Common sense healthcare. What would make common sense when you go to get healthcare? Well, there may be a few things that you think about when you're at the doctor's office. You think, well, how is my experience going to be? Am I going to wait for hours in the waiting room and then get a few minutes with my doctor and then be rushed to the visit and then.
be able to maybe email them or message them and wait several days for them to reply. Well, that's usually the common thing that happens. That's usually the regular run of the mill practice that you see. So imagine if you just were able to start from the beginning and say, hey, I want something that is new or different.
I want something that actually is patient centered as many of these health centers try to claim. So the first part you may think about is how do I enhance my own experience? What'd be a very cool experience for me to have? Well, you'd be able to call up the doctor's office or maybe schedule an appointment online really quickly and then get in and be seen within maybe five, 10 minutes.
and have a long time with your doctor so they can explain everything, you can tell them all of your problems and they listen empathetically. So they listen to you with this intention of helping you out and achieving your own goals. And then you want to be able to talk to your doctor after you leave.
So that would be kind of the experience. Well, the next part you may go on to think about after that's done is, well, how much is this all going to cost me? Is this going to be a hidden cost visit or is this going to be a transparent cost visit? And then can I actually afford it, right? How do I put this into my budget if I don't even know the cost?
Tom (03:42.826)
And so that would be your collection of the experience and then knowing the cost and being able to afford it. And then after you're taken care of, you may sit there and go, okay, I'm doing pretty good. I had this great experience. I knew all my costs. Well, how would I improve the health of everybody around me? How would I improve that so that I have neighbors who are healthy?
and then the rest of the town is healthy. And so you go, well, I could think about fitness, nutrition, is everybody sleeping okay? Can we get together socially? Can we have a party together and uplift some social spirits? And is my neighborhood running rampant with drugs? So.
These are things that you may think about to enhance your overall experience as well as your community. And it turns out that people already thought of this. So back in 2008, there was something called the Triple Aim, and this was by Don Berwick and colleagues. And so this is what I was kind of laying out, meaning,
They wanted to enhance a patient experience, they wanted to reduce costs, and then they wanted to improve the population health. So they were trying to think about this, and there wasn't really something invented for it until much later on, we'll talk about that. So.
the experience itself is super important because if you don't have a good experience, then you won't listen to your doctor. You will just be wanting to get out of there and not be able to implement the plan that expert as a doctor or a coach was able to give you. So that visit would be kind of just lost and your time would be lost too. And then if you...
Tom (06:04.922)
were to have a good experience, well, you get to this cost barrier, and if you don't know the cost or the cost is too high, then again, that plan just falls on its face and you actually don't get real help.
So that would be the experience and then reducing costs. Now, improving population health. There's multiple things that doctors have tried and that have had good success, like Walk with a Doc. Some of them have created gardens in the local area. They've funded local parks, like gyms in local parks, like the outdoor gyms. And then also they've created
entire cooking based classes for their patients to go to. And they've just done a lot of things to improve this population health. Well, that's all getting nice, but what happens is there is a fourth component and this goes from the triple aim to the quadruple aim. And this is really important and it kind of sheds light to
the difference between a person who's not a doctor thinking about it and then a person who's a doctor thinking about it because the doctors need to have good quality of life or good work life as well. And so do the nurses and everybody else who works in them. So you want your doctor to be empathetic to you. If that doctor is worn out, I'm not gonna say burned out, it's
actually worn out because the system that the people around them have created usually wears them out. And then that is passed on to your experience with that doctor. So they will not treat you empathetically because they are just worried about getting out of that visit and into the next one. So here's a little key tidbit.
Tom (08:20.694)
When you make your appointment with your doctor, you should ask them, well, how much time is allotted for me? How much blocked off time does that doc have with me? And a lot of times they'll say 15 minutes. And then you can say, well, am I double booked with somebody else? Like as if I'm flying on an airline? And they'll go, well, yeah, you might be. And you'll go, really? Because I thought...
My healthcare meant more than that. And so they don't.
Tom (08:56.334)
give you that quote unquote luxury of having time with the doctor. So these are systems that are built by managers and people who are not doctors because all they can see is the money. That's what they've been trained on. And so you don't get time with your doctor and that's something that you can ask them and go, hey, how is this quote unquote patient centered healthcare
place, right? Health care clinic.
And we realized that another thing that was contributing to the doctors being worn out was the electronic medical record system that they interact with. You see that doctor hunched over the computer and charting in. Now we'll say with the invention of AI, there is some very good transcription services that use AI to listen in the room and then put that in the note.
Well, the other part is that this doctor is seeing so many patients, the average insurance-based doctor sees around 2,000 patients in their panel. And so what happens is the number of dings and bells and whistles from that software, including their email, start to add up. And this causes them to be burned out or worn out.
And then again, that's passed on to you. So if your doctor is seeing far too many patients, that's another question you can ask. Well, what is his or what is her or his patient panel size? You can go, they can go, oh, well, it's about, you know, 16, 1800, and in your mind, that's a lot of patients. The doctors who do not practice in that model usually set a limit of anywhere between four to 600 patients.
Tom (10:53.566)
and that's realistically how much they can handle. So you imagine you're seeing a doctor who has these multiple things coming down on them and you are also thinking that you're going to get good care.
Tom (11:10.574)
And that is the quadruple aim, improving the work life of healthcare providers. And a lot of people have tried it with adding on more people on the team and really trying to use multiple people to address concerns. And it doesn't really work out very well because the doctor still has to make that decision. They still have to sign off.
on your physical therapy. So in effect, it never leaves the doctor's realm of cognitive strain. So that's the fourth area, improving the work life of healthcare providers. And then during this time, around this time, some doctors got together and decided, you know what? This isn't working. So they went off and created.
their own solution. And their own solution was to create a model called direct primary care, which is a non-insurance based subscription service. And in that service is the answer to all of these areas. So one, enhancing patient care. In a direct primary care practice like Pine, you get to, you can schedule online or you can text.
the doctor and say, hey, do you have an appointment today that I could see you? And they usually have same or next day appointments. You wait zero to five minutes, sometimes 10 minutes in the waiting room. And then you have an hour with that doctor. And then you can email and text them afterwards. You can even do a telehealth visit easily over your, whatever your phone is using. So if you want to FaceTime, they can usually do that. And so that,
answers the first part of that aim, which is enhancing the patient care experience. And then your doctor is also happy because they're not seeing 2,000 patients, they're seeing four to five to 600 patients max. And then the next part, reducing costs, well, they answer that too. They contracted as a large big group with people like
Tom (13:34.158)
Quest Labs or LabCorp, those are two main ones, and then drove down those prices. So they have an alliance created, so Direct Primary Care Alliance, DPCA, and this is how I get my labs with my patients. So labs that I've seen, I just had one last week, she said she was seeing functional medicine doctor, $600 labs. The actual cost, when I,
was looking over them, was about $100. So significantly lower cost, even my yearly labs are like $20. And so now we started to answer the cost of this. Not only that, there's a hidden cost. Hidden cost is that the patient would have to keep coming back because the visits are so short that now the patient is rescheduled again with that doctor. So now there's another copay.
whatever that is, $100, $150, well now there's another copay. Where in the direct primary care model, it's just a subscription base. So I can answer my practice, $25 for kids, $50, up to age 40, and then above 40, it's $75. And so now you know your cost upfront. You don't have to come in, you don't have to check in. Everything's...
pretty much done for you. And when you leave, you know the cost as well. So we can pull up that cost of the labs and say, okay, this will just be added on to your next billing cycle. And so they get to choose when they want it during that month, and then it's the labs and that's just passed off. If they need imaging or something else or an outside referral, well, we can either do an in-house referral to another doctor, like an endocrinologist.
and that can run about $100. And then the endocrinologist gives back the full plan. Well, if they need something else to a specialist, maybe in the area, we can use their insurance to pay for that. So we always say keep wraparound, but for your primary care, it's really low cost. So that kind of handles the cost aspect, meaning that this model,
Tom (15:58.274)
helps to lower costs significantly. Plus, you're not getting admitted to the hospital as much. So on the weekends, you can talk with your doctor, and guess what, you have an UTI, you don't have to wait several days as an elderly person, and they get admitted to the hospital for confusion, and now you have a huge ER bill, and that's running up the cost, even if they have Medicare.
Well, that's just another cost that's added into Medicare that the rest of the world in the US is gonna pay for. So now even that cost is going down. And then if businesses join, usually their premiums drop by about 30 to 40%. And so there's a lot of ways to control those costs. And even with medications, generic medications can be administered right in the office.
for sometimes a third the cost of Walmart, which is mind blowing to a lot of people. And I do it in my clinic with the medications that I can use for my patients. Sometimes I can't, sometimes I do have to send to a pharmacy, but even then I like to talk with local pharmacists who help run that pharmacy because we have a one-to-one relationship and they're not.
seriously worn out as well like in CBS or Walgreens.
And so this direct primary care answers that reducing cost. Now what about improving the population health? Well, now the doctors freed up with their time to go and do things like this, like create a podcast that says, hey, here are some health ideas, here are some health tips. So that's one thing they can do. Other thing is they can go out in the population and do walk with a doc, which is my next adventure.
Tom (17:59.642)
and they can also do multiple other things. Some of them have started teaching lifestyle medicine. And lifestyle medicine is the medicine that you want your doctor to tell you, as in, hey, you need to go to the gym three times a week, here's the actual full plan for that three times a week, increasing your muscle mass, as well as your cardiovascular stamina. And so this is...
how doctors in the direct primary care can now contribute back to the population of the surrounding city or town. And this was not possible before when I worked in the insurance-based world. In that world, I was told, no, you have to see this number of patients in order to sustain the practice. And here's another little secret hint or a secret,
secret that those clinics, those primary care clinics usually do not make money. The way they make money is by downstream referrals or labs. So the clinic itself does not make money. They will make money on the labs that they charge with that hospital system. And that's just how it is. So.
That's why they want you to refer inside the hospital network. And so that will be in the contract. It will say, hey, you gotta refer to the hospital network. You cannot refer outside. And.
I think that is actually illegal because I've looked that up before, talked with some attorneys and it's likely illegal. So that's how the
Tom (20:00.398)
direct primary care model contributes to the population health. Now, not only that, you go to one of these clinics or even one of these doctors and they're happy. They're very happy. They may be a little bit stressed because they're trying to keep their business afloat, but they're actually happy. They can look at you with a smile and then give you good advice with a nice happy voice instead of like they're stressed or wanting to run to.
the next room. So this addresses that healthcare worker being worn out. And they see less patients. So one of the questions is, well, if they're seeing less patients, why, you know, that means that I may not be seen because they're seeing less patients. Well, actually what it's doing is actually pushing
the medical students to choose primary care instead of a specialty. Because now they can control their own schedule, they can see how many patients they want, they can actually be nimble and switch up their type of care providing to address whatever that individual patient needs. Maybe they need genetic testing, maybe they need an ultrasound. So then that direct primary care physician
takes on that ultrasound cost and includes it in the membership. So now you're still paying, in fact, my family's doctor pays $50 a month, that includes ultrasound, which is absolutely unheard of in the insurance world. They need to charge for that in order to keep that clinic open. So that's just another way that it reduces costs. It also gives fulfillment to that doctor.
So it reduces the cognitive dissonance, meaning in the regular intranthes based practice, the doctor will want their plan to be fulfilled because that's how you get fulfillment in life is you help other people and then your plan gets carried out. Well, in the intranthes world, it doesn't always work like that because the ultrasound may cost a ton of money and the patient can't get it done. Well, now the doctor feels
Tom (22:25.138)
unhappy, they have to think about something else and try something else. So that really puts a bird on them as well. So you can see how the direct primary care model addresses that concern. And then the last concern, there is a recent addition to this, I think in 2021 by Shantanu Nandi, I'm just gonna read here.
Increasing health equity. And I'm just gonna read what she put there. Well, health equity is defined as a state in which everyone has opportunity to attain their full health potential, and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Health inequities affect many populations, including individuals who identify as black, Latino, Native American, or LGBTQ.
individuals in rural communities, individuals living in poverty with disabilities and older persons. And the reasons for health inequities are multi-fold, including structural racism, which shapes numerous opportunities that influence health, including educational attainment, employment, access to safe environments, affordable housing, healthful food, access to care, social relationships, and networks. So this is
a significant problem. And I'll give you one example. When I was in residency, I was treating a patient in the clinic who was having a sickle cell anemia attack and.
Tom (24:13.25)
they needed treatment, so I helped them out. And I think later on, I had to send them to the ER, so they show up in the ER, and I'm kind of watching their chart for the orders that the ER resident is putting in. And I realize, wait, there's no pain medications for this person. And I go, I wonder why that is. So I go over there, I walk back over there, and I ask them, I say, hey, why doesn't this
does this person have any pain medications? And I asked the nurse and she's like, well, how do you know he's not using something? And I go, oh, what do you mean using something? This is my patient, I take care of him, I see him. And then it dawned on me, I'm like, oh, this person is African American and they could be just profiling them in their head.
and this is in a prison town, so they had repeated exposure to bad events occurring in the African American population. So yes, their brain was wired to expect that people were going to use drugs in an appropriate way, inappropriate way. But it was one of the first realizations where, oh yeah, certain things like health inequities,
shape the administration of healthcare. And so I had explained to her, well, he's having sickle cell anemia attack. This is something that requires pain medications because it's like you put a blood pressure cuff on, pumped it up all the way and left it there. You imagine when your hand goes to sleep, well, that could be extremely painful if it just kept going on and on.
So these health equities need to be addressed as well. And that does mean some type of education in the medical world, but at the same time, that education also puts stress back on the healthcare worker, because if they have to take out time to do this, it's very stressful to them. And so it's a trade-off, right? So I think also,
Tom (26:38.45)
the direct primary care movement can address this because now that the doctor doesn't see as many patients, they can take that time to learn about these health equities. And then they can get that training that they need, and a lot of them want, because now that they're outside of that system that was driving them to treat patients like CogniWheel, they can actually take the time to...
address these health equities and even some of them will see about 10% of the population for free And there's no way that we can do that in the interns based world So I hope this was a decent overview about common sense health And if you have any questions, you know, please feel free to leave them in the comments and let me know My name is dr. Tom roundtree. I practice it
Clear Health Medical, which is my own direct primary care practice in Clinton Township. Thanks so much for listening, and I hope you have a great and healthy day.