Direct Primary Care Webinar - Part 1 - June 8th 2020 / HealthChoice

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well hello good morning everyone here from the Alliance my first day back at the Alliance office thank you for joining us for the first of a two-part webinar series on direct primary care I am Melina cam bitsy and I'm the senior vice president of business development and strategic marketing here at the Alliance so before I introduce our presenters I want to talk a little that you're all in newt mode and if you have

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questions during the webinar please send them in the chat box if you want to say something we'll respond to someone during the discussion please raise your hand as it is shown here on the screen so that the green arrow is pointing up on the hand icon so it is my pleasure to have here with us today dr. keller Patel chief medical officer at practive MD and dr. David Asher president and founder of

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reform medicine I will introduce each one of the speakers and then we will start this presentation with a couple slides from the Alliance and then over to dr. Patel so dr. Patel of Nan dr. Patel for a couple years now and he he is known and he continues to disrupt the healthcare industry was his unique views on the right care he currently serves as I said is the chief medical officer for Pratt's of Mt accompany laser focused on

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providing the patients they serve that right care and we'll talk more about that in this presentation proactivity a couple things about proactive MD and its relationship with the Alliance productivity is the company that the Alliance after a rigorous RFP has chosen to help us bring high value primary care to the markets and the employers we serve in the form of community health centers that are shared by employers we will talk a little more later about this and also in more

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details in the next webinar and also following other presentations as well dr. Patel will discuss how and why traditional healthcare doesn't have the systems in place to deliver integrated health and what we as employers can do to provide quality care to patients and incentivize providers appropriately he will also provide an overview of direct primary care what it is and how it works then the second speaker for today is dr. uh sure dr. David uh sure founded before

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medicine and as a matter of fact will work closely with dr. uh sure because several of the Alliance member employers are utilizing his services he reformed medicine is a low overhead family medical and medical weight loss practice that is affordable to employers and consumers alike working under a purely private medical model doctor uh sure can innovate and offer to patients and employers creative affordable solutions that large health systems are slower to

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adopt in his former life dr. Asher was a family doctor at the Mayo Clinic in Eau Claire and he served as the medical director of weight management services and chair of the Department of Family Practice at Mayo dr. Asher will discuss his background at Mayo and how this experience influenced him in 2011 to found a direct primary care practice that focuses on a quarter of our new primary care we work as I said very closely with dr. Usher and I would also like to note that there are several

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independent fiercely independent extraordinarily innovative services solutions providers in Wisconsin and the Alliance is proud and happy and looks forward to closely working with all independent providers so why not let me talk a little bit about why direct primary care I promise I will not speak a lot as we want to hear from our distinguished guests

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so um why direct primary care as you know the mission of the Alliance is to work on behalf of employers to negotiate better rates and higher quality with existing providers but we're all beholden to primary care as is delivered by the existing health care system and that means means a rigid appointments limited options and as we all have experienced multiple tests and other treatments outside of the primary

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care setting but direct primary care is different it is different because DPC's delivered outside the traditional health systems which means that providers have different incentives instead of aiming to generate more specialty care more tests more specialists and more visits DPC and we also by the way often refer to DBC as advanced primary care or high-value primary care exists to generate better health for employed employees and affordability for the

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employers who sponsor their health benefits so for these reasons and also for all the reasons we will discuss today the alliance of chosen direct to employers primary care as a strategic focus for 2020 and beyond in collaboration with practive MD were opening a new Community Health Center in Hungary in the fall of 2020 either September or October of this year we already have a number of interested employers and we'll be using this this is a shared sight clinic so no one

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employer has to go at it alone we look forward to sharing more details with you in the future but if you have interest in participating please reach out to me we hope that dr. Patel and dr. Oscar can talk through but why they decided to offer this service and on June 25th we will hear from a panel of our employers talking about how they're offering direct primary care and what it means to their business and their employees so without further ado dr. Patel I am gonna turn this presentation over to you and

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Paul turn it over to dr. K yours dr. patel's control there we go fantastic first of all milena I really appreciate the opportunity to speak to the group and deliver the message what I wanted to set there share with you is this is a a major automotive manufacturer that makes these cars and the supplied has been delayed by about three or four months because of the current events due

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to the delay in the supply event they were not able to deliver this specific fiber glass that they use for the body of this vehicle so they had to look at options of shutting down the entire plant 3,000 employees will be laid off these 3,000 men and women would line up for unemployment all tomorrow morning it put a burden to the entire nation these 3,000 men and women will have to think twice what they were put on the table

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for their kids tonight for dinner and so it's all because of the supply chain it's all because of the current events now their rival competitor uses the same alloy material the fiberglass and they actually have 50,000 extra sheets that they can essentially lend out so you would think logically what would happen is these two CEOs would get together on

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a phone call and say hey we got a shutout plate down you have material kill me borrow that sell it maybe make a little profit off it whatever they do you can actually sustain the other company but that's not how it's gonna work right this rival is going to figure out how to take a baseball bat and chop the other guy in the knees with both kneecaps at the same time this is how the market is today but most of the

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manufacturing market space let's flip this round I have a patient in the ICU a hospital that is has a very specific poisoning it needs this specific antidote to PA em and this hospital in the ICU doesn't have a two vials but we actually need about ten we're short at least eight or ten vials so the next logical thing the pharmacist will do up collar on and find out

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has to PA oh the antidote they've identified a hospital 30 minutes away on the south end of the town so now you got to pharmacist they've identified that they can deliver this medicine instead of the hospital a saying hey I'm gonna send my security guy to pick it up guess what the south end Haas was gonna say stop I wouldn't send my guy to you because he'll save me 30 minute commute time now these two pharmacists didn't

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have to call their CEOs did have to call the directors it was just the right thing to do it truly delivers the right care I mean it's innate it's the basic instinct that's what you would do because you are dealing with another product here and we need health care so overall you know when you look at the health care today I know we have a lot of sort of things to fix and gaps in care but overall the heart is there but it's the problem is how are we

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delivering it it makes it so difficult to Delors certain things is why we delay in some of our care so we have a good group melina today in this audience what if we took the entire audience and divided into six separate different areas or seven different groups and I said I want to build this car I want the fastest the most efficient and safest vehicle on the planet and we divide the room into six and we have unlimited money unlimited budget and I sell Group

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a go find the best brakes money can buy Group B go find the best transmission money and buy in Group C etcetera exert get the best of the best products that the industry has to offer so we get the best of everything then we bring it back into the central office and say let's get the top-notch hundred best mechanics in the world again money is not an option it's unlimited money so you would

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get the best mechanics money can buy you got the best money can buy now I ask you the group you can even put it in the chat line how long will it take to build this car six months one year two years five years how long do you think it'll take the best mechanics the best parts all in one warehouse you just got to put it together and the answer to this is we could be here another 10 years my lifetime and we will never have this car

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because no products talk to each other do you think the BMW is going to talk to the Porsche and the Porsche is gonna talk to GM and GM is going to talk to Chrysler it'll never happen they are not going to talk so it's not that we don't have the best ingredients it's not that we don't have a recipe it's just how to package it and deliver it reaches can't do it because there's no communications nothing talks doesn't healthcare today feel like this healthcare today think

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about it we have the best surgeons the best Oh our best prosthesis the best medications antibiotics cancer medicine best of the best money can buy we have the best surgeons best internist best family Doc's money can buy yet we just can't deliver and so when you start looking at this you really realize that if we can make an impact in the delivery we can maybe make a big dent so our

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focus over the last 10 years has been how do we change the delivery I'm not here to invent the next drug I don't want to invent the next cat-scan machine that does 300 you know bites I just want to recraft the delivery if we can recap the delivery we can actually make an impact so I want to spend a few minutes and just build and look and view what the health care system looks like today so if you were to take all the services right the

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doctors and nurses and the health care system is delivering and put it from left to right and the left being the most minimal care and the left the right being the most complex care so you can go from Wellness Urgent Care medications you know imaging specialty care hard cats and then going to Serge his ICUs and so forth so you going in a progression of complexity of care so that's the floor this is what healthcare is delivering then you have the

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consumers the patients now today's world patients can access care at any point they can go straight to a are they can go straight to the primary care doc they can't even go straight to the cardiologists get a cab tomorrow morning so they can go anywhere in the spectrum then on top is the payers right the TPA is the employers the pair and the consultants and so far you gotta stop cross on top so if you look at this house it's simple three pieces the

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provider of care the patients in the pair's all these three who's the most incentivized to put value in healthcare or look at value every time something's being deliver out of this three pieces the payers the consumers or the providers its the payers so I mean the consumers don't really care some insurance is paying for it they don't

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care it's just a copay and the providers have a system that doesn't incentivize them to make anyone healthy so it's really the payers are the only ones today that are interested in fixing the health system and that's why this conversation is to say how can you as the representation of the employers in the consultants of the employers fix help cut cost and put value back into healthcare but the problem with today is

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we have this sort of broken system on top of that on the bottom we put a broken electronic medical system so you put an electronic medical record system in there and guess what no one's talking the CT guy doesn't talk to the lab lab guy doesn't talk to the cardiologist cardiologist doesn't talk to the internist nothing is talking and in my lifetime it will not talk we've been talking about this for the last 10 15 years that there's gonna be a uniform one electronic medical record it is not happening it will not

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happen so you have this electronic Marburger is a foundation in a semi broken system that now you made the entire system dysfunctional and that's why our cost is high because there's replication of data replication of test replication of information and we were just having an excessive cost so as a solution and everyone on this meaning is aware that we can really unlock the

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existing model and break it apart a little bit and reglue it in the right place we can create a version 1.0 direct primary care and what I mean by that is we would take what's on the bottom the basics the Wellness the urgent care the medication dispensing take some of those basic principles or services and move it to the right side of the pillar and by doing that what we're doing we're moving to the right

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side it's one block at a time in allowing that Health Center or the clinic version 1.0 deliver that part of the care directly to the patients and it's an evolution that's what we've seen you know we've seen the first evolution of the direct primary care and now the second evolution is evolving and by just doing this version 1.0 there's about a seven eight 10% depends on what the stats you have a reduction in that overall health care spent by that

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particular employer so let's say you go to the version 2.0 it's simple all we are doing is taking what we can manage from the bottom move those bricks to the right-hand side one by one whatever we can manage what everyone can chew whatever we can master so what if we took now may the primary care consistent same primary care not like an urgent care where you have different doctor every day but the same primary care then you have more involvement you have more

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chronic disease management so you're moving these bricks from the bottom to the right and as you do guess what happens to the savings it goes up so we're essentially that a goal is to say one by one piece by piece what can we move and we can't move it all but we can make a big impact so if we were to just simply go to this version 2.0 you can easily say 15 18 percent on the total healthcare spent

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let's look at version 3.0 so what do we mean by that again take the blocks for the bottom of move along what if we were to take some of the consulting specialties we were to negotiate imaging some of these other areas where we're not touching if we can manage that we can increase the savings and do the right thing and maintain quality so when we started looking at this and said okay are we know who's doing this right I mean sorry I Google this about eight

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years ago and there were very few employers that were doing something creative but this is a recent data that I was able to pull up last week 2018 top 10 employers in the country here they are top 10 what do you think they have in common we think these 10 guys have in common this green illustrates that these folks these companies who represent the top 10 employers in the country have a centres

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of excellent identified that means they actually looked at and said here's our surgery here's our cost how can we get value for our dollar and maintain quality so they developed centers of excellence and if you recall Walmart was leading the pack October 2012 they publicly announced to all of their employees that if you are going to have these five major surgeries that you will get it done in our specialty areas by choice and if you move the traffic there

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that they'll eliminate the copay so it was incentivizing the employees to shift to the centers of excellence and soon later next year Lowe's and PepsiCo and frito-lay they all followed suit and Walmart pretty much let the pack in 2012 what did they do what did Walmart say they understand the entire complexity of health care so what they said is that we have X number of let's say knee surgeries hundred researchers so they

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said how can I take my hundred knee surgeries up give it up to the best highly qualified surgeon and get a price break so I'm putting value in quality and they were looking at surges five major surgeries what I suggest is they started there because they could in a global in a 50000 view when you sit with executives they're looking and saying what do we do at an executive level to make an impact on the health care cost that would be it but we as a employer group for smaller employers need not

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look at that we need to look at it and say look we need to make sure that the hundred knee surgeries that were supposed to be done could it be only 80 if we do the right primary care right specialty right imaging and directed them appropriately maybe those hundred knee surges actually could have been just eighty and if that's the case that we at least can say that we didn't even need to do twenty surgeons it could have been managed conservatively so we need to look at it and pin it from both ends we need to be

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able to go from the lowest complexity and it kind of meet somewhere in between so when you go out into the it you know the environment and looking at options for your employer's what are you looking for my suggestion maybe these are the few things that you can keep on your checklist or like shopping checklist so to speak what are you speaking to some of the folks that you want to partner with first thing is in my mind we you

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have to develop a quarterback for your system so if I were to ask you who's gotten the highest IQ in a football team who would it be the quarterback average IQ of a quarterbacks about 145 IQ this guy the quarterback knows where each one of the team players are who's gonna catch his ball who's left-handed who's right-handed whose wrist is hurting who is ankylosaurus now on a

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game today he knows where to throw that ball and this is the same analogy I'm using for our specialty care the quarterback has to be the family doc who has the ability to navigate all the specialty care and know where the patient is gonna be pinned and as soon as the specialty care sees a patient it needs to be pinned back to the primary care to reprocess what the next move is gonna be so unless you have the right

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clinician in the center it's not gonna work out because you the key thing is not just to see a patient for flu and cold a coffin UTI is to say how can we manage the referral center how can you manage the specialty center how can we manage the data that comes back who do we send the patient to that's the quarterback unless you identified that key person in the health center it's not gonna go anywhere so the next thing is whenever you set up the

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like the workflow and see how many patients you have and the volume and what the model should look like it becomes easy to get into this loop of saying let's see five patients an hour because it'll cut cost but the key thing is more time you spend with the patient take medicine fifty years back more time you spend with the patient and more you're gonna find issues that you can resolve and the least expensive care is a primary care so the more time you give

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to the primary care and the patient the better off you are because you're gonna decrease some of the specialty referral patterns and so think about it why is a quarterback the smartest guy on the team of course he's IQs 145 that gives him a advantage why else he's in the locker room spending time with other team players he knows everything about the team player who's not on their game this is exactly what I'm driving at if the physician and the patients spend time more time the better to believe because

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they'll understand what the next plan will be so going back to saying how do you put value into the health equation and you know in a simple CFO's mind it's like if I were to buy this suit and it's fifty dollars I got it from TJ Maxx you know I'm gonna say wow this is 50 bucks good quality cost is $50 there by the suit what if this was a $2,000 suit all these great feels good but $2,000 you're

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not getting value on that so you know it's the fullness quality of a cost but in health care it's not this is not the formula in health care this is a CFO's formula in the normal marketplace in health care if your cardiologist is amazing guy good quality normal cost good value but on two o'clock in the afternoon on Sunday if that cardiologist is not going to take care of you then what you get you no access to cardiologist at 2:00 and afternoon on Sunday you got zero value

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so unless you have access to care you you will not get the value need yet one more step forward we need to look at is who's offering you outcomes who's measuring outcomes that's gonna add value and this is what I'm driving at is the version direct primary care version 1 version 2 version 3 whatever whatever methodology you want to use is that we're adding more parameters to measure more parameters to be accountable for so if you are getting

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outcomes measured and someone actually came to you and said we will measure outcomes and you will pay on outcomes then you have just increased the value there's more skin in the game then centers are there and it's very practical if you think about it so I'm gonna end with this if I were to ask the group what is the leading 3rd leading cause of death in United States it's not cancer it's not breast cancer it's not the cardiovascular disease it's not COPD

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and smoking it happens to be healthcare related medical errors it's 2.5 jumbo jet 747 fully loaded crashing into the Atlantic every night that's the number of deaths are occurring directly related with medical errors there's gaps in care gaps in the air we have to have zero tolerance for errors and it's unfortunate it's not even possible for

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30 years so it's no longer used it's unfortunate that our patients our public gets their news from CNN because it's not news it doesn't hit CNN it's 30 years old damage the same it hasn't changed a bit so there's a lot of room for improvement in every facet we can make an impact this group can make an impact you can make an impact in the employer market that you serve in the way you can change

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the health care Thank You dr. Patel thank you very much we already have several questions that have come in but we will address them at the end dr. Ashur I would like to turn it over to you now sir and you have the next 20 minutes I had had a ton of experience and kind of leadership and understanding some of the things that went into running a clinical practice so in in primary care it's kind of a structural problem and that is that it pays a family doctor or a primary care

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physician more to see two short appointments than it does to spend one long appointment so we make more money if we see two 15-minute appointments than if they see one 30-minute appointment and that that's just going to incentivize people to work faster and see shorter appointments and so on so I always wanted to take more time with my patients so that was a bit of a problem for me but what happened was when the Affordable Care Act came along our

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patients already were complaining of not being able to pay their bills premiums were going to go up out-of-pocket costs were going to go up and so we decided to step out of standard primary care medicine and get into a direct pay model I say primary care providers are undervalued dr. Patel was mentioning that really primary care should be your quarterback and and we've and I'll thank him for the

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really high IQ reference although I don't know that that applies to me but your quarterback should really be the one who knows where the ball is at all times and knows what's coming up in the game and so forth but primary-care again because there of the reimbursement structure it's really hard for us to do that in the existing kind of fee-for-service model so primary care has kind of been bought up by the big clinics primary care is now used as a loss leader and a referral engine for

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referring people into bigger cost higher cost procedures that the clinic big this multi specialty clinics and hospitals would make more money on now and then the patient even if they have good insurance this year's charges becomes next year's premiums as you all know so every time this just escalates the cost of things to the patient and basically everybody involved this this slide maybe you've seen something like this these are from the Kaiser Family Foundation

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but basically you can kind of see the graph on the left over 20 years overall premium costs have risen three hundred and forty percent or seventeen percent a year in this survey and if you look at the employee contribution that's that's gone from twenty four seven percent to twenty eight percent so the employee have seen basically a 360 percent rise over that same 20 years so employers paying employees are paying more and more and more now if you look at the

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graph on the right basically you can see how much the deductibles or the amount of money that the individuals on the hook for even though they have insurance has gone up over eight times what their wages are earnings of Ghana effectively what you're seeing is people individuals knowing that cost of everything is going up and that they are on the hook for more people just sit at home and delay care or avoid chronic disease care because they know the cost

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is so terrible and I was seeing this a lot in the big system what you so what you have that some of those insurance but effectively they're medically homeless because they won't come home and see their primary care doctor they'll just sit and wait until things become really bad know that urgent care or emergency room so we decided our why excuse me why do we want to do what we're doing we think that better health

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care really starts with better primary care and dr. Patel mentioned we we like to think of it as high-value primary care high-value primary care starts with more time with patients better access for patients to get to their providers this leads to a deeper kind of more trusting relationship with providers and that trust really is a huge key when we're recommending certain things and and so on patients want to go with

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somebody they trust one of the other things is that we get to spend more time addressing root causes of a lot of problems in our case we we do a lot of medical weight loss so we have kind of a treat weight first a strategy rather than kind of thinking overweight as a cosmetic problem we see it as a root cause to literally a couple hundred different medical problems so we treat that aggressively just like we would high blood pressure diabetes overall you see we refer much less because we have

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more time with our patients dr. Patel mentioned if you have more time you can get to the root cause and address that more readily in primary care it's more affordable to patients and it yields a better work style and a better lifestyle for providers certainly and drink I make a direct pay model allows for all of that one of the things that a direct pay model though you can see whether you're a benefits broker consultant or advisor

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or an employer is the direct pay models can be a little disruptive to be sure so what we created back in 2011 started with a combination of primary care obesity care more time more access more affordability and and it was better our patients loved it one of the things just a side note obesity is right up there among the top killers about 300,000

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deaths can be attributed to obesity every year 42% of the population has obesity and another 30% are overweight or pre-owned ease so you really have to have an aggressive effective strategy for obesity and my humble opinion to be doing real good primary care Hey in any case at around 2013 a couple of years and my first employer came to us and we had some conversations about working with membership model to do some near

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site and on-site clinic work for them and thus we kind of started down that road as well basically this whole foundation was built on the idea that we did not want to get into the tail chasing problem of building third-party payers for a fee-for-service basis so we've avoided that for all nine years of our existence just to give you a sense of the cost difference this is our fee-for-service signs as you can see down the right the far right side those

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are most of these are pretty one-to-one kind of comparisons but I just want to give you a sense of the differential and cost compared to a lot of the big clinics here in town so what we started doing is working with employers and what we've learned over the years is basically you want to create a partnership we think of the patient's financial health as being as important to their overall health as their physical well-being and their psychological well-being not doing well financially if they're struggling that's going to lead to all

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kinds of potential health problems stress and alcohol and relationship issues and so forth and likewise employers have the same and an analogous sense if the employers not doing well financially they're they're not going to be able to grow they're gonna have to lay people off that are benefits they might not be able to offer and so so we see the employer in this case kind of like we see our patients us like this financial health thing is very important so we partner with the patient

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and the employer to try to be rolling get them get us all rolling in the same direction so that we wind up with healthier employers in a better financial situation also healthier workforce for the employers so some of the things we do with our employers is initially you just get in there with them and roll up our sleeves and try to understand their health plan goals and strategy we use high-value primary care

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as a base we do it either in a mere site model with our own clinics or if the employer wants to do an on-site clinic we can set one of those up as well and just work right out of their space again we this is all based on trusting relationships with patients anything the employer wants to do if if it doesn't come through a trusted primary care doctor that may be perceived as just trying to cut costs if it makes really good sense and it's really great care and you're your quarterback is is out

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there true leading for those things then the patients will be more likely to understand that we referral through the providers network I don't have all of our providers are trained to work very specifically with each employers plan so that we're sending them to places that are going to be the best value for the patient and the employer and then there's dr. L mentioned there's at the end of the day you want to be able to talk about what you're doing well and so we report data back to the employers

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sometimes through their TPAs for return on investment and value of investment kinda determinations so this is kind of where we've done we started in 2011 but just me and my medical assistant over there on the left over nine years we've become two people two twenty two people and we have went from zero employer clients to eleven and we're in four locations now including one on-site clinic this is from our on-site clinic they kind of publish this data where it says the part of our

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overall strategy we are they started changing their strategy before they brought us on you can see they already kind of bent their cost curve significantly even after adding us and that first year their costs went down so they're sitting on a whole different trajectory now there's a seven million dollar differential between what they might have been paying if they'd have stayed on the same trajectory versus what they're doing now with our on-site clinic as part of their strategy so how the patients like this well as dr. Patel mentioned this is a pretty popular way

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to go and you have more time with your patients and can really not only see patients but actually hear them that will get you a pretty high level Net Promoter Score these are true true things from people that have people have said about us but we survey our patients and 99% of them would would recommend what we do to others so it's really it's a popular it's a very great way for patients to be seen the Cova 19 response everybody's got one we have done the

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spacing and done a lot of Eve is 'its I don't want to read this whole list to you but bottom line is we checked in with employers frequently talk to them about testing antibody testing and virus testing and so on some unexpected outgrowth of this something we weren't thinking about top of mind is to be able to do more telemedicine including their medical weight loss program so it hasn't been all bad and the cogut 19 side of things but we've learned to adjust so

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many half in summary basically primary care should be viewed differently from the rest of the more expensive healthcare in that it's something you want your patients to use you want your people to be well just like you want to change your oil and have a good set of tires on your car you expect to spend that money and you budget for it primary care is something you want to be utilized you want to do preventive care if you have chronic illness you want that well controlled and then the insurance is for that other

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high-cost stuff that comes along and so you to get different outcomes from primary care you kind of have to pay for it differently so direct primary care is is Right perfectly situated to be that that new model because there really is no substitute for time building trust takes time I would make my own little plug for making sure that people are thinking about the obesity pandemic it truly truly as a as a disaster in this

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country so whoever you're talking with make sure they're they've got a good effective approach for managing obesity and then I just pitched in here that dr. Patel mentioned this the incentivizing use of your thigh right here program is really important okay Melina that's all I got yes and so thank you doctors very much we do have several questions in about ten minutes to answer

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some of those so let me start with the hotel either of you actually either doctor before uh sure mark is asking we're building a clinic in conjunction with a few other area employers and we're in a rural area can a DBC staffing work with a nurse practitioner or physician assistant as lead at the clinic dr. Patel um yes nurse practitioners in pas the again I think the key thing is what level of

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services are we trying to provide for most part nurse practitioners a PhD nominal job it's really navigating the care for the community for the specialty in your town and of course the resources sometimes it's hard to recruit our number one problem right now just getting the recruit in and moving into the area where you need help so we have many practices that do run on nurse practitioners and pas today is thank you dr. usher same question big

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lesson for now yeah no I would agree I we have among our providers are just have fantastic nurse practitioners PA staff who I really trust implicitly it's I agree with dr. Patel it's really a strategy issue from the standpoint of the employer and what it is they're trying to achieve as to how much they want to put into position versus and B versus PA there's just some cost differential

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there and recruiting is top recruiting is tough not everybody sees us as the quarterbacks thank you um something a question that I actually have there's several more questions but I have a question because we talked about both models the proximity model and doctor uh sure reform medicine handling more than primary care and I will talk to Ben about obesity but I handle I analyze I'm one of the people that look at employers

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data and we know that behavioral health and musculoskeletal issues are a very big ticket item and often not only expensive for our employers but often difficult to receive care such as behavioral health could you talk a little bit about that about other services that your clinic offers doctor uh sure I'll start with you and then move on to dr. Patel sure we have contracted with licensed professional counselors to see patients within our

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office space on a pre-business pre-coated of course since since then we've learned that gosh patients really kind of like that via telehealth so that same counseling a group has been providing telehealth services for our folks in the counseling realm so the patient doesn't even need to come in to our office so that that has going pretty well we have not power cells contracted directly with any kind

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of physical therapy or chiropractic those kinds of things some of our employers have contracted directly with them and have PT on-site for example and I do think that's a really valuable service so that's what I would say about that thank you dr. Patel yes the musculoskeletal and the physical therapy we all of our clinicians are trained in that direction number one number two we have one of our health centers right now

45:28

that is having a full time 40 hour on physical therapists on-site in conjunction with the clinician so essentially that relation of employees have access to a collection and a physical therapist and we've deployed that about eight nine months and we're looking at replicating this similar model in other areas others based on size volume in the knee and looking at even options of doing the smaller

46:01

population that telehealth would be another option of getting even though it's physical therapy we could do in as far as behavioral health and like David said it's very driven especially under health and we're actually looking to recruit folks and MD to help negate original first sight and then multiply it across our centers Thank You doctors another question by Nicole is Drew

46:33

clinics staffed by physicians people I will take part of that question I assume you're asking the Alliance if the Alliance clinic is stopped staffed by physicians because clearly before medicine doctor uh sure is a family practice physician or still is and you know will be of course um and so the answer is yes per octave MD has and the Alliance have made the commitment to bring in a physician to staff the first

47:05

clinic that we're going to be offering but going back to what dr. Patel and dr. Osler said we it's a strategic decision and we absolutely believe in the middle level provider offering services the nurse practitioner and the physician assistant as leads at clinics because this is first where the Alliance will will be will we'll have staffing by a physician okay you or do you have something to add to that

47:36

since rapport medicine is making that commitment no I agree I think that's in line what we're saying thank you and Nicole if I didn't answer your question of property please write us and let us know another question by mark do most of your employers in DPC models cover only those in their plan or do they cover their entire employee population and is it making it free critical for maximizing utilization

48:05

that's a great question mark dr. Patel is again it's a reform a reform medicine and profitability have a unique model here so dr. Patel yeah but so it depends on employers so a lot of though but most of our employers allow their employees that are on the health plan and their dependents all to join the DPC model but there are very few employers I'll say only the

48:36

employees and not the dependents so again just if they based on within your needs are thank you and another question is and I know Tanya I know you're directing it to reform medicine I think it is appropriate for both the doctors if how do we offer MRIs and how do we recommend war patients go to receive MRIs David would you mind telling us

49:07

some of the strategies employers are using for that right so the if I can pick you back on that last question one thing I would say is because direct primary care is not insurance and players can put anybody on the plan or allow anybody on the plan they want to involve again that dr. Patel mention that's just kind of employer dependent so you can have part-time employees and so forth on your plan if you wish what we do is again we look at what the

49:39

employers network is and usually they'll have a high value set of centers that they've designated as the lowest price the best deal for getting things like MRIs cat-scans specialty care and so forth so we always direct our patients to that resource person for their plan and they then can inquire of them what their options are and then the patient

50:11

lets us know last thing we want to do is send the patient somewhere out of network and and line them up in medical bankruptcy that's just not a very good wellness strategy for our patients so that's how we do it basically to make sure that the patient is interacting with their health plan and dr. Patel the same question for you I know the Alliance and proactive MD we're working to exchange data so that as the alliance controls cost data because we control the contracts you can have information

50:42

of the most and of course integrate with your quality metrics the high value you know how to send and word to send to high value specialists but same question to you so specifically you mention about the MRI or imaging and it also goes to the specialty services - so in we have 44 clinics total right now and each community is different so each community would need to kind of customized in that area to serve one of the resources how far do they have to travel to get the MRI and/or the specialty services and

51:16

each community will we will actually Kingdom database that says okay if you think I'm Iraheta or they can you get in who's making it and what the cost is so essentially we have a carer navigator a patient advocate roughly some of this for the patients of their now cost the system that's right yes'm we didn't talk about the patient advocate's but we will get a an opportunity at a further at a future webinar to talk about the patient advocates that come with a Recor

51:47

medicine with the brachot confusing the names but the drugs MMD model I have two questions here both regarding our X and so how do you approach to handling our X both potentially prepackaged medications but also our specialty drugs doctor uh sure with regard to prescriptions we are just inherently it's our nature to think use generics first of course we do dispense

52:21

some prescriptions out of the out of the office we're actually looking at painting that in future up the and often that just dispensing them out of the office can even save more money than what occurs under the PBM for example a pharmacy benefits manager so and that's really convenient for the patient particularly if they're not feeling well you can get them there antibiotics and so forth they don't have to go stand in

52:52

line at the pharmacy or high blood pressure drugs or diabetes drugs people if they can just send them with people it's a very nice option as far as specialty care drugs we are working the same thing occurs with basically the approach to how you get the MRI done you kind of put people back and touch with their health plan work with them as much as we can understand whether or not they actually need the medication that's one of the things that we don't really

53:24

we're not the specialists so we but we do want to talk with the patient and see what the specialist is saying about their medications to make sure that this is really the best thing for them at the time and so we'll kind of review that with them but we will refer people to patient assistance program sometimes or a variety of things that maybe help take some of the costs out but there's as far as specialty care drug we don't have a lot of direct control over that dr. Patel I see my clock it tells me to

53:55

follow one and I have tons of questions by the way folks on the webinar I would completely understand if you need to drop off we will answer these questions in collaboration with the two doctors and send to you but dr. Patel I can't help myself there is more and more questions I like to address to you and the question is how do you capture avoidance of needing a surgery by improving primary care and this comes to us from Dan who is actually pains actually a client of

54:26

Proactive MD currently so it's dumb when we say surgery let's take orthopedic surgery musculoskeletal spent if the patient comes to us the primary care and we navigate their care and we manage the imaging imaging back tools and navigated through the system we're not saying that they don't need to avoid surgery we're saying that could there be other options that are more viable like

54:57

physical therapy and that's why we have a physical therapist on-site and the idea behind it is to say if you can care for the patient early keep them moving the joint morning and not actually put a needle in there yet if it needs to so be it who we would spend time gradually in what usually longtime Subin patients will come in I have knee pain I won't blame REI a needle I want surgery but there's this wind of the opportunity that we're missing and if we can capture that you'd be surprised

55:27

really surgeries we can going all together and statistics are astonished especially for the Muslim world on how many surgeries can be avoided if we follow a pattern and so we're really what we're saying is we want to navigate with care in the community once they go along the curve I'm getting a x-ray MRI and immediately the next thing is just hope then it's just down that path fantastic and with not worse three minutes of our doctors thank you so very

56:00

much for your time we hope to see everyone again June 23rd for everyone on the webinar all all of those of you who I've seen and I cannot see thank you for the privilege of your time hey thank you thanks Bob all right thanks everyone see you

Direct Primary Care Webinar - Part 1 - June 8th 2020

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