Direct Primary Care in New Center

Today, Plum Health Direct Primary Care will be up in New Center at TechTown Detroit. This will be a part of "The Shop" at TechTown, where local entrepreneurs are featured on a rotating basis. 

This month's theme is health-related businesses, so we are excited to participate! If you don't know about Plum Health DPC, we deliver affordable accessible healthcare services in Detroit and beyond. This is a great time to learn more about the service and have your questions answered.

If you don't know about TechTown, it is a small business ecosystem that doesn't focus on tech-only, as the name may imply. It is billed as "the most established business accelerator in Detroit. Its work supports industry verticals that are specific to the region's inherent assets". 

Additionally, this is where I took the Retail Boot Camp course, which helped prepare me to start and run my business. 

Thanks for reading and watching,

- Dr. Paul Thomas with Plum Health Direct Primary Care

You Should Own Your Health Information

You should own your information, especially when it comes to your health and wellness. Unfortunately, health care consumers don't have easy access to their own healthcare information, and this can lead to serious problems. 

I firmly believe that you, the patient, health care consumer, or however you want to describe yourself, should be the sole owner of your healthcare information. When you visit a new doctor, you should take your health information with you, like a thumb drive or a credit card with an information chip. 

With your permission, your doctor would review and evaluate you and your health information before making any treatment decisions. This would be closer to ideal than our current system in which healthcare systems or large hospital systems own your health information.

This may become problematic or even life threatening if your health records are kept with one hospital system, but you have to go to a different hospital system because of an accident or injury. Mistakes can be made if you lose consciousness and are unable to communicate your past medical history, allergies, and preferences. 

Some hospital systems are beginning to allow patients access to their personal health information, but it is often through proprietary applications that may be difficult to navigate and even more difficult to share with different health systems or physicians. 

In my practice with Plum Health Direct Primary Care, I consciously and deliberately share and make clear your health information. Of course, I only give you this information with your written permission. I share your information, lab results, diagnoses and treatment plans because it will allow us to make better decisions together.

I believe that when you are well-informed about your health status and equipped with the necessary information, we can make the best decisions about your health and treatment plans. 

Furthermore, if you choose to seek a second opinion, the consulting doctor will have easy access to the information we discussed, and will therefore be able to make a better decision. 

On a related note, I am really excited about the recent FDA approval for Direct-to-Consumer marketing of Genetic Health Information, namely 23andMe's Health + Ancestry product. 

With only a saliva sample, 23andMe is able to produce a genetic health profile, with 10 potential genetic diseases including Alzheimer's Disease and Parkinson's Disease.

There are some pros and cons to this information. As I've stated above, with more information, you can make better decisions about your health care and how you want to live your life. On the down side, you may have a test with false positive or false negative results, or you may not understand the results at all. 

In the case of a false positive, this would mean that you have tested positive for a condition that you may not have or may not develop. In the case of a false negative, this would mean that you have tested negative for a condition that you actually have or will develop. 

These imperfections considered, I still think personal genetic testing will be a valuable tool as we move forward in this new health care ecosystem. It will enable patients and doctors to make better decisions about treatment. This is especially true as genetic profiles become more sophisticated and we may begin to learn how different genetic profiles are affected by different medications. 

Thanks so much for reading and watching and have a wonderful day,

- Dr. Paul Thomas with Plum Health DPC

Plum Health Direct Primary Care in Midtown Detroit

This week, I was able to sit down with Pamela Owens of yb2c Marketing and talk about what we do at Plum Health DPC. We had a wide ranging conversation and it was a really fun time getting to know Pamela and her husband Keith Owens. They record their podcast out of Green Garage in Midtown Detroit. For the full episode, hit this link!

We dove deep on some issues, like why I've chosen to be in Detroit to practice Direct Primary Care. Fist, I am here because I want to give back to a community that has given a lot to me and my family. Personally, I received a world-class medical education from Wayne State University School of Medicine along with so many volunteer opportunities at free clinics across the city.

I learned a great deal by practicing medicine at the Detroit Medical Center, Henry Ford Hospital, Oakwood, St. John Hospital, Cass Clinic, the Student Run Free Clinic, and the Joy-Southfield Clinic. All of these learning experiences have shaped me into the physician that I am today. 

I also see an opportunity in Detroit. This is a medically underserved area, with a dearth of primary care physicians. Because of my unique set of skills and training in Family Medicine, I am able to fill some of these gaps in care. I am proud to be providing this kind of affordable, accessible health care service in the City. 

Finally, Detroit has provided many resources for small business growth. I've talked about this before, but being able to take classes at the Build Institute and with TechTown's Retail Boot Camp has allowed me to improve my business concept and execution substantially. It has also allowed me to network with several entrepreneurs in the community. Larger grant programs like the Motor City Match program has also provided funding for the build out of the next phase of my business, as Plum Health grows over time. 

As a side note, If you haven't been to the Green Garage, it is a beautiful space in the Midtown community. It has been created in the most sustainable way possible, with almost all of the construction materials being repurposed from what had been in the building before the Green Garage built out that space. The materials were painstakingly conserved, and the space turned out wonderfully. 

They hold a weekly lunch and meet up at 12 pm each Friday at the Green Garage, which is a great way to network and meet innovate people in the Detroit community. Here's a few photos from the last one that I went to (below).

Thanks for watching and reading,

- Dr. Paul Thomas with Plum Health Direct Primary Care

My Thoughts on The Dip

Today, I finished reading "The Dip" by Seth Godin. In the book he talks about when to stick with a project and when to quit. I picked up this book for a few different reasons. First, it was recommended to me by a colleague in my small business community. Second, I felt instinctively that I was facing a decision point in my business, and I needed an external voice to validate what I've been feeling over the past few weeks.

"The Dip" is a relatively short book, and a key takeaway can be found in the section subtitled "Never Quit". Mr. Godin urges his readers to quit, which may be surprising at first. But his main point is this: "Never quit something with great long-term potential just because you can't deal with the stress of the moment". 

Starting a Direct Primary Care practice in Detroit has been one of the most difficult challenges that I've faced in my young career. With undergraduate study, MCAT preparation, medical school, and residency training, there is a great deal of certainty. The equation for success in these regimented environments is simple: study hard, get good grades, perform well on exams and you will succeed. There is a comfort in these structured environments, because I knew that if I studied for "x" amount of hours, I would earn "y" result.  

But with business and running a Direct Primary Care clinic, there is a great deal of uncertainty and a less direct relationship between effort and reward. For example, if I put too much effort into one marketing channel (Facebook or YouTube) and not enough into another marketing channel (email or in-person events), then I may not attract as many new clients. There is no specific formula for success. 

Even though there isn't as much of a direct relationship between effort and reward, I know that Direct Primary Care has excellent long-term potential. I truly believe that it delvers better health care at a lower cost, and that demand for this healthcare delivery model will grow, perhaps even exponentially as economic forces in the broader economy change.

That doesn't change the fact that there is a lot of stress in the current moment! The uncertainty about growth, next steps for the company, and broader adoption in the marketplace cause me a good deal of stress, and I was looking for something that spoke to these aspects of my business. Reading "The Dip" was like having an excellent pep-talk from a personal business coach. 

Intuitively, I can sense that I am in a dip, as described in the book by Seth Godin, and reading his book validated my feelings on my business at this point in time. It also gave some pragmatic wisdom with which I can rededicate myself to my business. After 6 months of operation, I can start to analyze what's working and what's not working. As Godin writes, "The opposite of quitting is an invigorated new strategy designed to break the problem apart". 

He goes on to describe a challenge I'm currently facing: acquiring more customers in the marketplace. He urges his readers to focus on the broader market rather than the individuals. I.e. don't call one lead 10 times, which he sums up nicely here in this passage, "If you try to influence one person, persistence has its limits". It's difficult to change the mind of an individual, and you want to avoid pestering people. 

But, the market is different than individual people. One line that struck me regarding this subject was his assertion that "most of the people in the market have never even heard of you". And this may be a good thing! He relates the story of Sergei Brin of Google and how it was better if customers found out about Google later on rather than right now. This gave Google more time to iterate and improve the product, which would then create better customer experience.

For now, I will continue to focus on improving my services and clinic flow, because I know that as each day passes, the experience of my customers improves. I will also be rededicating myself to email marketing, as I've let this slide over the past few weeks, so check your inbox!

Thanks for reading about the struggles of starting a Direct Primary Care practice. I'm looking to include some of these writings in a future project, so if some of the blog posts here seem random, know that they're adding up to something bigger in the future!

- Dr. Paul Thomas with Plum Health DPC

Plum Health out at America's Future Foundation Event

This week I was invited to speak at an America's Future Foundation meetup in Detroit. It was held at the Detroit Beer Company and the topic of discussion was free market healthcare. I was there representing Plum Health DPC and one of my colleagues, Chad Savage, MD of YourChoice Direct Care was there as well. 

We talked for an hour about free market options for healthcare services in Detroit and Michigan, specifically Direct Primary Care. It was a great event and the audience members asked some great questions.

For example, people often ask about the difference between Direct Primary Care and Concierge Medicine. I wrote a blog post where I discussed the differences in detail, but in a Concierge Medicine Model, doctors charge a membership fee that is often greater than $100/month, continue to bill insurance for visits, and they do not typically offer money-saving ancillary services. 

In contrast, Direct Primary Care doctors have membership fees in the $10 - $100/month range, do not bill insurance companies for services rendered, and typically offer money-saving ancillary services, like wholesale medications, at-cost labs and at-cost imaging. 

Another common question about Direct Primary Care is about the legality of the practice. In 2014, Senator Patrick Colbeck spearheaded an effort in the Michigan Legislature to make Direct Primary Care "legal" in the State. I place "Legal" in quotation marks because it was not illegal before, but a grey area. Senate Bill 1033 of 2014 clearly defines Direct Primary Care and similar retainer-based medical services as legal in the State of Michigan.

Another common question is "how is this possible?", in reference to the savings on medication, labs and imaging services. As in, where does all that extra money go between the insurance-based prices for services and the direct prices? I often give examples of how I save my members on their meds, labs and imaging, and the attendees at this talk asked specifically about how I was able to save on these services.

It starts with wholesaling the medications and setting up contracts with independent retailers for lab services and imaging services. This way, we can negotiate at-cost pricing for services that you may need. These are often based on volume, so the more people who demand these services, the lower the overall costs. Then, I am not paying any middle men between these ancillary services and you the consumer. I do not mark up the prices on my meds, labs, or imaging services, because I want to provide you with the greatest amount of value for your healthcare dollar. 

There were several other questions, but I will stop here! Again, it was a great meet-up and I'm looking forward to their next event! They have several chapters across the country, so you can see when and where their next events are happening on their Facebook page, just click "events".

- Dr. Paul with Plum Health DPC http://www.plumhealthdpc.com/

Direct Primary Care on NBC News

This week, Direct Primary Care was featured on NBC Nightly News with Lester Holt. If you are unfamiliar with this new model for healthcare delivery, Direct Primary Care is a membership model for healthcare that charges a relatively low fee for primary care services. The NBC News team starts out the piece by discussing the amount of time that the doctor is able to spend with the family, "maybe 30 - 45 minutes". At Plum Health, our visit time is about 1 hour for initial visits and 30 minutes for follow ups, so on par with what was stated in the video. 

The video then goes on to discuss the benefits of Direct Primary Care with unlimited visits and the ability to text message the doctor for a flat, monthly fee. For most direct primary care doctors, patients are able to visit the doctor and have digital interactions with the doctor whenever necessary. At Plum Health, our patients can call, text, and email anytime and see us in the office anytime they need us. 

The article then discusses the cost of the monthly membership, which is typically between $25 and $85 per month. In our case at Plum Health DPC, our prices are between $10/month for children up to $89/month for adults over 65 years of age. Young adults under 40 years old pay $49/month and adults over 40 years old pay $69/month. Direct Primary Care practices across the country typically fall in the $10 - $100/month range. Any monthly charges over and above $100 gets into the realm of Concierge Medicine. We wrote a previous blog post about the difference between Direct Primary Care and Concierge Medicine, here. 

The NBC Nightly News piece goes on to discuss what's included in or what is covered by a typical Direct Primary Care practice. Typically, DPC practices cover unlimited primary care visits. At Plum Health DPC, our patients have unlimited visits with Dr. Paul, unlimited texting, emails and phone calls or unlimited digital communication. In addition, we charge at-cost pricing for routine lab tests and we charge wholesale prices for medications. Some doctors choose to include some basic blood work in the cost of the membership.

Because we don't charge an enrollment fee, we chose not to include basic blood work in our service. Instead, we perform at-cost labs at Plum Health. Complete blood cell counts are $4, Comprehensive metabolic panels are $6, Thyroid Stimulating Hormone tests are $6, Lipid panels are $6.55, and we have a modest draw fee of $2.

How Much Direct Primary Care Costs Plum Health DPC.png

Families save money by choosing Direct Primary Care. The NBC News article discusses how the family featured in the video saves $500 each month by using a Direct Primary Care service and pairing that with a low premium, high-deductible plan.

This pairing of services is the ideal way to save money on your health care expenses. The issue that some people run in to is finding that Catastrophic coverage plan. Many of those plans have gone away after the Affordable Care Act was signed into law by President Obama. This is one of the many road blocks to wider implementation of Direct Primary Care plans. The other impediments include the inability to use Health Savings Account funds for DPC plans. 

The next part of the article gets into the philosophy of Direct Primary Care. It talks about how Dr. Cunningham left a traditional family medicine practice. Now that he operates a Direct Primary Care practice, he sees fewer patients and makes less money. But, the income loss is worth it to him, so long as the insurance companies no longer dictate how he's supposed to take care of patients.

This part of the video touched a nerve with me. So often, we as doctors do not take care of our patients in the most optimal or ideal way because of the barriers put in front of us by insurance companies. By not accepting insurance company dollars, we are free to take care of patients in the way that they deserve to be taken care of. Dr. Cunningham says "It feels great to be practicing medicine the way it's supposed to be", and I agree!

Operating Plum Health DPC has allowed me to develop deep, trusting relationships with my patients that I never got to experience as a resident or in a traditional practice. The element that is so important to developing this relationship is time. When I am able to spend an hour with each patient during each visit, I am able to give them my full attention and deliver the kind of care that they deserve. 

Dr. Cunningham, a Direct Primary Care doctor in Massachusetts, talks about how he is able to practice medicine the way he's supposed to be. 

Dr. Cunningham, a Direct Primary Care doctor in Massachusetts, talks about how he is able to practice medicine the way he's supposed to be. 

On the other hand, the article highlights the critical elements of Direct Primary Care: "Critics say there's already a shortage of primary care doctors". They don't really expound upon this thought or bring this thought to its logical conclusion, which is that if we already have a shortage of primary care doctors, then it is inexcusable for those primary care doctors to see less patients. 

I take umbrage with this remark. There is a dearth of excellent primary care doctors because the practice of primary care medicine is one of the most challenging fields in medicine and it is often the lowest paid field in medicine. Medical students often choose higher-paying specialties in medicine that come with greater job satisfaction and less role strain.

I see the practice of Direct Primary Care as solving some of the issues with the current system. DPC medicine helps to eliminate the role strain that young doctors feel. When I have an hour to take care of a patient, I can really address them as a whole person. In the traditional or fee-for-service model, a primary care doctor has 10 - 15 minutes to address the whole patient, and this is nearly impossible. I've been there, seeing patients at this rate, and the best you can do is address 1 or 2 concerns before you have to move on to the next patient. 

Direct Primary Care also can offer doctors a chance to earn a greater income if they have a panel of roughly 500 patients or members in their DPC practices. Some doctors choose to see less patients in their DPC practices, and therefore would make less money, but there is an opportunity to increase primary care doctors' salaries. 

By eliminating the role strain that primary care doctors experience and by paying them a better salary, we can attract more medical students to primary care medicine fields like family medicine, general internal medicine, and general pediatrics. I take umbrage with the thrust that doctors should not see less patients because the system is broken.

It would be worse to see the system perpetuated with exhausted, frustrated, burnt-out primary care doctors seeing 2,500 patients each year. It would be better to have more medical students attracted to primary care fields, seeing 500 patients each year, limiting their role strain and increasing their incomes. 

Another critique is that Direct Primary Care does not cover specialists visits or hospitalizations. I find this to be a moot point because the main thrust of Direct Primary Care is to deliver primary care services directly to our patients. We make no mention of Direct Specialty Care or Direct Hospital Care, and we make no attempt to promote these services in our offerings.

Too often, American consumers conflate "health care" with "health insurance", but these are distinct and separate services. You need to have health insurance, either a low-premium, high-deductible plan or a catastrophic coverage plan. This health insurance does exactly what the name implies: it insures you and your health against major, unexpected events. 

Direct Primary Care, then, delivers the affordable, every-day primary care services that are needed by  you and your family. You need to have primary care coverage, but you shouldn't have to pay an insurance company to pay your primary care doctor for what amounts to low-cost primary care services. 

It makes sense to pay an insurance company to pay hospitals and surgeons for higher cost care, but it doesn't make sense to pay insurance companies to pay your primary care doctor for relatively lower cost primary care services. 

As a side note, Plum Health DPC does offer specialists consultations for difficult clinical questions through our relationship with Rubicon MD. This allows us to ask about diagnostic testing, special labs to order, or to help us solve a difficult problem. But, as in the video, we do not offer specialists visits as a part of our service. 

The closing thought from the NBC Nightly News video is that despite the drawbacks, it is worth it for some individuals and families to pay for Direct Primary Care services. As a Direct Primary Care doctor, the benefits are clear: you have a doctor on call for you any time you need it and access to time and cost-saving auxiliary services. The NBC reporter says that "Direct Primary Care is the answer, to save money and have a doctor who's always 'in'". 

Thanks for reading and have a wonderful day,

- Dr. Paul with Plum Health DPC

Facebook Marketing for Doctors

Hello Doctor Colleagues! As I've started a new medical practice in the last year, I've had to become very familiar with several marketing channels. In this blog post, I will outline how to approach Facebook Marketing and how you can measure the results of your efforts for paid and unpaid posts. 

Basics:

Set up a Facebook page for your business. This will allow you to use paid advertising via the Facebook platform, which is one of the most valuable and effective marketing channels available. You should not market your practice from your personal page only, because the number of people who can "friend" you is typically capped at 5,000, whereas your business page can receive unlimited followers. Also, you cannot pay to boost content or purchase ad space on Facebook via your personal account. 

Create Engaging Content:

If you want to attract new members to your practice, create unique, interesting and engaging content. In simple terms, the most effective content consists of video, photos, sharing articles related to your practice or practice philosophy, and short lines of text. You want to create the kind of content that is "shareable", where your Facebook page followers will want to "share" this content with their friends and family. Educational material about hot topics in health and healthcare are especially "shareable". 

An Example:

Recently, I wrote a blog post and made a video about bike lanes in Detroit. Accessible healthcare is something that I'm passionate about, and if I can further the progress that we've made in Detroit in terms of human-centered urban planning and Complete Streets, that would be ideal! Anytime we improve our walking, biking, and transit infrastructure, we provide more people with access to parks, grocery stores and doctors - all things that people need to be healthy. 

As you can tell, I care a lot about this subject! So, pick a topic that you're passionate about and try to start a conversation with your community. Maybe for you it's vaccines, seasonal allergies, antibiotic overuse, the opioid epidemic, etc... These are all great topics that you can write about and share with your Facebook followers. 

Once I posted my video into Facebook regarding bike lanes in Detroit, I opted to boost the post. You can boost a post on Facebook by linking your business bank account to your business Facebook profile. You can boost your content for a few dollars on up to thousands of dollars.

As I've started to understand Facebook, it's algorithm, my followers, and my community better, my skill with boosting content has improved. It may take a few months and several boosts for you to understand what works for you, so start small with $10, $20, or $30 boosts and see what does well. As your comfort level grows, add more money to get better results.

In this video, I show my Business Facebook Page, and demonstrate how to boost a post, choose a location, choose an age range for my audience, and choose interests that my potential customers may have. You can also set the duration that you want the advertisement to run, and in this instance I select for a 24 hour period. View it here:

From there, I keep tabs on the boost by answering any questions and responding to any comments from my audience. After the 24 hour period has expired, I look at my results. These results can be "soft results": likes, shares, video views, audience members reached, etc... But, as we are operating businesses, these soft results are not as important as patient sign-ups. I discuss the "soft results" in this follow up video: 

Additionally, the results of your Facebook boost can be measured by seeing how many people went to your website. I use Squarespace, which shows some "analytics" or data related to web traffic. Below, you can see our web traffic over the last 1 month. That spike on March 20th and March 21st came after we were featured on Local 4 WDIV in Detroit. The most recent spike on April 12th is a result of our recent Facebook post and boost, which linked directly to our Plum Health website. Our traffic typically hovers around 20 - 30 unique visitors and after the boost, we received 54 unique visitors. 

Furthermore, in Squarespace's Analytics tab, you can see where your web traffic came from. These traffic sources are called "Referrers", places like direct browser traffic, Google searches, Facebook, Twitter, etc... Over the last 1 month, 47% of our traffic has come directly to our website, or people typing "PlumHealthDPC.com" into their browser. 39% of our traffic has come from Google, or people searching for "Plum Health" or "Direct Primary Care in Detroit" or something similar. 

Importantly, over the last 48 hours or the time frame of our most recent boosted post, 26.23% of our traffic came from Facebook or about 14 unique visitors followed us from Facebook to our website. This spike in traffic from Facebook outpaced Google traffic. This is demonstrated in the photos below:

Finally, if you received any calls or direct messages in the 24 - 48 hour period after your post, you can ask your potential customer how they heard about your service. If they respond that they saw your ad on Facebook, then your sales funnel is working to your advantage. As a side note, it is always important to ask your patients or customers where or how they heard about you - that way you can focus your marketing efforts into that area. 

For Plum Health and for this post, we received one inquiry during the advertisement and one inquiry in the 24 hour period after the advertisement ended. We were able to schedule both of those inquiries for appointments in the coming week.

Thanks for reading, and if you have any questions, leave them in the comments section below!

- Dr. Paul with Plum Health DPC

Where the Bike Lane Ends

When I think about creating an affordable, accessible healthcare service in Detroit, there are many factors that I consider. One of them is physical accessibility by foot, by bike and by car. How can I help to ensure that all patients and community members have access to the resources that I provide in my Family Medicine practice? Am I able to serve the spectrum of people with varying incomes and abilities in my office? What barriers do people face when trying to get to my clinic? 

Our Plum Health office is situated about 1 block from I-96/I-75 near the Vernor Highway exit. That's right, my office sits at the intersection of 2 "highways". Vernor Highway is not much more than one lane of each traffic in each direction, but the sentiment remains. We have a parking lot, there is sidewalk leading to our entrance, we are on a bus line, and we have parking spaces for persons with disabilities. 

However, there is one area where we can improve! There is a Bike Lane on Vernor Highway in both directions that extends from SW Detroit and ends in front of my office in between 20th and 21st Streets. This is unfortunate, because there are Bike Lanes going in both directions on Michigan Avenue, less than 0.5 miles away.

All I'm saying is that there's a real opportunity here to connect SW Detroit, Mexicantown and the historic West Vernor Business District with Michigan Avenue, Corktown, and the Corktown Business District. 

So for anyone in the City of Detroit, if you're reading/watching/listening, here's my prescription for a healthier road, healthier neighborhood, and healthier community: 

  1. Clean up the garbage that has accumulated underneath the Michigan Central Station Rail Lines and along West Vernor highway. I'd be happy to help with this myself or by organizing a group of people in the community to assist or get this done. However, we would likely need support with some bulk collection if we went this route!
  2. Extend the Bike Lane on Vernor Highway between SW Detroit at 20th Street and Michigan Avenue. This would be relatively easy and would make for a safer crossing in the greater Roosevelt Park area.
  3. Cross walk markings in the Roosevelt Park area. There are several intersections in the Roosevelt Park area that are not demarcated by cross walks. This makes for dangerous crossings for pedestrians and bicyclists and ultimately less connected neighborhoods. 
  4. Install lighting underneath the Michigan Central Station's viaduct.

Ultimately, citizens in Detroit face challenges with regular activity, obesity, and access to healthy food and parks. Creating an inviting environment for healthy activities by investing in Complete Streets at key intersections will be beneficial and will make an impact on the lives of residents in Detroit.

Sincerely,

- Dr. Paul with Plum Health DPC

Direct Primary Care versus Concierge Medicine

The phrases Direct Primary Care and Concierge Medicine are sometimes used interchangeably, but they are distinct entities. 

The Concierge Medicine movement began around the year 2000 with doctors charging an access fee for their services while still billing insurance companies. The average membership cost for Concierge Medicine is roughly $2,000/year and up to $15,000/year. 

Contrast that with Direct Primary Care or DPC. The DPC movement began around 2010 with doctors like Garrison Bliss in Seattle and Josh Umbehr in Wichita among others. Memberships cost roughly $10 - $100/month. There is an emphasis in DPC on a monthly membership structure - members are not locked in for a 1 year commitment. 

In Concierge Medicine, the membership costs allows for access. Because the membership cost is relatively high, these types of practices attract the top 1% - 5% income earners. These high income earners are relatively price insensitive, so they are not as concerned about saving money on medications, labs or imaging. These patients are willing to pay for these ancillary services via their insurance even though the price may be inflated.

In Direct Primary Care, the membership includes more services. DPC doctors typically don't charge per visit fees and they try to move away from fee-for-service type transactions. Many ancillary services are included in DPC memberships, like EKGs, Spirometry, Wart Removal, etc... In addition, DPC docs get their patients wholesale medications, at-cost labs, and at-cost imaging services. 

Concierge Medicine clinics attract members via programs like "Executive Physicals" or "Executive Health". These are tailored to high-income earners like people in the "C-Suite", aka CEOs, COOs, an CFOs. 

Direct Primary Care doctors focus on health maintenance, wellness, and the bread and butter primary care services like preventive health, screening tests, chronic disease management, and acute care needs. 

Concierge Medicine practices often mandate that you carry a high-end insurance policy - these practices often bill their patients' insurance companies for routine visits or services. 

Direct Primary Care doctors do not bill insurance companies for the services they provide. That means that DPC doctors can take care of patients across a wide spectrum of coverage. For example, if you are uninsured, underinsured, or fully insured, you can be seen at Plum Health DPC. This is true for most DPC clinics. 

I put together a short video to emphasize some of these differences. The audio got a little out of sync near the end, so I'm sorry about that! I'll try to re-shoot it later this week!

- Dr. Paul with Plum Health 

How to Start A Direct Primary Care Clinic Right Out of Residency

This week, I received a question from one of my followers on YouTube! Big shout out to everyone who follows/watches - I appreciate you! 

Anyways, the question is this: do you recommend starting a Direct Primary Care practice right out of Residency Training? And yes, I do! There are several ways to go about this, but it is better to start right out of residency than to wait until you have established fee-for-service patients or established insurance-based contracts.

Probably the best way to do this is to work for the first 6 months out of residence in an infusion center, urgent care, or hospital setting. Take one of these "moonlighting" jobs, work 40 - 60 hours a week, and spend the remaining 20 hours in your work week setting up your Direct Primary Care practice.

So, how do you set up a Direct primary care practice?

First, start with why. For more on this, read Simon Sinek's book of the same name. In short, you want to create a business that reflects your "why", or why are you doing this? For me, I wanted to create a healthy resource for the community that was affordable and accessible for all people. The name "Plum Health" reflects that mission. Plums are affordable and available to the community. You can buy them at nearby Eastern Market or from your local grocery store. They are also purple, representing inclusion, and health giving. 

Then, develop a brand and a website. You want to create a sleek, modern website with an easy-to-pronounce name. "Plum Health DPC" works for me for the following reasons: Plums are healthy, kind of like "an apple a day keeps the doctor away". Plums can be drawn by making two overlapping circles, for me symbolic of the doctor-patient relationship, which has greater overlap in my practice. Also, Plum Health DPC indicates that we're a Direct Primary Care practice - it says so in our name! Finally, the domain "PlumHealthDPC.com" was available, which is a must!

Try to avoid stuff like "Salubrious Health" or some similar SAT vocabulary word. Also avoid overly long names. Keep it simple! Other alternatives that would have worked well for me would have been "Plum Primary Care" or "Plum Family Medicine". If you live in a small town or are in a distinct neighborhood, you can highlight that neighborhood or town in your name. I am in the Corktown/Southwest Detroit neighborhood currently, so something like "Corktown Primary Care" or "Corktown Family Medicine" would have been reasonable, with a domain name like "CorktownPC.com", "CorktownFM.com" or "CorktownMD.com". But, choosing the name is contingent on the availability of the domain. 

The only downfall to naming your brand after a specific location is that if you decide to expand and open a second location, your brand will be incongruous with that second location. For me, I know that I wanted to be in Detroit to start and the goal is to expand regionally, so choosing a name that was not location-specific was important to me.

Your website is super important because it becomes a beta test for your market. If you are getting good traffic, engagement and responses from the community, these are positive signs. If not, it's not the end of the world, you may just have to be more proactive with your marketing efforts. 

Beyond Naming, branding, and websites

Beyond naming and branding, form an LLC, PLLC, or S-Corp. Consult with a lawyer on which is best for you. Perhaps hire that lawyer or set up a retainer agreement so that you can consult that lawyer as your business grows. Then, set up a business bank account. Link that business bank account to software like QuickBooks so that your expenses are tracked.

Everything that you spend on the practice stays within the practice, meaning that you should treat your business as a separate entity from your personal finances. You may infuse your business with your own capital and that's why working 40 - 60 hours/week makes sense for 6 months. This way you can make enough money to fund your DPC start-up.

Alternatively, you can get a business or medical practice loan from a bank like Wells Fargo or Bank of America. Next, you need to have someone review your expenditures, so hiring an accountant or having a retainer agreement with an accountant is a must. 

Choosing an Electronic medical record

Then, you should choose an Electronic Medical Record (EMR). Personally, I use ATLAS MD EMR because the platform is made by DPC doctors for DPC doctors. Also, ATLAS has a billing platform integrated into the EMR, which makes your life and your practice easier to manage. You can link your ATLAS MD account to your website and have people sign up directly on your site - these are called pre-enrollments. You can do this on a trial basis with ATLAS, and once you hit your start date, all those "pre-enrollments" will become paying customers when you hit "start" on the EMR side. At that point, your customers will start paying you for services and you will start paying ATLAS for the platform.

Other contracts

During this time, you should also be setting up contracts with your service providers. Internet, copy/fax machine, lab services, medication wholesaler, medical supplier, medical waste, shredding, general waste, etc... You should also be looking around for real estate options. A good way to test your model is to sublease from an existing doctor's office. Maybe you can find a general surgeon and you could sublease a few unused exam rooms - one to see patients and one to store meds, supplies, etc... If you are successful in that sublease location, you can look at expanding your business and setting up your own lease. 

Benefits to subleasing are numerous. You won't have to set up your own internet provider, copy machine, medical waste, shredding, and general waste contracts - they will likely be included in your lease agreement depending on what you negotiate for. 

Final thoughts

Setting up a Direct Primary Care practice is not easy, but it can be done successfully if you take measured risks as you grow. The website is your first test. For me, I started making house calls as a second test. As a third test, I subleased a one-room office from a local school. The next test for me will be to lease out my own office/building, and I'm just about at that point! 

Also in this vlog, I touch on Public Service Loan Forgiveness programs and the effect it may have on primary care doctors choosing Direct Primary Care practices. More on NPR's website.

Thanks for reading and watching, and have a wonderful day!

- Dr. Paul with Plum Health DPC

Sustainable Brands 2017

This is our Plum Health DPC application for Sustainable Brands 2017! Plum Health DPC http://www.plumhealthdpc.com/ delivers affordable, accessible healthcare services in Detroit and beyond. Read more at our website: http://www.plumhealthdpc.com/

We accomplish our goal via a membership model for health care, with children paying $10/month and adult memberships starting at $49/month. Patients, or members, can call me, text me or email me anytime. They can be seen in the office anytime without a copay.

In addition, we get wholesale medications, at-cost labs, and at-cost imaging services for our members. We saved one of our members $1,632 on one test. He needed an MRI of the Cervical spine. 5 years ago, he paid $2,000 for the test, which is the insurance-based price. We have a contract to get that same test for $368, which becomes a savings of $1,632. Our small pharmacy in our office has saved our members thousands of dollars on everything from blood pressure medications, anti-depressants, diabetic drugs, and more. 

Finally, our lab prices are unreal. We check a complete blood count with differential for $4 (aka a CBC). If you have this CBC performed at the hospital, your insurance will be billed about $100. Our Lipid Panel costs $6.55 while the same test can run for $120 via your insurance. 

This is how we're making health care affordable, accessible and sustainable. We put an end to out-of-control pricing that is causing so many problems for everyday people and their families.

Thanks so much for reading and watching!

- Dr. Paul with Plum Health

Steady Growth in the First Quarter of 2017

Plum Health DPC is a Direct Primary Care practice in Detroit, Michigan. It is the only authentic Direct Primary Care practice in Detroit and Wayne County, and one of two authentic DPC practices in the State of Michigan. 

When I started chasing the dream of Direct Primary Care in early/mid 2016, I wondered if this would be possible and/or sustainable. Could I really hope to spend an hour with each of my patients? Could I really operate a medical practice outside of the insurance-based system? Could I really be successful?

When I started making house calls in November and December, I experienced slow growth. I added only 10 people in those first two months. Part of the issue, in my mind, is that it's hard to visualize what I'm trying to accomplish. Unlimited visits? Wholesale medications? At-cost labs? It all seemed amorphous to those listening to my pitch.

Once I leased an office space (December 15th, 2016), the "idea" became more real for the people interested in signing up. Once inside the Plum Health DPC office, you can see the medications, the blood draw equipment, the scale, the otoscope/ophthalmoscope set, and the other accoutrements that make a doctor's office feel like a doctor's office.

Since that time and over the course of the last 3 months, we've experienced steady growth. My goal was to add about 20 new members each month, with a minimum of 15 and a maximum of 30 new members each month. 

So far, we are on pace, meeting those targets each month. As our membership base has grown, I've noticed more of a "snowball" effect, where current members are beginning to refer friends and family to the practice! This has helped us remain sustainable.

Further, only 2 members have cancelled over the period of 5 months! Both instances were similar - young 20-somethings who signed up because they needed some help with an immediate issue. After a few months of membership, they were able to garner health insurance through an employer or another source, and couldn't justify both expenses because of a limited budget. 

Finally, I am so grateful to the people who have given this Direct Primary Care practice model a shot - a huge thank you to our current patients/members who sustain the practice, leave us positive reviews, and spread the word to their family/friends/co-workers!

Sincerely,

- Dr. Paul with Plum Health

 

Health Benefits of Plums

Plums are a great source of fiber and vitamin C. I recommend eating 4 - 5 fruits and vegetables each day, and Plums can be a great part of this. When you eat a healthy balanced diet, you don't need to take as many supplements; the foods that are available for consumption have all the essential vitamins and minerals that we need to be healthy.

As an update, we were recently featured in Crain's Detroit Business, so a big thanks to their editorial staff and Mark S. Lee for giving me the platform to spread the word about Direct Primary Care. Here's a video update:

Thanks for reading and watching, and have a wonderful day! Also, Happy April Fool's Day!

- Dr. Paul with Plum Health DPC

Plum Health Featured in Crain's Detroit

This week, Plum Health DPC was featured in Crain's Detroit Business. The opportunity came up after meeting with Mark S. Lee on his program, Small Talk with Mark S. Lee. During the on-air interview, we only had 15 minutes to talk about Plum Health and Direct Primary Care. It simply was not enough time to get down into the nuances of what Direct Primary Care is, the mission of Plum Health, and the future of health care and health care policy in this country.

This follow up interview in Crain's Detroit allowed for a deeper dive into these nuances, and so I must thank Mark S. Lee and the Crain's Detroit editorial team for working with me and publishing this important piece. You can read the full article here.

I truly believe that Direct Primary Care will play a greater role in our health care ecosystem as people/health care consumers wake up to the actual cost of their medical care. By making health care prices transparent at Plum Health DPC, we allow people to use free market principles to purchase the health care that they need. 

Thanks so much for reading, thanks again to Mark and Crain's Detroit, and thank you the readers, followers, patients, and supporters that make Plum Health DPC possible!

- Dr. Paul with Plum Health

How Many Direct Primary Care Practices in Michigan?

The number of Direct Primary Care doctors in Michigan is difficulty to quantify. A reasonable place to start is with a definition of what Direct Primary Care is and is not. Philip Eskew is both a lawyer and a DPC physician over at DPC Frontier, and he sets forth a good criteria: 

FOR THE PRACTICE TO QUALIFY AS A DIRECT PRIMARY CARE, IT MUST:

1) CHARGE A PERIODIC FEE 

2) NOT BILL ANY THIRD PARTIES ON A FEE-FOR-SERVICE BASIS, AND

3) ANY PER VISIT CHARGE MUST BE LESS THAN THE MONTHLY EQUIVALENT OF THE PERIODIC FEE

I wanted to apply this definition to the State of Michigan, my home state, to see how many "DPC" practices meet this criteria. As far as pure Direct Primary Care offerings open to the public, there are two: Chad Savage, MD with YourChoice in Brighton and Plum Health DPC in Detroit. 

There are other Hybrid DPC offerings within clinics that also bill third party insurance companies: Dr. Younes in Dearborn, Dr. Tindle in Grand Blanc, and Dr. Kevin Roy in Saginaw. I take issue with the Hybrid practices, because you lose the accessibility piece that makes DPC such a great delivery model - these doctors are still seeing a significant number of insurance-based patients and offering DPC to a subset of patients. So if a DPC patient needs to be seen, they "jump the line" and are seen ahead of the insurance-based patients. This is less than ideal.

Premier Private Physicians offers what I would define as Concierge Care or Concierge Medicine. The membership is $200/month or $2400 for the year and some labs and vaccines are billed to insurance companies. Visits are included, but they do not have contracts for at-cost meds, labs, or imaging because their patients are typically high income earners/wealthier people who are not as cost sensitive. 

The other category of "DPC" in the State is employer-based DPC. Some large employer groups like United Shore have contracted with a "DPC" provider like SALTA or ProactiveMD to have on-site doctors to care for their employees. These practices are not open to the public and people who are not employees at these companies cannot access these services.

Because the access to care is limited, this operates more like a third party structure as the large company finds that it saves money to pay a capitated rate for each employee to an on-site doctor, rather than the patient using their employer-provided insurance to seek out urgent care or emergency services. Unfortunately, employees may start to use the "DPC" doctor more for urgent care type visits and less for primary care, chronic care, or preventive services. 

If you wanted to include all of the above practices in the definition of DPC, there are roughly 8 "DPC" providers in the State of Michigan. My argument is that there are only 2 "pure" or authentic DPC practices in the State of Michigan. Sincerely, I would love to see more doctors taking the plunge into authentic DPC medicine, and am here to inspire, encourage, and consult other doctors to do just that. 

If you want to add to the conversation or debate, please send me a message or write a comment below!

Thanks for your time,

- Dr. Paul with Plum Health DPC 

Wholesale Medications in Detroit

At Plum Health DPC, we get wholesale medications for our members in Detroit, Wayne County, and Southeast Michigan. Just this week, I've helped more than a few of my patients or members with wholesale medications.

For example, I had a patient with  lower back pain due to paraspinal muscle tenderness. A common treatment for this is with Cyclobenzaprine or Flexeril. This medication can retail for $5 - $15 at retail pharmacies. At Plum Health, we wholesale Flexeril for 2.8 cents/pill. When the patient got the bill for $0.28, he thought that it was an error, but that's the actual cost of the medication.

Next, I have a patient with chronic allergic rhinitis. He told me that he got Flonase or Fluticasone at Costco at a bargain price of $48 for 3 bottles. At Plum Health, we wholesale Flonase for $7.26. He was pleasantly surprised by the cost savings!

Finally, I had a gentleman with Diabetes and High Cholesterol. He had been paying roughly $50/month for his medications at the retail pharmacy. At Plum Health, we were able to wholesale the Lisinopril, Glipizide, and Simvastatin for under $5, essentially saving him $45/month! 

These are just a few examples of how we save people money on their medications and on their healthcare. If you have any questions about how we can help you, don't hesitate to call 313.444.5630 for a free consultation.

Thanks for reading and thanks for watching,

- Dr. Paul with Plum Health

Plum Health at Rock CF Rivers Half Marathon

This morning, I was out at the Rock CF River's Half Marathon and 5K in Grosse Ile, Michigan. Rock CF is an organization that advocates for patients with Cystic Fibrosis across the country, and their global headquarters are in Detroit on West Grand Boulevard. 

Emily Schaller is the founder of Rock CF and organizes this race to raise money for the organization. The Rivers Half Marathon started at Grosse Ile Middle School and ran the perimeter of the island. The Rivers 5K started at the Grosse Ile Airport and ended at the GI Middle School. 

I was representing Plum Health DPC as the race doctor and I was stationed at Mile 7.5/8ish. Fortunately, there were no major course injuries to report and things ran smoothly - no pun intended! 

I'm really proud of the Rock CF organization, their mission, and the work that they do in the community. If you'd like to be a part of Rock CF and/or donate to people with Cystic Fibroses, hit up their website!

As a physician, I recommend 30 minutes of exercise each day for 5 days each week. That's about 150 minutes of exercise each week. Aerobic exercise like running a 5K is a perfect way to get and stay in shape. Exercise has innumerable benefits from better heart and blood vessel function to better control of diabetes, high blood pressure, and depression. 

Now that the weather is nicer, it's the perfect time to develop healthy habits like running or walking every day. My pro tip is this: hang your workout clothes on your bed post and make exercise the first thing you do when you start your day. 

To learn more about how you can become healthier, reach out to me here!

Thanks for reading and have a great day,

- Dr. Paul with Plum Health

Plum Health DPC Featured in The HUB Detroit

This week, we were featured in an article by The HUB Detroit, a local publication that focuses on Detroit neighborhoods. From their mission statement, they emphatically state: "our focus is Detroit’s neighborhoods. TheHUB’s multimedia platforms were created to give Detroit city residents and supporters a dedicated voice and space to discuss the real issues surrounding viable city neighborhoods."

I am happy to be working in the neighborhoods in the City of Detroit, serving folks of diverse backgrounds via my clinic in Southwest Detroit. The article touched on this point by relating that I am embracing the neighborhood where I practice medicine. It's true - I spend a lot of time reaching out to folks in the community like small business organizations, small business owners, and non-profit groups like the Ford Resource and Engagement Center. 

Our goal is to improve the health and wellness of not only individuals, but also the community and we achieve this by delivering affordable, accessible healthcare in our community.

I really appreciate the time that the editorial staff took to share the Plum Health story, and I'm excited for what the future holds for health in our City and our region.

Thanks for reading, and have a wonderful day,

- Dr. Paul with Plum Health 

Plum Health DPC in Grosse Pointe

On Tuesday night we were invited to speak to a group called the Eastside Republicans at the Grosse Pointe War Memorial in Grosse Pointe Farms, Michigan about Plum Health and Direct Primary Care. 

Other speakers were Chad Savage, MD of YourChoice Direct Care and Senator Patrick Colbeck, a staunch supporter of Direct Primary Care in Michigan. This is a part of a tour across the State, a series of events across Michigan where Senator Colbeck and Direct Primary Care doctors talk about free market options in healthcare. 

This was the largest crowd on this tour, and there were about 100 people in the audience. There were some great questions asked and good information shared about DPC, health shared savings plans, and unique solutions for employers. 

The next event will be in St. Clair Shores on April 24th - mark your calendars!

Thanks for reading and have a great day,

- Dr. Paul with Plum Health

Plum Health at Build Institute

This week, I was invited to sit on a panel at the Build Institute to celebrate their 5th year of investing in and uplifting small businesses in the City of Detroit. Fortunately, I was able to take and graduate from a Build Institute course over the summer of 2016.

This Build Institute Course allowed me to develop and solidify my business plan, make connections with fellow entrepreneurs, and tap into Build's ever-expanding network of small business owners and service providers. Through Build, I was able to be a part of big events like Detroit Homecoming sponsored by Crain's Detroit. I was also able to meet future customers and future service providers like my lawyer. 

On Wednesday, I was invited to sit on a panel of small business owners who have benefitted from the Build Institute's unique programming. It featured Lana Rodriguez of Mama Coo's Boutique, April Anderson of Good Cakes and Bakes, April Boyle of Build Institute, and Christianne Malone of Build Institute. 

After the panel, Steve Garagiola of Local 4 News (WDIV) asked if I'd be interested in an interview. I invited him to my office at 1759 West 21st Street, Detroit MI, and he came over with his cameraman. During the interview, we discussed the basics of what we provide at Plum Health DPC. 

I was surprised at how fast the turn around time was for the interview, as it aired during the 6 pm news on Detroit's Local 4 News. In case you missed it, here's the interview!

In addition, Kurt Nagl, a writer from Crain's Detroit wrote an article about the event and it appeared on their website on Tuesday. 

Thanks so much for reading and watching!

- Dr. Paul with Plum Health DPC