Category: Uncategorized

Episode 15: Self-funded Insurance Options that Pair with DPC–with Dan Meylan



Quote
“The direct primary care physician and their compelling story is, ‘we reduce cost, we improve access, and we improve quality.'”
~Dan Meylan
Resources

  1. Allied National Insurance Company
  2. The Freedom Plan from Allied National
  3. Dan Meylan’s Presentation at the 2017 DPC Summit
  4. Dan Meylan’s LinkedIn Profile

Summary
Small businesses can often save substantial sums by providing employees with Direct Primary Care along with self funded insurance plans, which provides more access to healthcare for the employee via DPC along with substantial reductions in premiums via the self funded insurance plan. In Episode 32, Dr Roussel interviews Dan Meylan, a seasoned insurance agent with decades of experience in third-party administration, who discusses how combining self funded insurance plans with DPC works and how it can substantially improve care and reduce costs. As well, they talk about how many insurance agents aren’t offering them because they’re used to plans that offer a fixed commission over serving as advisors who negotiate a price for serving as a consultant rather than a broker. Finally, Dan gives his thoughts on why insurance companies have unwilling to give up the networks, even though their network-free (reference based pricing) insurance plans save money.
Time Stamped
[2:37] What is Allied’s history with self funded insurance plans and how Alliend has come in contact with direct primary care?
[5:39] How many plans do you have for patient who see direct primary care doctors?
[6:49] What’s the average employer size for your self funded insurance plans?
[9:36] What would your recommendation be for employers that go through medical underwriting where it would be more costly because of the health state of the employees to get underwritten?
[11:14] What is the Freedom First Plan and what pricing model does it use?
[15:47] Many insurance companies are very reluctant to let their health care networks go. Why is that?
[18:51] Why are so many insurance companies unwilling to work or adapt to direct primary care?
[25:37] What is the impact on direct primary care physician’s actions are on the overall cost of care?
[26:44] Why aren’t insurance agents “getting it” when it comes to direct primary care?
[28:52] What should a PCD do to get more information on working with Allied?

Dan Meylan

Guest

Dan Meylan VP of sales with Allied National Insurance in Kansas. Dan has spoken around the country about self-funded insurance plans. Dan is an excellent resource for direct primary care related insurance questions. Dan trains insurance agents around the country on how to integrate direct primary care options into their consultation process with employers. Having spent six years Allied National and many more in the insurance market Dan speaks from his deep experience.

 

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Episode 14

Episode 36

Episode 37

Episode 38

Episode 45

Episode 14: Health Sharing Ministries and DPC (Part 2: CMF CURO/Samaritan)–with Mr Michael Vacca

Resources

  1. CMF Curo
  2. Samaritan Ministries
  3. Health Sharing Video

Summary

Health sharing ministries work by pooling funds from members of a group, joined by a common belief system, to pay for medical expenses of its members. CMF CURO is a Catholic health sharing ministry whose members receive coverage of medical expenses through Samaritan Ministries International. Health sharing plans can often provide coverage of medical expenses at a fraction of the cost of insurance and without the hassle of insurance contracts and premiums. In the interview Mr Michael Vacca, Director of Ministry and Policy, discusses how the health sharing process works, how it is similar to and different from health insurance and how membership can be paired with DPC membership to provide full spectrum medical care.

Key Questions

  1. So to start out, can you each tell me about the history of your programs?
  2. Can you tell me about how the sharing process works?
  3. How are insurance and health sharing different?
  4. If the programs are not insurance, can they still pay? What about large bills?
  5. Both programs have some basic requirements to join including a statement of belief and a commitment to certain lifestyle requirements. Can you give us an overview of each?
  6. How do each of your programs treat DPC?
  7. How would you recommend a DPC doc who has interested patients get more info?

 

Michael Vacca

Bio

Michael Vacca is a licensed attorney in Michigan and prior to working with CMF Curo he worked with the Pontifical Council on the Family in Rome. He is now at CMF Curo where he provides a helpful voice for the program. He serves as Assistant Direct of Ministry and Policy Development. He is a strong supporter of DPC and has helped many health sharing members find DPC doctors as a way to receive medical care.

Related Episodes

Episode 13

Episode 15

Episode 13 DPC and Health Sharing Ministries Part 1: Liberty Healthshare–with Mr Dale Bellis

Quote

“We believe as health sharing members…that we have to break the [sick care] model.”

–Dale Bellis

Resources

  1. Liberty Healthshare

Summary

In Episode 13, Dr Roussel interviews Mr Dale Bellis, Executive Director of Liberty Healthshare. As one of the oldest health sharing ministries, Liberty has extensive experience coordinating healthcare sharing with DPC. Founded as an organization devoted to paying for healthcare expenses in a radically different way, Liberty’s health sharing process allows each member to share their healthcare expenses without the cumbersome requirements of an insurance plan. Liberty, notes Mr Bellis, is a strong supporter of DPC because it promotes the doctor patient relationship, lowers healthcare cost and allows for a more personalized approach to healthcare. In fact, Liberty has gone so far as to reimburse members of their plan for a portion of their membership expenses when they join a DPC Practice. In the interview, Mr Bellis discusses the health sharing process. In particular he discusses how the health sharing process works, how it is similar to/different from insurance. He also discusses what needs are or are not eligible for coverage. Finally, he elaborates on how Liberty membership pairs with DPC.

Time Stamped

[02:02] Mr Bellis on how the health sharing process works

[02:41] How healthcare sharing is different from health insurance

[03:42] Can Liberty still pay every time even if it isn’t insurance?

[05:00] Has Liberty ever not been able to meet a need?

[05:20] How Liberty views DPC

[07:53] Does Liberty pay for DPC?

[09:57] Where to find more about Liberty

Mr Dale Bellis

Guest

Mr Dale Bellis is the Executive Director of Liberty Healthshare. Prior to joining Liberty in 2012, he worked for decades in third-party administration of healthcare plans for employer groups. He is a strong believer in Direct Primary Care as a way for member’s to access healthcare. At Liberty he has made it a priority to encourage members to join DPC practices and is a firm supporter of the DPC movement.

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Episode 14

Episode 15

Episode 12 DPC and Authentic Medicine–with Dr Doug Farrago

Quote

“DPC is our only hope for family practice.”

–Dr Doug Farrago, AuthenticMedicine.com

Resources

  1. Authentic Medicine
  2. Dr Farrago’s Book
  3. The Placebo Journal

Summary

In Episode 12, Dr Roussel interviews Dr Doug Farrago about DPC allowing doctors to be true to themselves and true to the profession. A seasoned blogger, book author and speaker, Dr Farrago sees DPC as the only way that DPC doctors can be authentic amidst the harsh realities of present third-party care.

Time Stamped

[01:58] Dr Farrago’s inspiration to start writing

[03:28] How Dr Farrago’s writing about unhealthy influences in primary care aims to help doctors be true to themselves

[05:23] How authentic medicine is feasible in an age of industrialized care

[06:31] How Dr Doug sees DPC as connecting doctors back to the roots of medicine

[07:43] If everyone in the country had a DPC doctor…

[08:30] DPC is our only hope…

[09:06] How Dr Doug sees DPC as being able to help doctors with burnout

[10:23] Dr Doug’s book

[12:20] Dr Doug’s thoughts on the competition for DPC doctors

Guest

Dr Doug Farrago is a DPC doctor in Forrest, VA. He also has curated a blog for fifteen years, Authentic Medicine and is the author of “The Official Guide to Starting Your Own DPC Practice,”.

 

Episode 11: Reversing the Primary Care Shortage with DPC…with Dr Karl Hanson

Resources:

  1. Infinity Health
  2. DPC Frontier — Mapper
  3. DPC Summit

Summary

One of the major difficulties in our healthcare system is the primary care shortage. Many medical students and residents are loathe to enter/remain in primary care due to heavy workload, poor reimbursement rates and high burnout rate. In most other successful healthcare systems, there is no primary care shortage because nearly 70-80% of doctors are primary care doctors. In contrast, in the US, fewer than 50% of doctors enter primary care, and the number is decreasing each year. This is all changing with DPC, which offers a way for doctors to sustainably enter the field of primary care and remain in it for life. In this episode, Dr Roussel talks with Dr Karl Hanson, a DPC doctor in Kenner, LA about his talks with medical students and residents on the joys of DPC. DPC, he notes, offers the opportunity for young doctors to enter primary care and find a sustainable and enjoyable work environment.

Time Stamped

[01:31] Dr Hanson explains his motivation to convert his fee-for-service practice to a DPC practice.

[02:18] How Dr Hanson got involved with speaking to medical students and residents about DPC

[05:02] Why medical training gives little attention to healthcare administration and finance

[06:40] Whether medical school faculty support DPC

[08:07] Ways Dr Hanson has offered to help medical students and residents learn more about DPC

[12:02] How Dr Hanson  addresses the issue of income security and student debt for young/potential DPC doctors

[14:43] Dr Hanson’s experience with DPC’s reception by medical school faculty

[16:58] Resources for medical students and residents to learn more about DPC

Dr Karl Hanson

Guest

Dr Karl Hanson is a DPC doctor at Infinity Health in Kenner, LA. In addition to being a doctor, he delivers talks to medical students and residents around the country on DPC and how it can not only reverse the primary care shortage but also lead to a more satisfying and sustainable life for doctors.

 

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Episode 8: The History & Future of Direct Primary Care –with Qliance Founder Dr Garrison Bliss


Quote
“Once patients see [direct primary care] and doctors see [direct primary care], great stuff happens.”
–Dr Garrison Bliss

References

  1. Qliance
  2. BlissMD –Dr Bliss’ current practice
  3. NPR Article on Qliance Closure
  4. Times Article on Dr Bliss

Summary
What initially started as a frustration with health insurance eventually spawned a national movement to restore primary care. In 1997 Dr Garrison Bliss said good-bye to health insurance, starting a direct pay practice in the Seattle, WA area. While this initial clinic was out of the price range for many families, his experience forming deeper relationships and quality care led him to expand his practice model to be well within the price range of every-day people. This new model became known as direct primary care. It involved a low-cost monthly fee for comprehensive primary care. While regarded with skepticism by many, the model has grown rapidly over the years since its beginning and has been responsible for a grassroots movement to restore primary care from the ground up.

In the interview, Dr Roussel interviews Dr Bliss about the origins of his motivation to pioneer the direct primary care model, including a frustration with insurance-based care that made it difficult for him to provide the quality of care he felt he could provide. While a couple of his colleagues formed a concierge practice charging $1000 a month per patient, he wanted his practice to be accessible to every-day people. As a result, he founded Qliance in 2007. Since then, the direct primary care movement has exploded from a few doctors in the late 1990s to thousands of doctors. The reason for the growth of the movement is clear, says Dr Bliss, doctors and patients are tired of caregiving arrangements dictated to them by insurance companies. As a result, they are flocking to the DPC model in droves, improving the relationship between doctors and patients. This improved doctor patient relationship is what drives the DPC movement and what will ultimately be responsible for its success, says Dr Bliss, but it will ultimately depend on the motivation of grass roots activists (both doctors and patients) who have seen the model succeed to keep the movement going and push it into the mainstream.

Time Stamped
[3:54] Why Dr Bliss decided to start an insurance-free primary care practice.

[4:55] Dr Bliss discussion of trying to do ‘concierge’ affordably

[7:15] How and why Dr Bliss converted Seattle Medical Associates to a direct primary care practice, Qliance

[14:20] How has Dr Bliss viewed the evolution of the direct primary care movement

[18:33] Where does Dr Bliss see the tipping point where direct primary care becomes mainstream

[25:31] How can the direct primary care movement keep up its momentum?

[29:30] What happened to Dr Bliss when the insurance commissioner threatened to shut his practice down

Dr Garrison Bliss

Guest

Dr Garrison Bliss is an internist in Seattle, WA. In 1997, he started Seattle Medical Associates, a membership-based insurance-free practice. His positive experience providing primary care outside of health insurance led him to found Qliance, the nation’s first low-cost direct primary care practice. He is regarded by many as the founder of the direct primary care model and continues to speak around the country to doctors, lawmakers, companies, and patients about the beauty of direct primary care.

 

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Episode 6: The AtlasMD Story–with Dr Josh Umbehr

Quote

“The smallest minority on earth is the individual. Those who deny individual rights cannot claim to be defenders of minorities.”

–Ayn Rand

Summary

Dr Josh Umbehr is a one-of-a-kind doctor. “Fearless” as some have described him, he ventured in 2010 to start an insurance-free, cash-based practice straight out of residency. Now, his clinic, AtlasMD, has a handful of physicians and services thousands of patients in the Wichita, KS area.  Moreover, he has developed an electronic health record designed specifically for DPC doctors and provides free consulting for doctors interested in starting their own DPC practice and his clinic has served as spearhead for the nation for a new model of primary care.

In this episode, Dr Umbehr—who’s become a well-known voice in the DPC movement—discusses his motivation to start a DPC practice at a time when the number of DPC doctors were in the single digits. Inspired by Ayn Rand’s Atlas Shrugged, he found a direct relationship to be a more empowering way of delivering healthcare, one which better upholds individual liberty. When doctors and patients ‘shrug off’ insurance companies, he notes, they break free from the tendency to be treated as mere cog’s in a machine and find themselves free to make decisions directly between each other. While a great tool, Umbehr says, insurance should be used only for catastrophic events like hospitalizations, cancer care, hospice and critical illness. When insurance starts covering every day events, it not only creates un-needed work of mediating between another party but also undermines the liberty of the two more responsible parties: the doctor and the patient. In the interview Dr Umbehr cogently defend of DPC as the way to make healthcare not only more efficient but also make doctors and patients happier.

Time Stamped

[2:36] When did AtlasMD start?

[4:19] Where Dr Umbehr got the idea to start a DPC practice?

[5:54] How did AtlasMD go about figuring out what to do with few models to follow?

[8:26] How does ‘First Do No Harm’ apply to direct primary care and the AtlasMD model?

[15:15] How has troubleshooting helped AtlasMD be a better practice?

[15:43] How did AtlasMD build an electronic health record?

[18:48] What would Dr Umbehr recommend to medical students, residents or practicing physicians who are interested in direct primary care?

Dr Josh Umbehr

Guest

Dr Josh Umbehr is a family physician who completed his medical school and residency in KS. He started the AtlasMD clinic in 2010. He has spoken on direct primary care on Fox News, Hannity and many other venues and speaks regularly at conferences around the country on the importance of keeping primary care direct and free from involvement of government or insurance.

Episode 4: Legal Issues in Direct Primary Care–with Dr Phil Eskew


Episode 4: Legal Issues in DPC…with Dr Phil Eskew

Resources

  1. DPC Frontier
  2. DPC Coalition
  3. Heartland Institute
  4. Proactive MD

Summary
As a new model of healthcare delivery, DPC entails a unique set of legal challenges. DPC practices often find themselves charting new legal territory as they provide innovative care in a profession whose regulatory laws trace their roots back decades, if not centuries. DPC law is a new area and without much legal precedent, leading many doctors and even lawyers to shy away. But as noted by Dr Phil Eskew, lawyer, family physician and founder of DPC Frontier website, sailing the un-sailed seas of new legal scenarios need not be frightening.

The most common legal question that Dr Eskew is asked regarding DPC law deals with the Medicare opt out process. According to Medicare laws, it is illegal to charge a patient for a service that is already paid for by Medicare, so unless a physician ‘opts out’ of Medicare, he or she runs the risk of ‘double dipping’ if he or she charges a patient for a DPC contract that includes services that could be reimbursed by Medicare. Should the physician opt out, this prevents him or her from moonlighting under any employer paid by Medicare. According to Dr Eskew, there are several ways that DPC physicians can opt out and still moonlight, all of which he describes in his website here. DPC physicians can also avoid violating Medicare laws by charging a “fee for non-covered services,” which concierge doctors have traditionally justified with the provision of newsletters, but as Dr Eskew notes, it’s difficult if not if not impossible to justify to the government that everything in a DPC contract is not covered by Medicare.

Another common legal issue arising in DPC law is HIPAA compliance. While there is still some debate in the legal community about whether DPC practices are considered a “covered entity” that must abide by HIPAA compliance standards, there are steps a practice can take to be in compliance with HIPAA which Dr Eskew details in his website. Also, for ensuring compliance of electronic health records (EHR) software, there are many free EHRs as well as several low-cost EHRs that meet HIPAA compliance encryption standards. Finally, for practices who sign a business associate agreement (BAA) with Google, communication on Google core apps is considered to meet HIPAA level of encryption.

Finally, for those who practice DPC in states without DPC laws (see which ones have these here), DPC can run the risk of violating rules of the state insurance commissioner. If a DPC practice fails to set appropriate limits to what services can be provided by the annual or monthly, then it can become liable to scrutiny by insurance regulatory bodies for failing to appropriately pool risk (i.e. offering services on which it can’t deliver).  Per Dr Eskew, risk of violating insurance laws can be avoided by clear patient contracts detailing exactly what services are being offered. Areas where practices can get into trouble, he says, include not placing a cap on panel size or offering unlimited visits without a clear indication for the visit. By detailing exactly what can be offered, a practice makes clear that it can deliver on what is promised.

In sum, DPC law, while young, does present unique legal challenges. But with thoughtful preparation, these hurdles can be overcome. Brave pioneers like Dr Eskew and others have helped offer support along the way. He’s even started a website where he gives away as much legal advice as he can to DPC doctors. Certainly charting new legal territory can be daunting, but there’s help out there. Besides, for primary care doctors, what’s the alternative?

Time Stamped

[02:41] What led Dr Eskew to enter medicine and DPC in particular?

[04:48] Dr Eskew provides an overview of legal barriers to opening a DPC practice.

[06:26] Dr Eskew provides the Medicare opt out requirements.

[07:25] Dr Eskew discusses moonlighting options for opted out physicians.

[08:37] Dr Eskew describes the ‘fee-for-non covered’ services.

[09:49] Dr Eskew discusses relevancy of HIPAA to DPC law.

[12:33] Dr Eskew talks about how DPC doctors should go about finding EHRs with regards to HIPAA compliance.

[13:49] How insurance laws do or don’t apply to a DPC practices.

Dr Phil Eskew

Guest

Dr Phil Eskew is a family physician, DPC doctor, lawyer and DPC legal expert. Prior to graduating from medical school in 2012, Dr Eskew graduated from West Virginia University College of Law in 2008. He is now the VP of Clinical Development and General Counsel at Proactive MD, a company focused on helping employers design, staff, run and monitor onsite health and wellness centers. He is also the VP of Clinical Development and General Counsel at the Heartland Institute, a non-profit think tank devoted to discovering , developing and promoting free-market solutions to social and economic problems.

 

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Episode 27 

Episode 28

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Episode 3: DPC for the Underserved…with Dr Ryan Neuhofel

Quote
“I kind of consider my clinic a concierge safety-net clinic.”
–Dr Ryan Neuhofel

Resources

  1. NeuCare
  2. Dr Garrison Bliss
  3. Medically Underserved Areas and Where the US Needs Doctors

Summary
Direct Primary Care has been criticized by some naysayers as a luxury only available to the wealthy, but for Dr Ryan Nuehofel, this has been anything but the case for his practice. Self-termed a ‘concierge safety-net clinic,’ NueCare has provided care to many underserved patients via Direct Primary Care arrangements. In this episode Dr Ryan Nuehofel, founder of NueCare discusses his motivation for starting a Direct Primary Care practice and how he has been able to serve a predominately underserved population by going direct. Contrary to popular belief, many of his patients, though considered underserved, get far more attention and service due to the fact that they pay for services outside of insurance or Medicaid.

Time Stamped
[01:27] Could you tell us about your Direct Primary Care Practice?

[01:51] What kind of population does Dr Neuhofel’s clinic serve?

[05:21] What challenges has Dr Nuehofel dealt with when dealing with underserved patients.

[08:48] Has Dr Nuehofel ever had to resort to collections?

[09:55] Where Dr Nuehofel got the idea to start a Direct Primary Care practice?

[12:18] How did Dr Nuehofel go about finding a location, hiring staff and getting legal help?

[14:37] Administrative hassle of a fee-for-service practice versus a Direct Primary Care practice.

[15:25] Dr Nuehofel’s response to criticisms of Direct Primary Care being for the wealthy.


Dr Ryan Nuehofel

Guest

Dr Ryan Neuhofel is a Direct Primary Care doctor and the founder of NeuCare in Lawrence, KS. In addition to being a Direct Primary Care doctor, he is among the founding members of the Direct Primary Care Alliance, a grassroots organization devoted to supporting Direct Primary Care doctors through support, education and advocacy, and a a national advocate for the Direct Primary Care movement.

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Episode 25

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Episode 2: Transitioning from Employed Doc to Direct Care–with Dr Jeff Gold

Quote:

“What’s scarier to you: Being in a career that you spend time, money and energy to do and not be able to do it the way you want to for the next 20 years or taking a couple of years where it may be rough, you may have to take a loan out, you may have to moonlight, to end up coming out on the other side practicing medicine the way you always envisioned and that made you apply to med school in the first place?”

—Dr Jeff Gold, Founder, Gold Direct Care

Resources:

  1. Gold Direct Care
  2. AtlasMD

Summary

To embark on one’s own as a direct care doc can be daunting these days, especially when one considers the challenges that must be faced. This is the question Dr Jeff Gold posed to himself when thinking about leaving his nearly decade-old successful practice owned by a local hospital system and starting his own direct care practice. In some way or another, every direct care doctor faces the question when deciding on the model.

In addition to “just” caring for patients, there’s business planning, marketing, regulatory hurdles and, not-to-mention, financing. After four years of medical school and three years of residency, it would seem at first thought that such matters are best outsourced to administrators. After all, we trained to be doctors didn’t we? Not administrators.

Like most other young primary care doctors straight out of residency, Dr Gold took this path, starting a practice under the management of a major hospital system. But after traveling that path he came to realize that this was not what he went to medical school for. Having to see up to twenty patients per day, take time from patient care to fill in insurance codes, and see patients in office for reimbursement, he, like many other primary care doctors, felt like the system of insurance-based care got in the way of caring for his patients. So he made the jump to direct care .

While daunting at first, the decision has allowed him the opportunity to practice medicine with a freedom and joy that he’s never experienced. While at times the challenge of running a business and having to market oneself can be daunting, he notes, being able to help his patients when they need it and how they need it is priceless. This is why Dr Gold embarked on the “road less traveled,” and he has “not regretted it one iota.”

Time Stamped

[1:21] Dr Gold talks about his direct care practice.

[02:17] Where Dr Gold’s practice is located.

[03:01] What kind of demographic population Gold Direct Care serves.

[06:42] How long did it take from Dr Gold’s decision to start a direct care practice to starting his practice.

[10:05] What hurdles Dr Gold faced transitioning to direct care .

[13:30] Particular moments during a day’s work that motivate Dr Gold.

[16:55] Many direct care doctors recount similar experiences of being inspired by the model.

[19:14] Dr Gold offers to host other medical students, residents and doctors.

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Episode 24

Dr Jeff Gold

Dr Jeff Gold is a DPC doctor in Marblehead, MA. Prior to opening his DPC practice, Gold Direct Care, he worked san a primary care doctor at the Parters Healthcare System for 8 years.