admin
17 December 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Coronavirus Vaccine. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to update my patients and any prospective patients on the…
I have been receiving many questions about the COVID-19 vaccine, how it will be distributed and how to get it. The first shipments of the Pfizer vaccine will be going to hospitals and centers able to facilitate the challenging -100 degree storage requirements of this vaccine.
A few weeks back I called all x5 of my medical suppliers and not one had any knowledge of Covid-vaccines being able to purchase for individual clinics. The State of Michigan and NOT individual medical practices will be distributing and determining prioritization for vaccine administration.
Further, the State of Michigan has a multiple stage distribution plan prioritizing nursing home residents (who make up a sizable portion of the Covid mortality) and frontline healthcare workers (EMS, ER and ICU nurses and doctors, etc.). If you are one of these, please discuss with your hospital employer or place of residence how they plan to distribute/administer the vaccine
Once the State of Michigan moves beyond the first stages, CVS and Walmart have agreed to participate in the administration of the vaccine to the remainder of the population starting with high-risk people. It is hard to say with certainty when this will occur as it will be dependent on the speed with which the vaccine can be manufactured and distributed. It will likely be several weeks to several months before we reach that point.
Once clarity is provided as to how to get the vaccine and the process needed, I will share that with all of you so that those who want the vaccine and for whom the vaccine is appropriate can get it.
Please be aware that I- nor any other doctor- does not have control or influence over this process. It is being determined at a State and Federal level. But, I will do our best to assist all of you in navigating this process as it starts to unfold.
Please see the specific State of Michigan vaccine distribution plan here.
Truthfully the only individuals who should not get the Covid shot are children less than 16 years of age or people who experience a severe (life threatening) allergy to with other vaccines.
People with a cough or cold can still get the Covid shot.
Covid shots given may cause injection site soreness and pain, redness, swelling, fever, malaise and muscle aches- all of which are usually mild and go away on their own.
Thank you for reading.
admin
18 November 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Where can I find a Vivitrol Doctor in Ann Arbor. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to answer a common question…
Where can I find a Vivitrol doctor in Ann Arbor?
Vivitrol is a brand name medication available by prescription only from physicians or other professionals. Vivitrol is actually injectable Naltrexone, one of the active medications in brand name medications such as Revia. This medication is delivered directly to the physician’s office, and is typically given every 28 days- roughly once a month.
Vivitrol is injected by a physician as a liquid intramuscularly into a patient’s gluteus (buttock) area. Once inside someone’s body, it turns into a solid gel that gradually releases naltrexone at a controlled rate all month.
Vivitrol is used to treat opioid addiction or alcohol addiction, both are types of substance use disorder that is classified as a neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.
A great way to think of how opioids / alcohol and the medication works is my favorite comparison method- thinking of food. Imagine your brain has a bunch of empty ice cream cones on it- we’ll call these ‘receptors.’ When the ice cream- we’ll call these ‘opioids’ or ‘alcohol’ enters the space by the brain, they normally fit right into the empty cone. Unless you have a dairy allergy or are lactose intolerant, this will feel really good for most people.
This same mechanism is what happens for opioids (pills, drugs) or alcohol in the brain, when they result in a release of Dopamine creating a sense of pleasure and reward.
Vivitrol and the medication in it, Vivitrol, attaches to those ice cream cones making other scoops of ice cream less likely if not impossible to attach.
The simple answer is this medication is a method of harm reduction against opioid and alcohol use disorder, and it saves lives. I previously talked about what ‘harm reduction’ is in a post about The Sinclair Method here.
According to the National Institute on Alcohol Abuse and Alcoholism:
According to the Centers for Disease Control:
While on Vivitrol, individuals will receive a continual delivery of the medication naltrexone all month, and it only requires a once-monthly injection by a trained physician.
Why? The injection takes out any compliance issues for many folks battling opioid or alcohol addiction such as:
With Vivitrol we are not substituting one drug for another drug. We are substituting a researched, validated, and life-saving medication for drugs that can otherwise harm or lead to death.
You can always click through the Vivitrol website and look for providers that way. In addition to being a board certified family medicine doctor, I am also a board certified addiction doctor and utilize naltrexone products such as Vivitrol at my clinic Beyond Primary Care in Ann Arbor, Michigan. I use an eclectic and personalized approach- not a ‘cookie cutter’ plan- towards accessing and resolving your life changes and stressors. In addition to a thorough health history, I am going to ask about your family, where your quality of life is being most affected, and—most importantly—what you want to do.
If you think some of what you may be experiencing may be due to excessive opioid or alcohol consumption, or if you notice any coworkers, friends, or family members silently struggling, send them a link to this post so that they can join the conversation!
You can also contact Dr. O’Boyle directly. I look forward to hearing from you!
admin
13 October 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Breast Cancer Screening in Ann Arbor. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the first and highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Saline, Dexter, Chelsea, Ypsilanti and beyond giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to discuss an important healthcare decision females and yes- males need to consider as we age: Breast Cancer Screening
Breast cancer is a cancer that occurs when individual cells in the breast grow uncontrollably. Inside the breast, there are different areas where breast cancer can begin including lobules, ducts, and connective tissue.
Breast cancer is the second most common cancer among women in the United States, only behind lung cancer. White women and black women get breast cancer at about the same rate. However, discrepancies in diagnosis and treatment exist because black women have a higher morbidity than white women.
While most commonly discussed among females, breast cancer can actually affect males as well. Nearly 1 out of every 100 breast cancers diagnosed is found in a man. While rare compared to females, it is not to be ignored as males are more likely than women to be diagnosed with advanced breast cancer, most often attributed to a decreased awareness.
In 2017 for the State of Michigan, there were 7,582 breast cancer related cases reported- nearly 119 new cases for every 100,000 females screened. Recent epidemiological studies have suggested that incidence rates for breast cancer has been slowly increasing since 2004. Recent studies have concluded that increases in body mass index (BMI) and declines in the average number of births per woman (both breast cancer risk factors) have likely contributed to the recent increases.
The American Cancer Society (ACS) recommends for women at average risk to begin breast cancer screening at age 45. Women should get mammograms every year until the age of 55, at which point they can switch to every other year or continue yearly screening.
Factors for individuals to be considered average risk include not having:
It is mentionable that the United States Preventative Task Force (USPTF), another major panel that develops evidence-based recommendations for clinical preventive services, continues to recommend screening starting at age 50 years of age.
Why the difference in Screening Recommendations? It comes back to the harms versus the benefits of screening. Ahh yes, too much of anything can sometimes be fraught with unintended consequences. As example, the sensitivity of mammograms is generally higher in older women because of less denser breast tissue than younger women. However, If you’re reading this blog post, you have already accomplished the awareness for the need of screening. That’s a win, let’s leave it there for now.
Risk of breast cancer is due to a number of factors, with the main risk being a women and getting older. Most women have some risk factors. However, most women will not get breast cancer. Other risk factors include:
Once risk factors have been determined or a female has reached a particular age, the decision to be screened for breast cancer should be started. Below I discuss the most common types of breast cancer screening we encounter.
This is a low-dose X-ray of breast tissue and currently the gold-standard in breast cancer screening. Early detection of breast cancer by mammography reduces the risk of breast cancer death and increases treatment options, including less extensive surgery and/or use of chemotherapy.
This is called Digital Breast Tomosynthesis (DBT) and is actually a combination of multiple breast images, along with 2D breast mammography to construct a 3D image of the breasts She studies have found 3D mammography to be more sensitive, however this is not a wide spread imaging test available to all and may not be covered by insurance.
Thermography utilizes a special camera to measure the temperature of the skin on the breast’s surface. It is based on the ideas that cancer cells are growing and multiplying faster, thus blood flow and metabolism are higher in a cancer tumor. As blood flow and metabolism increase, skin temperature goes up. It involves no radiation.
In regards to radiation, I can certainly appreciate the concern to be less invasive and more natural. However, according to Wakes Medical Campus (Chapel Hill, NC), the total radiation dose for a typical mammogram with two views each breast is about 0.4 mSV. As perspective, they say we are normally exposed to 3 mSV of radiation each year just from our natural surroundings. Additionally, breast cancer screening via mammography is statistically about x20 more sensitive than thermography. Meaning, a radiologist may find a mass with thermography at stage 2, they likely could of found that same mass at stage 1 with mammography- and thus differing survival rates.
While monthly self-breast exams are no longer recommended based on increases in rates of false positive, all women should become familiar with both the appearance and the feel of heir breasts. Any changes should be promptly reported to their physician.
Such as breast magnetic resonance imaging (MRI) and ultrasounds are sometimes used on a case-by-case basis depending on risk factors and history of abnormal results.
At Beyond Primary Care, we encourage females to be proactive about their breast health and work with imaging centers that perform mammography screenings. The Affordable Care Act (ie- Obamacare) requires that Medicare and all new private health insurance plans cover screening mammograms without any out-of-pocket expenses to patients.
Note: screening mammograms are only covered through insurances. If your initial screening returns and advises follow-up, either a diagnostic mammogram, a breast ultrasound or MRI, working with Beyond Primary Care to determine your out of pocket costs is advised as some imaging price are more affordable without health insurance.
Please contact Dr. O’Boyle directly with any questions or to schedule an appointment to discuss further. I look forward to hearing from you!
admin
16 September 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Direct Primary Care Employer Healthcare. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to discuss an important healthcare option for employers that takes care of employees while reducing overhead:
Direct Primary Care isn’t insurance. Instead, it’s a unique high value membership that can be offered as a standalone employee benefit or used to supplement high-deductible health plans and catastrophic plans. At its basic level, DPC means the doctor works directly for the patient. No private insurance, no medicaid, no medicare, no middlemen. Since we are insurance free, DPC clinics contract with employers through a membership.
In return for a flat monthly membership of $50 at Beyond Primary Care, the employees and their families are provided with an incredible level of personal care including virtually unlimited office visits, in-clinic dispensing of wholesale medications, and wholesale blood work done at the time of appointment when necessary.
With the advent of the gig economy– which encompasses a range of full-and part-time jobs done by the growing cohort of contingent workers- nearly every U.S. industry will be employing a substantial amount of part-time and contract workers who won’t qualify for traditional health insurance coverage. These jobs include but are not limited to…
These are occupations with high levels of non-benefited employees.
According the the latest 2018 data, nearly 160 million American’s received their health benefits through an employer. But premiums and deductibles are pushing employer-based coverage increasingly out of reach. Additional businesses that would benefit from Direct Primary Care include:
On average, employers are spending $6,715 per employee per year for healthcare. Employers are tired of sitting around their board table every year and wondering how much of the health insurance increase is coming out of the employees pocket.
This is important.
Why? With Direct Primary Care the less employers spend on a health insurance plan, the more they can put back into salary or additional benefits. Employers can focus on building community-owned healthcare versus building the archaic insurer-owned healthcare. Employers can take active management of their spending patterns and discontinue relying on the traditional “passive management” approach provided by the ‘BUCAH’ insurances (Blue Cross, United Healthcare, Cigna, Aetna, Humana).
Currently employers have no power over healthcare costs with health insurance as it’s a patchwork in access to your physician and a free-for-all in which the prices of life-or-death essentials like insulin or epinephrine are set at whatever the market will bear. Efforts to check those prices are routinely trampled on by interest groups that hold influence over our lawmakers.
This important.
Why? The goal is to maximize employee health and minimize cost to the employer. Your employees are probably being crushed by out-of-pocket fees and lack of physician availability. Innovate by subscribing your employees (and maybe their families too) as a group to a local Direct Primary Care office. At no extra cost- you will get.
As example, at Beyond Primary Care, Dr. Jeff O’Boyle can get pretty much any generic medication for my patients at just a fraction of the cost. As example, we’ve had a patient paying $40 a month for a medication at Walmart and pay $8 for three months at Beyond Primary Care.
Direct Primary Care has become a key enrollment strategy to fill the healthcare solutions gap. If you are new to the Direct Primary Care movement, the good news is that Direct Primary Care is an easy sell. Employees need accessible and personalized coverage, and employers are happy with how affordable it is. If you ignore Direct Primary Care during open enrollment, you are leaving thousands of revenue dollars for yourself on the table as Direct Primary Care is a key strategy
Are you ready for some out of the box thinking on benefits? Don’t overcomplicate it. Qualifying for employer healthcare solutions at Beyond Primary Care offerings can be as simple as having at least 5 enrollees, and the cost can be as low as $50 per employee per month. Our clinic eliminates claims, pre-existing conditions, and other complications.
There are no losers with Beyond Primary Care. The employer can attract and keep talented members with great healthcare, reduce absenteeism, and brokers have a gap coverage product that can start paying off right immediately to assist in funding open enrollment.
If you think your business or you work for a place that would benefit from the services of Beyond Primary Care, send them a link to this post so that they can join the conversation. Many employers may have only a vague idea of what direct primary care is, believe it’s too expensive, and don’t understand how to introduce new benefits to employees who never had them before. Let’s change that!
You can also contact Dr. O’Boyle directly. I look forward to hearing from you!
admin
12 September 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Why Insulin Costs So Much. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to discuss an important healthcare question that often gets talked about: Why Insulin Costs So Much
The hormone insulin is produced by an organ in the belly called the pancreas, and insulin production is regulated through a feedback loop based on blood sugar levels in the body. Insulin assists cells in the muscles, fat, and liver to absorb glucose (sugar) in the blood, and that glucose acts as energy for these tissues.
The most common problem associated with insulin is diabetes, and diabetes falls into two categories. Individuals with type 1 diabetes have a pancreas that no longer makes insulin and they need insulin injections to use glucose from meals. Individuals with type 2 diabetes make insulin, but their bodies have resistance to it and most individuals need to take pills or insulin injections to assist their bodies to use glucose for energy.
Insulin can not be given as a pill. Like other proteins, insulin would be broken down too much during digestion and thus it needs to be injected. For type 2 diabetes who need insulin or type 1 diabetes who require insulin, there is no alternative medication.
In economics, inelastic demand occurs when people buy the same amount of a product, whether the price drops or rises. This occurs in many situations, from gasoline to food to medications- like insulin.
My demand for food is relatively inelastic—I will quickly die without it—but that doesn’t mean that any grocery store can extract hundreds of dollars- increasing prices from me each week. If they tried to do so, many other grocery stores will gladly win my business with lower prices and said previous grocery store will lose business (likely for good).
Inelastic demand is only a problem for consumers if there is limited competition among the suppliers of a good. Notably, the lack of manufactures to produce insulin is one of the main culprits of out-of-control costs.
There are only three incumbent manufacturers of insulin serving the U.S. market: Eli Lilly, Novo Nordisk, and Sanofi. Pricing of insulin is very complex and involves many layers of middlemen including wholesalers, Pharmacy Benefit Managers (PBMs), healthplans, and pharmacies. Within the system, there is no agreed-upon price for any insulin formulation.
According to the American Diabetes Association (ADA), the average list price of insulin has nearly tripled since 2002. In 1996, when Eli Lily’s Humalog first came out, the price for a one-month supply was $21. As of 2019, that vial is around $275, a 1,200% increase on the original price. Further data indicates when one insulin manufacturer increases the price for a given insulin preparation, the other insulin manufactures often increase their prices by a similar amount quickly afterwards.
Worse, these manufacturers ruthlessly exploit the patent system to fend off competition. Pharmaceutical companies use lawsuits combined with incremental patent changes that enables the manufactures to extend the patient on the drug. These practices prevent insulin from going generic and other manufactures from producing more affordable versions.
In fact, insulin manufactures and pharmacy benefit managers (PBMs) such as CVS, Express Scripts, United Health, and OptumRx have been accused of artificially inflating prices for insulin in a class action suit brought in 2020. According to the suit, these manufactures aggressively increased the prices for insulin past what they would have charged had there been no scheme.
Why doesn’t competition among the BUCAH (BlueCross, United, Cigna, Aetna, Humana) health insurers force the manufactures to offer plans tailored to the different needs of patients? As example, the needs vary drastically from a person suffering from Crohn’s disease versus a type one diabetic). There are complex reasons for this- including the pharmacy benefit managers discussed above- but a major one is the tax privileged treatment of employer provided health insurance.
In 2018, nearly 160 million Americans got their health insurance through heir job, which at best puts a weak bargaining pressure on health insurers brokered through employers rather than employees. This lack of bargaining leaves the employed individual needing the lifesaving medication powerless and exposed to the expensive out-of-pocket costs.
We recognize that cost-containment for life-saving medications such as insulin is a human right. We also recognize that we, the people of Ann Arbor, greater Michigan, and this great nation must unite together to form meaningful solutions.
We commit to doing our small part here at Beyond Primary Care by continuously pushing the status quo of healthcare to seek out more affordable treatment solutions to offset the financial effects our current healthcare system has on those who are most vulnerable.
It’s small, but it’s what we can do well and what we promise to do for those in our care.
Thank you for reading.
– Dr. Jeff O’Boyle with Beyond Primary Care
admin
9 September 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Where to Get the Flu Shot in Ann Arbor. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to update my patients and any prospective patients…
Flu season is just around the corner and according to the Centers for Disease Control (CDC) for the 2019-2020 cycle there have been upwards of 56 million Americans affected by flu-like illnesses resulting in nearly 25 million medical visits, a half million hospitalizations, and nearly 50,000 influenza deaths.
This is why we advocate for getting a Flu shot before the start of the Flu season- we want to prevent people from going to the hospital and potential serious consequences, i.e- death from the Influenza virus.
The flu shot is a little bit of a booster to remind your immune system what may be coming ahead. A similar process is going on with the coronavirus vaccine trials. The vaccine reminds people’s immune system what that virus looks like, so that when they are exposed they either 1) don’t get the virus or 2) get a very mild case.
Now more than ever, it is important to get your Flu shot. We do not want to see a Flu season with a Covid season together. Flu and Covid-19 are both respiratory illnesses, but are caused by different viruses. The Flu is caused by infection with influenza viruses, and Covid-19 is caused by a new coronavirus (called SARS-CoV-2).
It is possible to have the Flu and Covid-19 at the same time. At Beyond Primary Care we can test for both the influenza virus and Covid-19 at the same time.
There are many reasons to get the Flu vaccine each year. Here is a summary of the benefits of the Flu vaccine.
If you’re on the fence about a flu shot, here are five arguments to see if I can change your mind.
Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious Flu illness, like babies and young children, older people, and people with certain chronic health conditions.
Symptoms of the Flu and Covid-19 are similar, which makes it extremely difficult to tell the difference based on symptoms alone. Common symptoms that the Flu and Covid-19 share include:
Different than the Flu, Covid-19 may include a loss of taste or smell. While a person typically develops symptoms one to four days after an infection, with Covid-19 typically develops symptoms 5 days after being infected, although time range can vary.
Once the flu vaccine is administered, it takes your body about two weeks to develop antibodies to the virus. The vaccine should confer about 6 months of immunity. So, the earlier the better in terms of administration. We do see the flu start peaking in October with another peak in March every year.
Truthfully the only individuals who should not get the Flu shot are infants younger than 6 months of age or people who experience a severe (life threatening) allergy to a prior dose of a seasonal Flu vaccine.
People with egg allergies just need to be monitored for the influenza vaccine, as an egg allergy is not an absolute contraindication. A 2012 review of published data, including 4,172 egg-allergic patients (513 reporting a history of severe allergic reaction) noted no occurrences of anaphylaxis following administration of the Flu vaccine.
This suggests that severe allergic reactions to egg-based influenza vaccines are unlikely. On this basis, some guidance recommends that no additional measures are needed when administering influenza vaccine to egg-allergic persons
People with a cough or cold can still get the flu shot.
The Flu shot is an inactivated virus and cannot cause influenza, Flu shots given may cause injection site soreness and pain, redness, swelling, fever, malaise and muscle aches- all of which are usually mild and go away on their own.
Protect yourself and your family (and friends and co-workers) from the Flu this year! To make an appointment with Dr. Jeff, head over to our scheduling link to view our availability. Just as a reminder, we will be offering our patients opportunities to get their vaccines on select Saturday mornings, in which case an email will be separately sent to all Beyond Primary Care members.
Thank you for reading.
admin
30 July 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog: Using a Health Savings Account (HSA) with Direct Primary Care. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to talk about the Health Saving Accounts (HSAs), what they are and how to get one, why they are beneficial for healthcare, how to use it with Direct Primary Care.
Health Savings Accounts (HSAs) are a type of savings account where individuals or families can set aside money on a pre-tax basis to pay for qualified medical expenses.
Yup, you read that right- PRE-TAX: if you make a dollar and need to spend that buck on healthcare, it is a full dollar you get to use, not some percentage.
How did this come about? Great question- HSAs are designed to offset some of the expenses of a High Deductible Health Plans (HDHP) such as deductibles and copayments. To qualify for a HSA, you must have a HDHP, defined as an annual out-of-pocket deductible of $1,350 for single coverage or $2,700 for family coverage. I wrote a blog co-authored by a financial advisor that details the financial benefits of HDHPs.
High deductible insurance plans allow you to be covered for major “catastrophic” medical problems: eg- hospitalizations, surgeries, etc- in exchange to agree to pay more money out of your pocket for most or all medical expenses up to a certain limit. Once that limit is met, the consumer could expect near 100% coverage.
For 2020, if you have an HDHP, you can contribute to your HSA up to $3,500 for self-only coverage, and up to $7,100 for family coverage keeping in mind the limits can change year to year.
Before dealing what is a ‘Qualified’ medical expenses, let’s first discuss what exactly ‘Medical Expenses’ are. According to IRS publication 502, Medical and Dental Expenses, medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body. These payments include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners.
‘Qualified’ or eligible medical expenses are described by IRS code section 213(d). This list is long and includes:
The HSA provides funds that can be used to pay day-to-day healthcare expenses. HSA benefits important to understand include:
Like hundreds of other Direct Primary Care (DPC) clinics across the nation, Beyond Primary Care DOES allow our members to use HSA funds to pay for their membership.
The US department of Health and Human Services (HHS) under the Affordable Care Act (ACA) defines DPC as a primary care service, NOT insurance (or a health plan).
Additionally, the ACA allows coupling DPC with a ‘wrap-around’ qualifying health plan, stating that HHS “Shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home that meets criteria established by the Secretary.” Combining the definition from the HHS (not insurance) with HSA eligibility under the ACA allows DPC to embody the premise of HSA in the patient-centered free market.
If needed by the administrators of your HSA and requested by you (our member), Beyond Primary Care will provide an itemized bill with your encounter dates, billing codes, and medical service fees.
Many people who talk with me know I don’t hesitate for a second to discuss the unbalanced, non-transparent, maddening administrative business that is health insurance. People know that medical expenses are the #1 cause of bankruptcy in the United States. However, what people don’t realize is that 75% of those individuals actually did have some type of health insurance. Health insurance is the ONLY insurance that bankrupts folks when they use it.
All insurance, since humans first invented it, was designed for one thing and one thing only… to protect us from catastrophic loss.
High Deductible Health Plans are designed to protect us from catastrophic loss. When health insurance is used in this way, a significant amount of money can be saved through reduced monthly premiums and a cost-conscious individual can shop around for the best price for office visits, medications, blood work, imaging, and more.
Note: this blog post is not a substitute for tax advice nor does it suggest how to handle your own unique tax circumstances. If you require tax advice, you should seek the services of a competent professional.
admin
19 May 2020
Hi, thank you for coming back for the latest edition of the Beyond Primary Cares blog; treating menopausal symptoms. In my blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I’m glad to welcome a guest blogger, my friend Liza Baker. Liza is the owner of Simply: Health Coaching and is a full-time health coach and nonprofit consultant, author, blogger, and podcaster with a soft spot for supporting women in their 40s and above. This is a collaboration blog-piece, where we wanted to educate our patients and the community on treating menopausal symptoms, specifically how role lifestyle and nutrition can positively influence those changes, and what medications can positively influence those changes.
First, a little bit of clarity to the menopause timeline:
Every woman experiences menopause differently. Some of us reach the end of our cycles almost without noticing; others don’t have a period for some months and then get surprised to find that it was just loitering in there—and then we need to start the countdown over again. Your “regular” periods may have stopped years ago—regular in the sense of timing and in their length and heaviness.
Like most women, you may have an idea what to expect:
These symptoms can last months to years, and even post menopause, you can still sometimes “feel menopausal.” These symptoms can be severe, disruptive, and even feel embarrassing at times.
In a previous blog post, Liza reminds us that it doesn’t help to approach this shift in hormones as a problem, like we are entering this stage of life from the perspective of “we’re broken.” Instead, it’s important to approach this as a woman’s health experience within the context of identifying your own symptoms and getting clarity about possible therapies for treating menopausal symptoms.
You may have mined the women’s health section of your local bookstore looking for informed (dare we say evidence-based) resources to guide you. What you likely found is a broad spectrum of seemingly science-based approaches from “here is why you should be on hormone replacement therapy (HRT)” to “here is why you absolutely should NOT be on HRT!”
Liza is a firm believer that when advice falls on a spectrum (HRT: YES! NO!), the truth likely lies somewhere in the middle. And having learned that many of the top health problems in our country are so-called “lifestyle diseases”—meaning that they can be reversed and/or prevented through our food and lifestyle choices.
Liza’s personal experience with peri-menopause involved a large number of the most commonly recognized symptoms listed above—including raging migraines after decades of their absence and an appearance by anxiety and panic attacks, neither of which she’d ever experienced before.
And perhaps because Liza had been raised with fairly good food and lifestyle choices and began to make even better ones once she had her own family, many of my/her symptoms were quite mild.
That said, as a health coach, her work with clients is based on the principle of bio-individuality: your perimenopause is not my perimenopause; what works for you may not work for me; your kale may be my kryptonite. Dr. O’Boyle explains it this way: “Discussing the scope of treatment … is extensive and always carries asterisks for certain populations…. Treatment is multi-dimensional and must be individualized, your classic N of 1 trial.”
What matters most is that we—as patients/clients and as practitioners—take a holistic approach: yes, it’s about reducing the severity of symptoms—and about taking a longer view of what caused them and how we can shift that in a more positive direction. It’s as much (more?) about prevention as it is about a cure.
And it’s about giving you—the patient—permission to have some agency over your health care. As Dr. O’Boyle says, “Mainstream medicine has a challenge: continue to ignore your story and lose you to a subjective fantasy built on the mistakes of our brain, or join you in your life story ensuring you are taking responsibility for your wellbeing while making you central to the care and cure.”
The stress involved with menopause can be disruptive on many levels. Some women feel awful, and don’t want to be subjected to a physical exam, let alone interact with a physician when they can’t interact with their families, co-workers, and friends in a way that has meaning. At Beyond Primary Care, you can be assured there will be no judgement, no unnecessary physical exams, just compassion and an opportunity to share your story.
At Beyond Primary Care, I use an eclectic and personalized approach—not a “canned” conversation- towards accessing and resolving life changes and stressors. In a thorough health history, I am going to ask about your family, where your quality of life is being most affected, and—most importantly—what you want to do. I find validation of your concerns and education are often powerful methods in support when you are not feeling well. As you read above, some women prefer enhancing their diet and exercise along with support in allowing their symptoms to play out more naturally.
If more holistic approaches of treatment don’t work, I [Dr. Jeff O’Boyle] can get innovative with estrogen and progesterone hormone replacement therapy (HRT), depending on your needs. Getting the dosage right using hormone patches, pills, and creams is always individualized, and I [Dr. Jeff O’Boyle] works with my [his] patients to customize how much or how little may be needed. While HRT is sometimes a last resort for a woman, the relief it gives can be life-changing. Additionally, just like a great chef (shamless cook book plug) with their ingredients, I am constantly measuring and remeasuring your for safety and goal achievement.
Consider this your permission to make a decision about treating perimenopausal symptoms based on what’s right for you—because you do have options!
If you suspect some of what you are experiencing may be due to perimenopause, or if you notice any coworkers, friends, or family members silently struggling, send them a link to this post so that they can join the conversation!
Please share comments and questions below. You can also contact Dr. O’Boyle or Liza Baker directly. We look forward to hearing from you!
admin
24 April 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where can I find The Sinclair Method Doctors. In my blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Primary Care clinic serving patients in Ann Arbor, Ypsilanti, Saline, Dexter and the rest of Washtenaw county that offers virtually unlimited office visits, wholesale medications dispensed from the clinic, and wholesale blood work completed at the time of visit.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to answer a common question, where can I find The Sinclair Method Doctors?
According to the C3 foundation, the Sinclair Method (TSM) is a treatment for alcohol addiction that use a technique called pharmacological extinction- the use of an opiate blocker to ‘turn habit-forming behaviors into habit-erasing behaviors.’ The effect returns a person’s cravings for alcohol to its pre-addiction state. The Sinclair Method is named for the researcher, John Sinclair, Ph.D, who first developed it and helped it gain momentum, most notably in Europe. The Sinclair Method utilizes taking a medication, Naltrexone, prior to drinking alcohol- which for some people may be everyday.
In America, many physicians have a very narrow ‘one size fits all’ approach to substance abuse, in that a person needs to totally quit the drug in order to be considered successful. While good natured and in some cases necessary, this maxim is dangerous when applied to every person. Instead, the American term for what The Sinclair Method accomplishes is better known as ‘harm reduction.’ As comparison, the idea being 5 cigarettes is better than 20 cigarettes if you refuse to quit smoking. Still not a great habit, but long term there is less harm from a quarter pack than a full pack.
Naltrexone competes with other drugs for opioid receptors in the brain.
Wait right there!
This is a blog about alcohol treatment, why would we consider a medication that is meant for pain pills?
Multiple bodies of evidence such as this, this, here too, suggest alcohol reinforcement mechanisms – what we call cravings- involve activation of our endogenous opioid system. Alcohol binds to and alters functioning of opioid signaling receptors. Originally use to treat opioid dependence, Naltrexone is also FDA approved for the treatment of alcohol dependence.
As a board certified addiction doctor, I see hear the different stories all the time. As example:
You may of scoured every internet article for information that looked informed and accessible. In fringe support groups there are people enthusing about elixirs and ‘ten-day’ fixes. In ‘recovery’ websites you may feel like a marketing person’s dream- marginally desperate: open to attempt anything.
Naltrexone is a great medication for a lot of reasons. It’s a generic medication- so it is affordable. It is not habit forming nor a drug of abuse. It’s side effect profile is comparable to many other medications, and are typically mild and short in duration. As long a you start it under the guidance of a trained physician, you will likely not discontinue for tolerance reasons. It has little impact on other medications.
It is also important to know that taking Naltrexone alone does not guarantee success nor any successes will be long term. What improves the chances of success and duration of success? Follow-up with an addiction-trained physician and counseling with a certified therapist who has a substance abuse background are huge starts. From there, we can guide you on sleep health, journaling, support group meetings, exercise, diet, dealing with set-backs, and importantly- recognizing successes.
You can always click through TSM website and look for providers that way. In addition to being a board certified family medicine doctor, I am also a board certified addiction doctor and have been utilizing The Sinclair Method for years. At my clinic Beyond Primary Care in Ann Arbor, Michigan, I use an eclectic and personalized approach- not a ‘cookie cutter’ conversation- towards accessing and resolving your life changes and stressors. In addition to a thorough health history, I am going to ask about your family, where your quality of life is being most affected, and—most importantly—what you want to do.
If you think some of what you may be experiencing may be due to excessive alcohol consumption, or if you notice any coworkers, friends, or family members silently struggling, send them a link to this post so that they can join the conversation!
You can also contact Dr. O’Boyle directly. I look forward to hearing from you!
admin
27 February 2020
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to talk about the coronavirus, what it is, how is it spread, what are symptoms, and how to protect yourself.
Coronaviruses represent a large group of viruses, not just one we are hearing about in the news and media lately. These Coronaviruses are categorized as “Zoonotic diseases,” meaning they are transmitted between animals and people. The Coronavirus this blog is referencing (COVID-19) initially occurred in an animal or seafood market in the city of Wuhan, China. The disease has since spread throughout China and to a number of other countries.
On the ‘skin’ of the Coronavirus are a huge number of spikes (proteins) that give it the appearance of a ‘crown.’ Crown in latin = Corona. Just like the Human Papillomavirus (HPV), which is the causative agent such as non life-threatening conditions like foot (plantar) warts or very dangerous conditions such as cervical cancer, there are many subtypes of Coronavirus.
Think of subtypes like the seasoning, basil. There is cinnamon basil, Greek basil, lemon basil, well- you get the point.
Some of the subtypes cause respiratory illnesses as minor as the common cold, while others cause pneumonia. These tend to be mild. However, just like HPV, there are some types of Coronavirus that can cause severe disease, such at the China 2019 Novel Coronavirus. This new Coronavirus being spread has not been previously identified in humans.
There are 59 total cases of the China 2019 Novel Coronavirus. Eight U.S states have confirmed cases including Massachusetts, California, Washington, Arizona, Texas, Wisconsin, Illinois, and Nebraska. 57 cases have been diagnosed as a result of travel or being evacuated from high-risk countries. 2 cases are believe to have spread person to person within the U.S.
Being present on public transport areas is a major risk factor for transmission. This Coronavirus appears to be spreading easily in China, but not as much in the United States.
The Centers of Disease Control (CDC) states to prepare for the ‘inevitable’ spread of the coronavirus within the United States.
The City of San Francisco, despite not having any confirmed cases of the Coronavirus, has declared a local emergency because it is a major travel connection hub.
The exact mechanism (as of publication of this blog post) has yet to be discovered. In general, it is thought respiratory droplets – such as what comes out your nose or mouth when you cough or sneeze- or objects that have been contaminated with the virus, are the source of the Coronavirus.
A number of symptoms can present ranging from mild to severe. Symptoms typically take between 1 and 14 days to appear once the virus is contracted. Mild symptoms include fever (anything over 100.4F), cough, body aches, fatigue, sore throat, cough, and shortness of breath. Severe symptoms include pneumonia, kidney failure, and even death.
Currently, the only means of diagnosis is testing through a technique called Reverse Transcription-Polymerase Chain Reaction tests that can diagnose the Coronavirus from respiratory samples. This test is currently not available at any outpatient clinics in the United States.
These tests are only at selected U.S. States and local public health laboratories, Department of Defense (DOD) laboratories, and some international laboratories.
Currently there is no specific medication to combat the Coronavirus. Additionally, there is yet to be a vaccine- although these are in development. Treatment if someone is infected is supportive care.
A number of hygiene practices to help prevent the spread of the Coronavirus include covering your mouth and nose when sneezing or coughing (such as the vampire cough depicted above), washing your hands with soap and water frequently, and wearing masks if you could have the virus or around other people you care for who may have the virus.
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