A Health Care Choice You Didnt Know You Could Afford

[Music]

i’ve often heard people say

that kidney stones are as painful as

delivering a baby

and my wife and i would often debate

whether this was true or not so we

decided

let’s duke it out she got pregnant and i

got a kidney stone

actually two to be precise but i soon

realized i had made a terrible mistake

in this challenge

and it wasn’t that my wife was right

which for the record she always is

but these kidney stones cost me four

ultrasounds

three cat scans and a surgical procedure

yeah ouch but then as i looked at the

bill

something struck me i had paid over a

thousand dollars for a cat scan

and over 250 dollars for an ultrasound

and this was despite having a health

plan

that cost over two hundred dollars

a month so you can see that

the pain from these bills started to be

a lot more painful

than the actual stone and speaking of

stone

i did not intentionally cause my stones

to occur

if that were the case we’d be having a

very different kind of conversation

today

so here’s a real shocker i am part of

less than one percent

of doctors throughout the country that

practices a unique form of primary care

where i help my patients get cat scans

for

350 dollars and ultrasounds for 150

whether or not they have health

insurance and without any paperwork

hassle

so something literally doesn’t add up

but the cost of procedures

isn’t the only issue with our medical

system today

there is so much administrative burden

and bureaucracy

that sucks away a ton of time and money

25 of health care spending in our

country

which can be up to 900 billion dollars

is considered to be waste in our system

you know in the traditional system when

you get sick

you go to your doctor if you’re lucky or

nearby doc in a box

and you’re immediately greeted with a

stack of papers

which pretty much could be your

autobiography

questions about your anxiety questions

about whether have you have enough food

on the table questions about

your history so why are you asked all

these questions

about poverty work stress

family life well it turns out that only

11

of our health is determined by the

medical care we get and yet as a country

we spend over 3.2 trillion

dollars on health care most of which is

not going to the people working in it

so what are these other factors well the

biggest

is individual behavior followed by

social circumstances

genetics and biology and your

environment

so it begins to make sense why we want

to get to know about you

as a person why we want to know whether

you have enough

food on the table or whether your job is

so stressful

that you may want to leave it perhaps it

might influence

which medication you’re likely to take

or which test you may push

off or not so while these questions have

a great purpose in theory

to determine your whole person health

they’ve unfortunately become

deeply embedded in a financial model

one where if the box is not checked

it doesn’t count and if it doesn’t count

it doesn’t generate money so back to

your office visit

you complete your stack of papers and

you begin

the waiting game you wait

you wait and you wait

and you’re finally seen only to spend a

few minutes with your doctor

studies show that the average amount of

in-person face time

patients spend with their doctors is

between eight to 12 minutes

and yet sometimes they spend over two

hours

between traveling and sitting in waiting

rooms

for those precious eight minutes

so in these eight minutes you were told

you have strep throat

you needed antibiotics and you had to go

to the pharmacy and by the way

you’re carrying some excess weight so

you need to lose weight eat healthier

exercise more

the end and this cost you 120

so let’s put all this together right so

health is determined by so much more

than medical care itself the biggest is

individual behavior

you’re asked a lot of questions which

are important

but you only have eight minutes with

your doctor so you get through the

current issue at hand

in the long term perhaps more important

things such as

addressing your lifestyle challenges or

your eating or exercise

is pushed aside because there isn’t

enough time

because your doctor has to see 22

other patients that day and this cost

you

over a hundred dollars now many of you

can probably relate to the scenario i

just described

what if i told you that there are over a

thousand

doctors across the country that could

have probably given you that visit

for less than ten dollars if you’re a

member of their practice

and that they could spend an hour face

to face with you

exploring your challenges with your

health

and that whether you had health

insurance or not you could choose

to have that type of care

health insurance is a way of paying

for care it does not necessarily give

you access

to good care now think about every other

way you use insurance

you know car insurance you use for a car

accident not to

replace your wipers or rotate your tires

or for an oil change

homeowners insurance you use if a tree

falls on your house

not to your driveway or clean

your gutters or repair a faucet

so why do we use health insurance for

things

other than catastrophic events for say

primary care

which is often the lowest cost

service in health care

in a model known across the country as

direct primary care or dpc

for short doctors like myself operate

outside of the insurance world to give

you care

that is accessible doesn’t break the

bank

and doesn’t discriminate based on health

insurance

here’s how it works think amazon prime

or gym membership

but to your doctor’s office for a low

monthly

membership subscription fee which often

costs

less than a cup of coffee a day you get

an

all-access pass directly to your doctor

it includes things like in-person visits

telehealth

email texting phone calls all without

any copays

it also includes tests like ekgs or

breathing tests

at no additional cost doctors get to

provide

excellent care coordination by directly

working

with other doctors that take care of you

and bypassing

the layers and complexities of our

health care system

and there’s more doctors may offer lower

cost

labs at up to 90 percent lower the cost

lower cost imaging such as cat scans and

ultrasounds

and lower cost medications often times

dispensed right in the office

and there’s more depending on the type

of practice the doctor may offer

acupuncture or integrative medicine

by taking down these artificial barriers

that increase the cost of care

doctors get to not only give you great

care but help you save money

so let’s see how dpc work for john you

know john is in his 60s and he has a

form of

blood cancer that’s chronic but still

weakens his immune system

he does a lot of work with plants and he

noticed one day that his finger

was swollen so what did he do he sent me

a text message

thirteen text messages and four pictures

later

we determined that you know what we

needed a video visit so i can get some

more information

five hours later that same day john and

i had a video visit

which lasted about 10 minutes because i

knew him pretty well

toward the end of the visit we decided

you know what i really needed to see

this in person

and that he’d come in the next day so

john came in the next morning he didn’t

wait

which is reassuring because it minimized

any exposure for him

he came right in examined his fingers

and we decided

he needed antibiotics and then something

really

funny happened you know john’s wife was

also a patient of mine and had been

struggling to really understand

their direct primary care model of care

texted him

a question can you get the antibiotics

from the doctor she asked

now i can’t tell you how excited that

made me feel i was like yes she gets it

so john walked away that day antibiotics

in hand that cost him three dollars

over the next three days and through the

weekend john and i exchanged

19 text messages and three picture

messages

until his infection had resolved and

this entire

experience cost him three dollars

the strange thing about direct primary

care

is that those of us who do it are

incentivized

to work for you let’s think about that

for a second

who does your doctor work for you

their employer or in some way

the insurance company that ultimately

gives the money that

pays their salary what if your doctor

was not incentivized to refer within

their organization

or that they didn’t have to worry about

the number of patients they saw per day

and that you truly felt like you had a

partner who had your best interest in

mind

with minimal conflicting factors

the answer is not hypothetical it’s the

reality

at over a thousand three hundred

practices

across the country so now you’re asking

yourself

why doesn’t everyone do direct primary

care well some

argue that if every doctor that normally

takes care of

two to three thousand patients suddenly

went into direct primary care where we

take care of

300 to 500 patients that the primary

care shortage

in our country would get worse

the reality for us docs is that the job

of a primary care physician

is so under appreciated and overburdened

that many dread going into it

perhaps by changing the model we’ll get

more docs

and more access and i’ll be honest

as a direct primary care doctor i have

to do a lot more than medicine

i have to coach i have to care

coordinate i have to keep accounting

i have to negotiate test prices for my

patients i have to network

and it may not be for everyone but as a

patient

direct primary care clearly has its

benefits

studies have shown that employers can

save up to 40 percent

on health care costs by offering direct

primary care

they’ve also shown a decrease in cost

from demand for health care services

a 41 reduction in emergency room usage

and a 20

reduction in hospitalizations all while

having savings

with medications and labs that are

provided

at lower cost the satisfaction rate

remains high because the service

provider

the doctor is focused on the client

the patient but let’s remember that

direct primary care is a piece

of the puzzle the primary care piece of

it which really

should be your gateway to your

healthcare experience

it doesn’t replace the need for care

outside the scope of primary care for

say

hospitalizations due to heart attacks or

other life-threatening events

or labor and delivery or complex

conditions that

really need to be co-managed with a

specialist

but when you need to use other parts of

the health care system

your direct primary care doc is right

there

by your side helping to make that

experience as smooth

as possible and while i said that

primary care is a piece of the puzzle

it’s probably the most

important piece where eighty to ninety

percent

of your health care needs can be met by

your direct primary care doctor

at a fraction of the cost with much less

waiting time

much more time with your doctor and a

far more

personalized experience

now let’s be clear i am not blaming the

doctors

in the traditional system but i am

questioning

the system as a whole i’m questioning

the system

that doesn’t educate us patients and

doctors

about the choices that we have i’m

questioning a system

that is building artificial barriers so

that doctors and patients

can’t have relationships i’m questioning

the system

that is wasting billions of dollars of

your hard-earned money

on things like billing coding and

checking boxes

and i’m questioning the system that

isn’t solving the fact

that in eight minutes we cannot help you

work

on the most important determinants of

your health

but there are choices out there direct

primary care

is one of them it may not be for

everyone

for my patient john it made a difference

if you didn’t know it existed well now

you do and i hope that as you look at

your health

you remind yourself that you have

far more choices and decisions

you can make thank you