltzman (00:45):
I'm doing well.
Thanks for being here andsharing some of your expertise
with our audience.
We appreciate you taking thetime.
Chris Yarn (00:51):
Absolutely.
David Saltzman (00:52):
So let's level set.
How do you define hybrid careor mobile plus on-site clinic
models?
And do they represent thefuture of primary care access
for employer groups?
Chris Yarn (01:04):
Yeah, I uh I believe so.
I think that we've seen the bigboom of direct primary care
across the nation.
I think there's a lot of momand pop direct primary care
practices that are doing goodwork.
Um, but what we've discoveredis that patient behaviors are
not immune to the retail therapybuying behaviors that exist in
(01:27):
the marketplace now, meaning youlook at the amount of primary
care practices shutting down,being replaced by urgent care
centers across the nation andless access.
Part of the reason why is thebrick and mortar facilities are
not being utilized.
So when you put those sameclinics and those same providers
of medicine on site, all of asudden you get utilization.
(01:48):
And it's just the conveniencefactor.
So I just firmly believe themore convenient you make primary
care, the more it actually getsused.
And that's really what the aimis of most of these self-funded
employer groups.
David Saltzman (02:01):
So what are the main barriers, whether
technological, regulatory,cultural, all of the above, to
getting really good adoption?
Chris Yarn (02:09):
Yeah, I think I think the first one is again
convenience.
The best kind of story I cantell or example is we have a
client in Orlando, a boatmanufacturer, 800 employees.
We started with them a yearago, and we gave them access to
a near-site clinic, brick andmortar facility, 1.3 miles away
from headquarters, three days aweek.
(02:29):
And then we gave them accesson-site two days a week in one
of our mobile clinics at thesame company, same population
employees.
At the end of a 10-month periodout of 800 employees, we had
530 patients that were theprimary care home for, but only
15 being 1.5, were using thebrick and mortar facility nearby
(02:51):
versus the other 515 using theon-site clinic, even though
there was less access to thatclinic being two days a week
versus a near site three days aweek.
So I think that's really thelesson.
I think anybody in directprimary care and the near site
clinic industry or even HMOmodels, all these models that
are out there, brick and mortar,what the aim should be is how
(03:14):
do we connect to the patient andthen can in the most convenient
form possible and then continuethat relationship through the
cell phone.
David Saltzman (03:22):
Do you attribute that to just removing friction?
We've seen this in a lot ofother consumer fields where
people will partake if it's easyand they don't have to get in
the car or drive someplace orwhatever.
Look at Amazon and all thestuff that they sell.
Is that part of the what youthink drove that trend?
Chris Yarn (03:39):
Yeah, I think I think the convenience has a lot
to do with it.
I think so much more of it isabout in a world where
everybody's trying to connecthuman beings to chat bots or AI
tools and all that stuff.
What we really do is we connectthe patients and employees of
companies to human beings theyknow and that know them.
(04:02):
And then we use the sametechnology not to connect people
to chatbots, HIPASCURE portalsand chat and text message
capabilities.
Uh we use the same technologyto connect them, but to the
people that they see weekly orsee monthly, depending on how
frequent a flyer the patient isto the clinic.
And that's the key.
(04:23):
It's keeping the you're it's alot better telemedicine
experience when you're talkingto somebody that's also put
their hands on you and felt yourthroat, knows your family
history.
It's it's common sense.
Would you rather talk tosomebody on a virtual care
system that you don't know?
Or would you rather use avirtual care system with
somebody that you do?
I think, and sorry to keeprambling here, but Dave Chase
(04:47):
shared a great post about a yearago about Forward.
These guys were puttingtelemed, it's not just the
convenience, right?
So that's part of it.
But forward was putting thesetelemed pods on-site at employer
groups.
I think they had half a billionin funding or 400 million in
funding or something like that.
They went bankrupt.
Why?
These amazing telemed pods thathad all these measurement
(05:09):
tools, and you're talking with adoctor because you don't know
the person.
And then some people were, oh,they were too early.
It's like they weren't tooearly.
It's just it's human behavior.
But do you want to talk tosomebody you know or a stranger?
David Saltzman (05:22):
It's that speaking of human.
I'm sorry.
Speaking of human behavior, howdid your background as an agent
inform your approach todesigning clinic services and
plan design?
Chris Yarn (05:32):
Yeah, I I started my career property casualty,
Liberty Mutual.
First account I ever worked wasRosen Hotels.
Read the Rosen EmployeeHandbook, saw the on-site clinic
model there, and I saw why itworked for their 6,000
employees.
They have a lot of otherstrategic advantages, a lot of
migrant workers, and I don'tknow if they're on work visas or
whatever, but when you'retaking folks from another
(05:54):
country and then they'reemployed at a hotel, and then
you show them where to accesshealthcare, of course, you're
going to have high utilizationcompared to somebody that's
grown up in the United Statesand has touched the healthcare
systems and all the differentoptions.
But I saw that and it stayedwith me throughout my insurance
career, right?
What I didn't see change afterthe Affordable Care Act is
(06:17):
anyone taking that model, thaton-site clinic model, and
bringing it down market tosmaller employer groups.
More and more employer groupswere going self-funded.
They don't have retail space tobuild out a clinic, or they
can't afford to pay some of ourlarger competitors like Marathon
to build out a brick and mortarfacility.
And so then they do a sharedsite, which is really just a
(06:40):
reinvention of the HMO model.
If you're sharing a clinic withmultiple employers, that's
what's your access to care.
We so we look at it, and I saidthat as a consultant, I want
the win is when employees in anemployer group have exclusive
access on their time to providerthat's exclusive to them with
(07:01):
their time, not shared withother employers.
You're not giving up wait timesto other companies or
appointment slots to othercompanies.
It's like when the clinic isthere, it's there for your
employees.
David Saltzman (07:13):
So employer groups, as you very well know,
come in all shapes and sizes.
How do you decide what model isbest for them, whether it's a
permanent on-site clinic or anear site shared clinic or even
a mobile and fractional clinicpresence?
Yeah.
Chris Yarn (07:27):
It's got a lot to do with what the claims data looks
like.
How many employees are on theplan?
Um, what problems are theorganization trying to solve?
The on-site clinic industry 50,60 years ago, was started in
the manufacturing world just asa need and a function to reduce
reduce employee absenteeism,right?
And keep people on themanufacturing lines.
(07:47):
So they they saw a lot ofutility in the manufacturing
space of just the savings on alost revenue or lost
productivity size, keepingemployees healthy and keeping
them on the job line, or ifthey're gone for 15, 20 minutes.
So there's a lot of factorsthat go into that.
But the quick answer is dependson the number of employees of
(08:07):
an organization, depends on thetype of industries, number of
locations a company might have,what their geographic spread is,
and then also what type ofhealth plan they're on.
It obviously makes a lot moresense for a self-funded employer
when it's their money beingspent outside of the healthcare
system to try and contain thatand do nurse navigation on site
(08:30):
and have a quarterback on yourteam throwing the passes where
you need them to go within thehealth plan.
Because if you don't have thatand you're in a self-funded
health plan strategy, it's likeyou're walking, you're walking
into the casino in a riggedgame.
You're going to lose.
You can get lucky and have acouple of good years, but if you
don't have anybody directingtraffic in a self-funded health
(08:51):
plan of fill this prescriptionhere instead of there, go get
your imaging at green imaginginstead of the hospital system,
eliminating urgent care access,which is owned by the local
hospital system, you you'regoing you're going to experience
a lot of pain and plan noisewithout the primary care at the
(09:12):
forefront of the self-fundedhealth plan design.
David Saltzman (09:15):
You mentioned geographic spread.
So here an interesting questioncomes up.
How do you manage logistics andROI and multi-location or
distributed employer footprints?
How do you do that?
Chris Yarn (09:24):
Yeah, we have at Walk On Clinic, we have near
site facilities.
We can build on-sitefacilities.
I'm actually going to be doingone, I think, at the beginning
of this year at an employergroup.
But we use mobile clinics forcompanies that are
geographically dispersed, and itworks really well because you
put the clinic on site, all theemployees see it when they're
going in and out of the buildingat work every day.
(09:45):
It's not there, some peoplehave on-site clinics and it's in
some break room somewhere downa hall.
A lot of buildings are big, outof sight, out of mind.
So it's actually an advantageto have the clinic outside, a
little more privacy, but it'salways seen by every employee of
the company.
So it's in their awarenesssubconsciously on their as they
(10:06):
pull into the parking lot, or ifthey're dropped off by a bus at
work.
It's uh it's really amazingwhat that does.
But you you have to measure howmany employees at each
geographic location, right?
So some locations might makemore sense to visit once a
quarter, once every 90 days, ifthere's not a lot of employees
there.
Our kind of number is 300, 250to 300.
(10:28):
If you're a self-fundedemployer group with 250 to 300
employees, then it starts tomake sense to put a clinic on
site one, maybe two days a week.
We've seen positive return oninvestment at two days a week,
putting the clinics on site.
And then of course they haveaccess all the other days a
week, depending on what virtualcare option they buy, to use our
(10:49):
technology to connect to thesame providers the rest of the
week when the clinic's notthere.
David Saltzman (10:58):
So what metrics or early indicators that can
reliably predict whether aclinic deployment will succeed?
Is it just utilization, costsavings, employee acceptance?
And how do you balance all ofthose?
Chris Yarn (11:10):
Yeah, I think we do a really good job measuring.
I think we do a better job thananybody in the industry,
honestly, of measuring return oninvestment.
And that's because we're a kindof a broker and a
consultant-built on-site clinic,direct primary care company.
I think most people are comingfrom a background of medicine,
(11:31):
not insurance.
So they don't really understandthe metrics you have to measure
to be able to prove return oninvestment.
So what we do is we code everyCPT code in the clinic.
So we still use the EHR systemsand we provide and we report
zero dollar ghost claims to thecarriers, whether it's TPA or
Abuca, Blue Cross United CignaAetna, doesn't matter.
(11:53):
We report $0 ghost claims, sowe have a mechanism at which to
track at a Medicare rate whatwould all of these claims have
cost in the marketplace?
What would you have paid in aperfect world that only builds
you 100% of Medicare?
So we know that's not the case,but what we do is we provide
the most conservative estimatepossible.
And then we also take payrollnumbers and we calculate like a
(12:17):
four-hour or two hour, everyorganization's different.
What's the value of lost time?
Typically, most employers arecomfortable saying a lot of
people take a whole day off workjust to playing around a
doctor's visit, depending onwhat the issue is.
So they do four hours ofwhatever the payroll number is,
and then we provide that in ourreporting system of hey, here's
what the here's what the datasays, right?
(12:38):
And then on other groups, wealso can measure how much
emergency room utilization goesdown.
If we have other plug-in plancomponents like a green imaging,
like a pharmacy solution, wecan show a direct dollar ROI.
It's like here's how manypatients we moved from getting
their prescriptions filled atCVS or Walgreens to the mail
(13:00):
order international solution.
So here's your we we can findvery often a way to pay for the
clinic just on pharmacy spend,as long as we can take over
those patients and find whothose patients are.
Even moving certain patients atincome levels on the 340B
program, nonprofit pharmaciesfor medications like HIV and
(13:21):
other things that are, I don'twant to say plan killers, but
it's it used to be pharmacy was15% of plan spend and 20 to 25%
of plan spend now.
So it's a that's some of theeasy, low-hanging fruit that a
lot of companies go after.
But this is where I questionthe industry at whole, unless
you're working with an on-siteclinic company that understands
(13:44):
on the consultant and broker andhealth plan side everything I
just explained, you just haveanother doctor charging a
membership model that reallycannot help your individual
employer group quarterbackproperly all the different plan
design solutions for everydifferent employer, right?
So there's different brokers,there's different employer
(14:07):
groups, there's different healthplan design.
One carrier might have aLavango solution for managed
care, another carrier might havesomething different.
Another broker might think thatthey've got a better imaging
solution or surgical orthopedicsurgical solution than another
broker does.
What we do is we go in there,work with the consultants, and
say, what are all your plandesign solutions and how can we
(14:29):
support that and make sure thatthese things are actually used?
And that's where we, I think,have a our we're constantly
renewing groups and like we wedon't lose clients because we do
a better job of that, I think,than anybody in the industry.
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And now, back to ourconversation.
(15:52):
I know one of the conversationsthat oftentimes you have in
different kinds of plug-insolutions or additional
solutions, is how you approachintegrating your clinics with
the existing healthcareecosystem.
You talked a little bit aboutthat.
What are some of the thingsthat you talk to employers and
other and the base plan,assuming it's whether it's
self-funded or whether it's afully insured plan?
Chris Yarn (16:14):
Yeah, I think you're asking how do we like help
guide the employees through?
I just want to make sure Iunderstood the question, how we
guide employees throughutilizing their other plan
design solutions.
David Saltzman (16:26):
You're providing care and the main health plan,
whatever it is, however it'sdesigned as providing care.
How do you integrate those twoso that at some point the
employee has an entire pictureof what's going on?
Chris Yarn (16:38):
Yes, yeah.
So we work with once once we'rein there as the primary care
solution, the employees inpatients still have to choose to
come to the clinic, right?
So they still have to choose toutilize it.
Some people say, I already havemy primary care physician.
The interesting thing about themarketplace we live in now is a
lot of people have a primarycare physician, but it's still
six to eight weeks to getappointment with that primary
(17:01):
care physician.
It's again not convenient.
Convenience wins in today'sworld, right?
And so what happens is we endup taking over primary care for
a lot of folks to get take overtheir patient charts.
And then we are working witheach health plan on what the
other solutions are.
So if somebody's got anendocrinologist, right?
(17:22):
And they're with uh like anImagine 360 plan here in Tampa,
we already have a network of allthe endocrinologists and
cardiologists and dermatologyspecialists that they already
have a direct contract with thatthey want us to refer to.
And so what happens is whenthose employees come in there to
our clinic, we're making surethat they get the fast pass to
(17:43):
those specialist practices andthere's full communication
between us and all thespecialists.
And it's uh it's reallyincredible.
I think you hear a lot outthere about plan noise in the
self-funded world, employees notbeing able to they go to an
urgent care hospital orsomewhere and they say, we don't
accept this insurance becauseit's some TPA that a secretary's
(18:04):
never heard of or areceptionist has never heard of.
And that's one of the keydifferences.
Like our patients don'texperience that because we're
referring them to the placesthat already know who we are,
already know what health planthe employees are walking in
with.
And so that that'sfrictionless.
And it helps the TPA keep thebusiness much longer and not
(18:26):
lose it in a year or two yearsbecause there's not a good
rollout.
David Saltzman (18:32):
Looking back, what are two or three pivotal
decisions, or maybe you want tocall them inflection points in
walk-on clinics trajectory, goodor bad, that shaped where you
guys are today?
Chris Yarn (18:43):
I think probably one of the biggest inflection
points we've had is walking awayfrom a lot of wellness exam
opportunities.
I think throughout the years, alot of consultants that have
tried to work with us or wantedto work with us view it as an
events-based company becausethey see the mobile clinics and
(19:05):
they think, oh, this is onlyhere a day or once a year.
They think like Bloodmobile,and they don't translate the
real continuity of care thatbeing on site provides versus
near site.
Now, then once they see thedata, they're shocked.
They're like, how do you guysget this much utilization?
And it's just it's moreconvenient, it's more private,
(19:26):
and it's just a it's a I justbelieve it's a better solution.
But I think one of the maininflection points came a couple
years ago, right after COVID,when I realized a lot of the
consultants out there were stillviewing us as like an
events-based company, eventhough we're saving companies
millions of dollars on thehealth plan and a full direct
(19:47):
primary care membership model.
And so really putting a focusmore on that, both in the state
of Florida and nationally, andletting consultants know and
businesses know hey, we can beanywhere in the country in 60 to
90 days with our solution.
We've got medical directorsready to go, and every state,
let's make it happen for you.
(20:07):
I think that's walking moreaway from the wellness exam
stuff and fully funded plans,and we still do some of that,
but really trying to make itclear to the consultant world
hey, we're here to do on-sitedirect primary care.
David Saltzman (20:22):
Yeah, it's a problem that a lot of businesses
have, especially when they'redoing something that's not
ubiquitous.
It's the main thing is to keepthe main thing.
And you're right, it'ssometimes hard to say no, but
it's better long term forbuilding your business.
Let's take a left turn.
unknown (20:36):
Sure.
David Saltzman (20:37):
As somebody who's leaned into a, let's call
it, creative persona known asFrank Mike Dropper.
How do you build visibility?
Does that help with brandingand storytelling and scaling
your venture, or are you justhaving a damn good time?
Chris Yarn (20:51):
I'm having a damn good time because I grew up as a
performer.
And uh so this was just a wayfor me to have that creative
outlet, which I desperately needjust as a human being.
I think and you're a musician.
I think anybody that you knowis a musician or had that kind
of creativity growing up, orit's part of their being, like
you have to fill your heart andsoul with that in some way,
shape, or form.
(21:12):
Because if you don't, you'rejust I don't want to say I'm
constantly miserable, but it'suh it's a labor of love.
Like I grew up singing jazz, Ilove singing it.
I was in America's youngestjazz band growing up, and so
this was a way for me to do whatI love and attract awareness
for Walk on Clinic as well.
(21:32):
So it did work.
I've got a lot of followers, alot of people know the story.
I created a fake LinkedInprofile and in a week invited to
the World Health Congress,meeting Dave Chase, meeting
Nelson Griswold, pretty much gotthrown right into the mix just
from posting a video singingabout self-funded health plans.
And I think has that translatedinto business for Walk on
(21:55):
Clinic?
Absolutely, it has.
It has worked, but I'll go backto I think it also confused a
lot of consultants.
Is this guy serious or is thereserious business?
It's like we're a multi-milliondollar direct primary care
company with hundreds of clientsthroughout the state of
Florida.
And I like, I there's like ahandful of on-site clinic and
(22:16):
DPC practices that have thatkind of scalability that we do.
And so I think it's teachingthose same consultants that know
Frank or know Chris, hey guys,if you're talking to Marathon,
you're talking to Carrie TC,you're talking to Nextera,
you're talking to any directprimary care doctor, if it's a
near site solution, you need tobe having a discussion with
walk-on and just give the clientthe option.
(22:38):
Give the client the option tolook at an on-site solution
versus a nearsight solution.
Because what you're going tofind, like the story I told
earlier, which is if proof is inthe pudding, 1.3 mile away near
site clinic, nicer facilitythan our mobile clinic, like
tenfold less utilization.
And that's not a knock toanybody that's out there doing
(23:01):
phenomenal nearsight clinicwork.
I love everybody in directprimary care.
I just don't think they realizethat the consumer behaviors
have changed.
And if most DPC docs, when yousit down with them and you have
a conversation, or evenconcierge physicians or advanced
direct primary care, whateveryou want to call it, they will
acknowledge that 80, 90% oftheir patient interaction is
(23:23):
taking place telephonically orvirtual on the phone because the
patient will avoid the hassleof going into their facility.
And it's I love Best Buy.
I grew up working at RadioShack.
I still buy most of myelectronics now on Amazon or
wherever it's easier.
And I just think people havechanged and how they want to
access care.
And I think the key is get toknow the people in person and
(23:48):
then give them the ability toconnect with you afterwards.
David Saltzman (23:53):
If we look ahead five or 10 years as we wrap up
here, what's your moonshot foremployer-sponsored care or
clinic logistics?
Chris Yarn (24:01):
I would love to, it would be a true blessing to see
this company grow to hundreds ofmillions in revenue, maybe have
a one medical exit one day, orkeep it private.
I I don't know.
I think we'll have to bring ina lot of other people to make
that happen.
I know we will, just the sheersize and scale that some of
(24:21):
these companies do.
But the beautiful thing aboutthe on-site clinic space and
direct primary care space is thework doesn't start until 60 to
days, 60 to 90 days aftercontracting.
So we know the model, we knowhow to scale, we know how to
build the clinics, and we knowhow to provide care.
And we can do that in everymarket across the United States,
(24:42):
and we can do it well.
And we just need the salesforce and the contracts and the
opportunities to do that.
And then we will scale.
Look, people won right here inFlorida.
They did the Osceola Countyschool system here.
I think they had an $8 millionfirst round raise, and then
Google Ventures put in another32 million.
But I think they're around, I'mnot 100% sure, but I think
(25:05):
they're just over 20 million inrevenue.
And that's a it doesn't takethat long to get to those
numbers in this space if you'redoing good work, and we're doing
good work.
So we just gotta keep doingwhat we're doing and grow a
little faster, and then we'llwe'll get there.
All those things will happen.
David Saltzman (25:23):
And that's a great place to end our
conversation for today.
Chris Yarn, CEO of Walk OnClinics.
Chris, thanks for a fascinatingconversation.
Chris Yarn (25:31):
Thanks, David.
Thanks for having me so much.
Announcer (25:34):
The Shift Shapers podcast is a production of Shift
Shaper strategies and may notbe reproduced or quoted in whole
or in part without our expresswritten permission.
Copyright 2020, all rightsreserved.
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