Plum Health Blog
Direct Primary Care Doctor in Detroit with Concierge Service
Direct Primary Care Doctor in Detroit with Concierge Service
Over the weekend, I made a house call to Ford Field.
Most of our house calls are to help regular Detroiters with the type of affordable and accessible health care services that we are known for at Plum Health.
If you don’t know about our direct primary care service, we offer excellent medical services at a monthly membership. We have an in-house pharmacy and we dispense medications, we offer a wide variety of procedures (biopsies, pap smears, toe nail removal, BOTOX), and we are able to draw labs and have the lab results back for our patients next day.
Most people use our Plum Health service because we can cut out the middle man and deliver a seamless primary care experience for an affordable price.
Every once in a while, we help a visiting executive, athlete, artist, or performer who needs our medical care and attention.
We have taken care of CEOs who require PCR testing with a rapid turnaround, we have taken care of artists who are visiting and who need help before an important gallery opening, and we’ve taken care of performers who need treatment before their big show here in Detroit.
These VIPs use our Plum Health service because we have the time in our schedule to accommodate their needs, we bring our medical care to them, and we give them a seamless experience without hassles. They might call it concierge medicine, but we prefer Direct Primary Care!
Happy Thanksgiving and thank you for considering Plum Health DPC for your health care needs!
-Dr. Paul Thomas with Plum Health DPC
Dr. Paul Thomas Talks Direct Primary Care on the Powers Report Podcast
This week, Dr. Paul Thomas was featured on the Powers Report Podcast. In the podcast Dr. Thomas and Janis Powers talk about the pros and cons of Direct Primary Care.
Janis Powers talks in depth with one of direct primary care’s (DPC) most committed practitioners, Dr. Paul Thomas of Plum Health DPC. In this episode, Dr. Thomas gives some great examples of the benefits of DPC, describing his in-depth relationships with patients. Powers also probes some of the challenges of scaling DPC, given the exclusivity of both insurance and provider networks in America.
In our opinion, Direct Primary Care solves so many challenges in the primary care system. Direct primary care addresses long wait times to see the doctor and the inflated cost of care.
Direct primary care is different than concierge medicine. Direct primary care is a monthly membership for health care and it usually costs about $50 to $89 monthly. With DPC, patients are not required to carry insurance, although most members have some form of insurance coverage. Concierge Medicine is billed annually and usually costs $2,400 per year. Concierge doctors require a premium health insurance coverage to expedite referrals and minimize prior authorization requests. In the past, our blog has covered this in depth, here.
In the podcast, we discuss how we’re able to save our patients 50% to 90% on medications, lab work, and imaging services. We buy medications at wholesale and pass on the cost savings to our patients, we draw blood at cost and pass on the savings to our patients, and we have found local imaging centers with very affordable cash-pay rates for services. This cost savings can make a big impact on folks with a limited income and limited access to high quality health care resources. We were recently featured on Channel 7 Action News about how we save money on prescription meds.
Thanks for reading and listening, and have a great day,
-Dr. Paul Thomas with Plum Health DPC
Direct Primary Care versus Concierge Medicine
The phrases Direct Primary Care and Concierge Medicine are sometimes used interchangeably, but they are distinct entities.
The Concierge Medicine movement began around the year 2000 with doctors charging an access fee for their services while still billing insurance companies. The average membership cost for Concierge Medicine is roughly $2,000/year and up to $15,000/year.
Contrast that with Direct Primary Care or DPC. The DPC movement began around 2010 with doctors like Garrison Bliss in Seattle and Josh Umbehr in Wichita among others. Memberships cost roughly $10 - $100/month. There is an emphasis in DPC on a monthly membership structure - members are not locked in for a 1 year commitment.
In Concierge Medicine, the membership costs allows for access. Because the membership cost is relatively high, these types of practices attract the top 1% - 5% income earners. These high income earners are relatively price insensitive, so they are not as concerned about saving money on medications, labs or imaging. These patients are willing to pay for these ancillary services via their insurance even though the price may be inflated.
In Direct Primary Care, the membership includes more services. DPC doctors typically don't charge per visit fees and they try to move away from fee-for-service type transactions. Many ancillary services are included in DPC memberships, like EKGs, Spirometry, Wart Removal, etc... In addition, DPC docs get their patients wholesale medications, at-cost labs, and at-cost imaging services.
Concierge Medicine clinics attract members via programs like "Executive Physicals" or "Executive Health". These are tailored to high-income earners like people in the "C-Suite", aka CEOs, COOs, an CFOs.
Direct Primary Care doctors focus on health maintenance, wellness, and the bread and butter primary care services like preventive health, screening tests, chronic disease management, and acute care needs.
Concierge Medicine practices often mandate that you carry a high-end insurance policy - these practices often bill their patients' insurance companies for routine visits or services.
Direct Primary Care doctors do not bill insurance companies for the services they provide. That means that DPC doctors can take care of patients across a wide spectrum of coverage. For example, if you are uninsured, underinsured, or fully insured, you can be seen at Plum Health DPC. This is true for most DPC clinics.
I put together a short video to emphasize some of these differences. The audio got a little out of sync near the end, so I'm sorry about that! I'll try to re-shoot it later this week!
- Dr. Paul with Plum Health
One last thing, if you’re a Primary Care Doctor or Allied Health Professional that is looking to Start and Grow a Direct Primary Care practice, check out our sister site www.StartUpDPC.com. You’ll find more information and in-depth courses on building the Direct Primary Care practice of your dreams.
How Many Direct Primary Care Practices in Michigan?
The number of Direct Primary Care doctors in Michigan is difficulty to quantify. A reasonable place to start is with a definition of what Direct Primary Care is and is not. Philip Eskew is both a lawyer and a DPC physician over at DPC Frontier, and he sets forth a good criteria:
FOR THE PRACTICE TO QUALIFY AS A DIRECT PRIMARY CARE, IT MUST:
1) CHARGE A PERIODIC FEE
2) NOT BILL ANY THIRD PARTIES ON A FEE-FOR-SERVICE BASIS, AND
3) ANY PER VISIT CHARGE MUST BE LESS THAN THE MONTHLY EQUIVALENT OF THE PERIODIC FEE
I wanted to apply this definition to the State of Michigan, my home state, to see how many "DPC" practices meet this criteria. As far as pure Direct Primary Care offerings open to the public, there are two: Chad Savage, MD with YourChoice in Brighton and Plum Health DPC in Detroit.
There are other Hybrid DPC offerings within clinics that also bill third party insurance companies: Dr. Younes in Dearborn, Dr. Tindle in Grand Blanc, and Dr. Kevin Roy in Saginaw. I take issue with the Hybrid practices, because you lose the accessibility piece that makes DPC such a great delivery model - these doctors are still seeing a significant number of insurance-based patients and offering DPC to a subset of patients. So if a DPC patient needs to be seen, they "jump the line" and are seen ahead of the insurance-based patients. This is less than ideal.
Premier Private Physicians offers what I would define as Concierge Care or Concierge Medicine. The membership is $200/month or $2400 for the year and some labs and vaccines are billed to insurance companies. Visits are included, but they do not have contracts for at-cost meds, labs, or imaging because their patients are typically high income earners/wealthier people who are not as cost sensitive.
The other category of "DPC" in the State is employer-based DPC. Some large employer groups like United Shore have contracted with a "DPC" provider like SALTA or ProactiveMD to have on-site doctors to care for their employees. These practices are not open to the public and people who are not employees at these companies cannot access these services.
Because the access to care is limited, this operates more like a third party structure as the large company finds that it saves money to pay a capitated rate for each employee to an on-site doctor, rather than the patient using their employer-provided insurance to seek out urgent care or emergency services. Unfortunately, employees may start to use the "DPC" doctor more for urgent care type visits and less for primary care, chronic care, or preventive services.
If you wanted to include all of the above practices in the definition of DPC, there are roughly 8 "DPC" providers in the State of Michigan. My argument is that there are only 2 "pure" or authentic DPC practices in the State of Michigan. Sincerely, I would love to see more doctors taking the plunge into authentic DPC medicine, and am here to inspire, encourage, and consult other doctors to do just that.
If you want to add to the conversation or debate, please send me a message or write a comment below!
Thanks for your time,
- Dr. Paul with Plum Health DPC
Vaccine Finder
Recently, I wrote a blog post about getting your flu shot! #GetYourFluShot And when I was reading articles on the CDC website, I came across Vaccine Finder. Vaccine Finder is a nifty online resource that allows you to enter your zip code to find the nearest clinic or pharmacy that dispenses vaccines.
It lists the basics like the address, phone, hours of operation and website. In addition, as the clinic or pharmacy owner, you can enter in the price of the vaccines that you dispense. As a Direct Primary Care clinic with transparent pricing, we did just that! You can see that our Influenza Vaccine costs $10.53, our Hepatitis A vaccine costs $68.42, and our TDaP vaccine costs $47.47.
Another cool feature is that you can use the website to hail an Uber to get you to the vaccine dispensing location!
FYI, we're in Corktown/Southwest Detroit, and if you enter in our zip code (48216), we will be the #1 result!
Thanks for reading, and have a wonderful day, and #GetYourFluShot,
- Paul Thomas, MD
Plum Health + Vitamin D
Vitamin D deficiency can be a big problem in the winter months, especially if you live up in Michigan! At Plum Health, we delivery direct primary care services, meaning that we can get you wholesale medications and at-cost laboratory services, including Vitamin D Levels and Vitamin D supplements.
You should have a vitamin D level of 20 - 50 ng/mL - some experts in the field recommend 20 - 40 ng/mL as the appropriate range, others recommend 30 - 50 ng/mL as the best range. However, experts agree that a Vitamin D level of less than 20 ng/mL can lead to problems with skeletal health.
Having a sub-optimal vitamin D level can lead to osteoporosis, an increased risk of falls and possible fractures. Additionally, having a low vitamin D level can put you at risk for immune problems and cardiovascular problems.
We make vitamin D in our skin, and this production is aided by sunlight. The American Academy of Family Physicians (AAFP) noted that "humans typically obtain 90 percent of vitamin D from sunlight". Unfortunately, because of low sunlight levels in the winter, our Vitamin D production ceases in temperate areas like Detroit, Edmonton, and Boston.
Furthermore, you are at an increased risk of having low vitamin D levels if you are sedentary, if you have dark skin, if you are obese, if you are over 65 years of age, or if you take medications that alter Vitamin D metabolism, like steroids or seizure medications.
So, unless you are a young, active snowbird, it is wise to take a vitamin D supplement to offset your lost productivity in the winter months. According to the AAFP, a 3.5 ounce piece of fresh, wild-caught salmon has roughly 600 - 1,000 international units of vitamin D. Other sources of dietary vitamin D include tuna with 230 IU's for every 3.6 ounces consumed and milk at 100 IU's for every 8 ounces consumed.
If you'd rather get your vitamin D in pill form, Vitamin D3 or cholecalciferol comes in doses of 400, 800, 1,000 or 2,000 IU's. These can be purchased over the counter, but it is best to talk to your primary care doctor before deciding on which dose is appropriate for you.
Thanks for reading and have a great day!
Paul Thomas, MD, Family Medicine doctor in Detroit, Michigan