A startup called Zarminali Health has launched with $40 million in seed funding led by General Catalyst and an ambitious goal of transforming pediatric care nationwide. Danish Qureshi, CEO of the company, recently spoke with Healthcare Innovation about why he set out to create a better pediatric care experience for both clinicians and patients and how he plans to do it.
In a blog post on the company’s website, Qureshi explained how his personal experience gave him the idea for the company and why he named it for his daughter Zarmina:
“Last year, the need for a new approach to pediatric care became deeply personal to me when my daughter was diagnosed with an autoimmune disorder. My wife and I found ourselves navigating a fragmented pediatric healthcare system, desperately trying to get our daughter the care she needed to be able to thrive again in all aspects of her childhood. That experience highlighted to me the burden resting squarely on the shoulders of families whenever their child’s health even slightly deviates from ‘routine care’ and was the driving force behind founding Zarminali.”
Healthcare Innovation: Could you start by talking a little bit about your career background in the healthcare space?
Qureshi: Zarminali is the third startup that I’ve been a part of. The first going back 15 years was in the outpatient wound center space. We grew that company into the second-largest operator of outpatient wound centers in the country. We ended up selling it to the only larger group left in the space, back at the tail end of 2015. Then three of us co-founded what became LifeStance Health, which is today the largest provider of outpatient mental health services in the country, with a 33-state footprint and around 7,000 clinicians, as well as a very heavy telemedicine component.
I believe firmly, particularly within healthcare, that being very mission-driven is critical. This idea around pediatrics had been bouncing around in the back of my head for a few years, primarily informed by my own experience with my children getting pediatric care.
What we saw was that care was very siloed by specialty. Although there was a desire, there really wasn’t an ability to coordinate across all the specialists, or even the primary care pediatrician. And ultimately, the burden of care coordination ended up falling on us as the family. And even though I have 15 years of experience in healthcare, I found it extremely stressful, and still do to this day.
HCI: Was some of that fragmentation even within a health system, not just across different provider groups?
Qureshi: Many of those specialists that we saw were in the same health system and on the same EMR. Yet the way everything is set up, there is no incentive to drive care coordination among specialists. It really was surprising that even with specialists within the same health system, there really was a lack of coordination. In my opinion, it’s not a failure of clinicians lacking a desire to coordinate, or a desire to create a better experience for families and patients. It is just that the system is not set up to facilitate it.
Appointments are too short. There is this constant drive of needing to see more and more patients, and it it is one of the key factors that leads to physician burnout. They never get to really invest the time into any one of their cases.
So, going back to the formation concept of Zarminali. This is where it became a very personal mission. And for anything that I do, there has to be a core mission that you are trying to accomplish. It cannot be a financial mission. It has to be that we’re trying to make a certain specialty or healthcare space better and ultimately positively impact the lives of what will hopefully be millions of people. I can’t think of working on a more important aspect of healthcare than this.
HCI: It seems, though, like you are trying to tackle a really big thing. Where do you start? Are you developing a model for a type of practice that you think will operate fundamentally differently? How do you think about the payment mechanisms that will make that work?
Qureshi: You’re absolutely right. It is a big, complex issue to tackle, and it’s one of the first things that I get asked: How are you going to tackle something of this magnitude? First, if you look at our team, everyone comes with multiple years of healthcare operating experience in high-growth groups or companies. They have tackled similarly large issues in fields such as adult primary care or behavioral health.
The vast majority of pediatric practices today on the independent side are small. They are underfunded by the nature of their size and aren’t able to invest in areas like technology or bringing a modern look and feel to the way that care is delivered. But what they do have are dedicated clinicians who believe in what they’re doing and want to do better for their patients.
What we’re looking to do is to maintain the core of that and build a stellar national practice group around them that has all the things they dreamed of, but because of their size and scale they have not been able to invest in.
Today, an outpatient practice group is maybe five pediatricians with one to three locations, and they’re primarily focused on non-urgent issues. We will have primary care clinics but also have urgent cares co-located with many of the primary care locations. If you as a family wake up with a child who is sick, you can’t wait for an appointment a week later, and going to an adult or general urgent care that isn’t going to coordinate and share notes back with your pediatrician just doesn’t work.
Additionally, we will have multi-specialty hubs that are more centrally located within the markets we enter. We want specialists housed within the same practice group, so they are coordinating as teammates. Then we will also have a single, unified brand. So we will operate exclusively as Zarminali across the country, with a modern look and feel, from our digital presence to the physical spaces or clinics that we operate. The final piece is it will all be infused with technology to both improve the family and patient experience as well as the clinician experience, by reducing the burden of administrative tasks and helping to tackle the problem of burnout within the physician base. So that’s the different approach. It has not been done before — definitely not on a national scale. You may find pockets of it in cities here and there, but I really believe that this is the future of what good healthcare needs to be, and something that is sorely needed within the pediatric population. So we’re very excited to deliver that.
HCI: How many locations do you plan to open and over what kind of timeline?
Qureshi: Our current plan is to be in the top 30 states, which account for 90% of the U.S. population, over the course of the next 36 months. It’s a very aggressive and quick expansion plan. However, I really believe, if you want to make a material impact on families across the country, that national scale is important and will be a differentiator versus just being in a few states or a few cities.
HCI: Will it require working any differently with payers or developing contracts with payers?
Qureshi: This is a stat that always staggers me: half of the children in the U.S. are covered by Medicaid. So I do think that there is an inevitability, as you achieve scale across the country, of needing to be able to engage with managed Medicaid programs in a unique way and deliver great care for those children who are covered by Medicaid.
However, we are very focused on taking a staged approach to that. For the first few years of the company, we will be focused primarily on commercial fee for service. I believe you have to build scale and prove it in the traditional commercial space and then use the clinical quality outcomes that you can demonstrate to be able to go and have informed conversations with managed Medicaid of how we can bring the same quality and the same approach to care and engage in value-based care arrangements.
HCI: What’s the sales pitch to the pediatricians to come work for you?
Qureshi: For pediatricians, we are putting their experience at the front of everything we’re thinking about. It is not because we can pay more than a hospital system or competitor. The primary issue that pediatricians deal with today is a lack of ability to coordinate with specialists. Lobbing referrals over to whatever health system and hoping that I hear back just doesn’t work. It’s a core frustration. So they want to work in a multi-specialty group where they have access to colleagues, and can work in a way like they trained, which is in residency. Everyone trains in teams and collaborative environments, and then you get into the real world, and suddenly everyone is siloed. So that is, in and of itself, very appealing.
The second thing is a heavy focus on avoiding clinician burnout, and that means reducing administrative work for them, setting reasonable patient volumes on a daily basis that are significantly better than what you’d see elsewhere. And then, ultimately, building an environment that is conducive, ensuring they can have a strong work/life balance. Those are primary areas that we think of in terms of how we can build something unique and differentiated.
