Issue link: https://beckershealthcare.uberflip.com/i/1544360
16 GASTROENTEROLOGY Inside the model that cut GI wait times to 11 minutes By Sophie Eydis F or years, Russ Arjal, MD, a gastroenterologist and co-founder and chief medical officer of WovenX, watched the same pattern repeat itself in gastroenterology. e specialists were skilled. e care was strong. But patients were still falling through the cracks. e failure point was not inside the procedure room. It was before the visit ever happened. "It was incredibly hard for people to get to the door," Dr. Arjal told Becker's. "Once they got to the door, they were fine, but there was this long line and terrible things happen in that line." Dr. Arjal spent much of his career in Seattle helping manage one of the country's larger community GI practices. What troubled him most was not what happened during the visit, but how long patients had to wait for one. One case still lingers. "I had a young patient who waited three months to see me with rectal bleeding, and then another three months for a scope," he said. "is was 2017, when we were starting to see the effects of early-onset colon cancer. He metastasized while waiting to see me, and that was totally a systemic failure." at moment sharpened his focus. Specialty care did not need better procedures. It needed faster entry. "I wanted to be focused primarily on just one thing, which was access to specialty care and accelerating that," he said. But to Dr. Arjal, access is not simply about appointment slots. "Access is really what I talk about. It's patient agency," he said. "We give power back to patients and give them choice, and I think that's why patients love the service. ey get some control back." Turning friction into flow e premise behind WovenX, the company Dr. Arjal co-founded, is straightforward: demand for specialty care already exists. e system simply makes it difficult to capture. "It's just physics," he said. "It's easier to see us than a competitor where you have to call, you have to wait and a lot of things happen during that wait." WovenX partners with both health systems and independent GI practices, integrating seamlessly into their operations. "Last year, the median wait time to see one of our clinicians was 11 minutes across the country, versus usually weeks to months," he said. Speed changes the downstream trajectory. "People have quicker workups. ey have earlier diagnoses. ey avoid the emergency department," Dr. Arjal said. "A lot of these patients end up in the ED for GI issues, and we're able to direct them to the right place." In Washington state, one early partner, Tacoma-based Washington Gastroenterology, reported measurable results over 18 months: $5.4 million in total revenue generated, a 72% reduction in time from referral to completed procedure, a 5% increase in endoscopy suite utilization and a net promoter score of 88. Dr. Arjal attributes that growth less to marketing than to removing drop-offs in the process. "ere's a lot of demand out there. It just can't get in the door, and there are a lot of drop-offs," he said. "You get patients who are highly motivated. ey self-select. ey have something they want addressed or that needs to be addressed, and they fill those spots." Even high-performing GI groups, he noted, lose procedural capacity because friction thins the pipeline. Dr. Arjal said he was surprised to learn that even high-performing GI groups may effectively lose around 15% of their endoscopy capacity because patients drop off during long waits and scheduling friction. A resilience strategy, not just a growth tool e model was tested in a different way in 2024, when a large academic health system lost nearly its entire GI physician team, dropping from almost 20 physicians to just two. Wait times stretched into months, threatening both volume and trust. WovenX stepped in to stabilize the service line while the system rebuilt. "We came in and supported them," Dr. Arjal said. "We supported the clinicians they still had so they could spend more time in the endoscopy lab, where they were most needed, because we were able to take on much of the cognitive load." Without that support, he believes the remaining physicians would have reached a breaking point. "You start to really feel moral injury at some point where there's just not enough of you to do it," he said. Over the following year, the system rebuilt its team while maintaining continuity of care. "I wasn't sure how fast they would be able to recover," he said. "But they were able to recover and build that back pretty quickly." What could have been a collapse became a bridge. Why APPs are central At the center of the WovenX model are advanced practice providers. Dr. Arjal believes they are essential to scaling specialty care, but too oen placed in misaligned systems. "APPs are critical to the future of specialty care," he said. Too frequently, he argues, they function either as one-to-one extensions of physicians or operate with insufficient support. "ey were either just an extension of a physician, just a one-to-one, which doesn't really help you scale at all, or they were just le out there without much support," he said. WovenX was designed around APP workflows, using AI-guided intake, complexity flags and physician oversight triggered when needed. "e decision-making of our APPs is measured against expected performance, with complexity flags and utilization flags," he said. "If they meet certain criteria, it flags our physicians to come in and support and review." Over time, he has seen variability narrow. "What I've seen is the performance band narrow significantly," he said. "eir work improves in quality, even from a high-quality baseline." at infrastructure, he believes, makes expansion into other specialties possible. Urology is next. "e same bottlenecks and structural limitations we see in GI are present in urology," he said. "It's essentially the same challenge." e North Star When asked what signals success, Dr. Arjal does not start with revenue.