Plum Health Blog
Coronavirus Update for Detroit Michigan March 2020
Coronavirus Update for Detroit, Michigan for March 2020
I’m a Family Doctor in Detroit, and today I’ve gotten a ton of questions about the Coronavirus - ask me anything!
For starters, here’s what I sent out to all of my Plum Health DPC (https://www.plumhealthdpc.com/) patients earlier today and I thought everyone should know these things as well. Beyond what’s written below, ask me anything:
Plum Pack!
The Coronavirus is causing concern at this time - the President spoke last night about closing access to the USA from Europe, the NBA, NHL, and NCAA have cancelled/postponed all of their games, and other major events have been cancelled - but do not panic.
People Will Become Sick This Spring
Many people will get sick and have upper respiratory symptoms over the next few days and weeks. Most of these will be from the common cold, many of these symptoms will be from seasonal allergies, some will be the flu, and some may be due to the Coronavirus.
What I can do for you is to help you triage - I can help you determine if you're sick with the flu, a cold, or having an allergy flare up. I can help you determine if you have symptoms that are concerning for the Coronavirus.
If you contact me and I'm concerned, I may send you to the emergency department for further testing. As of now, Coronavirus testing is not available at our clinic.
Here are some algorithms about how I approach caring for our patients, caring for all of you.
Additionally, heres information from the State of Michigan regarding Coronavirus, released earlier today:
Finally, below is what we know and what you can do to protect yourself:
What You Can Do to Prepare for the Coronavirus
You can prepare for the Coronavirus by taking several actions and non-actions:
wash your hands thoroughly before eating
wash your hands thoroughly after using the bathroom
wash your hands thoroughly before touching your T-zone (eyes, nose, or mouth)
Cough or Sneeze into the crook of your arm/the bend in your elbow; again, wash your hands after coughing or sneezing
purchase food and supplies in case you need to be self-quarantined
if you become sick with a respiratory infection, but you’re not sick enough to require hospitalization, you may need to self-quarantine or stay at home to avoid infecting your neighbors and co-workers
if you become ill, call your doctor and discuss your symptoms. It may be better to call or text your physician, as going to the doctor’s office may
cancel any non-essential travel to areas where the virus is spreading like China, Iran, South Korea, and Italy
avoid large gatherings - parades, sporting events, campaign rallies - to avoid catching the virus or spreading the virus
What We Know About the Coronavirus or Covid-19
Here’s what we know thus far:
Every single one of us has had a coronavirus infection in the past — it’s one of the viruses (along with rhinovirus, adenovirus, etc.) that causes the common cold. This novel Coronavirus (COVID-19) is just a variation (or mutation).
This new coronavirus can cause anything from nothing to a mild cold to a potentially lethal viral pneumonia.
Those who seem to be most affected by COVID-19 thus far are those who are more at risk to begin with: those who are older, those with multiple chronic health conditions, etc.
The evidence out of the initial outbreak in Wuhan, China revealed:
Median age = 59 years of age
Estimated basic reproduction number (the number of people an infected person infects) is approximately 2.2
The average length of time from the onset of symptoms to hospitalization was 9.5 to 12.1 days
There have been new coronaviruses in the past — most notably the SARS (2002, 2003) and MERS (2012 – Present) epidemics; however, the mortality rate of COVID-19 (2.0% to 4.0% or below) is notably lower than SARS (9-10%) and MERS (36%).
From the WHO, they estimate that the mortality rate is somewhere around 3 - 4%. We are more concerned about this Coronavirus than the typical flu virus because of this higher mortality rate. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2
This virus spreads from person to person, though we aren’t exactly sure how. Our best hypothesis is that it is spread via bodily fluids and droplets from speaking, breathing, coughing, sneezing, etc (and potentially through the GI tract).
Children absolutely can get the Coronavirus that causes COVID-19. Two interesting points about pediatric patients: 1) there is early evidence that they carry a high “viral load” and — combined with the fact that they aren’t great at washing hands, not touching their face, etc. — because of this may be more likely to spread the illness and 2) children who do get COVID-19 seem to have a lower mortality rate than those who are older who contract the disease.
Here’s what we don’t know:
We don’t know if this virus will peter out as the warmer months kick in; we also don’t know if this is a one-season thing or if it will come back strong again next cold & flu season.
We don’t know when or if we’ll have a successful vaccine to prevent against this new virus. In a late February 2020 press conference, Dr. Anthony Fauci did a great job describing how a vaccine is created (starts at about 11:00 into the clip) and how far we are away from a successful vaccine.
How to Protect Yourself and Others from the Coronavirus
How to protect yourself & others:
Just like any other respiratory virus: stay home if you’re sick!
Just like preventing any other respiratory virus: take good care of yourself! Exercise regularly, eat nutritious, balanced meals, practice stress mitigation techniques, and get a solid 7-9 hours of sleep a night, etc.
Just like preventing any other respiratory virus: wash your hands! A lot!
Just like preventing any other respiratory virus: don’t touch your eyes, mouth, nose, etc., and get into the habit of washing your hands before eating.
If you can, avoid contact with those who are sick or are caring for the sick.
If you are not actively sick (or caring for someone who is), ear-loop/surgical masks are not likely helpful. Healthcare workers will wear masks (and often higher-rated ones than the ear-loop masks), as they have a much higher likelihood of caring for someone with the disease and are prioritizing mitigating the spread to others.
Those who are exposed to someone with COVID-19 or those who are being tested for COVID-19 will likely be asked to self-quarantine (currently not mandatory). If your job permits, start asking your employer about work-from-home opportunities; if your job doesn’t permit work-from-home, ask your employer what their plan is to keep you safe!
Because of the real possibility of a quarantine, stock a couple week’s worth of non-perishable foods items in a pantry. Also make sure you have the basics — like medications, OTCs like ibuprofen, acetaminophen, diphenhydramine, and pseudoephedrine, and (a rational amount of) toilet paper, facial tissues, etc.
Dr. Raquel Orlich Reaches A Major Milestone
This week, Dr. Raquel Orlich reached a major milestone - she now has 200 patients in her practice panel. Here’s what we said on Facebook:
A huge congratulations 🎈 to Dr. Raquel Orlich. She joined our Plum Health direct primary care practice on July 1st 2019 and she’s already reached 200 patients in her panel!
Dr. Raquel 👩🏻⚕️ is intelligent, compassionate, and a relentless advocate for the health and wellbeing of her patients. She focuses on chronic musculoskeletal issues, women's health, and preventive medicine.
We’re lucky to work with you, and our patients are fortunate to have such a kind and caring doctor looking out for their best interests. 💯
Of note, Dr. Raquel has room for about 500 patients in her practice panel, so if you’d like to sign up to be one of her patients, head over to our Schedule Now page to get started!
-Drs. Paul Thomas and Raquel Orlich with Plum Health DPC
Do I have the Cold? Flu? or Strep Throat? Answers for People in Detroit Michigan
Do I Have the Cold, the Flu, or Strep Throat?
Dr. Paul Thomas and Dr. Raquel Orlich are family medicine physicians in Detroit Michigan. Their office is called Plum Health DPC and it’s located on Michigan Avenue in the beautiful Corktown Neighborhood of Detroit, MI.
Many people want to know if their sore throat, body aches, chills, fever, stuffiness, runny nose, or other symptoms are related to the cold, the flu, or strep throat. So, in this blog post and associated YouTube video, we’ll explore the differences between these clinical entities.
How Do I Know if I Have The Common Cold?
People with the common cold have a runny nose, a stuffy nose, congestion, sneezing, and a sore throat. Common cold viruses prefer to affect the back of the throat - these viruses have a predilection for the posterior pharyngeal tissues. This causes your mucus membranes to swell up, which causes fluid to leak out or what you experience as a runny nose or congestion, post-nasal drainage, etc… These symptoms tend to come on gradually.
For this viral pharyngitis or viral upper respiratory system or common cold, antibiotics are not indicated. Antibiotics do not work for the common cold, because the common cold is caused by a virus that mutates rapidly and is difficult to treat. Antibiotics are indicated for bacterial infections, like strep throat and pneumonia.
How Do I Know if I Have Influenza?
Influenza usually presents with extreme fatigue, muscle aches, and a fever. Sometimes we say that there’s an associated “pajama sign” - sometimes people are so weak and so tired that they can’t even change their clothes before coming to the doctor’s office, thus they come to the office in their pajamas. There can also be chest discomfort, chills, and a headache. There is often an abrupt onset to these symptoms. The symptoms of the flu are often more severe, and sometimes fatal unfortunately. This is why we worry more about the flu and why we recommend that everyone gets the flu shot.
If you are positive for an influenza infection, treatment with oseltamivir (Tamiflu) should be started within 24 to 48 hours of your symptoms. It must be started within this timeframe to be effective in shortening the duration of flu symptoms and decreasing the severity of the flu virus.
It’s the Middle of February - Will the Flu Shot Still be Effective?
Yes. We’re still in the influenza season, and the flu shot has been shown to be 40 to 50% effective in preventing the influenza virus from taking hold. So, we strongly recommend getting the flu shot if you haven’t done so already. The flu shot costs $20 at our office and about that price at most pharmacies ($15 - $30). And it’s very important to get the flu shot, not only to protect yourself, but also to protect your loved ones. If you get the flu shot, you’ll be less likely to transmit the flu to a more vulnerable person in your life, like a newborn in your family or circle of friends, or an elderly relative or elderly neighbor. Getting the flu shot helps to protect these more vulnerable people with less strong immune systems from getting the flu.
How Do I Know if I Have Strep Throat?
When people come to our office concerned about a sore throat, it’s hard to tell if it’s a viral pharyngitis or if it’s strep throat (a type of throat infection caused by a bacteria). Strep throat is an infection of the tonsils in the back of the throat by a bacteria, Group A Streptococcus. The “strep” in strep throat comes from a shortening of the bacteria name, Streptococcus. The strep bacteria infects the tonsils and causes localized pain and swelling as well as purulent discharge, ie a discharge of pus from the tonsils.
There’s also a diagnostic criteria for Strep Throat called the Centor Criteria. You get a point for having each of the following symptoms:
fever
tonsillar exudate (pus coming from the tonsils)
absence of a cough (no cough)
anterior cervical lymphadenopathy (swollen and often tender lymph nodes in the front part of the neck)
age younger than 14 years
Kids with a sore throat are more likely to have Strep Throat because they have larger tonsillar tissue when they’re younger. As people age, the lymphatic tissue, like tonsils, shrink in size. This makes it less likely for adults to get strep throat. Of note, the tonsils are like a sponge and they take up large amounts of bacteria and viruses and show it to the rest of our body to make sure that our immune system can respond appropriately to these foreign invaders.
Because Strep Throat is caused by a bacteria, it is appropriate to use antibiotics for this condition. We often use Amoxicillin 500 mg for adults and Amoxicillin with weight-based dosing for children. Fortunately, we carry this inexpensive medication in our office, which is convenient for our patients with Strep Throat.
I live in Detroit, Am I more likely to get the flu or the coronavirus?
You are much more likely to get the flu than the coronavirus if you’re living in the United States.
As of 02/21/2020, there have been 34 documented cases of the Coronavirus in the United States.
Now compare that to the flu or the influenza virus. According to the Centers for Disease Control and Prevention, there have been:
29,000,000 to 41,000,000 flu illnesses
13,000,000 to 19,000,000 flu medical visits
280,000 to 500,000 flu hospitalizations
16,000 to 41,000 flu deaths
We know that the Coronavirus is scary because it’s new and different, and coming from a foreign country. However, the best thing that you can do to prevent getting sick this year is to wash your hands, cover your cough, don’t share drinks or eating utensils, stay home from work when you’re sick so you don’t infect other people, and get your darn flu shot.
Thanks for reading and thanks for watching
-Drs. Paul Thomas MD and Raquel Orlich DO of Plum Health DPC
Delivering Excellent Customer Service in Primary Care
Delivering Excellent Customer Service in Primary Care
Recently, we were featured on Hunter Schultz’s podcast, Winning Healthcare Food Fights and we were able to talk about direct primary care and how we’re actively lowering the cost of healthcare while improving the customer experience in health care. You can listen to the podcast on a variety of platforms, from YouTube, to Apple Podcasts, to Anchor, and others. Here’s what Hunter Schultz had to say about the show:
American healthcare isn't known for great customer service. More like inconvenience. Dr. Paul Thomas thought differently and started Plum Health DPC in Detroit, MI. He learned a secret from other physicians. Changing the business model so his practice could focus on customer service and care. Along the way, he wrote one book and now helps other physicians looking for a better way to provide great patient care.
Dr. Thomas went the never crowded extra mile too. He opened Plum Health DPC in the Corktown area of Detroit, instead of Grosse Pointe. Every day, he and his team provide proof old-fashioned American ingenuity is alive and well. They are putting the Wow back into care by giving great customer service.
Visit Plum Health DPC, here.
His book, Direct Primary Care: The Cure for Our Broken Healthcare System, is available here.
For more resources and other information, please visit our website.
Paul Thomas, MD at the Plum Health DPC office in Corktown Detroit. The office is located at 1620 Michigan Ave, Suite 125, Detroit, MI 48216.
Many thanks to Hunter for putting together this interview, even more thanks to him for being an Alpha Reader for our first book, Direct Primary Care: The Cure for Our Broken Healthcare System. Here’s some of the topics we covered during the interview:
Exciting or positive things in the US Healthcare System, like the growing direct primary care movement and some free market elements in our current system that can help protect patients from overcharges in the current marketplace.
The types of tests or new tools for assessing health and wellness - things like 23andMe, Aperiomics, OneOme, Butterfly Ultrasound probe, texting, emails and more consistent communication with patients.
Integrating patients’ health goals into their care plan
Dr. Paul Thomas’ path to becoming a doctor - volunteering at Cass Clinic and working with compassionate doctors and medical students at Wayne State taking care of uninsured and underinsured patients in Detroit’s Cass Corridor
The simplicity of the Direct Primary Care model and aligning the incentives - when patients pay the monthly membership fee for a DPC practice, they are incentivized to use the system and to use the DPC service. Likewise, doctors are incentivized to take care of patients promptly and ensure optimal health and wellness. Doctors in the DPC model are also incentivized to not over-test and over-treat their patients. Rather, we focus on counseling our patients through their healthy behaviors to optimize wellness.
Price points at our model, seen here. Our price points are less than a cell phone bill for an individual and less than a cable bill for a family. We are cognizant of the median income in Detroit, our community, and that is $26,000 annually. We intentionally made our service affordable for anyone with an income in our community, and we deliver excellent primary care services to the folks that enroll in our clinic.
We discuss our recent Ribbon Cutting ceremony with Mayor Duggan and our recent move to 1620 Michigan Ave, Suite 125, Detroit MI 48216, which is 1.1 miles from our old office. We have a more conveniently location in Corktown, Detroit.
We recently hired a medical assistant, Chris, and we recently brought on a new doctor, Dr. Raquel Orlich who is quickly filling her practice with new patients. We typically have 25 to 30 new patients enroll in our practice each month.
We discuss having enough time to work with our patients. We typically have 30 minutes to 1 hour to spend with each of our patients. In the typical system, your doctor has 2,400 patients and they only get 10 to 15 minutes to take care of each patient. Having fewer patients allows us to have more time with our patients and to build trusting relationships with our patients.
We discuss the importance of having continuity of care, or a long-term relationship, with a primary care doctor. In our practice, we really focus on building the doctor-patient relationship and continuity of care.
Demonstrating how valuable it is to have a primary care doctor that knows you well.
Delivering an excellent customer experience in primary care at our Plum Health DPC office. This is achieved by meeting people at the door, having enough time for the appointment, addressing their concerns fully, giving the medications from our office and not sending them to a pharmacy, having the ability to draw blood in our office, and the ability to text and email our patients. Because we’re able to do these things well, our patients often have a “wow” experience. This becomes evident over time as more and more folks review our practice and our service (see Google reviews below).
Here’s more information about Winning Healthcare Food Fights in general:
Winning Healthcare Food Fights is a weekly online radio show covering important healthcare issues. Hear from physicians about getting better care, experts explaining how we arrived at our current mess, and how we clean it up!
Healthcare's solutions cannot possibly be described in 2 minute soundbites. It takes some time to sort through the mess to discover the attributes of great care and how we move forward.
The rewards are more confidence about the direction we must head, and what to do about it. Less fear, uncertainty and doubt.
Thanks so much for reading and watching, and have a wonderful day - Dr. Paul Thomas with Plum Health DPC
As of February 2020, Plum Health DPC has 63 five star reviews on Google. Our hours of operation are Monday through Friday, 9 am to 5 pm
Emerging Leaders Connect at Michigan Association of CPAs Event
Last week, I was invited as a speaker/panelist at the Michigan Association of CPAs event in Midtown Detroit. The panel focused on entrepreneurship and working with folks who are solo entrepreneurs and self-employed individuals. Many accountants and certified public accountants (CPAs) in Detroit and Metro Detroit are self-employed.
Additionally, many freelancers and self-employed individuals make more than the cutoff point for Medicaid in the State of Michigan (around $17,000) but not enough money to comfortably afford private health insurance. Or, self-employed individuals may not want to spend so much money on health insurance, and rather invest that money back into their businesses.
We take care of many folks in this situation - people are looking for alternative ways to manage their personal health and well-being, and many people are choosing direct primary care services like our Plum Health DPC service as a stand-alone service or as an add-on service to their health insurance plan or catastrophic coverage plan.
This was a great event and brought together many interesting accounting professionals. A big thank you to Matthew Kidd and the Michigan Association of CPAs for the invitation.
Further, it was a pleasure to share the stage with Andrew Dickow, the Managing Director at Greenwich Capital Group. He is an enthusiastic and engaging speaker, and he brought a ton of insights to the table regarding entrepreneurship, investment, and the food and beverage industry in Detroit and beyond.
-Dr. Paul Thomas with Plum Health DPC
We had a great time with the Michigan Association of CPAs Event, called Emerging Leaders Connect. It was a pleasure to speak with Matthew Kidd and Andrew Dickow regarding entrepreneurship in Detroit.
Photos courtesy of:
Kelly Dzierzawski | Video & Creative Services Senior Manager | Michigan Association of CPAs
Plum Health in Crain's Detroit Business
This week, we were featured in Crain’s Detroit Business under a special section regarding the Caring for Kids radio program. Here’s the part about Plum Health DPC, our membership model family medicine service in Detroit:
Caring for kids: Advocating for the mental and physical care of children
On his monthly radio program, The Children’s Foundation President and CEO Larry Burns talks to community, government and business leaders about issues related to children’s health and wellness.
Guests for this discussion were Dr. Stephen Bloom, Medical Director of Rehabilitation, St. Joseph Mercy Hospital Rehabilitation, Ann Arbor; Dr. Paul Thomas, Family Medicine Doctor, Plum Health DPC; and David Coulter, County Executive, Oakland County.
The hourlong show typically airs at 7 p.m. the fourth Tuesday of each month on WJR 760AM. Here’s a summary of the show that aired December 31st; listen to the entire episode, and archived episodes, at yourchildrensfoundation.org/caring-for-kids.
Larry Burns and Dr. Paul Thomas discuss Plum Health DPC
Larry Burns: Plum Health DPC (Direct Primary Care) is the first practice of its kind in Detroit and Wayne Country. Tell us more about your mission.
Dr. Paul Thomas: We believe that health care should be affordable and accessible. We’ve lowered the cost of health care and allowed people to be more proactive in taking care of themselves. With this direct care model, my patients—or members—pay me directly. It’s $10 a month for kids and then it starts at $49 a month for adults. They can come see me any time they need to. They also have my cell phone number so they can call or text me anytime.
Burns: What might a parent get for that $10 kid membership?
Thomas: You have a doctor on call for you. You might send me a photo of a rash and I could walk you through that. Or you might be concerned about an ear infection and I’d want you to come in to be seen for that. Or you have your well visit.
Burns: If somebody has insurance can they still be a member?
Thomas: Yes. We see people who are uninsured, under-insured, and fully insured.
Burns: What are the membership advantages for adults?
Thomas: Again, you have me on speed dial. We also do in-house labs and medications for all of our patients at significantly lower cost. For example, for a cholesterol panel at the hospital, you might be charged $100; at our office it’s $6. Or, if you came in to manage your blood pressure and you’re taking Lisinopril, that tablet might be $10 at the pharmacy for a one-month supply. At our office it’s 1 cent per pill, so your blood pressure medications now cost 30 cents a month.
Burns: How’s the practice going?
Thomas: We initially launched in 2016 as a house call practice. I had a small office in Southwest Detroit with about eight members. We’ve now grown to about 580 members. We hired a second doctor to help with the demand and we moved into a larger office in Corktown.
Burns: What is in the future for Plum Health?
Thomas: We want to continue to grow and bring on a new doctor perhaps every year to meet the demand. There are only 100 primary care physicians practicing in Detroit for 600,000 residents. That’s one doctor for every 6,000 residents. If you go north of Eight Mile into Oakland County there’s one primary care physician for every 600 residents. That’s a 10x disparity in primary care access.
Burns: How can someone become a member?
Thomas: Go to plumhealthdpc.com.
Thanks for reading and have a wonderful day, - Dr. Paul Thomas with Plum Health DPC
This week, we were featured in a special section of Crain’s Detroit Business.
This week, Paul Thomas, MD of Plum Health DPC was featured in Crain’s Detroit Business with Larry Burns, CEO of the Children’s Foundation.
Dr. Paul Thomas on WJR with Larry Burns of Caring for Kids
This week, Dr. Paul Thomas was featured on Caring for Kids with Lawrence J. Burns, which was broadcast on WJR at 7 pm on December 31st. In case you missed it, there’s a re-broadcast of the program today, January 4th at 2pm and again at 12am (midnight) on Sunday January 5th.
We talked about a number of topics. We discussed how your health is influenced by where you’re born and where you live. We also discussed how there are too few physicians in the City of Detroit for the number of residents in the city, and that there’s a 10x disparity in primary care access between the City of Detroit and communities in Oakland County.
We’re very grateful to Larry Burns and his outstanding team for hosting us on the show. It was a great experience and a great opportunity to raise awareness around the critical issues of primary care shortages in Detroit and the ways we’re addressing the high costs of health care in the city and beyond.
Larry J Burns of Caring for Kids with Dr. Paul Thomas of Plum Health DPC on WJR. Link to this tweet is here.
The full episode will appear on this webpage when completed: https://yourchildrensfoundation.org/caring-for-kids/. Again, you can hear the interview on WJR AM 760 today at 2 pm and Midnight tonight.
Thanks for reading and listening, - Dr. Paul Thomas with Plum Health DPC
Here’s a few more tweets and images from the interview:
Dr. Paul Thomas Featured on the Soul of Enterprise Podcast
This month, Dr. Paul Thomas was featured on the Soul of Enterprise Podcast and we had a great conversation around the Direct Primary Care Model and how it can benefit individuals, small businesses, communities, and the nation as a whole. It was great being interviewed by Ed and Ron - they brought a high level of professionalism and integrity to the conversation with some excellent questions around the practice and the DPC model. Enjoy!
WHAT HAPPENS WHEN A SMART DOCTOR RECOGNIZES THAT THERE IS A BETTER WAY?
Is it possible for family physician to operate under a subscription-based business model, priced below what you pay for your mobile phone service? What about services not covered by the subscription? Could those be priced with full certainty and transparency?
For episode 269, we had the pleasure of interviewing Dr. Paul Thomas, founder of Plum Health DPC. Dr. Paul Thomas is a board-certified family medicine physician practicing in Corktown, Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit. He is a graduate of Wayne State University School of Medicine and now a Clinical Assistant Professor. Finally, he is an author of the book Direct Primary Care: The Cure for Our Broken Healthcare System.
Below are show notes and questions we asked our guest. Use these to help guide you along when listening to the podcast (embedded above).
Ed’s Questions
What is Direct Primary Care?
Based on an interview I saw you do, there’s no wait time for patients?
Why did you go this route—Direct Primary Care?
You were burned out in your residency. What was the moment that you said I can’t do what most people are signing up to do?
Most time patients do get with their doctors is spent with the doctor typing and facing a screen.
What are some of things that are covered in your clinic?
What you are capable of doing in your practice is probably 80-90% of what a healthy patient would need in a given year?
It would cost me personally about $840 in your practice. If you’re so cheap, why is healthcare so expensive?
It’s said America pays more than the average OECD country, but there’s no price transparency in the system, which inflates those prices, correct?
What are some of the barriers you see that are still in the way of physicians getting into DPC and patients being able to access DPC?
When you did start, did you consider other pricing models? Yours is based on age, but did you consider, for example, response times, or different services you would include and exclude?
Do you have any jumpers, and by that I mean people who pay for a month and then leave, then come back six months later?
You’re now also offering rates to small businesses in your area?
And the companies pay your membership as part of the employees benefit package?
You believe that patients should also have a catastrophic health insurance plan?
We don’t expect our auto insurance to pay for gasoline but we do expect our health insurance to pay for a blood test. It’s absurd?
I was struck that in your TedX talk you used the phrase “living my truth,” take us through that, what does that phrase mean to you?
Ron’s Questions
In your book, Direct Primary Care: The Cure for Our Broken Healthcare System, you cite a 2016 study performed by Medscape found 51% of physicians experience burnout. Burnout is defined as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. You felt this in your residency. How long did it take you to work up to 500 patients?
How did you market your practice, was it social media, word-of-mouth, press. I know you did a Tedx talk.
I know DPC is in the same family of Concierge Medicine, which has the reputation of being just for the elite, which isn’t true. But the DPC prices are usually less than a mobile phone bill.
On the cover of your book there’s a picture of you trying to catch sand through your hands. Can you explain that analogy?
You talk about technology and how there’s too much borrowing from Henry Ford’s assembly line, treating customers like commodities rather than human interaction. It’s not very efficient to sit and listen to your patient read you poetry. It is, however, highly effective. Would you agree with that?
You also talk how the average of GP doctors have 2,400 patients. Do you think this DPC model will alleviate this GP doctor shortage?
You talk about the growth of urgent care centers in the US is a symptom of a failed primary care system.
Do you feel that people who are not licensed could do some of the work now being done by physicians? What’s your view of occupational licensing and how it folds into this model/
You mentioned to Ed that insurance companies try to get as many dollars passing through the hands. They don’t seem to like the concierge or DPC models, not because they compete with actuarial based insurance but because they compete with pre-paid medical care. Did Michigan pass a law that made it clear that DPC is not an insurance product?
Just seems to be like insurance companies would like to block this model. Is that a fair statement?
There’s obviously some education going on with doctors with respect to DPC, but we also need to re-educate patients to see you even when they are healthy, not just when they are sick. Has that been an educational process to get patients to see you even when they don’t have an issue?
We talk a lot about the market share myth, that growth for the sake of the growth is the ideology of the cancer cell, not a sustainable, profitable business. You phrase it in your book as “Value over volume.” You must be asked a lot that healthcare is different than any other product or service we buy, how do you explain to people that it can be priced like other things we buy
Your model is restoring the sacred relationship between the patient and doctor. You’re bringing this back to the days of Marcus Welby.
I’ve read that most calls (82%) are received during normal business hours, that patients don’t abuse your time off. Has that been your experience unless there’s been an emergency?
Tell us about your new venture, www.startupdpc.com.
If you could wave a magic wand to reform healthcare, what would you do? [Price transparency and quality scores was Dr. Paul’s answer].
HOW TO LISTEN TO THE PODCAST:
Apple Podcast: https://podcasts.apple.com/us/podcast/tsoe-dr-paul-thomas-on-what-is-direct-primary-care/id668653849?i=1000459295760
Try saying, “Alexa, play the Sage Advice Podcast” on your Amazon Echo
Google Play: https://play.google.com/music/m/Dnjmmdjwf4wcptom74ttgymbqam
iHeartRadio: https://www.iheart.com/podcast/263-sage-advice-podcast-27588757/episode/tsoe-dr-paul-thomas-on-53897728/
Spotify: https://open.spotify.com/episode/376LlZkEKLMxe8UH9e8N4J
SoundCloud: https://soundcloud.com/sagena-47293133/tsoe-dr-paul-thomas-on-what-is
PlayerFM: https://player.fm/series/sage-advice-podcast/tsoe-dr-paul-thomas-on-what-is-direct-primary-care
Direct download: http://traffic.libsyn.com/sagena/TLS-TSOE-PaulThomas.mp3
Permalink: http://sageadvicepodcast.com/tsoe-paulthomas
Detroit Doctors Cut the Ribbon on a New Corktown Office with Mayor Duggan
Plum Health DPC Cuts the Ribbon on Corktown Office with Mayor Duggan
DETROIT (Dec. 14, 2019) – On Thursday, the Detroit Economic Growth Corporation (DEGC), Mayor Mike Duggan and community members of Corktown joined Motor City Match (MCM) awardee Dr. Paul Thomas at a ribbon-cutting ceremony to celebrate the opening of his Direct Primary Care practice, Plum Health DPC.
The Ribbon is Cut with Mayor Mike Duggan, Paul Thomas, MD, Raquel Orlich, DO, and Chris Lake, medical assistant at Plum Health DPC in Corktown, Detroit.
Photo Credit to Nadir Ali at https://www.3andathird.com/
Plum Health DPC has expanded its presence in Detroit, moving into a new 1,700 square foot retail space at The Corner - a mixed-use development on the site of the former Tiger Stadium at Michigan Avenue and Trumbull.
The health care office, previously located in Southwest Detroit, moved to Corktown after a significant increase in demand for Plum Health’s innovative services. The new location in Corktown allows for a much larger, more tailored, and community-oriented space with easy access for patients.
Mayor Mike Duggan speaks about Plum Health DPC and the importance of primary care services in Detroit with Paul Thomas, MD and Raquel Orlich, DO.
Photo Credit to Nadir Ali at https://www.3andathird.com/
“It is crucial for Detroit residents to have access to healthcare facilities in their communities without having to travel outside of the City,” said Duggan. “We are thankful to Dr. Thomas for his commitment to the wellness of Corktown and nearby residents. I’d like to encourage more health care providers to open throughout the City so that Detroiter’s are able to receive the medical services they so richly deserve.”
Wayne State University School of Medicine alumnus, Clinical Assistant Professor, and Plum Health DPC owner Dr. Paul Thomas started his business as a house-call only practice in 2016, recognizing the need for affordable and accessible healthcare in Detroit. His physical practice began in a one-room office located inside the Detroit School of Digital Technology, at the former Third Precinct police station in Southwest Detroit. At peak capacity in the old location, Dr. Thomas and his team were serving roughly 500 patients.
“We believe that health care should be affordable and accessible for everyone, and we are very grateful to our many community partners for assisting us in expanding our services, and therefore access to vital primary care resources,” said Dr. Thomas. “First we need to thank our patients for trusting us with their health care. Next, we need to thank Mayor Mike Duggan, the Motor City Match Program, the DEGC, Quicken Loans Demo Day, TechTown’s Retail Boot Camp, and the Build Institute. So many people and organizations have helped us get to where we are today.”
Today, Plum Health DPC has expanded to a team of two physicians, adding Dr. Raquel Orlich, a graduate of Michigan State University College of Osteopathic Medicine, to the practice in July 2019. The two physicians and a newly-hired medical assistant currently serve 600 patients out of the Corktown office.
Dr. Raquel Orlich greets Mayor Mike Duggan at Plum Health DPC in Corktown, Detroit. Paul Thomas, MD and other members of the Detroit business community look on.
Photo Credit Shawn Lee at https://www.shawnleestudios.com/
The expansion also enables Plum Health to add a third physician to their team in the future, providing the center with the means to serve more than 1,500 patients in Detroit and beyond. It’s convenient location in the growing and bustling Corktown neighborhood and its low-cost membership model are further addressing Detroit’s primary care shortage.
"From the first moment I met Dr. Thomas I knew his business reflected the genuine values of the Corktown community as well as our efforts to embrace small, local, innovative, Detroit businesses," said Eric Larson, President/CEO of Larson Realty Group. "I am thrilled to welcome Plum Health to The Corner."
Plum Health’s move to Corktown and the build-out for their new space was supported by a $50,000 grant from Motor City Match and a $50,000 award from Quicken Loans Detroit Demo Day. Plum Health has also received technical support from TechTown and Build Institute.
“Quicken Loans Detroit Demo Day exists to bring capital and exposure to businesses in Detroit – especially those with innovative products or services that are creating amenities and jobs in the city. Seeing Plum Health deploy that capital to scale their operations and serve more patients is exactly the kind of outcome we hope for,” said Lauren Hoffman, Director of Entrepreneurship, Quicken Loans Community Fund.
Plum Health DPC uses a membership model for healthcare, charging patients a monthly fee, and billing them directly for specific services. Dr. Thomas said that by eliminating insurance claims for primary care services, he can offer his patients an up to 90 percent reduction in costs. For example, while a hospital might charge $3,000 for an MRI, Dr. Thomas charges only $297 for the same service. A $150 Comprehensive Metabolic Panel costs $6 at Plum Health; a $10 pharmacy charge for blood pressure medication is only $0.36 for patients there.
“Winning an MCM space and cash award allowed Dr. Thomas to build a world-class primary care office in an underserved neighborhood,” said Batton. “With high local demand for the professional health services Plum Health provides, this business is positioned for success and future growth. MCM is pleased to support business owners like Dr. Thomas who are committed to Detroit’s residents and neighborhoods that are providing the type of services that create long-term stability in communities.”
Plum Health’s new location at 1620 Michigan Avenue serves patients of all ages from 9am to 5pm, Monday through Friday. Those interested in the innovative subscription service, a full list of included procedures, and pricing can find more information here.
Dr. Paul Thomas addresses the media at the Plum Health DPC family medicine office in Corktown, Detroit.
Photo Credit Shawn Lee at https://www.shawnleestudios.com/
Media Contact:
Paul Thomas, MD | 313.444.5630 | paul@plumhealthdpc.com
Plum Health DPC, 1620 Michigan Ave, Suite 125, Detroit, MI 48216
About Plum Health DPC
Plum Health DPC is a Direct Primary Care service that is the first of its kind in Detroit and Wayne County. The family medicine service has a mission of delivering affordable, accessible health care in Detroit and beyond. This is achieved through on-time appointments, same-day/next-day appointments guaranteed, and 50- to 90-percent savings on procedures, medications, labs and imaging services. Plum Health DPC is located at 1620 Michigan Ave., Suite 125, Detroit, MI 48216. The hours are Monday through Friday, 9:00 a.m. to 5:00 p.m. To learn more, visit www.plumhealthdpc.com or call 313.444.5630.
About Paul Thomas, MD
Dr. Paul Thomas is a board-certified family medicine physician practicing in Corktown Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit. He is a graduate of Wayne State University School of Medicine and now a Clinical Assistant Professor. Finally, he is an author of the book Direct Primary Care: The Cure for Our Broken Healthcare System.
About Raquel Orlich, DO
Dr. Raquel Orlich, DO is a board certified family physician. She is excited to join the mission of bringing affordable and accessible health care to Detroit. She is passionate about quality patient-centered care and establishing strong doctor-patient relationships. Her clinical interests include osteopathic manipulative medicine for chronic musculoskeletal issues, women’s health, and preventative health. She is a graduate of Michigan State University College of Osteopathic Medicine and completed her residency training at Ascension Macomb-Oakland Hospital.
About Direct Primary Care
The direct primary care (DPC) model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services, and care coordination and comprehensive care management. Because some services are not covered by a retainer, DPC practices often suggest that patients acquire a high-deductible wraparound policy to cover emergencies.
Direct primary care benefits patients by providing substantial savings and a greater degree of access to, and time with, physicians. Taken from the American Academy of Family Physicians website: https://www.aafp.org/practice-management/payment/dpc.htm
About Motor City Match
Motor City Match is a unique partnership between the City of Detroit, DEGC, the Economic Development Corporation of the City of Detroit (EDC) and the U.S. Department of Housing and Urban Development (HUD). Through 16 rounds, the program has granted $7.75 million in cash awards and leveraged a total investment of $42 million in Detroit neighborhoods. MCM also awards support in space, business plan, design and building categories. Competitive financial assistance is supported by a broad partnership of Southeast Michigan community development financial institutions and corporations. Detroit Economic Growth Corporation (DEGC) is a non-profit organization that serves as the lead implementing agency for business retention, attraction and economic development initiatives in Detroit.
Plum Health Featured in Model D Media
This week, the growth and expansion at Plum Health DPC was featured in Model D Media, under their Development News section. Here’s what they said:
Plum Health, the direct primary care practice founded in 2016 by Dr. Paul Thomas, has left its Southwest Detroit beginnings for one of the most high-profile developments in the city: The Corner mixed-use development located at the site of the old Tiger Stadium.
The move to the 1,700-square-foot space results from a significant increase in the amount of patients Thomas serves, from 8 in November 2016 to more than 550 active patients today.
Thomas hired Dr. Raquel Orlich this summer and, with the move, a third physician will be hired, meaning that Plum Health will eventually be able to serve more than 1,500 patients from their new Corktown offices.
"We believe that health care should be affordable and accessible for everyone, and this new office takes us one step closer to that goal," says Thomas.
"Our new family medicine office is warm and inviting, and we look forward to serving the medical needs of our community from this space for many years to come."
In June 2018, Model D wrote that Dr. Thomas "could disrupt the field of primary care" because Plum Health offers direct primary care services based on a subscription model. Rather than charge patients for each visit and service rendered, patients pay a set fee each month, gaining direct access to doctors as needed.
Patients also have access to wholesale medications, at-cost imaging services, and at-cost lab work.
No health insurance is required for Plum Health services.
Plum Health is located in Ste. 125 of 1620 Michigan Ave. in Corktown.
Got a development news story to share? Email MJ Galbraith here or send him a tweet @mikegalbraith.
We’re grateful to Model D Media for the continuing coverage and very excited to continue to serve people in this way. Thanks for reading and have a wonderful day.
Drs. Paul Thomas and Raquel Orlich
Better Ways to Spend Time and Money on Cyber Monday
There are better ways to spend your time and money during Cyber Monday, I’ll list a few of them here:
invest money into a retirement account, like a Roth IRA or a 401K or 403B plan
put a little extra money into your mortgage, or if you have an auto loan, pay a little extra on your auto loan
invest into a child’s education fund
visit an elderly relative or a neighbor, bonus points if you bring them some nutritious food
go to the gym and have a good work out, bonus points if you go with a friend or a partner/spouse/significant other
take time to make a healthy meal at home
schedule an appointment with your doctor
schedule an appointment with your dentist
check your tires before it snows again
your tread can wear down over time, and sometimes the cold weather can cause deflation
make a donation to a charity
volunteer at a local service organization
if you choose to shop, shop at a local small business and get to know the people that work there and the business owner
write a thank you note to whoever hosted you for Thanksgiving Dinner or a Thanksgiving-related event
meditate
be grateful for what you already have
I know that people can overspend during the Holidays, and I’ve read that people can go into about $1,000 in debt due to holiday spending, but there are better ways to spend your time and money on Cyber Monday. You can invest into yourself and into your retirement accounts, invest into your children’s education funds, take time to exercise and eat healthy foods, and visit and spend time with elderly folks in your life and in your community.
Thanks for reading and have a great day,
-Dr. Paul Thomas
Daily Detroit Covers the Plum Health Move to Corktown
Daily Detroit, shares what to know and where to go in Southeast Michigan in a 15-20 minute, local podcast. They recently covered our move from Southwest Detroit to our new location in Corktown Detroit. Here’s what we discuss:
The move into our new 1,700 Square Foot office in Corktown, at the Corner, which is the historic former site of Tiger Stadium. This is the corner of Michigan and Trumbull, and our address is 1600 Michigan Ave, Suite 125, Detroit MI 48216
We’re a Direct Primary Care practice in Detroit, and we provide Family Medicine services through a membership model for health care. Our members pay $10 each month for children, and our adult memberships start at $49 per month. With the membership, our patients can see us anytime they need to without a copay.
Dr. Raquel Orlich started with our practice in July 2019. She’s an Osteopathic Physician who studied at Michigan State University and was the Chief Resident in Family Medicine at Ascension Macomb.
Why did we move? We moved because we outgrew our original space in Southwest Detroit. We had also won some grant money through the Motor City Match program and the Detroit Demo Day that we needed to use towards our build out of a new office.
Why this specific location? We moved to the Corner because it’s very close to our original location. Our new spot in Corktown is only 1.1 miles away from our old spot in Southwest Detroit. Importantly, this allows us to continue serving all of our original members.
What have we learned since starting this business? If you’ve ever started a business, you know that it’s not the decisions, it’s the decisiveness. This was something that was difficult to learn as a Physician because Doctors are trained to over-analyze problems and leave no stone unturned. I still use that part of my brain when taking care of patients, but I have to turn that part of my brain off when I think about challenges in our business.
How can people get involved? You can enroll on our website, here. Or you can give us a call at 313.444.5630. Finally, you can stop by at our new office - 1620 Michigan Ave Ste 125, Detroit MI 48216.
Listen to the episode on Daily Detroit’s YouTube Channel (below). Our segment starts at the 4:28 mark.
If you like Plum Health, and if you like YouTube, you’ll love our Plum Health YouTube Channel!
Thanks for reading and watching and have a marvelous day - Dr. Paul Thomas and Dr. Raquel Orlich
How to Quit Drinking Alcohol in Detroit
The holidays are just around the corner. It’s that time of year we catch up with good friends and loved ones. As we are celebrating, it is important that we safely enjoy our alcoholic beverages. It is also imperative to be transparent with your doctor about the amount of your alcohol consumption as we will discuss more below, can greatly impact your physical health causing chronic ailments like heart disease, high blood pressure, and liver disease. Excessive alcohol use can also be associated with mental health concerns such as depression and anxiety.
What does it mean to be above the legal limit for drinking?
According to the CDC, all states in the United States have adopted a blood alcohol content percentage (BAC) 0.08% as the legal limit for operating a motor vehicle for drivers aged 21 years or older. However, drivers younger than 21 are not allowed to operate a motor vehicle with any level of alcohol in their system.
Legal limits are measured using either a blood alcohol test or a breathalyzer.
Legal limits are typically defined by state law, and may vary according to individual characteristics, such as age and occupation.
What is one “drink” according to the CDC?
12-ounces of beer (5% alcohol content).
8-ounces of malt liquor (7% alcohol content).
5-ounces of wine (12% alcohol content).
1.5-ounces (1 shot glass) of liquor (e.g., gin, rum, vodka, whiskey).
What are the current recommendations for alcohol use?
With the holidays approaching, it is important to drink alcohol in moderation. This means 1 drink per day for women, and 2 drinks per day for men. These recommendations should adhere to the one “drink” standard described above. This means that wine glasses should not be filled to the brim! It is always important to keep in mind that with certain medications interact with alcohol use, including sleeping pills, muscle relaxers or other sedative medications that may make you drowsy. Always be sure to consult your physician and check your prescription bottle for recommendations in regards to alcohol consumption.
Guidelines for Excessive Drinking
According to the CDC, binge drinking includes 4 alcoholic beverages for women, or 5 for men, in a two-hour period. Heavy drinking is considered 8+ drinks per week for women, or 15+ drinks per week for men. Any drinking by a pregnant women or individual under the age of 21 is considered excessive.
What are signs of Alcohol Use Disorder?
Some of the signs and symptoms of alcohol use disorder could include:
Inability to limit drinking.
Continuing to drink despite personal or professional problems.
Needing to drink more to get the same effect.
Wanting a drink so badly you can’t think of anything else.
Health Risks of Alcohol Use
According to the CDC, there are short-term and long-term health risks associated with heavy alcohol use.
Short-Term Health Risks
Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions. These are most often the result of binge drinking and include the following:
Injuries, car crashes, falls, drowning, and burns.
Violence, including homicide, suicide, sexual assault, and intimate partner violence.
Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
Miscarriage and stillbirth or fetal alcohol syndrome disorder among pregnant women.
Long-Term Health Risks
Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems including:
High blood pressure, heart disease, stroke, liver disease, and digestive problems.
Cancer of the breast, mouth, throat, esophagus, liver, and colon.
Learning and memory problems, including dementia and poor school performance.
Mental health problems, including depression and anxiety.
Social problems, including lost productivity, family problems, and unemployment.
Alcohol dependence, or alcoholism.
Signs of Alcohol Withdrawal
After discontinuing alcohol use, within the first 2-4 days days it is possible to have several symptoms including, shakiness, sweating, loss of appetite, nausea, vomiting, headaches and a fast heart rate (also known as tachycardia). More serious symptoms include delirium tremens (DT), seizures and death. Any withdrawal from alcohol should be monitored by your healthcare provider as these symptoms may occur.
Resources for Alcohol Use
Substance Abuse and mental health services’ (SAMHSA) National Helpline number, open 24/7 365 days, 1-800-662-HELP (4357)
For more information on how you can safely consume alcohol this winter, please visit the CDC.
How To Quit Drinking Alcohol in Detroit
If you need help with quitting drinking alcohol, we’re happy to help. We can direct you to the best resources available for alcohol cessation, and we can treat alcoholism in our office. The Sinclair Method is a reasonable treatment option in some cases and it involves taking Naltrexone one hour prior to alcohol consumption. There are also local Alcoholics Anonymous meetings and other support groups that you can attend to help you reduce or eliminate your alcohol consumption.
Thanks for reading and have a great day,
-Dr. Paul Thomas and Dr. Raquel Orlich
Meet our Medical Assistant at Plum Health
Medical Assistant at Plum Health DPC
Everyone this is Chris, Chris this is everyone! He’s our amazing Medical Assistant and he helps us give injections 💉 and draw blood among other things.
Chris Lake is the Medical Assistant at Plum Health DPC
You might be thinking 🤔 “why is Chris holding a plate of cookies 🍪?” Well, he had a small bet with one of our patients who bruises easily during blood draws. She said that she would definitely bruise, regardless of how good the blood draw was - she just always bruises, she said. Chris made a friendly wager of a plate of cookies 🍪 and our patient delivered after “the best blood draw she’s ever had.” Later that week, a plate of white chocolate macadamia nut cookies found their way to our office!
In all seriousness, it’s great to have Chris as a part of our team. He does excellent work and is a great person to know. We can’t wait to see you for your next appointment,
-Dr. Paul Thomas, Dr. Raquel Orlich, and Chris Lake
How to get a Pap Test in Detroit?
Affordable Pap Tests Available at Plum Health
Ladies - it’s time that we talk about Women’s Health! An important aspect of routine follow-up with your primary care physician is to discuss screening tests for preventable diseases such as heart disease, high blood pressure, and diabetes. Additionally, it is important to talk to your doctor about cancer screening tests that may be appropriate for you such as for screening for breast, colon, and cervical cancer.
Many of us know that mammograms are great screening tests to look for breast cancer --Did you know October is Breast Cancer Awareness month? Additionally, a colonoscopy is used (a procedure that uses a camera to look in your colon) for colon cancer screening. However, not as many of us know why our doctors stress the importance of cervical cancer screening and what a pap smear is.
Below we will explain the basics: What is a cervix? What causes cervical cancer? What is HPV? What is a Pap test? When should I get one?
What is a cervix?
The cervix is a muscle at the lowest part of the uterus. It meets with the deepest part of the vaginal canal. There is also a small opening in the center of the cervix called the cervical canal that connects the vagina and the uterus. This opening can open and close at different times --- It opens slightly during your period and fully during childbirth. But it also protects against infections from entering into the uterus. Amazing right?
Cervical cancer and Human Papillomavirus (HPV)
Unfortunately, this opening of the cervix can become infected by a very common virus called Human Papillomavirus (HPV). In most cases, the infection will clear on its own, however if the infection does not clear on its own, it can pose a risk of developing cervical cancer. According to the Centers for Disease Control and Prevention (CDC),12,845 new cervical cancer cases were diagnosed in 2015 and 4,175 deaths were caused by cervical cancer in 2015.
More about Human Papillomavirus (HPV) and how is it transmitted?
According to the Centers for Disease Control and Prevention (CDC), HPV infections are so common that nearly all men and women will get at least one type of HPV at some point in their lives. Nearly 80 million Americans are currently infected with some type of HPV. About 14 million Americans, including teens, become infected each year.
HPV is spread through intimate skin-to-skin contact. You can also get HPV by having vaginal, anal, or oral sex with someone who has the virus. There are many types or strains of this virus. Some of the strains can cause warts on the hands and feet and others can infect tissues of the genital region which can cause warts in that region as well BUT can also be associated with some cancers of genital region (i.e. vagina, penis, and anus) and of the head and neck.
What has been done to help prevent HPV infections?
At this time, the CDC recommends that all boys and girls start vaccination against HPV infection that can be started as early as age 9 through 26 years of age. As of October 2018, the US Food and Drug Administration (FDA) has approved the vaccination for men and women through 45 years of age with Gardasil 9 (common name brand for one of the vaccines). For the HPV vaccine to be most effective, the series should be given prior to exposure to HPV.
Dr. Paul Thomas and Dr. Raquel Orlich of Plum Health DPC discuss cervical cancer screening at their office in Detroit, Michigan.
How can your doctor screen for cancer and precancers of the cervix?
If you are between the ages of 21 and 65 years of age, your doctor will start screening you for cervical cancer. The screening test is called the Papanicolaou test aka the “Pap test or Pap smear”. During a Pap smear, your doctor will need to visualize your cervix with a small utensil called a vaginal speculum. With a small brush, he or she will gently scrape the cervix to collect a sample of the cells in the opening of the cervix. This procedure takes less than 5 minutes and most women report it to be painless or may have minimal discomfort. The sample is then sent to the lab for review.
According to the CDC, decline in cervical cancer cases and deaths in the past 40 years correlated with Pap testing and detection and treatment of cervical precancerous lesions. The majority of cervical cancers (50% to 64%) occur in women who were rarely or never screened.
The screening guidelines recommend that women between the ages of 21 and 29 years old should have routine screening every 3 years.
The screening guidelines recommend that women between the ages of 30 and 65 year old have two options for routine screening --
Have a Pap test every 3 years or
Have a Pap test with an HPV test every 5 years.
*However, if your results are abnormal, you will discuss with your doctor when you should return for a follow-up Pap test or need additional testing.
Luckily, cervical cancers usually take years to develop. If you’re getting screened regularly (every 3 or 5 years), you are extremely unlikely to develop cervical cancer. Let’s take control of our feminine health!
You can visit the CDC for more information on the Pap test and HPV
What does the Pap test NOT test for?
The Pap test does not test for sexually transmitted infections such as chlamydia, gonorrhea, herpes simplex, syphilis, or HIV.
How much does it cost to have a Pap test?
Depending on your insurance plan, Pap testing may be covered as a preventive service. If you are underinsured or uninsured, the test may be costly.
If you are a member of Plum Health DPC, we are able to provide affordable prices for many screening tests including Pap tests. The price of our Pap test is $30 to $60
How can I sign up for an appointment for a pap smear?
To make an appointment with Dr. Raquel or Dr. Paul, head over to our scheduling link and select her or him as your doctor. After you submit the information, Dr. Raquel will reach out and offer appointment times.
Thank you for reading and have a great day,
-Dr. Paul Thomas and Dr. Raquel Orlich with Plum Health DPC
Plum Health Grows into a Larger Office in Corktown
Plum Health expands into mixed-use development at former Tiger Stadium site in Corktown
Memberships and interest in Direct Primary Care prompted the move to a 1,700 square foot retail space at The Corner.
Detroit, Michigan, November 4th, 2019 - Plum Health DPC is pleased to announce that they have expanded their presence in Detroit by moving into a new 1,700 square foot retail space at The Corner, a mixed-use development on the former Tiger Stadium site at Michigan Avenue and Trumbull.
Doctors Paul Thomas, MD and Raquel Orlich, DO have moved from their previous location in Southwest Detroit to a much larger, tailored, and community-oriented space in Corktown. The move was prompted by the increasing demand for Plum Health’s innovative services and the desire to be more easily accessible to patients.
Additionally, the new space will allow Plum Health to have the capacity to add a third physician, further expanding access to primary care in Detroit. With a third physician, Plum Health will be able to serve over 1,500 patients through their low-cost membership model. Having more doctors will further address Detroit’s primary care shortage.
"From the first moment I met Dr. Thomas I knew his business reflected the genuine values of the Corktown community as well as our efforts to embrace small, local, innovative, Detroit businesses," said Eric Larson, President/CEO of Larson Realty Group. "I am thrilled to welcome Plum Health to The Corner."
Plum Health’s move and build-out into their new space has been supported by a $50,000 grant from the Motor City Match and a $50,000 award from the Quicken Loans Detroit Demo Day.
“Quicken Loans Detroit Demo Day exists to bring capital and exposure to businesses in Detroit – especially those with innovative products or services that are creating amenities and jobs in the city. Seeing Plum Health deploy that capital to scale their operations and serve more patients is exactly the kind of outcome we hope for.” - Lauren Hoffman, Director of Entrepreneurship, Quicken Loans Community Fund.
Doctors Paul Thomas, MD and Raquel Orlich, DO of Plum Health DPC in their new office at the Corner, 1620 Michigan Ave, Suite 125, Detroit MI 48216. We are excited to welcome the community into our space.
More about Plum Health DPC
At Plum Health, we believe that health care should be affordable and accessible for everyone. Members of the practice can call, text, or email the doctor anytime they need health care services. We guarantee same-day/next-day appointments. Additionally, patients have access to wholesale medications, at-cost imaging services, and at-cost lab work. Plum Health began in November 2016 with 8 patients, and now has 550 active patients, spanning in age from 4 months to 101 years of age. Our vision is to provide the best healthcare experience in Detroit and beyond.
More about Drs. Paul Thomas and Raquel Orlich
Dr. Paul Thomas is a board-certified family medicine physician practicing in Southwest Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He is a Clinical Assistant Professor at Wayne State University School of Medicine. He served as Chief Resident at Oakwood Family Medicine Residency Program. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit and is an author of the book Direct Primary Care: The Cure for Our Broken Healthcare System.
Dr. Raquel Orlich is a board-certified family physician. She loves the energy that Detroit has to offer and strives to make healthcare affordable and accessible to Detroit residents and beyond. She is passionate about quality patient-centered care and establishing strong doctor-patient relationships. Her clinical interests include osteopathic manipulative medicine for chronic musculoskeletal issues, women’s health, and preventative health. She is a graduate of Michigan State University College of Osteopathic Medicine and completed her residency training at Ascension Macomb-Oakland Hospital where she served as Chief Resident.
More about Direct Primary Care
The direct primary care (DPC) model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services, and care coordination and comprehensive care management. Because some services are not covered by a retainer, DPC practices often suggest that patients acquire a high-deductible wraparound policy to cover emergencies.
Direct primary care benefits patients by providing substantial savings and a greater degree of access to, and time with, physicians.
Taken from the American Academy of Family Physicians website: https://www.aafp.org/practice-management/payment/dpc.htm
Panoramic view of our new Plum Health office in Corktown. Our office remains in a Health Professional Shortage Area and we are very happy to continue to serve the community out of this new space.
Taking Care of People with Auto-Immune Conditions in Detroit
Auto-immune conditions can be very difficult and expensive to manage. We recently had a patient present with swollen fingers and painful joints going on for 6 weeks. It was disabling for him and he was having a hard time doing the work he needed to do at home and at work. Worst of all, he was having a hard time playing/being active with his grand kids.
We were able to complete a work up of his condition for about $100 in terms of labs, and about $50 in terms of x-rays. He pays our monthly membership and is able to have as many appointments as he needs in our office without co-pays.
After collecting the labs and x-rays, and after thoughtful deliberation, we came up with a diagnosis of Rheumatoid Arthritis. Rheumatoid Arthritis or RA is an autoimmune disease in which the body's immune system – which normally protects its health by attacking foreign substances like bacteria and viruses – mistakenly attacks the joints. This causes joint swelling and joint pain, as seen in our patient.
Once we had the right diagnosis, we were then able to start him on Methotrexate, a medication to manage his Rheumatoid Arthritis. The medication costs $4.08/week or about $16.32/month, which is affordable for our patient.
Best of all, the medication works really well for our patient and he can now do the work that he needs to do at work and at home, without the considerable joint pain that he initially experienced. Above all, he has a better quality of life, because he can now play with his grand kids and be the grandpa he wants to be.
I love taking care of people - people of all ages and stages, with diverse backgrounds and conditions. Thanks for reading and have a great day.
- Dr. Paul Thomas with Plum Health DPC in Detroit Michigan
Press Coverage for Direct Primary Care in Detroit and Michigan
This was a big week for press coverage for Direct Primary Care in Detroit and Michigan. The bottom line is this: people are hearing more and more about this Direct Primary Care movement and we’re getting more and better coverage as the DPC movement grows.
Plum Health DPC Interview on The Craig Fahle Show
First off, we had a fabulous interview with Craig Fahle of Deadline Detroit. Craig Fahle is the former host of the Craig Fahle Show on WDET and he currently hosts the Craig Fahle Show on Deadline Detroit:
A mix of interviews and commentary, The Craig Fahle Show is a daily 30 minute podcast telling the important political, business, and cultural stories that matter to Detroit and Michigan. Hosted by Craig Fahle, an award winning journalist and talk show host who for years hosted his eponymous talk show on WDET, Detroit's Public Radio station.
Craig Fahle’s coverage of our story at Plum Health DPC was insightful and robust. He brought a really well thought out, professional approach to this interview. You can listen to the full episode here:
Dr. Paul Thomas of Plum Health DPC interviewed by Craig Fahle of Deadline Detroit on the Craig Fahle Show. The conversation focused on the Direct Primary Care model and the impact that it is having in the Detroit market.
Paul Thomas, MD of Plum Health Mentioned During WDET’s Detroit Today
Second, during WDET’s Detroit Today radio program with Stephen Henderson, a caller rang in and asked if there was a health care model similar to the Green Bay Packers, where everyone buys in and benefits from the system. Start listening to the interview at the 34:30 mark to hear the question and answer. Additionally, I’ve taken the time to transcribe the conversation here:
Kevin in Grosse Pointe Park: “My idea may be a little simplistic, but I’d love to see something modeled off of the Green Bay Packers. As in, all of us pay our premiums to a hospital on a monthly basis, so the doctors, and the nurses, and the hospitals get our premiums. Let’s eliminate the insurance companies and the in-betweens. The doctors and nurses own the hospitals and we own shares in the hospitals and have an interest in this possibility.”
Stephen Henderson, Host of Detroit Today: “Hmm. Kevin it’s simplistic but it does get to a fundamental issue in the healthcare system. What role do the insurance companies play, and how much money do they add to the cost of things in the system and is there a way to eliminate them all-together. Abdul El-Sayed, we had a physician on the program a few months ago, Paul Thomas here in the City of Detroit, who is treating patients by eliminating insurance. He doesn’t take insurance, he has them pay into kind of a share system like Kevin is talking about. He deals with pharmaceutical companies directly to lower the cost of the meds and it seems like he’s got kind of a solution to some of the problems we see in the system now. The idea of dealing directly with physicians and hospital systems rather than insurance companies. Is that maybe a way forward?
Abdul El-Sayed, MD, MPH: “So, I love Paul’s model and I think it’s a great model for primary care. You pay him, he takes care of you, it’s simple, you eliminate the middle man. In fact though, Kevin’s idea, that’s how insurance companies started.”
Dr. Abdul El-Sayed goes on to talk about the founding of Blue Cross with Baylor’s Hospital System. When I heard this conversation, I was absolutely floored! It’s amazing that Stephen Henderson recalled our conversation and offered our model as a solution to our current health care problems.
Paul Thomas MD of Plum Health DPC was mentioned by Stephen Henderson of WDET and Abdul El-Sayed during a comprehensive conversation of healthcare costs during the Detroit Today radio program.
Direct Primary Care Physician on Michigan Radio
Finally, a friend and colleague of mine, Matthew Falkiewicz, MD Of Nova Direct Primary Care in Grand Rapids was interviewed on Michigan Radio with Cynthia Canty.
“Before insurance companies, and co-pays, and filing claims, the relationship between doctors and patients was simple. Those who needed medical care would visit their doctor’s office or request a house call. Once that care was provided, the doctor was paid directly.
“Some physicians are bringing that model into the 21st century by offering direct primary care to their patients on a subscription basis.
“Dr. Matt Falkiewicz is a physician with Nova Direct Primary Care in Grand Rapids. His practice offers a membership-based model where patients pay a monthly fee”
All told, three big mentions of Direct Primary Care in Detroit and Michigan over the last 1 week. This tells me that there’s a growing momentum for Direct Primary Care in our state. When I first started in 2016, I was an early adopter, perhaps the second doctor in the state of Michigan with a pure Direct Primary Care practice. Now, there’s over 10 doctors practicing in the DPC model in Michigan.
I believe in this model and these doctors - Direct Primary Care allows us to serve our patients on their own terms, and not at the dictates or mandates of an insurance company. The DPC model allows us to develop caring relationships with our patients and to deliver the best service possible to our patients.
I’m really excited for this growing movement - thanks for reading!
-Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan
Paul Thomas, MD of Plum Health DPC. Direct Primary Care allows doctors and patients to develop deeper, more trusting relationships that can result in better health for both patients and doctors.
Plum Health at the Detroit Men's Health Event
This week, we were at Ford Field for the Men's Health event. The event was really fun and really well organized. There were stations to have blood pressure checks, EKGs, Vision Screening, Vein Examinations, Skin Examinations to screen for Cancer, and several other tables with information about follow up care and the like.
Raquel Orlich, DO and Paul Thomas, MD of Plum Health DPC at the Ford Field Men’s Health Event.
We were happy to be invited and we met with several Detroit men and women in need of excellent primary care services. There were also some fun moments - they had a giant colon set up to promote colorectal cancer screening tests, like a colonoscopy. Also, we were able to go onto the playing field of the Detroit Lions, throw around a football and kick a few field goals! This was really cool and a nice perk of volunteering at the event.
Finally, if you’re looking for high-quality primary care services for you and your family, we’d be happy to help you with this sort of care. You see, at this type of event, conditions like high blood pressure and diabetes can be diagnosed, but the most important part is the follow up care after the diagnosis to make sure the condition is treated appropriately, well-managed, and ideally reversed with the right diet and lifestyle modifications.
Thanks for reading and have a great day,
-Dr. Paul Thomas and Dr. Raquel Orlich of Plum Health DPC
Detroit Family Medicine Office Offers Affordable In-Office Procedures
Detroit Family Medicine Office Offers Affordable In-Office Procedures
The beauty of Family Medicine Practice is it can be a one stop shop for you and your medical care. Family doctors can usually take care of 80-90% of your medical needs and that includes medical procedures. Family doctors are trained to perform a wide variety of procedures that can be offered in the office. This can help you save time and money from sending you to a specialist. At Plum Health, we love taking care of procedures for our patients, these can range from Pap tests to biopsies, from toenail removal to earwax removal, from abscess drainage to lipoma removals.
Our patient cut his hand aka had a laceration, and we were able to sew up the cut (suture the wound) about 20 minutes after the incident happened. This can ensure that healing is optimal and scar tissue is minimal.
List of Common In-Office Procedures Performed by Family Medicine Doctors
Some of the procedures that Family medicine physicians can perform are listed below.
Procedures that can be performed by your Family Doctor
Wound repair (sewing up small to medium sized cuts)
Abscess and cyst drainage
Skin biopsy of moles
Steroid Injection of joints and trigger points
Electrocardiogram (EKG)
Pulmonary Function Test
Pap smear
IUD (intrauterine device) removal
Ingrown toenail removal
Wart removal
Foreign body removal
Osteopathic Manipulative Medicine
Cerumen Disimpaction (ear wax removal)
With a flick of the wrist we can remove a significant amount of cerumen (ear wax) that may be impairing your hearing. There is no charge for this cerumen disimpaction procedure in our office.
Unfortunately, some of these procedures can be very costly depending on your insurance plan or lack thereof. A major reason for the expense of procedures vary from your insurance deductible plan and insurance coverage. Usually, the doctor’s offices will charge the insurance companies for the procedure. This inflates the cost.
For example, a typical charge for a sebaceous cyst removal might be $175 - $350. That service is $20 in our office. A skin biopsy can cost anywhere from $150 - $1,000 and an IUD removal can cost $150 - $250. For these procedures, we typically charge about $20 or the cost of the supplies that we use to perform these procedures.
Why are Common In-House Procedures Less Expensive at Plum Health?
At Plum Health DPC, we do not use or bill insurance for your medical care. Our membership plan does include performance of some procedures which helps cut many costs. We may be subject to charge for utensils and medications used during the procedure which is also offered at a discounted price.
Because the patients in our practice pay a monthly membership fee, we can lower the cost of procedures. Instead of charging you or your insurance company $100 or $500 for a procedure, we ask that you pay for the cost of the supplies that we use.
How to Schedule an Appointment to have a Procedure at our Detroit office
To make an appointment with Dr. Raquel Orlich or Dr. Paul Thomas, head over to our scheduling link. After you submit the information, Dr. Raquel or Dr. Paul will reach out and offer appointment times.
Thank you for reading and have a great day,
-Dr. Paul Thomas and Dr. Raquel Orlich