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 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

What is Family Medicine?

Hello, this is Dr. Paul Thomas with Plum Health DPC and I'm a Family Medicine Doctor in Detroit. I operate Plum Health Direct Primary Care, which delivers affordable, accessible health care services in Detroit. 

This week, I'm talking about Family Medicine Week, an official announcement from Governor Rick Snyder that makes February 19th - 25th Family Medicine Week. I'm a month late in bringing this up, but it's still important to recognize Family Medicine and the contribution of Family Medicine Doctors across the State of Michigan.

For starters, Family Medicine Doctors compete four years of undergraduate education, four years of medical school, and three years of residency. That's 11 years after high school and 7 years after college. Furthermore, some Family Medicine Doctors sub-specialize within Family Medicine. 

They complete a 1 year fellowship to become Sports Medicine doctors, or Family Medicine doctors that sub-specialize in adolescent medicine, geriatric medicine, addiction medicine, etc...

The point is that Family Medicine doctors are highly trained, and specialize in taking care of the whole patient in the context of the family and the community. 

Family Medicine doctors care for people of all ages and stages! We help deliver babies, we help infants meet developmental milestones, we complete school, work, and sports physicals, we take care of injuries like fractures and lacerations, and we take care of chronic conditions like diabetes, high blood pressure, and asthma. 

Family Medicine doctors also work across a variety locations. Family Medicine doctors work in emergency departments, in-patient hospital settings, and out-patient clinics. Family Medicine doctors lead health departments for Cities, Counties, and States. Family Medicine doctors teach at medical schools, volunteer at homeless clinics, and travel abroad with organizations like Doctors without Borders. 

Personally, I love being a Family Medicine Doctor - I love taking care of people regardless of their age, race, gender, and orientation. I love being able to offer care and compassion to those who need it, along with the standard medical care. 

Finally, we need more Family Medicine doctors to create healthy communities, healthy cities, and a healthy nation. Family Medicine doctors address small issues before they become big, complicated problems. Family Medicine doctors and Primary Care Physicians can effectively increase the health of a community and lower the cost of care in that community.

Primary Care and Family Medicine is vital, and I'm glad that we have a week to recognize the work that Family Medicine doctors carry out each day in the State of Michigan.

Thanks for your time, and have a wonderful day,

- Dr. Paul Thomas

Why Generic Drugs Cost So Much

Generic Medications Cost too much money!

There's a wide variability in the cost of generic medications from pharmacy to pharmacy. Researchers at Saint Louis University surveyed 175 pharmacies and asked for their prices for the meds Lisinopril, Carvedilol, and Digoxin. These are common heart failure medications.

The researchers found that the prices for three generic medications ranged from less than $20 to more than $150, with the highest price for all three medications being $397 for a 1 month supply!

This is way too much money. If you spent $150/month on medications alone, it would cost $1800 for the year. In contrast, if you spent less than $20/month on these same medications, it would cost less than $240 for the year. This is a difference of $1,560. Unfortunately, these costs have the greatest adverse effect on low income communities because they may not have the transportation resources to drive to these less expensive pharmacies.

A possible solution is Direct Primary Care. DPC doctors like myself buy medications at wholesale prices and give them to our patients at cost, or with a 10% mark up to cover the cost of shipping and handling. For example, at our clinic Plum Health DPC, we can wholesale these same three medications for about $18/month.

I created this video to more fully explain what I mean, see below.

- Paul Thomas, MD