How is Plum Health Making an Impact?

Family Medicine Doctor Reaching Out in Detroit

Dr. Paul Thomas speaking to elementary school students at Munger Elementary/Middle School on Detroit's West Side during Career Day.

Dr. Paul Thomas speaking to elementary school students at Munger Elementary/Middle School on Detroit's West Side during Career Day.

This week, I engaged in two outreach events, one at Munger Middle Elementary/Middle School on Detroit's West Side and one at the Northwest Activities Center in NW Detroit. The first event had me speaking to a group of about 30 elementary school students, sitting cross-legged on a gym floor. We talked about what it takes to become a doctor, the dreams that they had for their futures, and the steps that it would take to achieve those dreams. They even made me a nice gift for coming out - a small paper doctor. 

Dr. Paul Thomas at Munger Elementary/Middle School on the West Side of Detroit.

Dr. Paul Thomas at Munger Elementary/Middle School on the West Side of Detroit.

The event at the Northwest Activities center had me speaking to about 100 senior citizens who had innumerable questions about health and wellness. They asked me about everything from high blood pressure, to diabetes, to nutrition, exercise, arthritis, and declining cognitive function. Also at this event, the community had organized fresh food distribution.

Dr. Paul Thomas at the Northwest Activities Center in NW Detroit after speaking to a group of senior citizens about health and wellness.

Dr. Paul Thomas at the Northwest Activities Center in NW Detroit after speaking to a group of senior citizens about health and wellness.

Both were inspiring in different ways, and also showed how we can make a big impact by reaching out to the community and educating people from elementary age to senior citizens. I think a lot about impact, and how we're making a positive impact in the community, and I wanted to share an essay I wrote earlier this month:

How a Family Doctor Makes an Impact

The problem that I am solving is access to affordable medical care, not just for individuals, but also for small businesses and communities. On the individual level, I cannot count the number of people who have presented to our clinic to establish care with a family doc for the first time in years, sometimes even decades. They feel comfortable because the price point is understandable, services and charges are transparent, and we've created a welcoming environment for all people.

I’ll give the example of the lifelong Detroit resident who had a uncontrolled blood pressure, who avoided medical care because the cost was simply too high. She signed up for a membership with us, and we are managing her blood pressure with medication that costs under $2/month. She is now at goal, and cried in our office after reaching this critical threshold.

Next, we’re solving a big problem for small businesses. Small business owners want to provide services and benefits that will help them attract and retain employees, and often times traditional health insurance products are financially out of reach. Rather, they choose to provide Plum Health and our health care services for their employees: an affordable product that’s understandable and easy to access for their workers. We are now seeing small businesses that are proud to offer our service as a benefit to their employees as a mean of attracting and retaining talent.

Finally, we’re solving the problem of neighborhood-based primary care services in Detroit, a city that is critically underserved from a primary care perspective. There are fewer than 100 primary care doctors in the City of Detroit, equating to roughly 1 doctor for every 6,300 residents. We are meeting a significant need in our Southwest Detroit location by serving a community that otherwise would not have access.

Thanks for reading, and have a wonderful day,

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

Digital Marketing for my Direct Primary Care Doctor Colleagues

Starting a Direct Primary Care practice is a tall task, by any measure. Doctors emerge from residency with little to no business training. Starting a DPC practice is starting a business, and for many doctors, this is their first attempt at something like this. The journey from 'idea' to 'successful practice' is fraught with pitfalls and difficulties. 

Knowing how hard it is to start a business and how hard it is to start a DPC practice, I wrote a blog post for my colleagues. It is my sincere hope that they are able to grow while minimizing mistakes, errors, and difficulties. One area where I see that doctors could make significant improvements is their digital marketing. 

Specifically, DPC docs need to know how to build a sales funnel for their services. You see, when a doctor is employed by a large health system, her name is on the back of the insurance card for thousands of patients. That same doctor, when she breaks free from the insurance-based system, has to find her own patients. Where will these patients come from? 

Direct Primary Care (DPC) doctors must leverage social media, email marketing, networking events, etc... in order to grow their practices successfully. This piece that I wrote on the Hint Health blog will facilitate this growth, and it focuses on building a sales funnel for your practice.

Thanks for reading, and have a wonderful day,

- Dr. Paul with Plum Health 

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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

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.

-Dr. Paul Thomas with Plum Health DPC

One last thing, if you’re a Primary Care Doctor or Allied Health Professional that is looking to Start and Grow a Direct Primary Care practice, check out our sister site www.StartUpDPC.com. You’ll find more information and in-depth courses on building the Direct Primary Care practice of your dreams.

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

- Dr. Paul with Plum Health DPC

Plum Health at DNewTech Q&A

We were invited to pitch at DNewTech on Wednesday night, and after our pitch, we had 5 minutes to answer questions about Plum Health DPC. Here's the video of the event! 

You can see the original Pitch Video here, and you can see our original blog post here

One of the biggest barriers for people learning about our model is the difference between health care and health insurance. You need health insurance to protect you against the unknown or unforeseen: cancer, stroke, heart attacks and car accidents. Your health insurance should not cover your primary care services, because it introduces a middle man (or several middle men) between you and your doctor, driving up the price of those services. 

Health care is what we deliver at Plum Health. As your primary care doctor, I'm not that expensive and you're really paying me for my time. This allows me to answer your phone calls, texts, and emails in a timely fashion. It also allows me to get you in for an appointment when you need it, rather than having you wait for weeks just to be seen. 

Health care delivers the basics, like office visits, meds, labs, stitches when you cut yourself, and advice/counseling on lifestyle changes when you need it. Health insurance covers the unforeseen circumstances that are beyond our control. 

An analogy is auto insurance. We all have auto insurance, but we almost never use it, unless we're in an accident or our car is stolen. However, we don't expect our auto insurance to pay for the routine maintenance of our vehicles, like oil changes, tire rotations, and gas at the pump. If we did require our auto insurers to pay for these things, it would drive up the prices and make these basic services a hassle. Could you imagine long lines at the pump, prior authorizations to drive to Chicago, and auto insurance that only covers the basic oil, not the Valvoline. 

This would be an absurd way to take care of our cars. And I know that cars and people are different, but the way we've structured our health insurance coverage has caused very similar stress points to the imagined scenario above: long wait times to see your doctor, prior authorizations to get imaging studies like CT scans, and health insurance coverage that only covers some medications, but not others. 

In Direct Primary Care, we get rid of all of these middle men to deliver excellent, affordable services without the hassle. 

Thanks for reading and watching,

- Paul Thomas, MD

February Update

Hey everybody! It's February 2nd and time for an update about our services and a little bit of an overview about what we do. January was our first full month of operation in a brick-and-mortar space and we were able to have 20 new members join the practice! We are currently located at 1759 West 21st Street, Detroit, MI.

What makes them want to join? First it's our dedication to great service. When you make an appointment, you typically get 1 hour of uninterrupted time with me, Dr. Paul Thomas. We talk about your medical history, review any records that you bring, perform a physical exam, draw any blood samples if necessary and give any medications if necessary.

The great thing about our Direct Primary Care model is that we get these labs at-cost and the medications at whole-sale prices. Our lipid panel is about $7 and our Comprehensive Metabolic Panel is about $4. Our current price for Azithromycin or a "Z-pak" is $1.15. We sell Lisinopril for about $0.40/month. Yes, you read that correctly! Forty cents for a one month supply of Lisinopril. 

I give Flu shots for $10.53, Hepatitis A vaccine for $68.42, Tetanus Diphtheria and Acellular Pertussis (TDaP) vaccine for $47.47. Our price for Metformin is $0.40/month if you take 1 pill each day and $0.80/month if you take 2 pills each day. I recently dispensed Augmentin for a skin infection for $4.82. 

If you're interested in this type of care: more time with your doctor, clear and consistent pricing, the ability to have easier communication with your doctor via text and email, you should sign up for our services.

You can either call 313.444.5630 to set up an appointment or enroll on our website, here.

Thank you for watching and reading, and have a great day!

- Paul Thomas, MD

Plum Health DPC, making healthcare personal again

Hello all, this is Dr. Paul Thomas and I'm making healthcare personal again.

I'm launching Plum Health DPC this Fall and I'm starting my Beta Testing in September/October with a small number of members. Rather than having 2,500 patients like a typical Doctor's office and billing insurance, I will limit my practice to 500 members and charge a $49 membership fee. I will not bill your insurance company, I am not insurance, this is not an insurance plan. 

With the membership, you can contact me at any time via phone, text or email. You can also be seen at any time that you like without a co-pay. Members also get wholesale medications, at-cost labs, and at-cost imaging with pass-through savings. I basically try to save my members a lot of money by getting them deals in the healthcare ecosystem. 

Importantly, I limit my practice to 500 members, so that I can spend 30 minutes - 1 hour during each visit with you. During this time, we can get to the root of your issue. Rather than being rushed, we can talk about strategies that can help you be healthier. And if you forget to ask me something during the visit, just send me a text and I will do my best to answer your question ASAP. 

The time that you get with me allows us to build a trusting and beneficial relationship, so that I can learn about your health goals, and help guide you to better health. That's why we call it Direct Primary Care - we serve you, the customer/member/patient directly with excellent primary care services. 

If you want to learn more, send me a message or sign up at our website, Plum Health DPC. If you want to be a part of the Beta Testing, now's a great time to sign up!

- Paul Thomas, MD

The Basics of Direct Primary Care

Direct Primary Care is a relatively new idea, so it is worth discussing the founding principles. 

Direct Primary Care (DPC) is an innovative alternative payment model for primary care being embraced by patients, physicians, employers, payers and policymakers across the United States. The foundation of DPC is an enduring and trusting relationship between a patient and their primary care doctor.
Empowering this relationship is the key to achieving superior health outcomes, lower costs and an enhanced patient experience. DPC fosters this relationship by providing excellent customer service.
In terms of customer service, the health care system in the United States has failed. There are so many frustrations from the perspective of a customer: long wait times to get an appointment, long wait times at the office, unresponsive doctors, as well as confusing and unclear pricing. 

Direct Primary Care addresses these shortcomings of the fee-for-service system head on. When you enroll in a DPC practice, you will have your doctor’s cell phone number, email address, and the assurance that you can have a same-day or next-day appointment, guaranteed. 

In addition, DPC enables unhurried interactions – you won’t feel like you’re being rushed out the door with your DPC doctor. These extended visits allow for discussions to assess lifestyle choices, behaviors, and treatment decisions that maximize long-term health and wellbeing. 

How is this possible? Direct Primary Care doctors typically limit their practice size to 500 members. This relatively small panel size allows doctors to be committed to their patients, to deliver excellent customer service. 

To become a member of Plum Health Direct Primary Care in Detroit, Michigan, check out our contact page, here

- Paul Thomas, MD