Retired Maj. Gen. James Marks, Chairman, ADVON Healthcare
SPOTLIGHT: Retired Maj. Gen. James Marks, Chairman, ADVON Healthcare
Publisher's Note: For those readers who would like to know why General Marks has the nickname “Spider” scroll to the end of the interview and learn from this amusing story!
Medical Travel Today (MTT): Why is the Advon business model answering a market need?
James “Spider” Marks (JM): The thing that makes Advon so appealing is that it facilitates the requirements among the three healthcare touch points: medical/healthcare facilities, doctors and patients -- providing access to world-class care that wouldn't otherwise be available either locally or elsewhere.
The real issue is that when you discuss medical care, everyone assumes that it is in terms of what is available immediately around the corner. In this increasingly flat world, the definition of what the corner looks like has changed dramatically. You could have medical care almost anywhere, so it really goes beyond medical tourism and looks more like generating maximum usage and facilitation among those three separate points.
MTT: Are the existing facilities sufficient, or is more development required?
JM: Many of the facilities that exist in developing places around the globe are, in fact, world-class. However, they are not populated by sufficient quantities of qualified medical doctors and lack a robust, experienced staff with eclectic blends of capabilities.
But this can be achieved in a very smart way by identifying and marrying together doctors who are available to participate. This will require different functionality and skill sets, ranging from primary care to specialists such as orthopedics, gynecology, epidemiology and others.
The patient base is available and the demand exists.
MTT: The objective is to really maximize the capabilities of an existing infrastructure?
JM: The goal is to establish partnerships at the hospital department level so that a very thick bandwidth of relationships is in place. The next step is to identify the patient-client base that has specific requirements -- and you marry them up.
The idea is to put the right engine in the middle and drive the activities. In essence, Advon becomes the “Intel inside” of medical care.
MTT: So this could be in any location in the world?
JM: Yes, it could be. But we are being careful not to dilute our resources and chase after every potential opportunity.
Where there are facilities that have certain existing capabilities and reputations, it is feasible to drive occupancy without concern.
For example, many point to Thailand as a perfect place to get a hip replacement. This might be exactly what the individual wants and needs, because Thai hospitals utilize new scientific techniques and Thailand is the place to have it done.
What we don't want to do is chase after business needs that are already being met by others. Our model is not Doctors Without Borders. Concierge medicine more aptly describes the high-end part of our platform, and it provides an incredible niche for our business model. But it really is separate and distinct from what we're trying to describe here.
MTT: Who are your potential customers, your clients? How would you describe your market?
JM: The term medical tourism may not be completely accurate to describe our target market or clientele. We are talking about the ability to move in a direction with a very specific target in mind to solve a medical problem. This requires access and abilities that wouldn't be available to everyone.
MTT: Are there three distinct services that you are providing - telehealth, concierge medicine and, of course, developmental work in those areas -- that may require a higher level of medical and healthcare expertise?
JM: Yes. Very specifically, the concierge medicine platform can essentially stand on its own as a business model, one that would require very aggressive marketing to make sure you are touching the right folks. But the definition and its core make eminent sense.
For developing areas that have a long-term requirement for enhanced medical care through the creation of the medical infrastructure, the process begins with acknowledgement by the population that there is, in fact, a problem.
The development of an infrastructure allows you to address the issues, and then the population of that infrastructure sustains it.
MTT: Does concierge medicine work for every type of environment?
JM: I think it is a model that makes tremendous sense, but it starts where government dollars and government intervention get in front of the model…concierge medicine from the bottom up.
If you could get that top-down commitment, it is unlikely that there will be a migration to a traditional form of concierge medicine.
But concierge medicine could migrate in the direction of helping those developing countries to solve problems, with any eye on building a functional delivery model. Essentially, you create what that model looks like and link it to specific locations.
MTT: Please expand upon the telehealth or telemedicine component of Advon and its importance to medical travel.
JM: The conversation of telehealth or telemedicine begins and ends with robust access to electronic medical records (EMRs). As a nation, we still have a way to go. This is a classic example of letting a thousand flowers bloom -- which is great and should happen.
I don't think that the EMR should be centralized. Heaven forbid that the government reaches in and says, “Here's the solution for EMRs.” If that happens, we'll surely screw it up for the next four years.
However, we've reached a point where individual solutions in the information technology (IT) world, and specifically those that are EMR, can be part of an open architecture so that they can flow easily and be queried.
There should be no difference between my EMR and yours. Of course, privacy concerns must be overlaid on top of the platform.
Physicians should be able to sit down wherever they are located and pull up sufficient data with clarity and precision. This ability would allow them to help the patient and providers who are on the other end.
This is not hard to implement. We have figured this out and need to wrap the business model around the concept.
MTT: Are language barriers formidable for the implementation of EMRs?
JM: Multiple languages are not an issue. First and foremost, there are sufficient automatic language translation (ALT) services available. While it is an imprecise science, it gets pretty close.
We haven't yet created a software application that allows you to instantaneously, or with some level of delay, go from one language to another language with a level of clarity that you would expect.
But you can get the gist, or at least get a summary, of what is being said. A doctor could sit down in any language and pull up what the primary concern is -- if not the precise information on what happened and when it occurred.
Most everything in medicine is precise -- it's a universal language. So, I don't think language is a barrier, but we certainly have ways to work through that. It's just a matter of dedicating space in a facility to improve the process.
MTT: That's very interesting because when I speak to these doctors, the language barrier is cited as one of their major challenges in dealing with the international market.
JM: Translation should not pose a problem. During my service career, I was in charge of all language development requirements and the application language skills.
It is hard to achieve a level of excellence in language: in other words, training individuals to speak another language is very difficult and takes time.
Then there are the elements of total immersion, and we all understand this phenomenon. We know how the brain works and how it picks up a different language at different stages. Apparently, when you're a child you're more inclined to learn a different language.
My point is that you could overcome all of that.
The doctor doesn't need to have someone sitting next to him who speaks the language. It certainly would be helpful, but there are ways to facilitate those interactions via telemedicine or a virtual approach that would allow care to be delivered according to recognized standards.
MTT: That it is going to be a very welcome message. Can the Advon business model be replicated in multiple geographic markets?
JM: I would say yes. It is a matter of defining the requirements and the ability of that particular market to accommodate the various movements that would have to be in place.
It starts with a government that is willing to accept the application of medical care that is fraught with a whole dose of danger - and the movement of doctors who would have to be certified in specific nations in order to provide medical care.
So the short answer is yes. There's no real restriction to how it is done. But an important factor is the level of hygiene that exists. There are some places in the world that are just “basket cases,” and we know where they are.
But in order to provide a capability, there has to be a business model that allows for the establishment of a facility -- whether it is temporary or temporary that leads to permanent.
You have to get beyond altruism in trying to solve all of the world's problems. There has to be an incentive to do that, and Advon has the capabilities to perform.
A receptive government on the receiving end must acknowledge there are things that it must do to facilitate and meet the needs of its people.
MTT: What is the strength of Advon in accomplishing these goals, and why is the depth of Advon leadership so key to the success of this company?
JM: Look at the names. Look at the skill sets.
In every position on the Advon team, there is a combination of medical professionals, as well as senior military leaders, who have served in all operations and environments. They've seen medical and societal issues that normal citizens in their lifetimes will never see.
The sense of the unknown is minimized. Everybody on this team has a tremendous set of experiences, so we are not ambushed by new requirements, and actually form the delivery of quality care.
We've seen it and we've lived it. We also have problem solvers. These are people who have been senior leaders in the military, and that's what they are fundamentally trained to do: deliver solutions.
They understand the problem, acknowledge its various elements and then deliver honest, honorable solutions in a way that is repeatable.
You try to avoid being lucky. What you want to do is be good -- because you understand what it is that you are engaged in. So if you're lucky all of the time, it is not a repeatable event. You want to establish processes that are repeatable, and you do that through knowledge and by understanding practice.
This is what Advon brings to the table.
MTT: I would think that is a key market differentiator - if anyone tried to replicate your breadth of services, they would not have that type of team available.
JM: They wouldn't.
I hate to say it, but we've been in situations where we've not only seen it all -- but we've seen it all and have been shot at.
And so we've been able to work our way through the environmental conditions to provide the quality care that you would see in your neighborhood clinic. I think that is highly significant.
There are a lot of issues out there and there are a lot of problems that could be solved. I think Advon is positioned in a way to make a significant difference.
MTT: Even a hybrid company would not have this experience or perspective.
JM: The key thing is that this is a business.
In many folk's eyes, even in the altruistic world of medical care and delivery, there are those that would look at this and see it as a competitive space. They would not want to embrace it -- even though they themselves would benefit and could, in fact, increase their ability to be successful.
MTT: Do you want to point to any imminent activities?
JM: I would say that we are on the cusp of several great opportunities that will help to define Advon and its core capabilities.
These activities might accelerate our corporate pace or validate the direction of the Company. We will be positioned to make announcements in very short order. Again, we are positioned in such a way that we can grow accordingly.
MTT: Your background and military service are quite impressive. Can you also share with our readers how you got the nickname “Spider”?
JM: Essentially, I was a tall, skinny kid -- and am still tall and relatively thin. When I played football, I looked like a spider. A bunch of friends just starting calling me “Spider,” and I learned that there are two things in life that you can't pick: your parents and your nicknames.
When I went to West Point with five of my high school classmates, an impressive number from the same school, they carried along the nickname.
I tried to abandon the name because at West Point you want to remain anonymous and do nothing that might give you any sort of notoriety. But the name Spider has stuck with me since I was 17 years old, and I don't think it's going anywhere.
But all of the women in my life call me Jimmy, including my mother and my wife of 35+ years, who was present at the creation of this nickname during the time we met in high school.
MTT: Well, at least they don't call you Spiderman!
JM: You should see my office at home. My three daughters give me such incredible stuff. I've got this great Spiderman poster, and I just love it.
When I was in the Army's Intelligence Center, I was the Commanding General and had the duty much like every General Officer to honor our deceased soldiers. You preside and are the Commander at their funerals.
We represent the President of the United States, and it is humbling, as you can imagine. We are burying these great soldiers who have sacrificed all, and it just brings you to tears.
I did these a number of times, and at each one the governor of the state where this great young American was being buried sent a representative. On each occasion, that representative would come to me and say, “General, after you present the nation's colors, I request permission to present the state colors on behalf of the governor. Would you allow me to do that in your ceremony?”
The Army owns each ceremony and has a way of doing it. This is a request to do something a little different, and on each occasion I said, “Of course. Please thank the governor for his/or her support to our soldiers and their families. God bless you and yes, the answer was yes.”
MTT: Did you have the same experience in every state?
JM: For the most part it was the same. I've buried many soldiers and a few from the state of California. Arnold Schwarzenegger was the governor at that time, but he chose not to follow that tradition.
Now, I don't know that he consciously made a decision not to do so, but nobody on his staff had the smarts or the perspective to carry out the tradition in comparison to some of the other governors.
There was one very difficult burial/funeral that I had to attend. It was a soldier who I had sent into combat, and he had gotten killed -- so I took personal responsibility for his death. You just tear up.
Even for a crusty old soldier, it was very hard and the governor wasn't there -- he did not even have a representative present, and I thought it was really kind of BS.
I wrote a letter to Gov. Schwarzenegger, and said I found his actions unacceptable. Essentially, the tone of my letter was, “I'm disappointed in you Governor. I'm not sure what my expectations should be, but you confirmed my perceptions that you are narcissistic, self-centered and not surrounded by the right people.”
There is another expression in the Army, “If it feels good, don't do it.”
MTT: Did you send the letter? Was there a response?
JM: So while this letter made me feel really good, I'm basically shooting the bird to the governor and I'm giving him input. I've said that he should have done something and what it means to the families of these soldiers.
Essentially I was saying, “Let me tell you what it says about you as a leader in your state. You've chosen not to participate and you have every right to make that decision. You've chosen not to do it, so I'm disappointed in you, and I think it's bad form.”
So I gave that letter to a couple of my staff officers with whom I had a great relationship and really respected their thoughts.
They all said, “You know, Boss, do it - you should send this to him.” So I did. And here's the point of the story: the next day I had on my desk a picture that one of my soldiers had drawn. He knew I had written the letter, and he had read it.
The picture he drew was of Spiderman kicking the (expletive) out of the Terminator. I gladly embrace both Spider and Spiderman.
About Retired Maj. Gen. James Marks
A graduate of the US Military Academy, Gen. Marks has more than three decades of experience in the Intelligence field. During his career, he held command and staff assignments from infantry platoon leader and infantry company commander in the 101st Airborne Division to senior intelligence officer for the Coalition Land Forces during combat operations in Iraq as part of Operation Iraqi Freedom. He concluded his career as the Commanding General of the US Army Intelligence Center and Fort Huachuca, Ariz.
Gen. Marks was co-founder and principal at Willowdale Services, and was president and CEO of Global Linguists. Currently, he resides in Virginia, is a contributor to the BBC and a military analyst for CNN.
His awards and decorations include: the Distinguished Service Medal, the Defense Superior Service Medal, Legion of Merit with one Oak Leaf Cluster, Bronze Star, Defense Meritorious Service Medal, the Meritorious Service Medal with four Oak Leaf Clusters, the Army Commendation Medal, the Army Achievement Medal with one Oak Leaf Cluster, the Armed Forces Expeditionary Medal, the Global War on Terrorism Expeditionary and Service Medals, the Korean Defense Service Medal, and the NATO Medal.
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Editor's Note: for more on concierge medicine, see link (The red-carpet treatment) in NEWS IN REVIEW.