 The latest edition of Telehealth in Hawaii. I'm your host, Vikram Acharya. I'm the chief executive officer of Cloudwell Health, an all virtual position founded telemedicine organization based out of Hawaii. We have a very special guest today, Dr. Tony Tribskovsky, also known as Dr. T, well-known physician, entrepreneur and founder of NeoHealth based in Hawaii. Dr. T, how are you doing today? Good morning. Thank you, Vik, for inviting me on the show. I'm doing great. Thank you for being on. Thank you for being on. Tony, you are embedded in the world of healthcare in Hawaii and you've been there for 20 years, long time. To get the ball rolling, why don't you tell us a little bit about yourself, where you're from and what brought you to the great state of Hawaii? Well, it kind of began with the passion for helping people when I was, I guess a little kid, it kind of led me to want to go to medical school and become a physician. I think when you think about becoming a doctor, it's more of a calling. And I think I believe in that strongly because there's so many other things we could have done with our lives. Majority of people who become providers or doctors, they are intelligent and they're hardworking and they could have gone in many different career choices, right? So why do they go into healthcare? Well, because the overall premise is you really want to help, you really want to care for people. So that kind of led to my direction in life. I was born in the States, I was born in Michigan and then we moved then to the Chicago area. And I did my primary education there where I completed high school in a year of at university. And then I was offered this opportunity to get into a program in my country of my ancestry. My parents were from, at that time it was Yugoslavia and they were the most southern region, the Balkan part of Yugoslavia called Macedonia. And I had been given opportunity through an organization to go back and we all had moved back by that time to Macedonia as a family. And I decided to move forward and go to medical school in Macedonia. And it was quite an adventure because it's a different type of educational system that I was not familiar with but through a lot of perseverance and hard work I did very well. And after completing my medical education I wanted to move forward and come back to the States. And I did that and I did an internal medicine primary care residency in Dayton, Ohio. And then from Dayton, Ohio after finishing that I went on to opening and working in a group practice in Florida in Venice, Florida Sarasota area. And that was fine but I came to Hawaiian vacation and after coming to Hawaiian vacation I said, okay, this is true paradise. This is where I'll fit in. And so did anything in my means that I got here and I started working for Hawaii Pacific Health in Luhui and had a practice in Kapa'a where I also did primary care and open day and also I did a hospitals work as well. And then life takes different directions and one thing led to another and now I'm here in Oahu and I've been here for quite some time and I was continuing to work for Hawaii Pacific Health but I always was an innovator and a type of person that wanted to change things and make things always better. And so working for a larger organization made that difficult for me. And though I was very fortunate to come up with a concept for the tourists in Waikiki, Doctors of Waikiki which I co-founded with Dr. Alan Wu. And then in that gave me kind of some success and then gave me a launch pad to really reach out further in a broader way to try to come up with the solutions for the healthcare industry. And this led me to developing a new product called New Health, New Health Urgent Cares. The concept is to be a health tech company and to really focus on the quality of care, access to care and costs. And so this is what got me in this situation now that I'm working on really hard to develop a product that will focus on the main problems of healthcare. I think in general it's cost. Because cost is, I think the reason we have difficulties with access to care. I think quality care can be affected by that as well due to the fact that if you are worrying about, you have cost restraints, you're not gonna be able to hire enough staff and have the ability to take care of these people. But from the aspect of also, in general people tend to need care and now in the situation we're in, access has been the biggest problem. And then access, again, I go back saying that it's related to cost. Yeah. But yeah, I'm happy to be in Hawaii and Hawaii is where I wanna stay. Starting this new project in Hawaii and helping the current problems that I see in Hawaii with healthcare is my main focus. And then tried to develop, as I said earlier, a global product to kinda make a solution for healthcare across the world. You know, you made the transition from position to physician entrepreneur. And what made you wanna go into the business aspects of doctors of Waikiki, but also now new health? Well, in order to grow as an individual, you need the ability to do things for yourself. You know, when you work for a larger organization, there are restraints and there are things that you wanna do that you just wouldn't be able to do them unless you're independent. So you have to make that transition to become a businessman in the medical field if you are a progressive thinker. Otherwise, you're just gonna get frustrated working for a larger corporation and you'll never get to fulfill your dreams. Now, new health has very specific messaging around access and you mentioned cost. Can you give us an example of the cost? You know, we know medical care is very expensive, but new is offering an alternative and it's very cost effective. Can you walk us through an example of that? Sure. So, since I've been dealing, you know, in general being a physician for almost 30 years, I noticed some of the biggest problems are due to the way we actually approach, you know, how a patient needs to get service, right? And it's either he has insurance or he has insurance through the state like Medicaid or he has to pay out of pocket. And most people live paycheck to paycheck and it's really difficult for them to all of a sudden have to pay $150, $200, $300 visit fee, right? If they don't have insurance. Some people have insurance, but the insurance they have a lot of providers aren't comfortable with because of the low reimbursement rates. So I wanted to come up with a concept that I'd never turn anyone away. So I'm doing a membership based healthcare company. If you have insurance and I take all insurances that are possible in the state of Hawaii, but if you don't have insurance, I have a $10 a month model. So you pay $10 a month that covers all your physician or provider services. If you have to have certain procedures done, there's an Ellicart menu, which is low cost. And because of this, I came up with a alternative way to get your medications by having them dispensed in office. And those are also low cost. Majority of the medications I offer are less than $5 from medications for your blood pressure, your diabetes, antibiotics. I wanted to be affordable so that nobody can not get care that they need. Yeah. And again, I keep on focusing on costs and I'm trying to come up with different ways to monetize healthcare so that I can provide more services and even lower the cost further. Yeah. Now you also address the issue of access because you're open 24-7-365, you have various pathways in which physical locations that patients can get care at new health as well, right? Right. So telehealth is great, but telehealth is just not enough. So offering telehealth options is great due to the fact that gives people access instantaneously. They get in the queue, they wait five minutes, they talk to one of my providers. But you need to have physical locations because everything can't be done online. And so at the physical locations, we provide urgent care services from laceration repair to the ability to draw your labs, to physically, you know, assessing you and giving you a better assessment as we're able to actually put our hands on you. And telehealth is the future for access because it's very easy for people to get in front of a provider and get what they need done, but just not enough. You have to have physical clinics to provide all these other services. Yeah. Now, when it comes to taking all payers, for example, you, does that include both public payers, private payers, anyone that wants to, because I know most of the folks in the state of Hawaii have health insurance at greater than 90%. So it's a value add knowing that not only can they come to new health, low cost care, high quality care, but also that then you take all the payers too. Yeah, because if you think about it, most people, they try to find a good job and they'll find a job and they'll be working, but then all of a sudden some other opportunity arises and they have to switch employers, right? Well, then that puts them in a gap for a month or two before they start having insurance provided to them by their new employer, right? Yeah. So here I am at this point where I can help them fill in a gap so that they're not addressing their diabetes or not addressing their hypertension or if they don't feel good. And that's what a lot of people do because they're so afraid to come in because they know that there's a high cost associated with healthcare. Unfortunately, that's the case and that's the truth. And then a lot of providers also, as I said earlier to have a hard time dealing with these state funded insurance plans which are like Medicaid because their reimbursement is so low and that leads to a disparity because most of these areas are underserved and these underserved areas tend to have a Medicaid heavy and nobody really wants to build a clinic there or provide services there except state funded clinics or state supported clinics and that limits then access to care. Yeah. So it's just interesting that again, as I said earlier, it all comes down to cost. Cost is like the deciding factor of why healthcare exists in the aspect of disparity due to the cost. Nobody really can afford care out of pocket the way it is currently, you know? Yeah, you know, it's very interesting having this conversation with you because not only are you seeing patients every day but you're also in a lot of meetings. I know that you're out building up the business for new health meeting with a lot of stakeholders in the community. What's a typical day for Dr. T? I mean, it's busy and it's frenetic but it's wearing different hats at the same time. What's it like? Well, from a patient care perspective, I've limited most of my office work from seeing patients at Doctors at Waikiki. So I put in about 40 hours a week at Doctors at Waikiki and then the rest of the day that I have the ability to do so is mostly me getting up in the morning doing some meetings, going through my email, trying to think of ways that we can grow and become a bit larger and a more sustainable healthcare solution for the community and the world. And but some days are not as busy as others but it's usually I've got a lot of meetings. I like to be very aggressive about a patient acquisition and be able to do that. I have to find time to go into the community and do things that gets my face in front of these either union leaders or other organizations to explain to him what I'm doing and get the ability to acquire new patients. Yeah, yeah. Now, how does that conversation typically go? So if you meet with the representative of the union and you want to speak to the many benefits of new health for the members of the union, what's the typical approach that you normally take? Well, like everyone knows that lives in Hawaii. Hawaii is very relationship based. So before I even can start to have any significant conversations that really kind of just feeling me out. In general, they wanna see what kind of person I am. Am I who I say I am? Am I gonna provide this trust that's very important here in Hawaii? Do I have the loha spirit? And I do have the loha spirit. And so that kinda starts the opening relationship building. And then we build into what products, what product do I have? What services am I providing? Why am I better, I believe, than the current healthcare systems what it's providing currently? And then that's not enough. Then you have to show them. Then you have to actually have somebody physically see or physically use the services. And then when they do that, then you have a really good beginning. Then they understand who you are. They understand what you're doing and you develop this trust. And that's very important here in Hawaii. Yeah. You also, as a way of advancing new health do a lot of community events. And you're very involved, highly involved in delivering care to the medical community, not only in your organizations, but also in the community outreach that you do. Can you walk us through some of the things that you do? There's a lot of good stuff that's underway. So one of the things we do is by providing services on the spot in certain locations. So, for example, for Hawaii on Nuanu, we go once a month and we provide healthcare services to the members and people in the community. And we do that in a really interesting way by allowing them to get access to care all throughout the day. And it's really interesting at the Y because the Y is kind of a health-centric member community as well. And they're really interested about their blood pressure and they're interested about their cholesterol and they're interested about all these things that I'd like to help them with. Then we actually then do outreach to organizations that have a younger population that really forgoes healthcare because they're too busy and they think it's difficult to get access to care. So we started this with the longshoremen. We have what we call docks on the dock. So we actually go to the dock and set up a mini clinic and kind of give some heads up that we're going to be coming. And then we go there every second, every second, I'm gonna get it wrong, every second Thursday. And then they know we're coming and they get in contact with the provider and they get to see the provider. They get evaluated and they can get treated and taken care of, which is great. And then this kind of opens the door for them to understand that it's important to get healthcare. And I'd love to be able to do more outreach. I'm currently looking to get a mobile type clinic so that we can go to these other areas like underserved areas and throughout Hawaii to be able to again, do this outreach. This outreach is really interesting because it really does get people more access to care and kind of opens their mind to a lot. This is not that difficult. I can see a doctor, I can see a provider and get what I need, right? Instead of, I'm kind of not forcing them into it but I'm kind of making it as easy as I can for them to get access to care. Yeah. As you're building up new health, as any entrepreneur has, there are challenges. What are some of the challenges that you're facing, building up the brand and building up the company? Well, brand building takes time. That's one of the challenges. It takes a long time to get your, first off to get you on a search engine so that you pop up when people are looking for urgent care in their area. That's really difficult but it takes time to get that done. What also takes time is building a brand understanding what you actually are. When I started, people didn't know what new health was. They thought maybe it was a insurance company. They thought it was, I had some people think because of this Alamoana location, they thought it was a health food store. They would come in, they wanted to get a smoothie. So I had to really push that we are urgent care. We're not a insurance company. We're not a, we're not a smoothie shop. And those are some of the challenges. And then some of the challenges always comes down to funding to grow, you need to make sure that you can have the necessary funds to do so. I'm trying to do a very strong quick growth. My goal is to build out and get at least six clinics here on the islands before the end of the year. And that costs money and that's some of my concerns being the CEO and founder of the company. That's one of my major, major, major problems. But every, every time I've come up with a problem, every time problems come my way, I've come up with a solution. So, so far so good. So it's kind of like it's destiny to keep on going in this direction. Yeah. Now you're, you know, your entire care team, your executive team all works and lives in Hawaii, correct? It's the homegrown company with homegrown team. Except one, I have a, I have a chief product officer who's in Berlin, but everybody's here. Everybody's here in Hawaii. And he'll be coming, he'll be coming to Hawaii as well. Good. Are there any stories in particular, patient stories that around new health that you want to share them? So I use these stories because it's interesting to me and it gives a good example of what's going on in our healthcare industry. So I had a lady who had came to see us and she had a cast on her forearm. And she had been wearing this cast for, I'd say almost six months. And so she had insurance and she broke her arm and they put it in the cast. And then she lost her job and then she lost her insurance and then she would go, and usually you know, you wear a cast maybe two months. And so she went to get the cast off and everybody was trying to get, you know, $500 from her, $400 from her and she couldn't afford it. And so she just said, I'll just keep the cast on. So she wore the cast. And then when she saw that I was offering this $10 a month service, she rushed in and we don't provide orthopedic services. I don't even have like a cast saw, but I went and borrowed a cast saw from one of my orthopedic friends and from Dr. Paul Morton. And I was able to, we were able to help her and her hand needed to get better because it was in that cast for so long. But I mean, that's just one example. And I had another example of this gentleman from Big Island. He had a abscess on his back and he didn't have insurance at that time. And so he signed up for $10 a month and he was getting quotes of $500, $700 to address his abscess on Big Island. So he had some miles saved, flew down to Oahu and we addressed his problem. And it was like, after everything said and done it cost him I think $60 some dollars with the antibiotics and the procedure and everything. And that's like examples. People just foregoing their care cause of cost. And here we are in a very affluent country and that should never be an issue, but it is even in the United States. I can't even imagine in other parts of the world. Right. And you have, you know, these are great stories and what's great to hear about new health is that you have vision for growth and scaling beyond Hawaii, correct? I mean, you wanna take this, yeah. Global, so what I'm, we're creating a platform as we speak to do global outreach. And the purpose of that is I wanna be able to create a product that can be put anywhere in the world and be self-sustaining. And the way to do that is we have to monetize care a little bit differently. Here in the world in general, it's kind of linear, right? The how we monetize healthcare. Either the patient pays or insurance pays or the government pays, right? So the best way to monetize is by using other examples, right? So I looked to Google, I looked to Facebook, I looked at, you know, credit karma. I looked at all of these web-based companies that actually monetize using the internet by different means, right? So why can't we apply that to healthcare? So, and also, you know, the blockchain and crypto coin, all that can give us revenue stream if it's done correctly that gets the patient engaged in their health and what they get is a high quality, lower cost product. When I initially came up with this concept I wanted to call it free care. And then I had a couple of my friends who were kind of like my mentors, they said, no, nobody's gonna give you money for free. You gotta come up with a better concept. But that's the ultimate goal, to provide a way to monetize care or monetize engagement of care and other things to cover the cost. So that it's either very low cost or none at all to provide service. How did the name Niu come about? Well, I like that it's only three letters but what was really cool is that Niu means coconut in Hawaiian and the coconut was very vital to the Pacific Islanders for them to spread out through all these islands that they're at, you know, from, you know, ages ago. And so they used the coconut, you know to drink the coconut milk, they ate the coconut, they planted the coconuts where they went, those turned into trees, the trees they use to make clothing, to make shelter and other things. So I wanted to be kind of like the coconut and provide this care throughout the world, you know. That's why I called it Niu. Yeah. And I like, cause it's like Niu, it's Niu. Yeah, yeah. It's a new way to provide healthcare. It's a very recognizable name and it's a very recognizable brand, you know and you're doing this tremendous work in not only highlighting what Niu Health is but also the mission of it, providing low-cost care. You know, and I know that I'm sure you get many patients that call in and many patients that visit you either virtually or in person, they're very thankful, you know, for what you're doing. Yeah. Yes, they are, they are very thankful. That's, that's, then you know that you're really onto something when really people are very appreciative. I mean, I yesterday went and bought dinner, I was on a break and I ran into the server and I had my Niu badge on and he just couldn't stop talking how happy it was with the services he got in Hawaii, you know. And I hear that a lot, you know and people, it really makes me happy that we're able to provide a service that people really recognize different and that we're kind of trying to help eliminate any disparity in access to care. Yeah. Yeah, Dr. T, it's a pleasure talking to you because not only are you taking care of people every day as a physician but you're also advancing healthcare as a whole, you know, in the state of Hawaii with plans to grow globally through new health. And you know, it's just really inspiring listening to you and you know, we all wish you all the best in your endeavors. And I can't thank you enough for being on the show. You know, it's always a pleasure to talk to you. You know, I was like, this is well. Yeah, thank you very much. But yes, we have more in store for the community, we have more in store for. Excellent. Mahalo, Dr. T. Thank you very much. All right, thank you. Bye. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter and LinkedIn and donate to us at thinktechhawaii.com. Mahalo.