Direct Primary Care: Niche Marketing for a Small Practice

OK, you read about my listing with the Physician Hospital Alliance that we are taking patients without insurance (or are willing not to use their insurance in our practice).  We got about six calls in three weeks, half of which were insured and wanted to use it in our practice.  DPC is sometimes hard for people to understand when they're used to the traditional medical insurance that includes family physicians.

Remember, we have about two hundred total patient slots to use for enrolling DPC families.  We're a two physician, independent practice.

Next we'll market to a health food store where a lot of their customers are less prone to go to physicians for minor problems.  The clerk at the cash register understood DPC instantly.  "I just have medical insurance for hospitalization and disasters requiring emergency care," she noted.  "Your membership practice sounds like a great idea.  Can you give us some of your cards?"

It's nice to be understood.  We have the only practice in our city accepting uninsured patients, and they're not pouring in.  Because they don't know.  Yet.

We'll also market to the local urgent care, owned by the hospital system that we relate to.  Then we'll see where the callers learned of us.

Our strength/limitation is that we only take families (households) so we get 2 to 4 new patients per enrollment.  Costs for our subscription practice are $80 to enroll, $60 at the end of each month, and $20 per visit for adults.  Children pay less, seniors 65 and older pay more.  Patients also pay for labs that are sent out of the office and imaging.

After the health food store and the urgent care center, we'll market to one or two religious groups.  They may have uninsured or underinsured persons in need of medical care.

More later.

The Dr Synonymous Show Aug 27th, 2013

The Dr Synonymous Show August 28, 2013 on Blog Talk Radio.

In my weekly blog, tweet, medical literature review I mentioned and commented on the following:

JAMA Aug 28 edition, Vol. 310, Number 8 article on Changes in Health Care Spending and Quality for Medicare Beneficiaries Associated with a Commercial ACO Contract. Spending and Quality in ACO

Medical Mojave blogs Medical Mojave  about acute inability to connect with her physician in a moment of medical need.  Fat Head posts a review about a helpful book about cholesterol. Cholesterol Clarity

Dr Howard Brody posts about Overdiagnosis and Overtreatment Hooked: Ethics, Medicine and Pharma, as does Dr Kenny Lin in Common Sense Family Doctor and the above JAMA Overdiagnosis and Overtreatment in Cancer  has an opinion piece on the same topic with a recommendation to the National Cancer Institute.  This issue will be heating up a lot.

Dr Lin also mentions his book in progress, Conservative Medicine and his perspective on the need for passion and outrage in medicine. Common Sense Family Doctor

On Twitter, several chats were in progress including #CHSOCM, #HCLDR, #EOLCHAT

Dr Synonymous post reviewed is about "Direct Primary Care:  You're Worth It" DPC You're Worth Itl
I end with a comment about the upcoming Direct Primary Care National Summit

Direct Primary Care: You're Worth It!

I often advise patients in my Family Medicine office to get a massage.  "Is it covered by my insurance?" they ask.  "No, but you're worth it," is my reply as I point at them with two index fingers.

Healthcare is shifting, "transforming" and becoming way too expensive while also moving ahead on the insensitivity scale.  What happened to "Hi Tech, Hi Touch?"

What happened to your doctor?  Did the Electronic Medical Record (EMR) steal your doctor away from you?  Was your doctor sucked into a billing cartel by a large corporate (possibly even "not for profit") member of the Medical Industrial Complex formerly thought of as a hospital?

If you want your doctor back, get them into Direct Primary Care.  It is a way to refresh your relationship with them while freeing them from onerous mounds of paper work and misguided quality initiatives driven by insurance companies.  Freedom might feel good for your doctor and for you.

Direct Primary Care is not insurance.  It is a way to have direct access to your doctor.  You pay them.*
"You're worth It!"

Your doctor and interested others can learn more at the Direct Primary Care National Summit in St. Louis at the Airport Marriott, October 11-12.

Direct Primary Care National Summit

*Many employers arrange to pay for Direct Primary Care for their employees.  They also should know, "You're Worth It!"

Direct Primary Care Summit: Bending the Cost Curve

Healthcare costs are (shamelessly) way beyond affordable by the average American Family.  How do we move toward financial reality in healthcare?

Direct Primary Care (DPC) is a good start.  It is a business model that allows patients to pay their Family Physician directly.  It allows employers to pay Family Physicians directly.  It saves money.

It may even allow governments to pay Family Physicians directly someday, but both the government and the insurance companies are failing as stewards of healthcare dollars and processes.

Hundreds of Family Physicians, averaging twenty years or more in practice, have now moved into Direct Primary Care practices and more are on the way.  The movement is seeing a crescendo of activity as the transformation of healthcare crushes physician morale and shows no potential for a course correction via an increased primary care workforce.

Direct Primary Care is affordable primary care for most families.  Getting Family Physicians out of insurance plans is a critical element.  Getting health care from someone not employed by "The Beast" (Medical Industrial Complex) is another good idea.

To further advance DPC, a Direct Primary Care Summit for primary care physicians, employers, health care providers, interested medical students and residents is coming to St. Louis October 11-12 at the Airport Marriott.  Speakers such as Garrison Bliss, MD and Dave Chase, leaders in DPC will deliver the nuts and bolts of DPC for both new and veteran DPC fans and practitioners.

 Direct Primary Care Summit

Family Medicine: The Man in the Closet

"My dad used to lock me in the closet for hours at a time.  He would let me out to abuse me.  It was horrible.  I felt so afraid and alone.  I didn't understand sexual abuse at the time, but I knew what he was doing to me was wrong."  A patient told me this story one day when I asked about her childhood.  She had a long list of diagnoses and medications and specialists and hospitalizations.  I wanted to hear the background that delivered such levels of medical interventions.

She continued, "I used to have out of body experiences, flying through the closet door and around the house.  I don't know how it happened, but it was real.  I eventually was able to do it while he was abusing me.  I told my mom about flying around and ended up in the psych ward in the hospital.  They said it was schizophrenia.
I got a lot of pills and hospitalizations.  My sister was abused, too.  She got the schizophrenia, too, and pills and doctors."

"One day when I was locked in the closet, I noticed I didn't feel afraid.  I was calm. There was light in the closet and a man.  I didn't feel nervous about this man.  I decided that he must be Jesus.  He was kind.  I didn't cry anymore.  I even looked forward to being locked in the closet to be with the man..  He seemed to care.  He never harmed me.  He gave me peace."

She asked me to write about the Man in the Closet.

Family Medicine: If It was Easy, It Wouldn't be Fun

I have fun every day being a Family Physician and doing what I do.  I get to meet and interact with wonderful people whose situations may have taken a turn for the worse, possibly caused by one of several thousand variables, somewhere between the biosphere and their atoms.  The complexity of the situation and the unlimited amount of variables involved make it a nice challenge..

The complexity of the human condition is remarkable.  Identifying strategies to engage people about their life and health for mutually beneficial purposes is a daily challenge.  We will never fully know at the atomic level exactly what is happening, but we often seem to get close enough for people to recover from disease.  I'm amazed at the make-up of human biology.  I'm amazed at the ways each individual relates to their health and well-being.  The complexity is part of the fun.

Simplifying the complexity is fun, too.  We get to think and engage others about their values, goals and dreams.  OUR values, goals and dreams are involved in our shared decisions with patients, too.

Over the years, I've found some processes that seem to be facilitative in the patient-physician problem solving challenge.  First is to RESPECT each other.  Trust and truthfulness seem to follow respect, enabling better connection around the concerns of each person.  This is a key to understanding, diagnosing and treating disease.

Respect is also a key ingredient for the kind of long term relationship that patients and Family Physicians enjoy.  The respect for each other is helpful during critical illness and/or end of life situations.  Complex decisions become easier after years of sharing and respect.  I get to be reminded of that too frequently these days with an ageing patient population and an ageing physician (me).  We share our thoughts about life, family, God and death.  Not just once.  Not just at the very end of life.  Concurrent with treating multiple diseases and conditions which involve multiple medications and sometimes multiple other physicians, we discuss these end of life issues.

That's part of Family Medicine.  It's challenging.  If it was easy, it wouldn't be fun.

Direct Primary Care: Survival by Sustainable Differentiation

The intensity of concern about health care is increasing as critical dates for the Affordable Care Act are upon us (e.g., October 1, 2013 and January 1, 2014).

It sometimes reminds me of battle preparation when I was in the Army.  We used the 9 Principles of War to analyze past engagements and plan future endeavors.  I wrote about using them in health care in a previous post on September 20, 2010. Learning from the Military

You patients and physicians may be seeing and hearing more and more about Direct Primary Care, maybe even from my blog posts.  How might DPC survive to give patients and physicians another choice?  I like the term sustainable differentiation.  Which says to me, "stay different over time in a meaningful way."

Since survival with any new business model will be like fighting a business war, I would refer to the Nine Principles of War mentioned in the Learning from the Military post mentioned above.  Two principles stand out initially for patients and physicians:  Offensive and Surprise.

Offensive:  Seize the initiative for DPC.  Celebrate it's inclusion in the Affordable Care Act as one of the Exchange models (although definitions for qualification/ Federal certification as a DPC aren't yet finalized).  That gets increased awareness, acceptance and legitimacy, both for patients and policy makers.  Boldly announce your intentions.

Deliver (or participate in) DPC in a pure or hybrid model.  Boldly celebrate as you notice what you like about it.  (Maneuver a bit-see number 5).

Family Physicians:
     Surprise:  Yourself and your patients by doing it.  Your community by public celebration and effective marketing, especially via social media.  The "enemy" by boldly noting how DPC is different and will stay different.  It's moving away from "The Beast".

     Use more surprise by marketing through your Physician Hospital Alliance, if you're relating to a hospital system, to specialist offices, hospital employees and their referral service for patients.  (How many patients without insurance call the PHA daily looking for a family physician only to find none?  They will now find the DPC physicians.  AND, the PHA staff will love you, as will the patients well served by DPC).  Hugging "The Beast" (which we are actually mired in) may soften it a bit.

Security (number 7) is continually important- remember that enemies to Direct Primary Care abound.

Here is the list of the Nine Principles of War with the military definitions:

1. Objective:  Direct every military operation toward a clearly defined, decisive , and attainable objective.

2. Offensive:  Seize, retain and exploit the initiative.

3. Mass:   Mass the effects of overwhelming combat power at the decisive place and time.

4. Economy of Force:  Allocate minimum essential combat power to secondary efforts.

5. Maneuver:  Place the enemy in a position of disadvantage through the flexible application of combat power.

6. Unity of command:  For every objective, ensure unity of effort under one responsible commander.

7. Security:  Never permit the enemy to acquire an unexpected advantage.

8. Surprise:  Strike the enemy at a time or place or in a manner for which it is unprepared.

9. Simplicity:  Prepare clear, uncomplicated plans and  concise orders to ensure thorough understanding.

Review these principles from time to time (you may wish to "civilianize" them a bit) and revise your plans accordingly.  Number 4 is another must for Family Physicians and patients.  We don't have a lot of reserve power without each other.

How do you think the above principles might help Direct Primary Care to Survive by Sustainable Differentiation?

For More information about Direct Primary Care, visit www.dpcare.org and attend the Direct Primary Care National Summit in St Louis October 11-12 at the Airport Marriott.

Direct Primary Care National Summit

Business uses of the nine principles were nicely explored in a 1992 book titled Duty, Honor, Company: West Point Fundamentals for Business Success by Gil and John Dorland, brothers who graduated from the US Military Academy at West Point in the Viet Nam era.  Military references to the nine Principles of War include the Combat Leaders Field Guide, Department of the Army FM 22-100 Military Leadership and FM 100-5 Operations.  I'm not aware of any medical works about using the Principles of War.  We're ready for some applications of the Nine Principles of War to health care.

1. Objective:  Direct every military operation toward a clearly defined, decisive , and attainable objective.

2. Offensive:  Seize, retain and exploit the initiative.

3. Mass:   Mass the effects of overwhelming combat power at the decisive place and time.

4. Economy of Force:  Allocate minimum essential combat power to secondary efforts.

5. Maneuver:  Place the enemy in a position of disadvantage through the flexible application of combat power.

6. Unity of command:  For every objective, ensure unity of effort under one responsible commander.

7. Security:  Never permit the enemy to acquire an unexpected advantage.

8. Surprise:  Strike the enemy at a time or place or in a manner for which it is unprepared.

9. Simplicity:  Prepare clear, uncomplicated plans and  concise orders to ensure thorough understanding.
- See more at: http://drsynonymous.blogspot.com/2010/09/family-medicine-learning-from-military.html#sthash.0yx1bJXr.dpuf

Business uses of the nine principles were nicely explored in a 1992 book titled Duty, Honor, Company: West Point Fundamentals for Business Success by Gil and John Dorland, brothers who graduated from the US Military Academy at West Point in the Viet Nam era.  Military references to the nine Principles of War include the Combat Leaders Field Guide, Department of the Army FM 22-100 Military Leadership and FM 100-5 Operations.  I'm not aware of any medical works about using the Principles of War.  We're ready for some applications of the Nine Principles of War to health care.

1. Objective:  Direct every military operation toward a clearly defined, decisive , and attainable objective.

2. Offensive:  Seize, retain and exploit the initiative.

3. Mass:   Mass the effects of overwhelming combat power at the decisive place and time.

4. Economy of Force:  Allocate minimum essential combat power to secondary efforts.

5. Maneuver:  Place the enemy in a position of disadvantage through the flexible application of combat power.

6. Unity of command:  For every objective, ensure unity of effort under one responsible commander.

7. Security:  Never permit the enemy to acquire an unexpected advantage.

8. Surprise:  Strike the enemy at a time or place or in a manner for which it is unprepared.

9. Simplicity:  Prepare clear, uncomplicated plans and  concise orders to ensure thorough understanding.

Imagine that the enemy is the H1N1 influenza.  You might be able to recognize how each of the principles might - See more at: http://drsynonymous.blogspot.com/2010/09/family-medicine-learning-from-military.html#sthash.0yx1bJXr.dpuf

Business uses of the nine principles were nicely explored in a 1992 book titled Duty, Honor, Company: West Point Fundamentals for Business Success by Gil and John Dorland, brothers who graduated from the US Military Academy at West Point in the Viet Nam era.  Military references to the nine Principles of War include the Combat Leaders Field Guide, Department of the Army FM 22-100 Military Leadership and FM 100-5 Operations.  I'm not aware of any medical works about using the Principles of War.  We're ready for some applications of the Nine Principles of War to health care.

1. Objective:  Direct every military operation toward a clearly defined, decisive , and attainable objective.

2. Offensive:  Seize, retain and exploit the initiative.

3. Mass:   Mass the effects of overwhelming combat power at the decisive place and time.

4. Economy of Force:  Allocate minimum essential combat power to secondary efforts.

5. Maneuver:  Place the enemy in a position of disadvantage through the flexible application of combat power.

6. Unity of command:  For every objective, ensure unity of effort under one responsible commander.

7. Security:  Never permit the enemy to acquire an unexpected advantage.

8. Surprise:  Strike the enemy at a time or place or in a manner for which it is unprepared.

9. Simplicity:  Prepare clear, uncomplicated plans and  concise orders to ensure thorough understanding.

Imagine that the enemy is the H1N1 influenza.  You might be able to recognize how each of the principles might - See more at: http://drsynonymous.blogspot.com/2010/09/family-medicine-learning-from-military.html#sthash.0yx1bJXr.dpuf