Tag: Direct Primary Care

Sedera Health + Beyond Primary Care = Premium Healthcare Without Insurance

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19 November 2019

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 a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. 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 Sedera Health, which is a cost-sharing model that can help with that ‘Back End’ healthcare coverage.

To be 100% upfront, myself nor my clinic- Beyond Primary Care, have any special relationship or financial interest in Sedera to disclose. I am simply educating the public and my patients on affordable coverages for those ‘what if’ scenarios.

The American Health Insurance Experience

In 2018, the average monthly cost for health insurance for an individual was $440.00 and for a family of 4 the average cost rose to $1,168.00, per month. That’s $14,016.00 per year. But wait, there’s more. The average deductible for that same family was $8,232.00 with many plans being over $10,000.00. What does all this mean?

Well, if you need any major medical coverage for your family, be prepared to pay about $22,000 in out-of-pocket costs before your insurance kicks in. We can’t afford to get sick anymore. For a large number of Americans and businesses, this is the new reality. Monthly health insurance costs increase every year while at the same time out-of-pocket deductibles have sky-rocketed.

Front End, Back End

You may of heard the terms ‘back end’ and ‘front end’ healthcare coverage before, but what does that mean? 

Front end is basically any, and the vast majority of healthcare services that you would routinely use. Such as a regular doctor visit, needing medications, blood laboratory work, routine imaging, scheduled procedures. 

The back end of healthcare are any surgeries, hospitalizations, or emergent care situations that may arise. Surgeries, hospitalizations, and emergency room care can be inherently expensive. People can go bankrupt from these events. That is why we recommend some ‘back end’ coverage.

However, treating a rash, urinary tract infection, common cold, or doing a well visit is vastly different than brain surgery.

Why are we paying for them in the same manner?

Have you heard of Sedera Health?

So, what is medical cost sharing? There are better options out there for you. Sedera Health is one of those options. 

Sedera Health uses a medical cost-sharing model to challenge the status quo of health insurance that many of us have become so frustrated with. Instead of making payments to an insurance company that do not have your best interests at heart, medical cost-share members make payments to a community fund and those funds are only drawn upon when they are needed. Typically, members can save between 30-50% of what they were paying in insurance premiums and can chose a set amount that they are willing to pay as an initial unsharable amount. This can amount to $1,000s of dollars a year. So, you get lower costs and predictable expenses for those times when you do have major medical events.

Sedera + Small Businesses + Direct Primary Care

Sedera Health offers employer groups of 5 or more a group discount on their cost-sharing for a Direct Primary Care membership. At Beyond Primary Care we believe that great healthcare should be affordable, accessible, and authentic for our members and that is why we have decided to discuss Sedera Health as an option. With your Beyond Primary Care membership you can add Sedera Health medical cost sharing to help cover the back end of your individual health risk with those larger major medical expenses. Then, let your Beyond Primary Care take care of all your primary and preventative care issues and rely on Sedera Health for the other wraparound medical needs for a total healthcare solution.

Final Thoughts

Beyond Primary Care + Sedera are working together to help you on your journey to great health. It’s premium quality healthcare with peace of mind for those ‘what ifs,’ without the high cost of insurance premiums and out-of-reach, out-of-pocket expenses.

Ways Your Family Doctor Helps You

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25 September 2019

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 a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves.

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 family medicine and what exactly can your family doctor (such as myself) do for you. 

Family Doctors

Family doctors are trained to practice a spectrum of comprehensive primary care medicine ranging in ages from newborns, toddlers, teenagers, and through adults including end-of-life care. I like to say we take care of people at all ages and stages, guiding males and females through the complexity of human health and helping coordinate care of their health.

Why such a broad age range? That allows your family doctor to better know you and your family over what is hopefully an extended period of time- years to decades. Not just days to weeks. Family doctors don’t just see you when you are ill and at your worst. This continuity allows us to give you that longitudinal care which can help aid diagnosis, understanding, and treatment of any medical condition far more than someone just seeking that ‘one-off’ or ‘one-time’ visit.

Imagine you love your car. You depend on it. In return for continued performance you have to put periodic maintenance into it such as oil changes, new tires, new brakes, etc. You could go to a different auto shop every time.

The mechanic who doesn’t know your car may lift the hood and start tinkering with the engine even if it’s the radio that’s making the noise because he doesn’t do radios, he does engines. 

But, like any other process, you want trust. Trust that the mechanic is going to recognize you (and your car) every time you go in and can be counted on to tell you when there may be a forthcoming issue. You also want that person to be approachable and genuine in their assessments and responses. 

In much the same way, you want trust, sincereness, and consistency with a family doctor. These are attributes of a family medicine physician, not urgent care or other ‘one-time visit’ clinics. 

Family doctors specialize in the diagnosis, treatment, and prevention of acute and chronic conditions. 

Acute issues such as:

  • Rashes
  • Urinary tract infections
  • Colds / congestion
  • Skin wounds that needs stitches
  • Chest pain
  • Shortness of breath and so much more.

It is our goal to try to keep you out of the emergency rooms, and instead in the familiarity of your home and family. 

Chronic issues Family Doctors treat include:

Not Just Sick Visits

Don’t let all those illnesses distract you though! Family doctors are not just there for the ‘what if’ scenarios, giving you only that ’reactive’ healthcare that is part of America’s cost control problem. Family doctors are ‘PROactive ‘ physicians.

This is why we encourage ALL of our patients to have at minimum yearly physicals were we can have a conversation about what we can do together to keep you healthier, longer. Infants and children often times have to be brought in multiple times a year for wellness checks to make sure they are growing properly and meeting milestones to keep up with their peers. There are few other physician specialties that actively work to keep you continuously healthy than family doctors. 

Keeping It Simple

Family doctors are not referral specialists. Referral rates to specialists in the United States are estimated to be at least twice as high as in Great Britain. Family doctors can help you control your healthcare costs through the elimination of unnecessary referrals to medical specialists.

As you can see, a good family doctor can cover 95% of all medical conditions. Family physicians knowledge is expansive. Because of this eclectic knowledge base, there is less likely a chance of the proverbial ‘hammer and nail’ approach than you may find with more specialized, narrowly focused physicians. 

Life Expectancy Increases

You will also live longer with a primary care physician! If you take a population of 10,000 and add a family doctor, there is a statistically significant drop in the death rates.

With family doctors your care will be individualized and engaged with a guided decision making approach. 

I believe knowing the person is way more important than knowing the disease. 

Deconstructed Egg Salad Sandwich

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16 August 2019

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 a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

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. 

This featured recipe is a Deconstructed Egg Salad Sandwich. 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.

Deconstructed Egg Salad Sandwich

Prep Time: 30 minutes
Total Time: 30 minutes 
Adapted from: Spoon Fork Bacon

Ingredients (makes 4 sandwiches):

– 1 baguette with ends removed, sliced lengthwise
– 3 tablespoons olive oil
– 6 large eggs, hard boiled, shelled and sliced
– handful of greens
– 1 avocado, pitted, and mashed or sliced
– handful sweet gherkins, sliced lengthwise
– red onion, sliced
– Salt and pepper to taste

Instructions:

1) Bring oven to 400 F. Place baguettes on tray. Drizzle with olive oil and bake until lightly toasted.
2) Once toasted, top baguettes with avocado spread, greens, onions, sliced egg, and sweet gherkins. Season with salt and pepper, serve.

Storytelling in Anxiety and Depression

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12 August 2019

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 a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.S

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. 

Storytelling

We talked about what anxiety is in an earlier post. In this post I am discussing something that is important to me in treating any mental health condition- especially anxiety and depression- and that is storytelling.

Why We Listen

Not only is it a way of relaying information about my patients when discussing care (eg- talking to a therapist to find the best medication), but it is an an essential way I continue to learn at work. It has struck me recently that even more than these obvious examples, storytelling has a direct impact on not only how we understand anxiety and depression (or any disease) but the process of healing itself, from the perception and expectations of the patient to the diagnosis and treatment by the physician. One thing I find myself doing on a daily basis as a physician is listening to patient’s stories. I sit down with them, make myself present, and just listen.

Listen For Understanding

Think about any instruction list TELLING you how to do something: 
Step 1: take an anti depressive medication, followed by 
Step 2: get 8 hours of sleep a night, followed by
Step 3: walk 30 minutes each day, and so on. 

People may complete the task, but long term learning for long term success from this method is limited. When someone is stuck in the dark hole that is anxiety or depression, it’s hard enough just getting OUT of bed in the morning, let alone doing any number of tasks. Treating anxiety or any mental health condition is not comparable to assembling a piece of furniture from Ikea.

Now, compare this to learning something from a story, where someone has pushed their own human experience and emotion into those tasks. Hearing the struggles, failures, and successes through story are more likely to shape your ability to learn and cope. Understand there are some conditions that we treat through empathy and ability to get to know people at people at a deeper level. The conversation can lend the support you need as you navigate the ‘hard’ in your own life.

Our Stories Are Ourselves

Sharing your story will help you feel better. Why are you not sharing your story? Perhaps you feel embarrassment, fear, resignation? If you do not share your story then those thoughts and feelings are just randomly going through your mind, and you may only be inclined to be reactive towards them when they do pass through… that is randomly.

We use stories to describe to others our needs, and mental health is no exception. It doesn’t make much difference what we leave in and what we take out, what is important is that we tell the story. There is magic in that. It’s in the listener and storyteller- us. And for each and every ear, it will be different. And it will affect us in ways that we can never predict. From the mundane to the profound. You may tell or hear a tale that takes up residence in your soul, becomes your blood and your purpose. That story will move you and drive you. And who knows what you might do because of it.

The Challenge

The truth is today we are not treating everyone we need to who suffers from anxiety or depression, and can not do so if we continue to insist on one-on-one therapy with only an ‘expert.’ If listening to and sharing stories helps people, how can we withhold it? It will be there, doing its thing, whether you want it there or not. To ignore it seems to me to be the least ethical thing one could possibly do.

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.

Medicare for All Act of 2019

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16 July 2019

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 a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

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 will not discuss my personal political views nor will I use this as a medium for healthcare horror stories, like this sad story, this sad story, or this frustrating story… because we have heard these before. In this blog I will discuss facts of what I learned from 1) attending the EMU hosted event for ‘Medicare for All,’ and 2) reading through all the pages available online regarding H.R. 1384.

Medicare for All 

I recently attended a town hall hosted at Eastern Michigan University (EMU) on Saturday July 13th where Congresswoman Debbie Dingell (Michigan’s 12th District), Congresswoman Primila Jayapal (State of Washington 7th District), State Senator Jeff Irwin (Michigan’s 18th Senate District), State Representative Yousef Rabhi (Michigan’s 53rd District), State Representative Ronnie Peterson (Michigan’s 54th District), as well as Michigan Nurse Association Vice President Katie Scott were all discussing the ‘Medicare for All Act of 2019.’

They were having a discussion about H.R. 1384, the Medicare for All Act of 2019 which is a bill that would establish a national health insurance program to cover all U.S. residents. Currently (as of 7/15/19) the bill has 117 co-sponsors. 

Speaker Panel Talking Points

To start with the discussion at EMU, I always appreciate an elected officials time (especially on a Saturday night) to discuss what impacts our community. Yes, they did start the panel discussion late, exactly 20 minutes- much like an overfilled physicians waiting room. However, much like those doctors we want to see, we can look past that.

To briefly summarize what they discussed, I felt the panel discussion had an overall vibe of a small group rally for the ‘Medicare for All Act’ with very little substance discussed. To be fair, each speaker only had about 5 minutes. However, 5 minutes should be enough time to pitch something they want to sell. And let’s be honest, our elected officials were trying to sell this bill to the room.

Debbie Dingell

To start with Congresswoman Debbie Dingell’s talk, it was heavy on current healthcare disparity statistics in the US. She did offer some brief talking points such as “We are going to a single billing system that will eliminate a lot of costs.”

The bill claims savings of $500+ billion annually from reductions in costs of billing and administrative costs.

As you can see below of the graph of physicians and administrators from 1970 to 2009, administrative costs are having a major impact on healthcare spending. 

I am curious to see how exactly they will implement this administrative cost savings. Does this mean simply cutting back (i.e.- firing) extra staffing? Those are jobs too. Many physician offices utilize administrative staffing such as front desk receptionists, a dedicated phone staff, nurse triage staff, laboratory staff, billing staff, imaging staff, medical record staff, transcription staff, and office management. 

Primila Jayapal

Congresswoman Primila Jayapal was next. Seattle, you should be proud, you elected a great official. I would be proud to have her represent me if I were there. I was impressed because I felt she actually covered more substance in her discussion than any of the other speakers regarding the ‘Medicare for All Act.’ She states the act will have four components:

  1. Cover Everyone ( Dr. O’Boyle likes this )
  2. No copays or deductibles and be able to go to any doctor or hospital you want to.
  3. Comprehensive coverage including primary care, vision, dental, substance abuse, mental health, maternal care, and more.
  4. Control costs.

Yay! Some material I can work with. Then congresswoman Jayapal says with these ‘controlled costs’ we will pay 14% less then now. WHAT! 14% ?? So that MRI, instead of being $1,400 is now $200 less? That colonoscopy that is billed at $5,000 is now only $4,300. This cost savings is not significant nor will it move the economic needle of medical costs.

Reading through H.R. 1384, I could honestly find only one section (616): Payments for Prescription Drugs and Approved Devices and Equipment that discussed any effort to reduce healthcare expenditure.

Has she heard of Direct Primary Care (DPC)? Does she know I can get a member an MRI for $300, or a colonoscopy for $700? Direct Primary Care is moving the needle on medical cost economics by saving our patients anywhere from 50-90% off of insurance billed costs.

Jeff Irwin

Michigan State Senator Jeff Irwin spoke next. Again, a good speaker. He discussed how doctors are fighting insurance companies over billing and how much a wasteful system this results in. Senator Irwin did say something I believe is important when discussing healthcare: speaking about what people value in their health and healthcare coverage. But, nothing that added any insight on the actual bill. 

Yousef Rabhi

State Representative Yousef Rabhi discussed efforts from a Michigan effort to start universal healthcare plan called ‘MiCare.’ In an acknowledgement of supporting information to Representative Rabhi, he did discuss how he plans to fund MiCare through a vote of the people in Michigan for progressive taxation. Yet, to be fair to the audience, I felt his talk was a bit of a curve ball as all other speakers were focused on the federal bill and not the state bill. 

Ronnie Peterson

State Representative Ronnie Peterson added some personal stories about his history of fighting for racial equality and now fighting for healthcare equality. Again, his talk was touching but added no material onto why or how the ‘Medicare for All Act’ would work.

Katie Scott

The last speaker was Katie Scott, the vice-president of the Michigan Nursing Association. From her talk, I was able to pick out that she was an Intensive Care Unit  (ICU) nurse. Again with the story telling theme of the night, she gave a personal narrative of high prescription drug costs and how that impacted her. 

I absolutely love what nurses do and think their roles are critical towards healthcare. However, ICU nurses and the need they fill are vastly different than what primary care doctors see and what a vast majority of people experience when we think of and utilize healthcare. 

If the elected officials pushing for the ‘Medicare for All Act’ want to be serious, they need to get feedback and collaborate with the primary care providers out there already making changes in their communities. Instead of pushing for town halls on why we need change, Direct Primary Doctors are having town halls in communities on how we are already changing healthcare to improve patient access, improve price transparency, and reduce out of pocket costs on everything from office visits, medications, imaging, speciality care, and laboratory studies.

Guide to Erectile Dysfunction, Beyond Primary Care, Primary Care, Family Doctor

Guide to Erectile Dysfunction

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11 June 2019

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 a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

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. 

Erectile Dysfunction

In this post I am discussing a common condition that I see at my clinic: erectile dysfunction. Let me repeat that last part- a common condition. If you suffer from erectile dysfunction, you are not alone. Those two words can make any man nervous. It affects all men but becomes increasingly prevalent as we age. At least 12 million U.S. men between 40 to 79 years of age have it, but can occur at any age. Older individuals are more likely to experience health conditions that require medication, which can cause or even worsen ED. It is a very emotional and sensitive topic to discuss.

Anatomy & Physiology

The penis consists of two parallel cylinder-shaped tissues called the corpora cavernosa that run the length of the penis, a hollow tube called the urethra that is responsible for expelling urine and ejaculate, erectile tissue surrounding this tube, and various arteries and veins. The process of erection involves increased blood flow and pressure to the penis, and those cylinder-shaped tissues mentioned above become engorged and expand- thus an erection. Erectile dysfunction (ED) occurs when those tissues fail to become engorged or the penis fails to maintain rigidity and resumes a normal shape.

Essential Components for Function

How ED is affecting one male may not be the reason for you. Your doctor will help to differentiate which components are affecting you and this is important in differentiating treatment options.

  • Your interest and desire for sexual activity (libido)
  • Ability to obtain and maintain an erection
  • Ejaculation (orgasm)

Select Causes of ED

Male sexual arousal is a complex subject. Discussing in broad terms, ED can generally be separated into two categories: physical and mental health. Many instances of ED may involve causes from both categories.

Physical Causes

  • Medications: Take a look at your existing medications. Several medications may lead to ED. As example, anti-depressants like SSRIs (citalopram, fluoxetine paroxetine, sertraline) used to treat mental health concerns and Beta-blockers (metoprolol, carvidilol, labetalol)  used to treat blood pressure can cause ED. Review all your medications with your doctor.
  • Smoking: Compared with men who have never smoked, the risk of ED is increased by 51% in current smokers and 20% in ex-smokers. Ask your doctor for help in quitting.
  • Diabetes: If you’ve ruled out other causes, there’s a chance your ED is due to diabetes. Patients with diabetes are three times more likely to develop ED. Review your risk for diabetes or work with your doctor to bring your sugars under control.
  • Low Testosterone: Also called hypogonadism, is a condition that generally occurs to all men as they age. By age 80, 50% of men will have testosterone levels in the low range, however the decline is faster in some men than others. Testosterone levels can affect  a man’s overall health including sex drive and sexual function.

Mental Health Causes

  • Sexual Performance Anxiety: This happens when a man anticipates a problem during the sexual encounter and, as a result becomes anxious while attempting to have sex. Doubt and insecurities may take over your thoughts: “Will I get hard enough?” “Will I maintain an erection?” “How do I compare?” “What if I can’t finish?” These pervasive questions can ruin any performance. Talk to your doctor because once people understand the mental that cause anxiety and how to reduce or eliminate them

Treatment

  • Exercise and Nutrition: A change in eating and drinking habits can potentially reverse the contributing causes.
  • Therapy: Seeing and talking to an accredited sex therapist can lead to an overall happier sex life for men and their partners.
  • Medications: The availability of oral medications such as Viagra, Levitra, and Cialis, make it much easier to treat erectile dysfunction. However, medications should be part of a more comprehensive long-term plan. At Beyond Primary Care, we wholesale generic Viagra 100 mg, 10 pills to our patients for $4.20.
  • Testosterone Replacement Therapy: For men experiencing sexual frustration and have low testosterone, testosterone replacement therapy is a safe and effective way to return T-levels to the normal range.

Keeping Laboratory Costs Low

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10 May 2019

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 a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is a Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

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 post I am answering a common question that I receive, and that is how does Beyond Primary Care (DPC) keep laboratory costs low for it’s members? Offering low bill rates for labs is a key feature of virtually all Direct Primary Care (DPC) practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic phlebotomy and can provide numerous laboratory studies to their patients at a tenth of the costs that many hospitals and fee-for-service providers can provide.

How DPC Practices Keep Laboratory Costs Low

To start DPC practices typically do their own phlebotomy (that is the collection of blood from your veins) and rarely bill for these services. This starts the savings before a single drop of blood is collected. DPC practices then contract with laboratory diagnostic companies, many times the same companies that service smaller hospitals or fee-for-service clinics. My clinic, Beyond Primary Care, uses a few laboratory diagnostic companies, Quest Diagnostics, True Health, and Aurora Diagnostics

Prior to drawing any labs for our patients, DPC practices negotiate what we call ‘client bill rates’ with these diagnostic companies. A client bill rates is basically saying, what is the lowest cash price for a particular laboratory study you can offer to my clinic’s patients? Compare this to smaller hospitals or fee-for-service providers. They bill for phlebotomy (U of M states they charge $9 for this service alone) and then these providers bill the labs through your insurance. Often times the laboratory costs often never negotiated down on behalf of the patient because there is no incentive from the practice to do this. 

DPC gets these low laboratory fees for their members in this innovative manner because our primary business is taking care of you and NOT being just a blood-draw center. Your membership for care to a DPC practice allows for this innovation.

Savings from Laboratory Costs

I have a colleague who recently had a pap smear completed, which is a diagnostic test used in females to detect cervical cancer.  She claimed she had ‘Cadillac Health Insurance’ through her employer, meaning basically she thought she had really great insurance that would cover the costs of her healthcare. Look at her bill below and what she was left to pay out of pocket. At my clinic, Beyond Primary Care, the procedure of completing the pap smear if part of the membership. No extra charges. The fee for the pathologist (that I have negotiated) is $44. The difference in costs in this ONE laboratory study alone would pay for months of healthcare at any DPC clinic.

DPC Members can obtain Labs other Doctors Order

DPC providers understand you may need to see another specialist from time to time, and these providers may want their own labs completed. A common question I receive is if the other specialist request labs, can I get them done through your clinic? 

Yes, absolutely this is another great way to minimize your financial impact. No doctor or hospital can force any patient to have routine laboratory studies done only at their location or where they tell a patient to complete them at. That is against the law. They may use convincing language saying ‘the results integrate into our electronic system faster,’ or ‘those other providers may not know exactly what I want.’ Stay firm and request a written and signed order for your labs. Your DPC clinic will complete the exact same labs, bill you at the much lower rates (compared had you used your insurance), and will promptly fax the results over to the requesting specialists that meet their needs. As noted by this Wall Street Journal article analysis of medical services, prices tend to be higher when services are performed in hospital outpatient facilitates instead of at doctors’ offices.

Improve Your Financial Health

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20 April 2019

Dr. Jeff O’Boyle with Beyond Primary Care teams up with Dennis LaVoy CFP® CLU® with Telos Financial to discuss ways individuals, businesses, and families can free up cash flow.

Free Up Cashflow In Your Budget

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4 April 2019

What are some ways to help free up cashflow in your budget? How about healthcare through Direct Primary Care?

Hi, thank you for coming back for the latest edition of Beyond Primary Care’s 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 a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

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. 

Today, I’m glad to welcome guest blogger, my friend Dennis LaVoy. Dennis and I co-authored this piece about freeing up cashflow through Direct Primary Care (DPC).

Who is Dennis LaVoy?

Dennis LaVoy is the owner of Telos Financial, a fee based, holistic financial planning firm located in Plymouth, Michigan specializing in serving young professionals and families. Dennis is a Certified Financial Planner (CFP®) professional and a Chartered Life Underwriter (CLU®) founded Telos to provide financial advice and uses his experience, knowledge, and expertise to help families and individuals in Ann Arbor, Detroit, and across the country achieve their financial objectives.

He went to school at Eastern Michigan University where he graduated Magna Cum Laude while receiving his degree in Finance. He has worked 10+ years as a financial advisor and opened his own firm, Telos Financial in February 2018. 

We’re going to discuss some of the financial incentives for using a DPC model.

What could using a DPC practice mean for my budget? 

Health insurance coverage is a very personal decision each family must make on their own, considering their personal values, tolerances, geographic location, and needs. Direct primary care is a membership model of health care that works well in conjunction with a High Deductible Health Plan (HDHP), commonly referred to as ‘catastrophic insurance.’ Combining a DPC membership with a HDHP addresses the main drivers of increasing cost in healthcare, such as the patient being seen in a timely manner, being proactive about your health, and ancillary medical costs (medications, labs, imaging). This allows individuals and families to have extra money on-hand every month, often saving thousands of dollars per year. So, if this type of insurance aligns with your values and tolerances, it can mean big monthly savings for your family versus a higher premium insurance arrangement.

How would it work?

Hospital systems and insurance-based clinics have higher costs for many medical services and their prices do not reflect the true cost of services even after insurance negotiations. When eliminating the costs of using health insurance, many patients can find equally effective and far more affordable options for their healthcare needs.

For example, let’s say your family is pretty healthy overall and have a high premium/low deductible health insurance policy that you pay a lot of money towards every month, where your monthly premium is $1,600, or $19,200 per year.* You believe you are not extracting enough value from your insurance, but still want coverage for those ‘what if’ scenarios. 

Switching to a HDHP insurance plan combined with a DPC membership still means you have that insurance for those ‘what if’ scenarios, but now also you have virtually unlimited access to your doctor where they can focus directly on you and not the middleman (insurance companies). Your new monthly insurance premium is $718*, and by enrolling in a DPC practice for as low as $130** a month you will have $750 in savings every month, or $9,000 per year.

*These figures were obtained by providing realistic information to ehealthinsurance.com to compare health insurance rates for 2 adult non-smokers along with 2 children for comparable health insurance plans that are compliant with the Affordable Care Act (ACA), commonly referred to as Obamacare. 

**This figure was obtained by combining the rates for adults and children at Beyond Primary Care, Ann Arbors only direct primary care practice.

Financial Savings and Opportunities

Combining a DPC membership with a HDHP can save families and individuals thousands of dollars per year where this arrangement is appropriate. Because Direct Primary Care provides so much in a membership, it is gaining national attention for the associated cost savings. A testimonial to this national attention is Consumer Reports listing Direct Primary Care as a top five smart money move in 2019 saying “joining a DPC medical practice will give you around-the-clock access to your doctor and could save you money on primary care.” 

With a couple hundred saved each month, that is money you can have working for you- not the health insurance companies. An extra $9,000 may allow you to create an ‘emergency fund,’ pay off loans, or even invest for the future. 

A $750 savings per month could build a substantial investment portfolio over time. I always recommend working with a financial planner to decide how best to invest for your family, but depending on your income, goals, and life situation, you could also save to a Roth IRA, Traditional IRA, or to a non retirement investment account. 

The Power of Compound Interest

$750 per month is a lot of money for many families. Over time, it can be hugely impactful for long term financial. Let’s further play out the scenario in this example and you have a family of 4 and that you were able to invest $750 per month at 7% growth. 7% is an assumption based on a balanced portfolio, as a point of reference, the S&P 500 from 1937-2017 (90 years) averaged 10.4%. Further, let’s assume in this example the family of 4 is two adults aged 30 and they’ll save for 12 years (Let’s say until the kids move on). 

In this example, at the end of 12 years or age 42 for the adults, you would have saved a total of $108,000 and the account would be worth over $175,400! If they didn’t save another dime after that, the account would be worth over $1,000,000 around their age 65 and 3 months. If they were able to continue the $750 per month savings, when they reached age 65, the account would be worth $1,532,591 on a total investment of $315,000. The numbers really speak for themselves and really demonstrate the power of compound interest. 

Why wouldn’t I do this?

DPC is not available locally in all communities. If you do not utilize healthcare services on a regular basis or when you do, you are just looking for one-off visits or one-time services, DPC probably is not the right fit. As always, it is something you have to consider personally.

If your employer provides a ‘comprehensive’ high premium/low deductible policy, DPC may not initially be advantageous. Still, consider bringing up DPC to your human resources leaders and incorporating into your benefits package. A partial, or fully self-insured model in conjunction with DPC has been show to result in a 30-60% reduction healthcare expenditures. 

The views expressed are my own opinions and do not apply to every situation. Your situation may vary so make sure to consult a professional for advice prior to making any decisions.

Conclusion

Financial planning should take into consideration all your needs and wants, review costs and tolerances, and educate yourself about the options. To learn more about financial planning, Dennis LaVoy, CFP®, CLU®, or Telos Financial please check out his website at https://telosfp.com/. If you believe Dennis may be a good fit for your family and you live in the southeast Michigan (or really anywhere), call him today at 734-468-3050.

These examples are for illustrative purposes only, not indicative of any specific investment product. Material discussed herewith is meant for general illustration and/or informational purposes only, please note that individual situations can vary. Therefore, the information should be relied upon when coordinated with individual professional advice.

Dr. Jeff O’Boyle of Beyond Primary Care is not affiliated with FSC Securities Corporation.

Direct Primary Care keeps Medication Costs Low

admin

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!