Podcast by Dr. Don Angle
How DPC fits into the new healthcare model
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[00:00:00] Dr. Don Angle:
So the real issue is this. Two words, misaligned incentives. If you pay doctors to do stuff, they will do stuff, and all of that stuff is not necessarily good for you. I don’t care how expensive it is. So the idea is, Align the incentives correctly. Once you do that, the ship writes itself.
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[00:01:12] Joel Erway:
Hey, what’s going on everybody? Joel Erway here and welcome to another very special episode of Experts Unleashed. I’m excited because today I’ve got a very special guest, Dr. Don Angle and we’re gonna be talking about a shift in the way that the healthcare industry is going. Dr. Don and I had a conversation a couple of weeks ago to kind of talk and, and prep about this conversation because this is something that quite frankly, I, I really.
Wasn’t exposed to, aside from a, you know, my personal experience with my own primary care physicians. And, and so we had a very, very interesting conversation. And Dr. Don is gonna be talking about how what he’s doing is revolutionizing the primary care physician world and how he’s trying to change healthcare moving forward.
It was, it was a fascinating first conversation. I’m very excited to dive deep and now, A second conversation, a more enlightening conversation now that I’m all prepped, now that I’m brought up to speed on, on really what he is talking about. And so I’m excited to bring him on. Dr. Don, welcome to the show.
[00:02:15] Dr. Don Angle:
Thanks, Joel. I really am excited about this show today.
[00:02:19] Joel Erway:
Awesome. Well, why don’t you give us, give my listeners give our audience just a quick 30 or 62nd background about your credentials and, and really what we’re gonna be talking about here today.
[00:02:28] Dr. Don Angle:
Well, it happens, Joel, that I learned how to solve the healthcare dilemma.
Everybody knows healthcare in America is unaffordable, inaccessible, and just totally too expensive, but nobody has a plan to fix it. I learned a plan 25 years ago when I had an encounter With a mentor that actually told me about healthcare and, and how we fixed it. And we did fix it. We actually went in that company, we took that company public listed on the nasdaq, and ultimately we became the target of the healthcare company in the world at the time.
And they bought us up and then two months after they bought us, they. An implosion cost them nearly a billion in revenue. Lost opportunity, but our opportunity got stuck in the back corner, light and well. But I was, I was worn out, I was tired. I didn’t wanna do it. It cost me a divorce and a lot of other money, and I just really didn’t want to do it over again, and I really was afraid.
And so about four years ago, I decided my kids can’t afford my healthcare and I just decided that we needed to bring it out again and do it. And so I’ve been working on this project and it’s coming to life.
[00:04:03] Joel Erway:
So explain what’s broken currently. We all know it’s broken, but you understand why it’s broken at a much deeper level.
[00:04:10] Dr. Don Angle:
Yeah, that’s a great question because one of the most important things is clarifying why our system is broken. If you. Ask 12 people what the problem with healthcare is, you’ll get a dozen different answers. It’s the pharmacy costs are too high, or the doctors are mismanaging the system, or patients have an incentive to ask for everything, and, and more is better.
More cost is better healthcare. That’s not true. And so the real issue is this. Two words. Misaligned incentives. If you pay doctors to do stuff, they will do stuff, and all of that stuff is not necessarily good for you. I don’t care how expensive it is. So the idea is to. align the incentives correctly. Once you do that, the ship writes itself.
It always comes back up and gets in the, in the course that’s best for the patient. And the problem right now is the primary care doctor is the only person who can do that. But the problem with the primary care doctor is he doesn’t believe that he can do it. And I know that feeling well because I didn’t think I could do it when I, when my mentor first told me the solution or we, we discovered it together really.
But he said to me that I needed to take some financial responsibility because, as a provider, I was only a paid advisor. I didn’t have any skin in the game, and therefore I couldn’t demand excellence out of the system. But when you put a little financial responsibility to the provider, then he has incentives to do the right thing.
And here’s that. Here’s the definition of the right thing. The doctor, the primary care doctor, and the patient both have the essential incentive that they want the best medical outcome, but the patient wants the best medical outcome with outgoing, bankrupt, and we all know that medical bankruptcies are the biggest part of bankruptcies in the United States.
But if the primary care physician has some limited financial responsibility, not only does he now want the best medical outcome, but he wants it at an affordable price. And that’s how we are disrupting healthcare now.
[00:07:02] Joel Erway:
So there’s a lot to unpack there. And for sake of simplicity, you know misaligned incentive. When you say misaligned incentives, I took this from our previous conversation, so I’d like you to correct me if I’m, if I’m wrong. Sure. But when you say misaligned incentives, this is really explaining how doctors getting paid to treat, not necessarily paid to prevent. Is that a good way to kind of simplify it, or is there a better way to explain that?
[00:07:30] Dr. Don Angle:
Let’s make it simple. When a doctor prevents a problem, he cuts his. Yep. Because right now he only gets paid to solve problems and if he eliminates problems, he doesn’t get paid and, and so they don’t stay up late at night worrying about a problem that they can prevent. That’s the difference when doctors have prevention and wellness and all of those other basic ideas that we are supplying healthcare, not sick care.
Then the doctor really does have a good outcome when he prevents things, when things don’t go wrong, he’s got the best outcome.
So their primary incentives right now are to prescribe things cuz that’s directly related to their income, right?
Fix things, right? Fix things with prescriptions in under eight minutes, he’s in there writing those prescriptions while you’re still talking. And that’s not what people want. It’s not good for, the doctor doesn’t want that and patients don’t like it. The real answer is this. Hey, let’s have a meaningful conversation.
Get to the root cause, try to prevent everything possible and solve this thing in a good way. We don’t want to take out your your spleen or your appendix if it’s not necessary, but you know, if it’s. Not necessary, and I get paid to do it. I’m not saying that doctors do that, they don’t, but the idea is every time they prevent a problem, they hurt their income.
[00:09:10] Joel Erway:
Yep. So let’s kind of dive down this rabbit hole of, you know, how do primary care physicians really take financial responsibility? Because I think this sounds very utopian in, oh, okay, well we need to change the narrative and we need to make, you know, make it So now the doctors are back in the position where they are incentivized to actually do what they wanna do, because I think we all can agree with this. Most doctors, they just wanna help people. It’s been their whole, their whole, every doctor that I’ve met, you know, especially primary care doctors, all they’ve wanted to do is just serve their patients. But now it becomes this whole convoluted mess, which will, well, how are they gonna stay in business?
Because one of the most stressful occupations and career paths on the planet with suicide rates, you know, ridiculous rates. So, One And debt. How do we create a, a financial business model that makes sense for doctors?
[00:10:03] Dr. Don Angle:
Well it’s not that hard. But it is different and physicians don’t really appreciate the difference.
But the difference is there’s an incentive for some limited financial exposure, and when the patient and the doctor both have some limited financial responsibility, they both share the incentive to get the best outcome. At the best price. And so our model puts together a financial responsibility that the physician has for his work, for his outcomes.
And when he has a financial incentive for those outcomes, then he’s working to prevent things that can be prevented and deal with things. Cost effectively, which basically is what the patient wants. He wants the best outcome, medical outcome, but he also wants to stay afloat financially. When they do that, they don’t want, he doesn’t wanna spend his whole retirement on a plan that’s gonna keep him alive for 20 more days, you know?
But the physician is the one who can understand that, and those two are right now, the only two people who are not at the table about cost of he. Neither one of those doctors just don’t have a clue how much an aspirin costs in the hospital. And patients can’t get the message even if they try. And there are lots of examples where patients try to get, how much is this gonna cost me?
And they can’t even get it. And it’s a lot to give it to ’em now. Yeah.
[00:11:43] Joel Erway:
So what does financially responsible mean? Go into a little bit more detail, explain how this all works.
[00:11:50] Dr. Don Angle:
So my mentor was an insurance guru, he taught insurance. He was a high ranking official in the insurance world. And basically I didn’t understand one thing and that was how experience was calculated in healthcare insurance.
And he was mentioned in an article in the paper one day and. Called him up and just said, Hey, I am a doctor. I got more questions and answers. Can you help me? I’ll buy lunch. Can you help me answer some of those questions? And of course he did. And we became friends and we together set up. And I don’t like to hit doctors with the insurance word because it freaks ’em out.
They don’t like insurance companies, they hate people in insurance, but whenever there’s a transfer of financial responsibility that is fundamentally insurance, he showed me how to take some limited financial responsibility. Basically we bought an insurance company our, our group did. And when we did that things just blew up and it became instantly clear why this makes everything better.
Because when primary care physicians have some limited exposure to the financial downside, they can do really well. By practicing excellent medicine, which is what the patient needs and wants. So the patient wants to prevent those things that can be prevented. He wants to get in early. We want him to get in early if there’s a problem, instead of having all these.
Financial disincentives for them to come in early. And then we want ’em to get their medicine and we want them to complete their treatments so that they resolve the issue completely and fully without inordinate expense. The primary care doctor is the one who knows how to do that, and he knows the technical issues with the patient.
He knows the idiosyncrasies of the patient and he knows the local lay of the land. Who the best surgeon is, who’s the, who’s not going to overprescribe or over do procedures that would be unnecessary. And when he has that intimate knowledge, and, and, you know, so for a phase the last couple of years, the insurance world has said high deductible plans will make patient more savvy, make ’em a better patient.
That’s a bunch of cock stuff. The patient cannot be savvy, cannot compare prices, cannot get the best deal, cannot negotiate a thing, and that just puts the patient into a situation where there’s more stress. Where. The primary care physician is the only person who knows the patient, who touches the patient, who actually gets to spend time with the patient to talk about all of the options, all of the intricacies, and get the full understanding of the program that the patient should, the journey, the patient would, that would be best for the patient.
And that’s how primary care doctors are, they have a lifelong relationship with the patient. They have a complete understanding of the technical issues involved, and they are the one who know the local landscape providers the best, the hospitals the best, and they can actually negotiate Pricing issues.
Now, I understand doctors, they don’t wanna negotiate price, they don’t wanna do all that. We do all of that for them, but they can help. And if it’s in their best interest financially, then they can help as well. So it’s, it’s a, I don’t wanna scare doctors off because when you say the I word, they get a little upset or concerned that they have to do more work and they don’t have enough time, because right now they’re undervalued by insurance companies except one of them who’s bought 60,000 practices in the last few years.
And they just spent another a hundred million for physician practices, primary physician practices last year.
So I’ll save that for another discussion, but the idea is insurance companies understand the value of primary care doctors and they’re happy to pay him 15 cents on the dollar to get that value from him. But you know, doctors, the primary care doctors doing all the work, why should he work for 15% of it?
He can have the whole dollar in our system.
[00:16:56] Joel Erway:
Yep. Well, so now from a consumer standpoint, it starts to make sense, right? So if the primary care physician has a pool of money that is allocated towards whatever treatment or whatever method that they’re trying to prescribe, now they’re, that’s where the incentive comes in.
Like they’re, they’re financially motivated to make sure that. Clients that their patients are are doing everything in their powers to, to stay healthy. Right? Yeah. And when something does come up, when something does come up, and this is where it really started to make sense for me when we had this first conversation.
You know, from a patient standpoint, the last thing I want to do is negotiate with insurance companies. The last thing that I wanna do is go walking in blind to some treatment because I have no idea how much it things are going to cost. And it’s like you walk in and you know, it’s almost like you’re writing a blank check to god knows who. Like you really have no idea who is even gonna be building you many times.
[00:17:56] Dr. Don Angle:
You don’t even know who was in the room. You know the, the cardiologist comes and visits you. When you’re in the ICU and you’re unconscious, you don’t even know he is there. And so those are the things that your primary care doctor can do, but he doesn’t get paid today to do it.
Our method, gets him paid and he can make a lot of money because he’s paid to take some responsibility for all of those things in the healthcare system, navigating it and being ahead of the curve on problems.
[00:18:28] Joel Erway:
So this is called, this is referred to as the direct PCP model. Is that correct?
[00:18:34] Dr. Don Angle:
No, no. Let me clarify one thing.
Direct primary care doctors. Have got the first step up in this game, okay? They are already taking responsibility for primary care services. Everything that can happen in their office, they can fix that, that problem. But if you have a surgery that’s gotta go to a hospital or to a surgical center, or if you have some other illness or wanna deliver a baby.
They do not take responsibility for those services. See, that’s what we did in our model in the nineties. We basically started a direct primary care practice for employers. I wasn’t smart enough at the time to name it anything, so we just called it the company doctor. But at what we figured out later was, that’s the direct primary care model, so those doctors are already performing a partial service.
This service goes to the full. The full growth of that system, it basically did what we did. We got it, bought an insurance company to pay for those claims that came to the surgeon or to, had to go to the hospital and we ensured that loss.
This is what that does. We have an insurance model. It’s basically called a segregated cell captive insurance company. And when you participate in that, you as a physician and it’s only open to primary care physicians, you are essentially participating in your own many insurance company inside of our bigger insurance model. Does that make sense?
[00:20:35] Joel Erway:
Yes it does.
So part of this already exists. The direct PCP industry already exists, but now you’re taking it one step further to be all encompassing on any emergency or large, larger scale expenses that that come up. Right. So outta curiosity, you know, the existing. Industry, you know, direct PCPs have already kind of taken that first step, right?
Right. What are they struggling with, right? Is there an industry problem that they’re struggling with, that you come in and you help, you help solve? Like why not just, why not just stay with the direct PCP model without going broader scale?
[00:21:11] Dr. Don Angle:
Well, that’s, that’s what they like to do right now because, you know, they did not want to be classified as insurance companies.
They have to meet all kinds of regulations. If they. Classified as an insurance company. So that’s one of the reasons they hesitate to get into this model. But the answer is we can provide all the regulatory compliance and, and handle all the accounting that has to happen. And once they are, once their practice is in our model, they can be a part of the insurance company, but they’re walls of separations. They’re segregated into a cell. That’s really just their practice. And so they’re not responsible for Joe’s practice over across town or in a different state. They are only responsible and they’re graded on their practice and their accounting is through their practice and reserves that they accumulate through their practice.
And all of those models are what we take care of.
[00:22:24] Joel Erway:
Got it. Now, but why would an existing direct PCP want to consider moving to this?
[00:22:31] Dr. Don Angle:
Couple of reasons. One, save healthcare in America. Save 2 trillion, 2 trillion a year. In healthcare costs, restore the middle class because health insurance has been, or healthcare has been robbing the middle class for more than three decades.
This is a problem that’s been going on for decades to be their grateful, their grateful. Patients want this, you know, the direct primary care doctor has. Incentives that so, so let me tell you a couple things about primary care and direct primary care doctors as well is they are undervalued, they are getting paid the least of all doctors, and they’re technically the ones who have to know the most about the patient who have to deal with the patient all the time and all of that is what causes burnout that you referred to earlier.
So the idea is when physicians are getting burned out, when physicians are undervalued, they get burned out and and now 70%, 70%, seven out of 10 doctors are now owned by insurance companies or hospitals. And the reason is, They’re undervalued by insurance companies.
You know, they’re worth the most, so insurance companies are buying ’em up left and right, but they get paid next to nothing. And now they have to get on a hamster wheel to see a patient every eight minutes, or they can’t make any, they can’t make a living, you know, so it, so the problem is insurance companies have devalued primary care.
Really 40% of primary care physicians or direct primary care physicians believe that they may be irrelevant in five years. That’s a terrible statistic, but the idea is primary care physicians have not gotten into direct primary care because the transition is a little convoluted. Direct primary care physicians don’t want to get into this other model because they have a relatively good life and a decent lifestyle, and they are proud of the work that they do.
Well, I’m, I’m proud of the work that they do too, but they can do more, they can change the calculus for the patient. They can make the patient. Get the best healthcare and free our, our model shows that we can give patients free healthcare primary care for free. Excellent. And it’s excellent because primary care physicians are now in the mode to get everything they can prevent, prevent it in everything they can deal with effectively in the front.
Dealt with, and so that makes our model just superior. Now, why will people not do it? Because they are. Concern that they cannot do it themselves. We do it for ’em. We’ll do it for as long as they want us to, but we generally believe that any doctor who’s learned the Creb cycle, something you have no idea about, but all the doctors in the audience will understand the Creb cycle.
If they can manage the Creb cycle. If they can understand that health insurance is nothing and they can do primary care. Balance an insurance entity. They know what to deal with. They know what to look for. We can do all the hard lifting for ’em, but at soon, at some time, they are going to want to do it for themselves because the closer the physician is to the patient, the better they can manage that whole case.
They don’t have to be told what’s important, what’s, they know what’s important. They know how to manage the patient’s medical side. All they need to understand is what are the financial consequences of this? Now let me answer a question, Joel, before you ask it. So we’ve had some doctors who say, well, I have a conflict of interest and I don’t want to have that conflict of interest.
I understand that completely. And we have a solution for the conflict of interest. What happens? Will I withhold medical care from from a patient if they need an expensive procedure or expensive drug? Listen, insurance companies, Tens of billions of dollars a month in net revenues, not gross revenues.
We spend 3.7 trillion in healthcare and we barely get anything for it compared to other economically developed countries. The idea is in this. You may have a conflict of interest, but the patient can sit across the desk from you. You can’t go into your insurance company and you can’t get a signature on a piece of paper.
You get it from the support system or the support. Clerks, there’s no one that you can talk to outside of either a recording or a piece of paper. You, you, the system already has someone who has a conflict of interest, and that’s the insurance company. And the reason you don’t deal with them is because they don’t deal with people.
They deal with pieces of paper and financial accounting and that’s it. But, Can deny a claim for you tomorrow at the same time.
[00:28:15] Joel Erway:
So what I understood with everything you just said is, you know the reasons why somebody, an existing direct PCP would want to go and take the next step with this model is, number one, help fix the healthcare system.
Number two, do right by their patients and essentially you. Be a change agent in the overall healthcare system. Is there a lifestyle? You mentioned something, I think this was referring to non-direct PCPs where they’re on the hamster wheel of having to, of having to, you know, see a patient every eight minutes now that we’re changing the model.
Is there a lifestyle improvement for the primary care physician where they’re not on the hamster wheel of needing to get somebody in eight minutes and get ’em out the door? Cause the next one’s waiting in line. I’ve got 40 people today that I have to see. Right, right. How does that look? How does the operations look in terms of that?
[00:29:16] Dr. Don Angle:
Great. Great point. Joel. The answer is simple. If the primary care doctor has a care. Focus on teamwork. He can make a better system with better outcomes. He does not have to get on the hamster wheel. He’s got nurses and physician assistants and social workers and a group of people that he can call upon and channel patients through.
And two, and the idea. With the care team, the primary care doctor can have lots of help. Instead of him handing somebody a copy of a diet that’s been a copy of a reprint of a reprint he can have a nutritionist on staff. He can, he has enough money to take all of those. Primary care team members on board and provide the best healthcare possible.
And he also gets the patient better, faster and it’s better than he can do. And he doesn’t have to spend you know, all night dictating charts that he should have been dictating while he was seeing patients. You know, the idea is now he can provide a care team that is totally. Ready and totally available.
And he is the quarterback and he’s the one calling the shots, or she’s the one that’s calling the shots. And basically at that point, It makes total sense to have the best care team you can afford, and you don’t have to be on call 24 7. You have to be on call when the patient’s needs arise to the level of the primary care doctor’s full capabilities.
And that’s sometimes when patient goes into the ICU or into the hospital. And right now doctors are being pushed out of hospitals by A bad system, which it basically says hospitalists who are paid by the hospital to take in the patient will do that hospital work for ’em. Well, you know, that makes the life of a PCP doctor or primary care physician.
It makes it easier because they don’t have to go back and forth to the hospital, but it’s terrible for the patient. The patient never has seen this doctor at the hospital. He doesn’t know ’em. They don’t know each other. There’s so much missing in that transaction that it’s a terrible idea, but primary care physicians do it to get some of their lifestyle back when they’re busy seeing patient.
Like you said, 40 patients a day on the hamster wheel for eight minutes with each patient giving the patient poor service. And both of them hate that system. And this system gives the doctor assistance with a care team, with specialized people who have better knowledge of diet, nutrition than the doctor probably has.
So it’s, it’s a better system for everybody.
[00:32:26] Joel Erway:
You mentioned something that kind of triggered some curiosity in my brain. Cause you, you talked about how you know, when moving to this model, the PCP can now hire specialists within the practice to help make the system run smoother. You talked about hiring a nutritionist but it, it just, in your estimation, on a percentage basis, what percentage would you say of PCPs are understaffed with proper specialists, and that might be part of the bottleneck that’s causing the hamster wheel. Right.
Is that a problem with, you know, either direct or non-direct, like not having specialists available to help delegate the right, the right people to through the right systems? Is that, is that a problem?
[00:33:12] Dr. Don Angle:
Well, for the independent physician, the one who’s in that 30% mode, not the 70% mode. It’s a big problem. Every one of ’em does not have enough resources, but the physicians who are in the 70% mode that are hospital or insurance company owned, they have all of those resources because they get. All of those services.
So as soon as you step into a hospital, the hospitalist is going to transfer you from one specialist to another specialist, to a care team member, to another care team member, because that’s what the hospital wants him to do. They’re not interested in holding down costs. They’re interested in collecting as much from that body that they can, while the patient is still living.
Same way with insurance companies insurance, c. Now this is something that I did not fully appreciate when I first started with my mentor. I didn’t realize that insurance companies don’t have an incentive to hold down costs. I thought that, you know, insurance companies wanted to keep costs low, and for that reason, they didn’t want people to spend extra days in the hospital or do things in the hospital that were easily done as an outpatient.
Figured insurance companies were smarter than that, but they are smarter than that. They go another step. Insurance companies get paid on a cost plus basis, whatever the cost is tack on 20%. That’s how insurance companies are paid. And so they have been smart enough, and this is an unbelievable statistic, but it’s verifiable every year.
For the last 50 years consecutively without fail, insurance costs for health insurance have gone up more greater than the rate of inflation. So if you look at the rate of inflation as it’s gone up all these years, every year insurance costs for health insurance have gone up 1.7% greater. Now, do you think that some sort of coincidence. It can’t be. It’s a fact.
Insurance companies get paid on the cost of the care and the cost, and they just are, they’re there to slow down the rate of rise, not control the total cost, and that’s why the insurance companies are happy. They’re part of the financial sector that’s done well for the last 50 years and it never seems.
It all goes up. I mean, last year there was a 12% increase in total cost of healthcare, and, you know, that’s, that’s even greater than the rate of inflation is now. But healthcare statistically has gone up more than the rate of inflation for every year for 50 years, and it hasn’t stopped. Why? It’s because insurance has an incentive to keep going.
And so that’s why we pay the highest amount by far in the world. And for the last three years, we’ve lost statistics. We’ve lost the statistical advantage of gaining ages, expected life. We don’t have that and we have a much less healthy population at death than than other economically. Countries in this world have, and they pay far less than what we pay.
[00:36:53] Joel Erway: So is this as simple as now, from a consumer standpoint? From a patient standpoint, rather than paying for umbrella insurance, whether it’s Excel, you know, blue Cross, blue Shield, whatever, now I’m paying through insurance through. My my pcp. Is it that simple? Like I’m just now diverting those costs and sending my insurance what I would be paying as a premium.
I’m now just paying that directly to my pcp. Is it that simple?
[00:37:21] Dr. Don Angle:
One simpler step, you pay 20% less upfront, so our price is 20% less upfront, and you don’t have to pay your PCP ever again. You can go see ’em as much as you want now. Want you to respect his time and his expertise, but you get free primary care and your insurance costs are 20% less than what you have been paid and expected to go down from there.
[00:37:55] Joel Erway:
I gotta say. So Don, we would now talk twice. It finally dawned on me that that was the model. Like, so I mean, when you start talking, you know, it, it can get confusing, right? Cause if you’re, it is trying to think about it on the doctor, on the PCP side and the direct PCP side. Then how that applies to the financial model with the with the patient.
Like, how does this all work? And it’s like, right as I was listening, I’m like, oh, so. As the patient, now I’m just paying my PCP as the insurance provider, right? Instead of paying a third party for insurance and then them dictating where to go, where I can and can’t go in network, blah, blah, blah, blah, blah, and I take all responsibility for whatever and negotiating all that.
Hoopla. Okay. Right Now it makes sense. Now when you’re saying your, your direct PCP becomes your, I’ll throw in air quotes cause I know that this industry doesn’t like the word insurance, but if they are right, the insurance provider, now you’re paying the premium to your pcp. Now they’re incentivized to give you the proper care and preventative care and making sure that you don’t get any unnecessary care cause they don’t benefit from prescribing you a thousand different drugs that you may or may not need or, or sending you to go get all these expensive tests, which you have no idea how much they’re gonna cost.
It all starts to make sense now.
[00:39:17] Dr. Don Angle:
I know it is simple, but it’s complicated because insurance companies have made insurance unnecessarily complicated. They do that for purpose. You can’t read an EOB explanation of benefits. I mean, it takes a. An attorney or an accountant or both to interpret what that all means?
And the problem is straightforward. Confusion makes people discouraged about trying to get change. It makes doctors discourage to deal with insurance, and that’s where Direct Primary care doctors just gave up. They said, Hey, I don’t want to participate in your little process anymore. I’m just gonna charge my patients a flat monthly fee.
They can come and give all they want. And this is why Direct Primary care has become more and more popular, keeps doctors from killing themselves.
[00:40:11] Joel Erway:
So, describe the trend, right? Like what is the growth rate of direct pcp? Like what’s, what’s the industry seeing right now? And are insurance companies, are they nervous about it?
[00:40:22] Dr. Don Angle:
[00:40:22] Joel Erway:
[00:40:24] Dr. Don Angle:
Insurance companies are so big and they make so much money that it’s hard to even fathom how much money. Listen. Just reading United Health Group now, they’re the largest insurance health insurance group in in the country. I was reading a financial statement for their third. Just came out a few days ago and they’ve managed to pay their investors 10.5 billion in dividends.
Now, I was the CEO of a publicly traded company, and I can tell you, you do everything you can with the money that you. In your company, the last thing you do is reimburse your investors’ money as dividends. So you buy all the stereo, tactile anything that you want and pay your administrators billions of dollars, and you can then, Go spend that money on dividends and now, so, and, and doctors just don’t get that.
And insurance companies don’t have us on their radar. And frankly, I’d rather keep it that way for as long as possible. But I do think that primary care physicians ought to take note. They’re being forced into. Captive work by insurance companies and hospitals. Their lives are getting miserable because they don’t see another alternative to this model.
But if they join our movement, if they join our movement, they can and will see a change in healthcare. And if you are patient, You can tell your doctor about this and let him investigate it. Because if a patient sees this interview and wants to have this, he’s gonna have to go to his doctor and say, why aren’t you in this?
And if enough patients do it, doctors will do it. The only reasons doctors don’t do it with us is because they can’t believe that they can manage their own mini insurance. , but I Say it again. Cause I, I wanna reinforce this to doctors. We’ll do all the work. You don’t have to do anything, just practice excellent medicine.
That’s all you have to do. And then we will support you in terms of back office care team, and that’s what we will do because we want you to have the best outcomes. Now we charge you for that, but it’s a fair charge and you can take it over. As soon as you’re up to it, you get scale. You wanna, you, you know, you have 10 patients, you may not wanna do it when.
A thousand patients, it’s certainly worth you doing it, and you can have a manager do it for you. But the idea is straightforward. This is something that can only be done by the primary care doctor, and that’s why, and, and he, he’s equipped to do it. I know when we were doing it, I was stunned by our doctors who came up and said, you know, they’d grabbed me for lunch and say, Hey, we need to get rid of this group that we’re referring to.
They’re, you know, they’re not the best group, or We need to do this procedure because this procedure is easy and we’re spending a fortune to get it done so we can bring cost containment back into the whole model, you know, and. It’s something where the incentives are right, and you don’t have to chase down doctors with preauthorization forms.
You don’t have to deny their claims, you don’t have to downcode their claims. This is something that doctors will do on their own. They’ll save America trillions of dollars and they’ll make a lot of money for doing it. Oh, let me ask, let me answer one more question you haven’t asked me, but listen.
There’s called, there’s something doctors understand. It’s called social determinants of health. That’s something that’s not in the direct control of doctors who are in any healthcare model. Yet we can save enough money to fund a food bank. We can save enough money to fund giving somebody a prescription that they couldn’t afford.
You know, those are the kinds of things that doctors cannot do now. Insurance companies don’t dream of doing it. Yet it helps the patient with at least 50% of the total cost that they have to face. And so, you know, by just covering some of the determinants of health, social determinants of health, we can improve that 50% factor of that healthcare of that individual.
[00:45:40] Joel Erway:
Let me ask you something. So I know you have an incentive for existing, you know, for anyone who wants to implement this next step of a direct PCP model. Explain what that is real quick. And then I have one final question for you that I’ve been. Anxiously, you know? Okay. Actually, two, two final questions.
So talk about the incentive that you’ve got. Cause I think it’s, it’s fascinating cuz this is your mission to, to help, you know, direct PCPs take that next step, become their own build in their own insurance, their own insurance companies so they can, you know deliver better healthcare. Explain your incentive briefly.
[00:46:13] Dr. Don Angle:
So in order to write policies against your, you have to have reserves and you have to put those reserves up in the form of collateral, and we will put up those collateral forms. Now it’s a $50,000 hit. It’s cost. But 40,000 of that is directly funding your reserves. Once you have that and 10,000 goes to set it all up and working capital for the corporation.
So the idea is we will lend you that $50,000 up front. And, you know, part of it is hopefully you’re a good doctor and you don’t spend it all in the first two weeks. But, you know, I think most doctors are pretty smart. They understand that they need to keep people healthy and they have the opportunity to do what’s best for their patients and themselves in a limited form and fashion.
But there’s so much, so much wasted. In healthcare that we can save a trillion dollars just on the waste itself. And the growth and the waste is something that we think we can achieve, and the incentives for the best prices and that kinda thing are built into the second trillion dollars. In any event, we can do social determinants of health, pay the doctors more, and let them write.
Policies against their reserves. As their reserves grow and we’ll fund the first 50,000 for, they’ll pay some small interest fees, but that’s it. Does that that explain it clearly enough?
[00:47:55] Joel Erway:
Yeah, so that helps. That helps people, you know, get that comfort level of like building that up, that initial reserve that an insurance company would need in case of, you know, high cost, you know, medical expenses or claims.
[00:48:08] Dr. Don Angle:
And the other issue is we have set up reinsurance. Now. Reinsurance is insurance for insurance companies. And the idea there is we want to be able to make people comfortable that we are a legitimate insurance company, have regulatory requirements met and audits met in the specific states that we’re operating in.
[00:48:32] Joel Erway: Yep. When somebody does start to migrate over to a direct PCP model, or even from direct PCP to this model that you are that you are supporting. Does it have to be all in one fell swoop? Like, do they have to convert all, try and convert all their patients into this model, or can they do it in baby steps?
Meaning convince, you know pitch it to one patient at a, I say pitch it, but explain it to one, one patient at a time. How does that transition work?
[00:49:04] Dr. Don Angle: Here’s the answer. Insurance companies are the bane of doctors. They make doctors skin crawl because they’re unreasonable, unfair, and have total control, and they can’t ever get any satisfaction.
Most of the time you can’t get any satisfaction at all. So the insurance company, that’s your worst nightmare as a new doctor in this system. You wanna put that patient’s insurance company on the chopping block and you wanna go to all of your patients and say, Hey, you’ve got this ugly insurance company and we don’t want to do business with them.
But we have an option for you, which is basically this. We will give you 20% off. We’re state regulated and audited. And we’re legitimate. And the idea is if you want to stay with me as a physician, you have to get a new insurance carrier cause we’re dropping your insurance company. We have this other option, and you know, the, it’s 20% cheaper at the same time, it’s not only 20% cheaper, you get all my services free.
So that’s the, that’s the pitch that they could give their existing patients that belong to an insurance company that they’re not fond of.
[00:50:21] Joel Erway:
Got it. All right. So Dr. Don, final question. Okay, sure. From a consumer standpoint, from a patient standpoint, let’s say there’s somebody listening right now and they’re attracted to this model. They wanna move their care over to a a, a PCP or a direct PCP or somebody who’s following this model. Is there a directory that they can search for, or do they need to, do they need to pitch it to their PCP and say, Hey, would you consider doing this model? Where can somebody go and and find someone that, that follows this?
[00:50:52] Dr. Don Angle:
Well, we have a website. It’s 3p.insure but I’m afraid we don’t have a roster of people up there right now. What we want patients to do is to introduce their primary care physicians or direct primary care physicians to this model and. When, when doctors hear it from their patients, they understand there’s a movement and, and we think that will make them interested.
You know, they can hear it from us and they can hear it from their patients. That makes ’em think there might be a market for it, but the idea is the patient can introduce their physician to primary physician partners insure or 3p.insure on the web, insure. They can do that and their physician can get the insight, contact us, that we can start the consequence of.
I mean, right now what we’re doing is we’re giving. An event, a webinar event, to basically say, this is what we’re doing, this is how it affects you, this is all the details. And then they can start looking at providing what we’re asking them to just sign a non-binding letter of intent right at this moment, because we have to have a minimum number of participants in the country to be able to acquire the reinsurance is the basic.
So patients can help by just informing their doctors.
[00:52:29] Joel Erway:
I’ve learned a ton through our second conversation through this conversation. You know, cause it’s a complex topic. It’s a complex That’s right. Situation. You know, healthcare is enormous and we all recognize that there is a lot of problems on all sides of the coin.
And so it does become a murky navigation to try and figure out what that solution is. And I think we’ve, I think we have come to a conclusion. I think we’ve come to a, a clear resolution of what that, of what that potential solution is. I, I, I think it’s a, a fascinating proposal. I, I think it makes complete sense with, you know why the pcp, why it’s in the best interest of everyone involved.
Aside from the external insurance companies, why it’s in the best interest of everyone, everyone that matters involved, right? To put the financial liability on the service provider on the right primary care physician. And I’m excited to kind of see this. Take, take charge and, and see this momentum and this movement grow.
And so, you know, are there any other links that you want to share where people can go reach out to you or they can, you know possibly explore what it takes to take that first step as a direct pcp? You know, is it, is the links that you already shared or is there, are there other.
[00:53:54] Dr. Don Angle:
Well, I’m on LinkedIn so they can go to LinkedIn and find me there.
But the idea, and I’ve written a few articles, especially complicated articles like how physicians don’t understand any of this and breaking it down for them. So they can find me on LinkedIn or the website and I’ll be happy to speak with them. We’d like to introduce, To this whole idea with a series of letters so we can kind of educate them in a fashion that they can comprehend.
Because once you understand a few basic things, it’s really not hard to understand. But those basic things are important. It’s like, it’s what’s the cause of this problem? You know, is it really pharmacy benefits managers that are making all this money? I think there’s definitely some guilt to go around there is that insurance companies that have Tune this system to their own benefits. Sure. Is it doctors who have been exploiting Medicare, Medicaid? Who knows? I, I imagine that’s true too. But the idea is this, you must know something about the system and we can send them a series of emails, then we can invite ’em to a webinar and let them ask all the questions they can ask.
And like you, it does. One or two exposures to try to sink in because it is complicated. It’s unnecessarily complicated, and frankly, one of the only people who can solve it is a primary care doctor because he’s in that sort of quarterback position, not getting paid to do it. Right now, he is not getting paid to be a quarterback.
He’s getting paid to get sacked, and at this point we, we ought to get better at it. We ought to get better at this whole thing, and this is a solution that my mentor taught me. I’m convinced God put him right in front of me because he was the right person at the right time, and just graciously gave me a lot of insight.
[00:55:54] Joel Erway:
Dr. Don, I appreciate your insights, appreciate your time. And if you’re listening right now, I encourage you to go reach out to Dr. Don Engel and inquire more about what it takes to take these steps in the direct PCP world and, and and possibly exploring the opportunity of bettering the healthcare system and being a participant in being a change activist.
[00:56:15] Dr. Don Angle:
Amen. Change . Thank you, Joel. You’re making history. I keep pointing that out to you. I appreciate you.
[00:56:24] Joel Erway:
All right, take care. We’ll see him around the next episode.
[00:56:26] Dr. Don Angle:
Sounds good. Thank you so much.
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