Plum Health Advocating for Direct Primary Care in Washington DC

This week we're in Washington DC, advocating for affordable, accessible healthcare services on Capitol Hill. We're meeting with the offices of Senator Stabenow, Senator Peters, Congresswoman Lawrence, and Congressman Conyers. This is one of those moments where I feel like the mission that I'm on is bigger than the community that I live in and bigger than my city and my state. Access to affordable health care is a National concern and our representatives and their office personnel have given us open ears. 

On Thursday morning, I boarded a plane to DC. That day, I met up with several of my Direct Primary Care colleagues at the DPC Summit 2017. We took a bus from our hotel in Crystal City to the Dirksen Building on Capitol Hill. We received instructions from our advisors about how to talk to our legislators: be authentic and tell your story. 

Here's the video I shot in the Detroit Metro Airport prior to taking off:

After our briefing, I was able to meet up with legislative assistants from the offices of Senator Stabenow, Senator Peters, Congressman Conyers, and Congresswoman Lawrence. Here's a video I shot inside the atrium of the Hart Senate Office Building:

The Hart Senate Office Building houses the offices of Senator Peters and Senator Stabenow. I was bouncing between this building and the Rayburn House Office Building, where Congresswoman Lawrence and Congressman Conyers have their offices. Here's a video I shot just outside of the Rayburn House Office Building:

Thanks for reading and watching, and have a great day,

- Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan

Local Detroit Doctor on Channel 4 News WDIV

This week, Plum Health Direct Primary Care was featured on Channel 4 News, station WDIV, in Detroit, Michigan. Plum Health was billed as a service that is saving people "thousands of dollars". While we are able to save folks money on their health care needs, the reason why we do this goes much deeper.

Our mission is to provide affordable, accessible health care in Detroit and beyond. We build relationships with our members and make ourselves available whenever our patients are in need. We make the prices for all of our services transparent so that you can understand both the cost and the value. Here's what WDIV wrote on their webpage:

DETROIT - Dr. Paul Thomas, who runs the Plum Health Clinic in Detroit, might just have a plan to revolutionize healthcare -- it's called Direct Care.

Thomas said everyone needs health insurance in case of catastrophic illness or injury, but he quickly added, "Basic healthcare outside a hospital is actually low cost."

When was the last time "low cost" and "healthcare" showed up in the same sentence?

A hospital test for cholesterol can cost $120; Thomas charges $6.50. A month's supply of Prilosec costs about $17 at the pharmacy, Thomas' clinic members pay 96 cents for the same prescription.

"The more money the insurance companies touch, the more that sticks to their hands," Thomas said.

Thomas argues that Direct Care removes the profit-takers between your dollars and your doctor, and makes affordable healthcare a reality.

I am deeply grateful for the coverage, and am deeply grateful to be a physician taking care of people's medical needs. Please let me know how I can be of service to you, and thank you for reading and watching.

- Dr. Paul Thomas with Plum Health Direct Primary Care

Primary Care Clinic in Detroit

When I was a first year medical student, I worked with a group of my fellow medical students to build an outdoor medical clinic. We wanted to raise awareness about the lack of primary care services in Detroit, and we accomplished this by constructing an outdoor medical clinic.

Currently, there are roughly 50 - 100 primary care doctors in the City of Detroit. This equates to about 1 primary care doctor for every 6,000 - 12,000 residents, which is horribly underserved. In the future, I would like to see 1 primary care doctor in every single Detroit Neighborhood, from East English Village to Ford/Wyoming, from Old Redford to Lafayette Park. 

Having community primary care doctors creates a tremendous amount of value for the surrounding neighborhood - that doctor becomes a go-to person for folks who need health care and even emotional support. 

However, the current reality in Detroit is that folks either don't have access to a primary care doctor or are driving to the suburbs for their care. To illustrate that lack of primary care services, our group of medical students built an outdoor clinic as a part of the Heidelberg Project on Detroit's East Side or what you may call the McDougall Hunt Neighborhood. Of course, we had the approval of Tyree Guyton, who checked in on our work that day, and we also received some press from the Detroit Free Press and the Wooster Collective out of NYC. 

It was a simple clinic, with a reception desk, a door frame, a door, an exam table, and some chairs. On the door, we wrote all of the barriers to accessing health care services in Detroit and in the Nation. This was in 2009, when the debate over the Affordable Care Act was raging. 

I visit the location periodically, to see how it has changed over the years. The last time I visited the site was in September 2016 during the Tour de Troit, an annual bicycling event that takes riders around the city. Someone had added a skeleton and some body parts, and it looks like Tyree made his signature drawings of faces on our plexiglass wall. 

Plum Health may be in its infancy, but I know that we are already filling a need in the community in terms of primary care services. We recently surpassed 100 members and continue to grow, adding new members each week. We've taken care of newborns, toddlers, teens, and adults, and have addressed conditions ranging from sore throats to cancer.

As I continue to serve in the community, I hope to live up to the ideals that I put forth in this work of public art, to be the kind of community doctor that addresses the lack of access to health care in Detroit. I will also work to inspire the next generation of Family Physicians to take the leap into private practice in a community-based setting.

Thanks for reading, and have a wonderful day,

Dr. Paul Thomas with Plum Health DPC 

Medication Price Comparison in Detroit

As a part of our service, we do free consultations for folks struggling to pay for their medications. Medication pricing is a hot topic in the health care field and overall health system - we've all heard about drug companies raking in huge profits on drugs that used to cost just a few dollars. 

I bring this up because real people in our community are struggling to pay for their blood pressure meds, diabetes meds, blood thinners, and other pharmaceutical products. Even worse, they are paying inflated prices through the "retail pharmacy" like CVS, Meijer Pharmacy, or Walgreens. 

We give folks free consultations at Plum Health, and a big part of this is price checking their medications. Today, I had someone in the community reach out to me to ask for a price check on a whole list of medications that they take. Here's what we found:

DRUG LIST                      PLUM HEALTH Price/pill, Price/month            Insurance price/month

Atenolol 25 mg                  $0.018/pill or                  $0.54/month                     $12.99/mo

Carbidopa/Levodopa 250/10   $0.096/pill or         $2.88/month                     $47.80/mo

Finasteride 5mg                     $0.073/pill or              $2.21/month                       $15.40/mo

Flomax 0.4 mg                          $0.11/pill or                $3.40/month                     $62.75/mo

Metformin 1000 mg                  $0.0129/pill or          $0.38/month                     $12.99/mo

Levothyroxine 50 mcg                $0.27/pill              $8.25/month                       $33.67/mo

Plavix 75 mg is                            $0.06/pill               $1.92/month                         $12.99/mo

Brilinta 90 mg is                        $5.54/pill               $166.20/month                    $999.35/mo

It's eye opening, even after doing this type of medical care for the last 8 months, to see these prices side by side. The left hand column has the drug name, the second column has the Plum Health price per pill, the third column has the Plum Health price per month, and the final column has the insurance-based price per month. 

Again, this gets at the main principle: if you use a third party payment system to purchase things in the market place, the prices become inflated. However, if you buy things directly from vendors in the market place using your own money, costs tend to be less. We are able to get these low prices because we buy medication in bulk from whole sale medication suppliers. 

If you have any questions about medication prices, please feel free to call us at 313.444.5630. We routinely save folks about 50 - 90% on their medication prices. In the example above, this is about how much this person will save. 

Have a wonderful day,

Dr. Paul Thomas with Plum Health DPC

Opinion Published in the Detroit News

Our opinion regarding Health Insurance and Health Care was published in the Detroit News last night, and it is currently on the front of the Opinion Page

 

Our opinion made the top of the page for the Detroit News Opinion section on June 5th 2017. 

Our opinion made the top of the page for the Detroit News Opinion section on June 5th 2017. 

Here's our opinion in full: 

Health insurance does not equal health care. As Americans, we often conflate these two entities. But they are in fact separate.

Health care is when you see your doctor. They listen to your story, empathize, perform a physical exam, make a diagnosis, and discuss treatment options. They can also order tests and give you medications. The compassion, the sincerity, the relationship — that’s health care. Health insurance is what covers you in the case of a medical catastrophe, like if you’re involved in an accident, have a heart attack or a stroke. Health insurance is a financial tool to prevent you from going bankrupt in case these catastrophic events occur.

These may seem like obvious statements, but we’ve grown accustomed to a system in which health insurance covers everything, from flu shots to ICU. This may not be a terrible thing; we all need flu shots, and some of us may end up needing ICU care. The problem exists in how we pay for these services.

If we continue to ask insurance companies like Blue Cross Blue Shield and government entities like Medicaid and Medicare to pay for all of our health care services, from blood pressure medications to cardiac bypass surgery, costs will continue to be inflated.

So if you’re paying $10 for your lisinopril each month, know that it actually costs $0.37. If you’ve paid $120 to check your cholesterol this year, know that it actually costs about $6.55. If you’ve ever paid $150 for a chest X-ray, it actually costs about $40. When we use our insurance cards to pay for the basic, routine health care services, prices are inflated. Fortunately, we now have a choice, an opportunity to use free market principles to save money on our health care services. More Direct Primary Care clinics are popping up in Michigan and across the nation.

Direct Primary Care doctors ask that patients pay a monthly membership, which allows them unlimited visits with their doctor and the ability to call, text or email the doctor any time. These doctors also provide wholesale medications, at-cost labs, and at-cost imaging services. By cutting out the middle man and asking consumers to pay for their basic services, the cost of these basic services decrease. Typical savings for medications, labs and imaging services range from 50 percent to 90 percent.

Ideally, people will pair DPC services with a health insurance plan that fits their needs and their budget, and covers them in case of a catastrophic event.

Paul Thomas, M.D., is a family doctor at Plum Health Direct Primary Care.

A screenshot from our Opinion in the Detroit News on June 5th, 2017. 

A screenshot from our Opinion in the Detroit News on June 5th, 2017. 

Thank you for reading and have a wonderful day,

Dr. Paul Thomas with Plum Health Direct Primary Care in Detroit, Michigan

How to Quit Smoking in Detroit

The adult smoking rate in Michigan is 20.5%. So, of the Michiganders over the age of 18, roughly 1 in 5 are smokers and that translates to 1,557,000 smokers in the State of Michigan. Among the United States, Michigan has the 9th highest smoking rate among adults.

This is unfortunate because there are many adverse effects of smoking, from increasing the risk of heart attacks and strokes to increases in the rates of head and neck cancers and lung cancers. 

However, there are effective treatments that can help you quit smoking, and once you quit smoking many health benefits can be realized, from lowering your blood pressure to decreasing your risks of cancer. 

This week, I've had a few people ask for help in terms of smoking cessation, and I am happy to provide that type of help. In fact helping people to quit smoking has some of the best patient-oriented evidence in medicine. Full stop. 

Logistically, I would have you come in for an appointment. We would talk about where you are - pre-contemplation, contemplation, or ready to quit aka "quit mode". Then we'd review your medical history, current medications and any pertinent health-related issues. We would then formulate a treatment plan based on you as an individual.

In the person discussed in this video, we used Zyban or Wellbutrin or Bupropion (all different names for the same medication). This is effective in reducing the cravings that people feel for cigarettes. Then, we set a quit date. This is 1 week after starting the Zyban (bupropion).

After the quit date is reached, nicotine replacement therapy is used to tamp down hour-to-hour cravings. This can be in the form of a patch or gum or lozenges. Again, we personalize the method based on your preferences. 

Let me know if you'd like to start your journey to better health with Plum Health, you know that you can reach me through our contact page or by phone, 313.444.5630.

Sincerely,

Dr. Paul Thomas with Plum Health DPC

Direct Primary Care Doctors Have More Time

Have you ever had this experience: a doctor tells you that you have condition "X" with treatment "Y", they then proceed to leave the room. A few moments later, the medical assistant hands you a pamphlet explaining condition "X" and treatment "Y", saying "thank you so much and have a great day"?

Questions start to pop in your head - do they know that I've already tried medication "Z"? What are the common side effects of treatment "Y"? Perhaps you've then asked the medical assistant, who then tries to pull the doctor out of the next patient's room. 

This can be extremely frustrating, and for good reason. When you see the doctor, you want to have a plan. Further, you want to understand this plan, the side effects of treatment, the potential costs involved, and other options if this option fails. 

Direct Primary Care doctors have more time to spend with their patients. We use this time to explain treatment plans, from why we chose a specific medication to what you should expect and when it's time to make that referral. 

As an aside, I was discussing this with some of my Direct Primary Care doctor colleagues: should we be sending information to our patients via digestible video segments? 

My answer is as follows: 

Should Direct Primary Care Doctors make videos for their patients? In short, maybe. If you are consistently repeating information for your patients, it might be a good idea for you to make a short "explainer" video. For example, the difference between strep throat and a viral sore throat or a preferred diet method, or what to do in the case of a tick bite. 

If you are seeing common ailments, it may make sense to make videos explaining the symptoms, but you became a Direct Primary Care Doctor for a reason! You wanted to have more time to discuss issues with your patients, more time to explain why you are using that medication or why you are pursuing that course of action.

It would make more sense to make videos for a larger health system. If the videos are really high quality, the doctors who have less time to explain themselves can use them to give patients the information that they would want to convey themselves, but don't have enough time to convey.

Thanks so much for reading, and have a great day,

Dr. Paul Thomas with Plum Health Direct Primary Care

Detroit Startup Week 2017

Detroit Startup Week 2017 will begin on Monday May 22nd!!! It's going to be a great week of stories, panels, and information sessions about starting businesses, large and small. It will also provide entrepreneurs with an opportunity to network and learn from eachother. 

This year, I was selected to give a presentation about starting a business in one of Detroit's neighborhoods, Southwest Detroit. I'll be sharing some of my experiences and I hope you can come out to the session, the link is here.

From their press release: "Startup businesses of every type and stage are invited to over 100 completely free events that are designed to support startup growth and build a stronger business ecosystem in Detroit."

In the session, I will be talking about how we started Plum Health, some of the mistakes that we've made, some of the experiences that we've had, and some of the support systems in Detroit that has allowed us to be successful.

If you're contemplating starting a neighborhood professional service in the City of Detroit or elsewhere, I hope that my session will be extremely helpful for you.

Thanks so much for reading, and I look forward to seeing you at the Masonic Temple next week!

- Dr. Paul Thomas with Plum Health Direct Primary Care

WeWork Creator Awards Detroit Application

Today, we submitted our application for the WeWork Creator Awards! I really enjoy submitting applications for contests like this, because it helps me to clarify our mission, vision and values. And it's an opportunity to learn and grow through outside feedback about our internal operations. 

In the application, they ask: "What problem is your idea, business, or organization solving?" For us at Plum Health, it's all about providing high-quality Family Medicine services in the community. It ain't sexy and it ain't super exciting, but it's so darn necessary! Having excelling primary care services in your neighborhood saves costs and improves health outcomes.

As they put it in this linked article, "One primary care doctor per 10,000 people in the U.S. can decrease hospital admissions by 5.5 percent, emergency room visits by 11 percent and surgeries by 7 percent."

This point is salient in Detroit, where there is an epic primary care shortage. Currently, there are only 50 - 100 primary care doctors in the City of Detroit for 680,000 people. That's 1 doctor for every 6,000 - 12,000 people. I recently wrote an article about this in the Detroit News.  

Historically, this has been a difficult issue to solve because practice location for doctors is often tied to reimbursement from the community. Primary care doctors have avoided Detroit because more than half of Detroiters are on Medicaid, which generates low reimbursements.

With Plum Health, we do not rely on government or third party payers of reimbursement. Instead, we bill patients directly: $10/month for children and $49 for young adults, which covers all doctor's visits, texts, phone calls, and emails.

Additionally, members also have access to wholesale medications, at-cost lab work, and at-cost imaging services. From January - May 2017, we have saved our members roughly $15,000 on their meds, labs, and imaging. We are here to provide a tremendous amount of value to our patients and our community.

Our ask for the WeWork Creator Awards: help us reach our goal of providing value for the community by supporting what we do at Plum Health DPC!

The WeWork application continued with the following question: "How do you, your business, or your organization interact with the community?" Put simply - we are imbedded within the community and provide ours services to community members.

At Plum Health DPC, we take care of folks of all ages, races, ethnicities, and orientations. We are practicing on the street level, open and accessible to the community. Our youngest member is 14 months old, our oldest is 63 years; some of our members earn less than $30,000 and cannot otherwise afford health care. These folks are often shut out of the traditional insurance system because they cannot afford the premiums.

In addition to serving our paying customers in the community, I regularly volunteers at Cass Community Social Services' Clinic in Cass Corridor and the Student Run Free Clinic at I-94 and Conner. Here, I'm able to deliver free care to the most vulnerable members of the community - typically the homeless and uninsured.

Finally, Plum Health is regularly at health fairs throughout Detroit, performing free health screenings for non-profit organizations and church groups.  

The last major questioned asked in the application was about how we would use the money if we won: "If you were awarded a grant, what new benchmarks would you be able to reach?" We are doing pretty well at Plum Health, adding new members each month and growing at a sustainable pace. However, if we won the Creator Award, we would be able to grow more quickly and therefore serve more people in Detroit and beyond.

Specifically, A grant of $18,000 - $36,000 would allow us to lease a larger office space and hire a second doctor. In a city with such limited primary care options, hiring a second doctor to work in the city would make a substantial difference in the lives of the people in our community.

We've taken care of folks who earn less than $30,000 and we've seen people who haven't been to a doctor in years, living in fear of generating large medical bills, and living with the consequences of their worsening high blood pressure and diabetes. Without the grant, the goal of leasing a larger office space and hiring a doctor would be at 6 - 12 months. With the grant, these goals would be achieved in 3 - 6 months.

Thanks so much for reading more about what we do at Plum Health DPC, and if you're a member of the WeWork community, thanks for taking the time to read our application and this blog post!

Sincerely,

- Dr. Paul with Plum Health DPC. 

Travel Medicine in Detroit

It's that time of year where people start traveling! If you have travel plans for this summer or fall, let us help you at Plum Health DPC. We have helped several of our members get their vaccines at-cost, we deliver the vaccines in our office, and we save our traveling patients time and money. 

We give our vaccines at-cost to save you money on your trip, from Hepatitis A, to Typhoid, to TdaP, and Malaria prophylaxis, we've got you covered for your upcoming travel. Here are our prices:

  • Hepatitis A vaccine $68.40
  • Typhoid Vaccine: $72
  • Tetanus Diphtheria and acellular pertussis (TDaP): $47.47
  • Malarone for malaria prophylaxis: $3.16/pill, or roughly $50 for an 8 day trip

There aren't many travel medicine options in the City of Detroit, and we are happy to be filling a gap in coverage and a gap in care for the folks that are taking trips outside of the country. You may not need all of the above listed vaccines, but we will work together to figure out which are necessary for your trip. The CDC.gov website has a great tool for learning which vaccines you need. 

Thanks for your time, and happy travels,

- Dr. Paul Thomas with Plum Health DPC

Book Review for Designing Your Life

This week, I read "Designing Your Life: How to Build a Well-Lived, Joyful Life" by Bill Burnett and Dave Evans. These two Stanford professors discuss the course that they teach on lifestyle design and guide you through the process that they have used for thousands of their students.

I enjoyed this read and they had some crucial take aways, both for individuals and larger groups. 

In the Chapter 3, the authors write "Work is fun when you're actually leaning into your strengths and you are deeply engaged and energized by what you are doing". I feel this in the core of my being and this sentiment has been a driving force behind my decision to pursue my current career. 

If you don't know about me, I left the high-speed churn of fee-for-service medicine for more meaningful and fulfilling relationship-based medicine. Plum Health is a membership model for healthcare and I routinely spend about 1 hour with each of my patients, especially during their first visit. 

As this is a new business (as of November 2016), I still work at an urgent care two days each week to pay my bills and keep my business finances separate from my personal finances. When I'm working at the urgent care, I feel drained of energy with a mental fog. It's hard for me to "lean in" to this type of work environment where patients are shuffled in and out of the office as quickly as possible. It is not uncommon to have 40 - 50 patient interactions each day at the urgent care.

Compared to my work with Plum Health, where my visits last an hour and I have roughly 2 - 5 visits per day, I am able to fully engage with my patients and lean in to the work. I leave this environment energized after learning more about the people that I take care of. I also experience joy from time to time when the care that I deliver is especially meaningful or beneficial for the people in my clinic. 

In Chapter 11, the authors discuss the importance of working and collaborating with others. They state, "We design our lives in collaboration and connection with others, because 'we' is always stronger than 'I'". They go on to relate the following: "Life design is intrinsically a communal effort. When you are way finding a step or two at a time to build, not solve, your way forward, the process has to rely on the contribution and participation of others."

This passage reminded me of the environment that I experienced while taking the Build Institute's course entitled "Co-Starters". It was awesome working in a collaborative setting, with a group of entrepreneurs working through similar but different problems. I learned a great deal from these classmates and it helped me to clarify several parts of my Life Design.  

Later in Chapter 11, the authors discuss the importance of a community, and they define a community in this way: "community is more than just sharing resources or hanging out now and then, it's showing up and investing in the ongoing creation of one another's lives". It must have kindred purpose, and the best communities have a shared goal or mission. These groups should also meet regularly, so that an ongoing conversation can be held among members.

I see the TechTown, Build Institute, and Bamboo organizations facilitating a healthy community environment for small businesses and entrepreneurship in Detroit. Being a part of these organizations and attending the different programming put on by these groups has definitely added value to my life and the development of my business. 

Thanks for reading, and I'd love to hear your thoughts on the book or the topics discussed in the book. Again, the book is called "Designing Your Life" by Bill Burnett and Dave Evans.

- Dr. Paul Thomas with Plum Health DPC

Direct Primary Care in St. Clair Shores

Last month, we were invited to a Health Care Forum in St. Clair Shores, Michigan with Senator Patrick Colbeck. We had a great meeting, with about 30 - 40 members of the community who are interested in the principles of free market healthcare that we discussed. 

Senator Colbeck has been making a tour across the State of Michigan, talking with folks in similar forum-type settings about health care and ways that we can reform our primary care system. The last Town Hall that I was able to attend was in Grosse Pointe. The aim is to deliver higher-quality care with better service and at a lower price. Senator Colbeck is a staunch supporter of Direct Primary Care services and he has proposed a Medicaid Pilot program at the State level for DPC services. 

Here's the portion of the talk that featured Plum Health DPC and the services that we provide:

Senator Colbeck spoke about the legislative efforts to advance Direct Primary Care at the State Level in his speaking slot, and to conclude the evening, we took time to answer questions from the audience about DPC, insurance, and other concerns:

Overall, it was a great event, with a great turnout and excellent audience participation and questions. I'm looking forward to the next one! Below are some still shots from the event.

- Dr. Paul Thomas with Plum Health DPC

Common Criticisms of Direct Primary Care

In this blog post, I'm going to list some common criticisms to Direct Primary Care and my responses to these criticisms. 

In a traditional family medicine practice, each doctor typically sees a panel of 2,500 patients. If each patient comes in twice each year, that means roughly 100 visits each week, assuming that the doctor works 50 weeks each year, or roughly 20 visits each day. In Direct Primary Care, doctors reduce their clinic panel to 500 patients. Now, if each patient visits twice each year, the doctor will see 20 patients each week, or 4 patients each day. If each patient visits three times each ear, the doctor will see 30 patients each week, or 6 patients each day. This allows the doctor to spend up to an hour with each patient and use the remaining time in their schedule to answer phone calls, texts, and emails as well as handle the administrative duties that go along with running a Direct Primary Care practice.

The biggest criticism of doctors who switch from a traditional or fee-for-service practice to Direct Primary Care is this notion of patient abandonment. This means that if the doctor cuts down their practice from 2,500 patients to 500 patients, there will be 2,000 patients that are "abandoned" or without primary care services.

My response to this is simple: I will no longer perpetuate a bad system. In the current fee-for-service system, patients do not have enough time with their doctor for a thorough evaluation, for all of their questions to be answered, and to feel truly cared for. In the current fee-for-service system, doctors are rushing from room to room to room and are unable to provide the kind of high-quality care that their patients deserve,

In the current system, primary care doctors are marginalized and devalued, predisposed to burn out and leaning towards early retirement. Younger medical students see their burnt-out, grumbling, and overstretched attending doctors in Family Medicine and choose not to become primary care doctors in the first place. Why earn less than other specialties in a field that is less-than fulfilling? 

Direct Primary Care doctors are fighting to make primary care relevant again, to restore the doctor-patient relationship, and to create value for patients in a way that the current fee-for-service system cannot.

There's an old adage: "take care of yourself so you can care for others", and it's something that primary care doctors have forgotten about. The expectation of the system is that we should work hard, keep our heads down, and not question the health care administrators who send an overwhelming volume of patients into our clinics each day. 

But when we begin to sacrifice the quality of our work simply because we don't have enough time, it's time to take a stand and re-think our practices. 

This brings me to the next criticism: how many conditions can a primary care doctor really treat? aka how much coverage can a family medicine doctor really provide? 

When a well-trained family medicine doctor is able to practice at the top of their training, they are able to manage between 80 and 90% of all patient concerns. From sore throats, to blood pressure management, Pap tests, skin biopsies, abscess drainage, diabetic management, and beyond, family medicine doctors are able to care for a broad and diverse range of conditions. 

The secret sauce in Direct Primary Care is the amount of time we are able to spend with our patients. If I have an hour, I can use it to drain an abscess, to talk about the efficacy of your antidepressants, to draw your blood for the lab work you need, to remove that ingrown toenail, to fully evaluate your vertigo, to evaluate your child's Vanderbilt scores for ADHD, to dispense the necessary medications and more. 

In the current fee-for-service system, the expectation is that primary care doctors perform a cursory evaluation and then make a referral to a specialist. In the Direct Primary Care model, primary care doctors have more time to address concerns to the fullest of their training. And if that specialty referral is necessary, Direct Primary Care doctors have enough time to personally manage the transition of care, to make the follow up phone call and to get a full picture of what happened during that referral. 

To summarize, Direct Primary Care doctors who leave the traditional fee-for-service system are not abandoning their patients. Rather, they are now free to practice medicine to the best of their ability by having enough time to give high-quality, thoughtful, and comprehensive primary care services to their patients. This will allow burnt out doctors to stay in practice for a longer period of time and it may inspire the next generation of medical students to choose primary care. 

Thanks for reading, and have a wonderful day,

- Dr. Paul Thomas with Plum Health Direct Primary Care

 

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