Month: March 2019

BPC Good Eats: Chicken Stuffed Acorn Squash


23 March 2019

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Chicken Stuffed Acorn Squash. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Chicken Stuffed Acorn Squash
Adapted from: Eat At Our Table
Prep time: 20 minutes
Total time: 1 hour

2 small acorn squash (2-3 lbs)
1 tsp olive oil
Salt and pepper to taste
1 (12 oz package) chicken sausage- your choice flavor
1 tbsp olive oil
1 tbsp chopped fresh sage
1 tbsp chopped fresh rosemary
1 tbsp thyme leaves
1 cup cooked quinoa
1 cup grated parmesan (divided)
½ cup panko bread crumbs
1 egg (beaten)
½ tsp salt
¼ tsp pepper

1) Preheat oven to 400F.
2) Cut acorn squash in half, rub with teaspoon of olive oil and season with salt and pepper
3) Place the squash cut side down on a sprayed baking sheet and roast 20 minutes.
4) While squash is roasting, place a saute pan on over medium-high heat, add 1 tsp of olive oil
5) Cut the chicken sausage into bite sized pieces and brown in saute pan
6) Add the fresh herbs and sautee for an additional minute, then remove from heat.
7) In a bowl combine the cooked quinoa, ½ cup parmesan, panko, and salt / pepper.
8) Add the chicken sausage/herb mixture to bowl, and stir together. Add the egg and stir again.
9) Stuff chicken mixture into acorn squash, sprinkle with remaining parmesan.
10) Bake for 20-25 minutes


Direct Primary Care keeps Medication Costs Low


19 March 2019

Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is how does Direct Primary Care (DPC) keep medications costs low for it’s members? Offering low priced medications is a key feature of virtually all DPC practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic dispensing and can provide hundreds of medications to their patients at a tenth of the costs that many national retailers can provide.

How DPC Practices Keep Medication Costs Low

DPC practices, like pharmacy retailers have applied for and obtained their medication dispensing license from their respective states. This allows a DPC provider to contract with pharmaceutical wholesalers of medications, the same wholesalers who retail pharmacies such as RiteAid, Walgreens, or CVS may use.  My clinic, Beyond Primary Care, uses two wholesalers of medications, AndaMeds and Bonita Pharmaceuticals. 

These wholesale companies sell the medications, often in large quantities to the DPC practice. However, unlike hospitals and retail pharmacies where selling medications IS their business – resulting in the expected mark-ups (250%!) and high-prices as noted by the American Journal of Pharmacy Benefits– DPC practices turn around and sell the exact same mediations to their patients at those near-wholesale prices. As noted, DPC sell the medications to their members in this innovative manner because our primary business is taking care of you and NOT being just a pharmacy. Your membership for care to a DPC practice allows for this innovation. 

Savings from Medication Costs

You may be or may know some people who take multiple medications. Medications for blood pressure, diabetes, urinary incontinence, anxiety, heart conditions, COPD, or erectile dysfunction may add up to hundreds of dollars a month you are paying out of your pocket. Compare this to the costs I charge my members for the exact same medications. Often times the money saved in medication costs alone pay for a DPC membership! Don’t see your medication on my sample list? Don’t worry, I may still stock it or I can order it too!

* Prices are subject to change without notice, one month supply listed unless noted

Did I Mention In-Clinic Dispensing?

Many DPC practices do in-clinic dispensing of medications. Once the doctor evaluates you and discusses the best course of treatment, that provider can have the necessary medications dispensed to you before you leave the office. In urgent situations, this saves you time, energy, and of course MONEY, something that rarely happens in fee-for-service medical offices. 

Obtaining Specialty or Brand Name Medications

As I mentioned in my earlier post, there are times a member needs or would benefit from a certain medication that is brand name only (very expensive) and would be best obtained through insurance that requires a prior-authorization (what is prior authorization) from the insurance company.

In this scenario, we will work to fill out the necessary paperwork to get your needed medications at reduced costs or even reach out to the pharmaceutical companies seeking a reimbursement or free supplies on your behalf. A great example is we got one of our members Vivitrol, a vital medication for Medication Assisted Therapy in Addiction Medicine. This medication costs over $1,000 on the market, but we worked to get our member the medication FREE of charge with their insurance. Did I mention the office visit and the injection itself were included with the membership? So the patient literally paid $0. Saving money for our patients gets me so excited! 

Spinach Tuscan Chicken

BPC Good Eats: Spinach Tuscan Chicken


13 March 2019

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Spinach Tuscan Chicken. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Spinach Tuscan Chicken
Prep Time: 15 minutes
Total Time: 1 hour
Adapted from: Alvin Zhou at Tasty

4 bone in, skin on chicken thighs
2 teaspoons sea salt
2 teaspoons pepper
1 tablespoon olive oil
5 cloves garlic
1 onion, diced
2 tomatoes, diced
4 cups spinach
2 cups heavy cream
Salt and pepper to taste
1 tablespoon cornstarch
½ cup parmesan cheese, grated
2 tablespoons parsley, chopped

1) In a medium bowl, season the chicken with salt and pepper.
2) Place a skillet over medium-low heat, add the olive oil.
3) Place the chicken thighs skin side down and cook for approximately 12-15 minutes. Move the chicken around to ensure even cooking. Flip the chicken, cooking for another 15 minutes until chicken is cooked through. Remove from pan and cover with foil.
4) To same skillet, add the onion and garlic, stirring until onions are translucent. Stir in tomatoes and spinach until spinach is wilted.
5) Add the heavy cream, salt and pepper. Bring to a boil.
6) Remove 1 cup cream mixture into a small bowl, add the cornstarch and stir until dissolved. Once dissolved, add mixture back into skillet.
7) Add the Parmesan cheese and parsley, stirring until thickened
8) Place the chicken back in the pain, spooning the sauce on top of the chicken.


Why NOT To Go to the Emergency Room


8 March 2019

Hi, thanks for reading! My name is Dr. Jeff O’Boyle, and I am a board-certified family medicine doctor who owns his own clinic, Beyond Primary Care located in Ann Arbor Michigan. Like most family medicine doctors, our goal is to keep our patients healthy and out of emergency rooms if at all possible. My best friend is an emergency room doctor and I have the utmost respect for the care ER doctors provide and the role they serve in medicine. I have seen people in emergency rooms with life-or-death conditions such as chest pain and shortness of breath, and am grateful we have skilled providers in this area of medicine.

Why Not to Go to the ER

Yet, I meet a good number of people who utilize an emergency room like it’s a one-stop-shop for all their medical health. People going to emergency rooms for dental pain, refills on blood pressure medications, common colds, and various other complaints that have been manifesting themselves over the past 3 months. As a Direct Primary Care (DPC) family medicine clinic, I promote and encourage that longitudinal care with my patients to ask me for medical advise or treatment that can’t be achieved in emergency rooms. Here is some free advice why NOT to go the emergency room.

1) The ER doctor doesn’t know YOU

The trust that develops over time between a doctor and a patient (or family) is absent. It is also extremely helpful to have seen a sick individual or child when they were healthy, to know how far from their baseline they are.

2) You don’t know the ER doctor

Sick people are not happy people, and it’s hard to do a physical exam on someone stressing out. A familiar face causes less distress, and allows the doctor to do a better evaluation.

3) “Emergency” does not mean that you’ll be seen soon

 The ER team takes care of the sickest patients first. If you have a minor illness and a severely ill or injured person rolls in, you’ll be waiting a while.

4) It’s expensive

 Really expensive as noted here and here. It costs about $1,000 more to evaluate a minor illness in the ER than it does in an office setting–and that’s without any tests.

5) You will probably have tests

 This means needle sticks, radiation exposure, and increased cost. Often, a DPC doctor could do a thorough physical exam and schedule a follow-up the next day, all at no additional cost to you. But the ER gets one shot, and they can’t afford to miss something, so they tend to over-order imaging and labs.

6) The ER’s job is to figure out what you don’t have

 They are not tasked with figuring out exactly what is going on and solving every problem; the focus is on ruling out life-threatening conditions and deciding which patients need to be in the hospital. This often frustrates patient’s who come in wanting answers.

7) There are sick people there

 In the summer it may be vomiting or diarrhea. In the winter, it’s the flu. Emergency rooms do their best to keep things from spreading, but viruses haven’t survived this long by being bad at what they do. If you weren’t sick when you went in, you may be soon.

8) If the beds are full, really sick people can’t be seen

This is more altruistic, like vaccinating yourself so nobody else gets the flu–but it’s real. Every ER has a limited number of beds, and when they’re full, they’re full. If they’re full of relatively healthy people, the really sick ones sit in the waiting room until a bed opens up.

So What Should You Do?
Find a Primary Care Doctor that you trust

This is the most important step, and it’s one that you should take when you are healthy. A good physician can identify diseases early, track a child’s growth and development, provide reassurance when that’s all you need, and handle the vast majority of acute illnesses. If–or rather, when–you get sick, your doctor has access to her records and history, avoiding expensive and unnecessary repeat testing. That doctor will understand your personality and perspectives, and you will be less scared of a familiar face. Look for a Direct Primary Care doctor, who routinely offers same-day sick visits, weekend hours, and phone availability even when the office if closed–a lot of ER visits can be avoided by talking through symptoms over the phone.

BPC Good Eats: Tomato Basil Parmesan Soup


2 March 2019

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Tomato Basil Parmesan Soup. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Tomato Basil Parmesan Soup Slow Cooker
Adapted from: 365 days of slow cooking
Prep time: 15 minutes
Total time: 35 minutes + slow cooking time

2 (14 oz) cans diced tomatoes, with juice
1 cup finely diced celery
1 cup finely diced carrots
1 cup finely diced onions
1 teaspoon dried oregano or 1 Tablespoon fresh oregano
¼ cup fresh basil
4 cups chicken broth
½ cup flour
1 cup grated parmesan cheese
½ cup butter
2 cups half and half
1 teaspoon salt
¼ teaspoon black pepper

1) Add tomatoes, celery, carrots, chicken broth, onions, oregano, and basil to large slow cooker.
2) Cover and cook on low until flavors are blended and vegetables are soft.
3) About 45 minutes before serving, take the vegetables out of slow cooker and add them to a blender until smooth. If you prefer a chunkier texture you can leave it as is or just blend some of it. Return blended veggies to slow cooker.
4) Meanwhile, in a saute pan over low heat melt butter and add flour. Stir roux constantly with a whisk for 5-7 minutes. Slowly whisk in 1 cup hot soup. Add another 3 cup and stir until smooth. Add all back into slow cooker.
5) Stir and add the Parmesan cheese, half and half very slowly, salt and pepper.
6) Cover and cook on low for an additional 30 minutes or until ready to serve.