About This Episode
Welcome to episode 4 of the PHW Podcast! In this episode, Dr. Marvin interviews our very own Dr. Jeff Davis, who shares his journey from a traditional medical practice to founding Prairie Health and Wellness (PHW). Dr. Davis discusses the principles of Functional Medicine and Direct Primary Care, explaining why these approaches form the foundation of PHW. He delves into the benefits of our membership model, the importance of quality supplements, and the comprehensive in-house services PHW offers. Dr. Davis also addresses common misconceptions about traditional insurance and how PHW supports patients' overall health through key pillars such as sleep, movement, nutrition, stress, and detox. Tune in to learn about the challenges within mainstream healthcare and gain valuable tips on navigating the system. Don’t forget to visit PrairieHealthWellness.com/podcast for more episodes of the PHW Podcast.
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Episode Transcript
Auto-generated from the episode audio — may contain minor transcription errors.
People say, you know, you're in the business of healing, I'm really in the business of observing healing, you know, and many times I have to just buy time for — for the body to do what I believe God designed the body to do, and then if we remove these barriers, what we're going to see is this flourishing happen, the body, you know, begins healing in — it's the way that it's designed, and so for me that's really fun to watch, and we get to do that day in and day out. Yeah, that's amazing, I also like to think of it as, I'm in the business of teaching. Yeah, well, the word doctor comes from the Latin "docere," which means to teach, so we really should be teachers, you know, we should be sitting with our patients, and we should be educating them. That's right, here's how your body is supposed to work, here's things that may be getting in the way, let's see if we can remove those barriers.
Hello everyone, and welcome to the PHW podcast, this is episode four, and I am Dr. Kristen Marvin of Prairie Health and Wellness, and I get the honor of being a host today of this podcast, because I get to interview the amazing Dr. Jeffrey Davis, who happens to be the owner, um, and he is a medical, uh, doctor at Prairie Health and Wellness. And so, um, we thought it would be a great idea to interview him, and let our listeners know the genesis of Prairie Health, um, but also get into your journey too, because I think a lot of our listeners will find that very, very interesting, of, you know, starting in a very traditional or conventional medical model, um, and then transitioning into what you do today. So I will turn it over to you, so you can — but please share with us, like, we — you know, I know everybody wants to hear your background, more about you.
So well, first, thank you for having me on the podcast, um, yeah, I think, um, my story, um, I — I don't know, I grew up in the Midwest, um, here in Wichita, Kansas, and grew up the, um, oldest of four boys, and my dad was a family doctor, so medicine was something that we talked about a lot, uh, I saw — I had a very realistic, um, view of what, uh, it looks like to have someone in the family who's a doctor. You know, my dad was frequently gone doing rounds in the morning in the hospital, he'd come home with a stack of charts and sit back there, but it was also really neat to watch him out in the community, and how people would constantly come up to him and say things that maybe he'd help them with, or things that they appreciated about him, so that was sort of my view, was that doctors just helped people.
Um, I think the thing that really drove me to medicine, well, it's — it's actually a funny conversation, my dad and I had out by, uh, in the backyard one day, and he said, um, this was before — I think I was probably a senior in high school, and he said, well, what — what do you want to do, and I said, you know, I think I'd really like to be an architect, and he — he kind of, he looked at me, and he goes, well, that's great, but you don't know how to draw. And I thought about that, and I was like, yeah, I don't know how to draw, so I kind of started rethinking life plans at that point.
And um, it was sometime in college that I decided to go pre-med, and I loved the sciences, I mean, I loved learning, uh, you know, my favorite classes were always the science, the natural science classes, so I had a love for science, I enjoyed taking things apart and understanding the intricacies, I love learning about how things worked, and I loved helping people, I was a people person, I liked being around people. So it felt like it was a really good blend, to say, I can dive into this very complex world that has a lot of discovery yet, and through that I can help people and be around people, so that was kind of my reason for going into medicine.
Um, took a longer path, uh, after college I graduated and actually worked in a life insurance company for a few years, and then um, worked for, um, the Huffington Center on Aging, doing grants, uh, management, which was really mind-numbing. Um, and it was from there that I got, um, accepted into medical school down in Texas. So in medical school, I loved doing every rotation, I — I did, I enjoyed, and so for me it was very natural to think, I cannot see myself specializing in one area of medicine, so for me family medicine seemed to be the best, um, the best option, because I could sort of tailor my practice to whatever I enjoyed doing at the time.
Um, after residency, uh, joined my dad's practice, um, we — we had moved back to Wichita, Kansas for residency, and um, by that time, you know, we'd have our — have our first of four kids. So started practicing with my dad, which is just amazing, my dad and I have a fantastic relationship, he's — he's a hero of mine, been a big inspiration for me for years, and somebody I've always looked up to. So that was where I started my practice, and then, you know, it was the traditional insurance-based model, um, you would see, you know, on a busy day, 30 patients, sometimes up to 40, um, you'd frequently be there past closing time, trying to wrap up the day's business paperwork.
And it was during that time I sort of started to feel that I — I didn't feel like people were getting the benefit that I thought they should be getting, I was — and maybe I didn't notice it at that time, but I was very much in that mode of, you have a problem, here's a pill, and that's the way we had kind of approached most things, I think, in medicine is a — is a pill for problem approach. Um, it was during that time that my wife really encouraged me, um, to — to read this book, and actually it was my wife and my mother-in-law, to read this book about hormone therapy, and you know, I said all the normal things, like, oh, it's not FDA approved, there's no study showing that, you know, hormones help people, and I kind of threw out all my standard things that I — that I was really just parroting what, you know, the medical community that I was in at the time had been saying.
And um, I finally — I really just — I got worn down by them, and I said, fine, I'll go to a conference. And so I went to — I think the first conference I went to was an A4M conference, and it was in Orlando, and what happened there was, was that I — I fell back in love with the basic sciences, and I heard these lecturers and other physicians and clinicians getting up and really talking about how the body works, and let's go back to the basics and let's go through these biochemical pathways I hadn't seen since medical school. And so in a very real way, I felt like they were applying the true scientific method of understanding the function of the human body, and how we can help what was naturally designed — the body's naturally designed to do, how we can help and improve that way.
So it was almost like someone said to me, you know, you enjoy science, you enjoy helping people, there's this gigantic toolbox you're missing, and we're going to give you this toolbox to now go back and help people. So that's, for me, what functional medicine was, was just having a bigger toolbox, more things that I can apply in terms of lifestyle management, helping people with supplements, um, you know, deficiencies that we might identify, um, helping them with hormones that may have, for various reasons, you know, failed them. Um, and so then taking that back and trying to apply that in the standard medical model, where you're seeing 30 to 40 patients a day, and you're trying to get insurance to pay for everything, was a soul crushing experience.
Um, I remember one day I was — I was ordering vitamin D, because that's a level that, you know, I think is important, it's an incredibly important, um, nutrient and hormone, really, for humans, and I would have patients come back and go, man, I got billed, you know, $225 to check vitamin D, and I thought, oh my gosh, I'm sorry, what happened, so I went and found out, oh, insurance denied the vitamin D test. And so we would, you know, contact the insurance company, what happened, well, you can only get a vitamin D checked if they've had a fracture, I thought, well, aren't — I thought we were in preventative medicine, I mean, don't — don't you have some interest in preventing fractures, or — or the other one, they said, is you can't check a vitamin D level unless they're vitamin D deficient, which, you know, very well, there's no — you can't look at somebody and say they're vitamin D deficient, right?
Um, right, so then the final answer they gave us — we got three different answers — the final answer was, we just treat everybody with vitamin D and don't check, and I thought, this is crazy. So I went to our billing department, and I said, okay, why are we charging $225 for vitamin D, and how much does it cost us to get, and I think that at the time a vitamin D test was around $35 for the practice to order it, that's what we had to pay LabCorp. And I said, well, that's great, let's just — let's charge 40, you know, we'll make enough to cover the cost of drawing the lab, and the cost associated with it, and we'll be able to get this information for our patient, and the — the coder, or medical biller, um, said, well, we can't, we have to charge what the insurance allowable is, and I said, but the insurance companies aren't going to pay that, she said, yeah, but we can't go lower than that, because then they'll — they'll pay even less, and we'll lose money on all these tests.
So that was kind of an eye opener, that I might need to find a different way to — to do functional medicine, and in the insurance industry it doesn't seem like it's going to be open to these kind of things, right? Um, so that's — that's where the idea of looking for an alternative way to practice began, and actually started with my dad and I starting a company called Capstone MD, where we were doing kind of a concierge model within the practice, we were seeing — it was sort of a test project, to see, can we — could we just float this to some of our patients and see if they would be willing to pay a member type model, you know, a membership model, to have increased access to us.
And I think it really was, that it was primarily just, we would take calls after hours, you know, even maybe do house calls, and there was — there was interest, for sure, and it was during that time that I had a friend in — in the community, she's another provider, she's an OB-GYN, and she was practicing functional medicine, so we were both trying to practice into this insurance model, and unfortunately she, um, called one day and said, we're closing our practice, and I was shocked, because I thought, why, cause her patients loved her, I mean, her practice was blowing up, and they just couldn't make the financial model work.
And so, you know, I had been doing this Capstone, I said, well, hey, why don't you pivot, there's this membership medicine model, you can totally do it a different way, and I think they were just at the point where they were like, we're — we're out. And so she wanted me to take over the practice, that was Prairie Gynecology at the time, and there was a nurse practitioner, Jolene, she — you know her very well — who wanted to stay at the practice, and so I kind of went and talked to my dad and sat down and had a hard conversation with him, saying, I think I — I think I need to leave the practice, and I think I'm going to try this different thing, and I'm just going to go all in on a membership model, and do functional medicine.
And um, he completely blessed it that day, he goes, I think that's exactly what you should do, and that sounds fantastic, and it was — it was really, it was probably, I think it was — it was a pivotal moment in my life, to be able to, you know, the person I had been practicing side by side with for 10 years, I mean, we — we had such a fun time. That's amazing, and I know that had to be hard for him to say, go off and do your own thing, um, because I know as a father, I don't know that I could have said that, I would have done everything to talk me out of that, probably.
So, so, so that's where Prairie Health and Wellness started, we — it was Jolene and I and a few, a handful of nurses and front desk staff, and yeah, I remember the first meeting we had, where I walked in and I told them, hey, we're going to do something completely different, um, we're not going to take insurance anymore, we're going to do this cash model, we're going to have memberships available, and the goal is that we have the lights on, uh, here, and we can pay the bills. Um, and that's kind of where we — where we've grown out of. Um, yeah, we grew very quickly, and we, you know, I made mistakes along the way, I think, and we've learned a lot, um, but it has allowed us to then, um, you know, I think the — the fundamental difference with a membership model, or what we call Direct Primary Care, is that it's — it's us directly caring for the patient, without the mindfulness of, like, what will your insurance cover.
And it's not that we've gotten away completely from insurance, we still have to consider it for, you know, if we have to refer somebody out, or get an expensive, yeah, exam or imaging or something like that, but for the most part, when we're having a conversation, we don't have this invisible third person in the room that we always have to consider. And in reality, in my old practice, the patient wasn't really the customer in that equation, the customer was the insurance company, and the insurance company's customer was my patient, and I — I don't think I understood how difficult that model was until I came out of it, and realized, oh, this is so much simpler, I can just sit and talk with people.
And lo and behold, we can look at the vitamin D test now and say, hey, this now makes sense for us to just do a vitamin D on everybody every year, as just part of their membership, right, and so we are able to provide that, um, value, I think. Well, let's pause for one minute, because I think there's something that our listeners are wondering, and probably want to hear, with something that, you know, is doing an amazing job kind of navigating us through the earlier days, but what was that like for you, to jump from, you know, especially like you said, how, you know, wonderfully supportive your dad was, and all of this, um, you know, you'd kind of just known this one thing for so long, like, what was that like for you to make that jump?
You know, it's — it's funny, I, um, I look — I look back and I try to remember, like, what — what made me make the jump, um, because I'm much less risk tolerant today than I was then, and I'm like, I — that was crazy, because we — I left a practice that was busy, I mean, it was — I was full in my practice, and um, you know, you would look at that and go, why would you walk away from that, but you know, I — I think I was looking more at what — what I was hearing, is that, you know, in our meetings with our managing partner, he — he showed a graph one day, and he showed that, you know, revenue from insurance companies was going down, our costs were going up, but — but not to worry, we still have a comfortable margin, but the trend lines were impossible to ignore.
I mean, I was like, well, you're going to retire, here, I'm going to be trying to practice in this model when the margins are razor thin, and — and that's all you're going to be able to think about, right? So part of it was, a — I felt like this was the only way to do it, but it was terrifying to step out. And you know, when we first opened our doors, I thought, who — who's going to come, because it was — it was soon after we announced that we were doing that, that we were not taking insurance, that Obamacare was passed and became the law of the land, that you had to have insurance, right, right, you remember, you were going to be fined, and actually it was, I think it was a tax, it was something through the tax system, that the fine would be levied if you didn't have insurance, and I don't know if that's still the way, but I remember thinking, oh great, here I am, I'm not taking insurance, and everybody's required to have it.
But it ended up being probably one of the better things for us, because people who didn't have insurance, or that, you know, switched to Obamacare, they suddenly found out they have this high deductible, right, and I remember patients saying that they — they went in with their new insurance plan to, you know, take their two kids in for a strep throat or an ear ache, and then they got a bill for $600, you know, two or three months later, wait a minute, we have insurance, and they would call and go, yes, but you have a $5,000 deductible, none of this visit was covered, right? And you know, this particular mom actually reached out to me and goes, well, how much would that visit have been if we had been in your practice, and I said, well, strep test was $5 or $6, the visit would have been completely covered by the membership, or I can't remember what our cash pay price at that time was, but it was significantly less.
Um, and so you could see this aha moment happening with people, that they're like, oh, I can call you and you'll tell me exactly what it's going to cost, right. In fact, I remember when we did this, the Blue Cross Blue Shield, I had to send them a letter and say, I'm out, you know, cancel my contract with them, and they sent their, um, this guy who'd been there for 35 years, I can't — I wish I could remember her name, but she sat in our break room at the new office, and she said, this is a mistake, you don't want to do this, and I said, well, I — I begged to differ with her, and I showed her the super bill, uh, which was a sheet of paper that had all the names of the things we would do, the ICD-10 code associated with it, or — it wasn't ICD-10, but it was some code, the billing code, and then the price.
And when I handed her the sheet, she goes, oh my gosh, you've got the prices on here, and I said, uh-huh, transparency is important, and she started looking at our prices, she goes, I don't think you're going to be able to make this work, because she knew that whole insurance allowable thing, and she was looking at the various labs that we were including — in some cases we had a zero next to a lot of the stuff, cause, you remember, we would say, well, this was just included if you're a member, right, and I remember saying, challenge accepted, in my mind, you know, I'm — you know me, I'm a little bit of a contrarian, and I was like, I'm going to prove her wrong, and I think we've been able to do that.
Yeah, yeah, well, let's — can we define, or we can — you define for our listeners what direct primary care really is, and what that looks like, yeah, and maybe even start to get into kind of how you start to weave that into functional medicine too. So direct primary care, I — I first learned about this from, um, another doctor here in town, Josh Umbehr, of Atlas MD, um, who I really credit with blazing the trail, I mean, he was on the bleeding edge, you know, we followed very quickly, and he was so — so gracious, to offer free advice, I mean, he helped us through — through so many of the complexities of, how do you get out of Medicare, what does that look like to still take care of Medicare patients but not be a Medicare — I mean, there's a whole — there's a lot of complexity out there of switching teams.
Um, so I really — I don't think we could have done it without him, I mean, he really was instrumental, and his practice has grown as well, and he's — he's been on Sean Hannity's show, and you know, so he's sort of the superstar in the direct primary care space, but a lot of people will say, well, that's — you're doing concierge care, that's just healthcare for rich people, I mean, I would say we cut across the — the breadth of the socioeconomic scene, because people of all economic statuses find value in what we're doing, or hopefully they do. So the direct primary care model is really just our business model, and membership medicine is how we run the day-to-day business.
So you know, when we first started out, we had member, non-member, and that became very tricky, because people might transition from being a member to a non-member, you know, the — we heard, they'd go, well, I'm getting better, I'm not coming as much, so I don't want to pay the membership, I'll just pay as needed, but then, you know, they remembered all the member services and what it felt like to just be able to pick up the phone or send an email, and so it felt bad to say to them, well, you're not a member anymore, you don't have that level of access. So we did an analysis at some point, and found out most of the people who are highly satisfied with our practice were members, the people who were dissatisfied with the practice were non-members, so we made this shift, to say, if — why spend so much effort going after the 20% of people who are unhappy, let's do better at delivering a membership model.
So we did what Josh really recommended from day one, he's like, I don't know about this blended model, it's going to be difficult, but it did allow us, I think, to grow quickly, and for people to have a lower barrier of entry, right. So, so now I think for us, what — what really helps in the functional medicine model, is that instead of seeing 30 to 40 patients a day, my busiest day is 10 people, and sometimes eight, right, and so I get to sit down with people for an hour to start out with, and that shocks most new patients, when they — when they come in, and they go, I know you don't have much time, so I'm going to try to get this out, and I sit back and go, we've got an hour.
And so um, I — that wouldn't work in the insurance model, I don't think, so — the pace at which we can deliver care changes, the ways in which we can deliver care will change. So I remember back in the day, I had a patient who — they were out of town for an out-of-town job, but needed a medication refilled, and so they called Blue Cross Blue Shield and said, can I have a phone appointment with my doctor, and they said, yes, we cover that, but there's some paperwork that has to be completed beforehand by your doctor. So she called me and said, I want to have an appointment, and I said, well, you have to come in physically to see me, she goes, well, I've called my insurance, they say if you'll do this paperwork beforehand, they'll pre-approve it, and I thought, okay, well, I'll try, and it took us an hour and a half of talking with the insurance company back and forth to pre-approve a 15-minute phone conversation.
I said, this is never going to work, so you know, now I see patients — actually we have patients who are all over the country, I mean, they've moved away and said, I still want to be a member, can we do virtual care, and so yeah, we get on Zoom calls, we get on phone calls with people. So, so direct primary care has really, um, made it so that I think we can provide better value to our patients, probably the short way of saying that. Yeah, so it sounds like what you've said is, you know, you've taken out the middleman, essentially, and it really does come back to that doctor-patient relationship, without that, you know, tag along the insurance company.
Yeah, yeah, and — and it's like I said, we still have to consider insurance, but you know, now we've got a lot of tools where we can help people, even, I think we do even a better job now, in helping people navigate how to use their insurance in the wisest way. You know, so for instance, you know, we've got Fair Market Health here in Wichita, Kansas, which is a marketplace that gives people access to cash-based procedures, so if someone needs a colonoscopy, we can say, well, if you went with your insurance, you'll have your $5,000 deductible, then you'll have your co-pay for the procedure, and then you'll have your co-insurance for whatever is past your deductible.
And so somebody going in for a colonoscopy, easily, if you go the insurance billable route, that could be $6,000, $7,000, easy, depending on whether they take biopsies, what kind of anesthesia was used, whereas we were able to navigate, because we're cash based, and we're — we're concerned about how people are spending their money, we could navigate that with patients and say, but if you wanted to purchase that with cash, you know, it's $1,400 to $1,600 on the marketplace, and it includes all these things, doesn't matter how many biopsies are taken, and it's amazing how many people will say, oh, so I don't have to use my deductible, because the deductible, people think, well, I want it to apply to my deductible, I'm like, that's still your money being spent.
Yeah, maybe talk about that a little bit more, because I think, you know, that's something I certainly see in the clinic, with some of our patients, there's a lot of misunderstanding or misconceptions with insurance, like, I hear — I hear things like, oh, my insurance will pay for that, or you know, I want to use my insurance, so can you expand upon that for listeners, because I think it would be so helpful for more people to learn some things. Yeah, yeah, well, the insurance system, by design, is complex, and unfortunately all these plans operate differently, so they each have things they consider to be covered expenses, things that aren't covered, they have things that, um, will go towards a deductible, some things go to an out-of-network, a whole separate deductible.
But in general, for you to have insurance, either you or your employer, or sometimes a combination of both, will have to pay your premium, and that premium, um, then gives you access to a network of physicians, usually, so they'll say, well, here's the physicians that take your insurance, in a city like — most providers take almost all of the major plans, so you've got your big players, your Blue Cross Blue Shield, your Aetna, and your Cigna, and everybody takes it, it's very rare that you find somebody — so the whole network thing used to be this, you know, oh, Blue Cross Blue Shield has the best network of doctors, well, you know, obviously Blue Cross should want to get as many doctors into that as they can, and doctors coming new to town would go, well, I don't want to be the odd guy out and not have any patients be able to see me, so pretty soon everybody in town takes all the insurance products, so the network thing isn't really — it's not a selling point of the plans anymore.
But so, if some things might be 100% covered by your plan, so for instance, Obamacare — I think some of the positive things that Obamacare did, is it made it so you couldn't pre-exist people, so if someone had hypertension and got an insurance plan, you know, under the old system they might have a rider that says, we won't cover anything related to hypertension for the first, you know, so many months or years sometimes, and Obamacare said, no, you have to cover them from pre-existing, so that was a nice change. Um, but what it did is, it suddenly — these affordable — I mean, this is kind of crazy, but insurance used to be affordable, I mean, someone who was young and healthy could go out and purchase a high deductible plan that wouldn't really pay for any of the preventative care, but if they had a car accident, or they had some terrible diagnosis and had to go to the hospital, it would cover that, so it wouldn't financially bankrupt them.
Well, under the Obamacare plan, those — under, I'm sorry, the Affordable Care Act, let's be fair — those plans were no longer allowed, so everything kind of homogenized to this plan of where you could have, uh, low deductible or high deductible, the low deductible plans were incredibly expensive from a monthly standpoint, the high deductible plans were more affordable, um, but they were super high deductibles, I mean, we're talking, in some cases, $5,000 to $7,000 deductibles. So that meant if you were on a high deductible plan and you went in for the sore throat or the strep test, you were going to be billed the insurance allowable, which, under the old system, would have been, you know, negotiated and paid down to where you might have a small co-pay for that, a $20 or $30 co-pay for the visit, and then your insurance covered everything else.
Now, under the new plan, you were on the hook for the first 5,000, plus whatever you've paid into your premium, right, and then they added on things called, you know, there's the co-pay for a surgery or a visit that you'd have to pay no matter what, and then there was co-insurance, which said, in most cases, after you meet your deductible, some things would be an 80/20, meaning the insurance will pay 80% of that, but you're still on the hook for 20, so even though you've paid out 5,000 out of your pocket for your care, and you had some really expensive knee surgery, well, you still could end up paying thousands and thousands of dollars for the knee surgery even after you've met your deductible.
So there's — there's all sorts of ways that the insurance industry hides these fees, you know, makes it sound like everything's going to be covered, and then on the back side, we would say, okay, well, I think this is covered by your insurance, so let's get this test, and then later, like with the vitamin D, they'd find out, oh, the insurance denied that. So then, you know, we'd say, okay, we'll find out from your insurance company why it's denied, and then the insurance company would typically say back to the patient, well, there wasn't enough information in the doctor's note to justify this charge, which means the code that the insurance company wanted to see wasn't on the chart.
And I always said, well, just put whatever code you need, tell me and I'll put it on the chart, well, we can't do that, you definitely know it's not the right code, right, cause you're not paying this, you know, the code you're looking for, but you're not going to tell me, correct, we're not going to tell you. So there's this back and forth of fighting with insurance companies, and it — and it sometimes would culminate in this thing called the peer review, this is my favorite, so the peer review, they — where they would say, well, what we need to have you do, is we need to have you talk to one of our doctors, the insurance company's one of our doctors, who's a peer of yours, and you can explain to him why this test was necessary, why you had to do, you know, whatever you did.
And sometimes I would get on the phone call with someone, and I would start telling them, like, okay, I want to get this advanced lipid test, I need to check their ApoB because of this complex family history they have, and the symptoms, and the person on the other end would go, hold on, I'm an anesthesiologist, I don't know what ApoB is, and I would say, okay, I know you're an MD, but you're not my peer when it comes to the family medicine, you know, uh, preventative care space, and yet I was supposed to try to educate this person about why I needed this test. So this is where the whole insurance industry — it's so refreshing now, we're 10 years out of it, and I still talk to my colleagues who are in it, and I'm like, I'm so glad to be out, to be out.
Yeah, I mean, I get the medical economics journal, you know, which is basically a journal of, like, here's how you navigate the complexities of an insurance industry, and I read through the articles and just smile and go, I don't have to worry about any of that. Well, okay, okay, I'm — you know, I just sat there, and I'm sure many of our listeners did too, and their heads are swimming, right, I don't know that it's any clearer. You know, yeah, and I — I think it really hopefully gives some of the listeners, um, perspective on, you know, those types of things don't take two or three minutes when you're trying to see patients, and like you said, especially in a more traditional model, when you have to see 40 patients a day, it's like a windy — a waste of time, right, to get on the phone and try to negotiate these things with the insurance companies.
Well, it's interesting, so there was, um, there was a group of — there was two physicians that were, um, at a conference doing CME somewhere, and you know, you've been to the CME, um, there's — it's usually some huge hotel room with all these banquet rooms, and you know, there's going to be other conferences going for other industries, you know, the airline industry might have a conference running the same day, and you're crossing paths. Well, they were walking by a conference room, and saw that the insurance industry was having, um, the medical insurance industry was having a conference in there, so these two physicians grabbed a cup of coffee and they go sit in the back of the room, they're like, oh, this will be fun, let's find out what they talk about.
They were shocked, what they were discussing was, um, pre-authorizations, that with pre-authorizations, the insurance industry is shooting for a walkaway rate. So you might say, what's a walkaway rate, well, a walkaway rate is, how many, at what rate, will physicians just walk away and go, I'm not doing pre-authorization, it's too painful for me to sit on the phone with these insurance companies and do these peer reviews and do all this paperwork to try to get things covered, there's a certain amount of physicians that just say, I'm not going to do it, well, the insurance company wins, because now they don't have to pay, and they get to look like the good guy, because they can tell their client, you know, the patient, well, your doctor refuses to fill this out, we're really sorry, you know, we've made it so easy for them.
So these two doctors were shocked to find out that this is actually something they're trying to do, the pre-authorization was never about trying to manage the cost of care, it was about making more money for the insurance company, making it harder for doctors to order tests, right? Right, yeah, um, well, let's go back a little bit, so if I'm a patient coming into Prairie Health and Wellness, you know, what does that look like, so you explained a little bit about the membership model, so, you know, that's a monthly fee that I'm paying each month, that's going to guarantee me what?
Well, so this is where I tell people, if you've seen one direct primary care practice, you've seen one direct primary care practice, because I think we all do things differently, you know, I do things different than Atlas MD does, we've got other practices in this town, Antioch, the phenomenal group of providers there. So under Prairie Health and Wellness, the — the monthly membership, first of all, there's your appointments are covered, so whether you need to come in once a week, once a month, once a quarter, once a year, we don't keep track of how many times you've come in, that's just the access to us as providers.
Then on top of that, we have an annual panel of labs that we do, um, so again, these were things that I felt were important for me to be able to check with people. So we do a complete blood count, we do a lipid panel, we do a comprehensive metabolic panel, we look at your insulin, we measure your A1C, um, we measure your omega-3, which is almost something that no one measures, uh, that vitamin D3 test that was $225, we just throw that on there for free once a year. Um, we also have a full body GE Lunar DEXA scanner, so once a year we do either a DEXA scan looking at body composition, or we'll look at bone density, because again, I think those are very important metrics to track, depending on which population you're in.
Um, what else do we have in there in the membership? So access to us through the portal, so it's very easy to communicate with the providers in our practice, oh, and then, um, any additional labs — so this is really exciting — so that whole panel I mentioned, and there's other things on there that I probably forgot, uric acid, mhm, so that whole panel is once a year, you're just covered by your insurance, or by your membership, you don't have to worry about the cost of that. And then if there are additional tests that we have to get, we were able to negotiate pretty aggressively with LabCorp, and we got that vitamin D test even lower now, right, and so if we have to come back and recheck a vitamin D, or do a full thyroid panel, what could, in some cases, cost people thousands of dollars if they were using their insurance at another practice, is costing $100 or $200, I mean, it's a significant savings on the labs alone.
So we can do that same thing with prescription medications, so if we have patients who need prescriptions, which we sometimes have to keep them on, or you know, we use the pharmaceutical, uh, solution occasionally, well, we can go out and buy those drugs for them, and we can have our own pharmacy for our own patients, this is something that's unique to the state of Kansas, other states do this, but um, Texas, for instance, you can't dispense medications out of your office. So even with things like metformin, um, you know, hypertension medications, uh, blood pressure medications, we can offer those at even lower price than sometimes the, you know, $40 copay was for, like, a Walgreens or a CVS.
Um, other things that are unique is, we have a full line of what I call pharmaceutical grade supplements, um, and we can talk more about what that term means, but we offer those at a discount that — in fact our discounts are so deep on that, that our contracts with, uh, the supplement companies, they say, you cannot publish this price, because it's below what the recommended manufacturer price is, and so we're able to provide very high quality, you know, pharmaceutical grade, pharmaceutically equivalent, I would say, uh, supplements to patients for a much better cost. Great, yeah, that sounds like a lot of wonderful things that, you know, I think people don't always know that they have access to.
Yeah, so, and we've — we've added other services, so we have chiropractic, we have, um, PT in our office, we have occupational therapy, we have muscle activation, and so if patients need those services, they get them at a member discount, which is, I think, helpful. That's great, that's great, um, let's talk a little bit more about functional medicine, so, um, you know, I think you shared a little bit that it was maybe your wife and your mother that recommended this book, um, were there any other things that happened for you that made you kind of start thinking about things a little differently, and maybe even define, like, for you, or for the listener, what functional medicine really means?
Um, yeah, I think for me functional medicine is really, um, I mean, there's kind of a joke in the functional medicine world that functional medicine is about treating problems you didn't know you had, in ways you don't understand, you know, cause we really get deep into the weeds on the biochemical pathways, and helping people understand that stuff, but really, I think for me it goes back to simply that toolbox of, um, I really think functional medicine gets back to the heart of what family medicine is, which we want to treat the whole person, right, that's one thing I loved about family medicine, the model wasn't that I'm going to focus on the knee, or focus on the shoulder, or I'm just going to treat, you know, the eyeball, but I'm going to look at the whole person, and that's the person from a spiritual person, an emotional person, a physical person, and approach their healthcare from that way.
So I do think family doctors are still best trained to adopt functional medicine, um, but for me functional medicine was really getting to the root cause, so I'll use blood pressure as an example. When I was in medical school, we were taught that, um, that if someone had high blood pressure, you would diagnose them with essential hypertension, I said, well, what does essential hypertension mean, and um, the way the older doctors would say it is, well, they have high blood pressure and we don't know why. Well, what do we call that in other areas where we don't know the reason someone has it, we have a term for that, we call that idiopathic, meaning you have idiopathic pain, it's pain that we just haven't figured out what the source is, but for blood pressure we just say, oh, it's essential hypertension, we're going to start you on some medications, and now the recommendation is to start on usually three medications at a time, um, and in cases they're combinations of one and two.
So I began challenging that, well, don't we want to know why they have high blood pressure, and the answer was, no, don't — don't waste time on that, you won't find out why, um, and if you do, it's rare that you'll be able to reverse it, so just manage that with medication. And that never sat well with me, that we weren't trying to fix problems, we weren't trying to figure out what is the reason they have it, so for me, functional medicine was really about always trying to drive to that root cause, and I think in some cases we get to a root cause, and sometimes we're at a limit where we're like, okay, well, this is a root cause, and then patients go, but why do I have that, and I'm like, well, that's a really good question, I don't — we'll hopefully future understanding will help us understand where that comes from.
So there's still a lot of things in functional medicine where we're not getting the root cause, or the true root cause, let's say, um, but I think it's still a noble pursuit to always say, well, let's see if there's something else we can do to treat this, right. Yeah, oftentimes I'll tell my patients that trees don't typically just have one root either, right. Oh, for sure, a lot of times we're looking, you know, root causes should be plural, usually, instead of just one thing. So well, and in functional medicine, I — I learned, um, that naturopaths — when I would go to these conferences, I would try to sit next to a naturopath, because if I had questions I could lean over to them and be like, what am I talking about with this methylation stuff, and that's because in your training, you know, you spent four years of really, really doing that, out of the gate, and um, and then also had to learn all the drugs and all the herbs, so it's kind of amazing the breadth of knowledge that naturopaths have to have.
Um, but but I think, you know, that not only root cause but the determinants of health, I think it's the way naturopaths talk about it, like, what are all the determinants of health, and that's what's led us to develop, in our practice over the last 5 years, are — are pillars, you know, our pillars of health are kind of a homage to the determinants of health that naturopaths use. And it's been great, like, I love now, like, I'll come into a room, and you know, sometimes I'm running a little bit late, so the patient might have been sitting in there for a while, but they'll — they'll point to our poster on the wall with the pillars, and they'll go — I'll say, what do you want to talk about today, and they'll go, okay, um, sleeping terribly, my nutrition's awful, I'm not exercising, and they're just hitting the pillars for me, I'm like, fantastic.
And so, you know, if someone has a health problem, we have to go look at those things first, you know, and sometimes the way I say it is, I feel like in medicine the order of operations is backwards, so in math you have an order of operations that you follow, in medicine I think we need to start with subtraction, right, and I think so much of medicine we start with addition, well, let's add something, and see if we can help, we're going to add, add, add, and even, in some cases, in functional medicine it's adding a bunch of supplements to people, which, you know, you and I call green allopathy, right, allopathic medicine, naturopathic medicine.
So the important point, I think, is functional medicine we really should start with subtraction, are there — are there things you're doing which you need to remove from your habits, or is there something in your diet that you need to remove, is there something, you know, alcohol, that you need to remove, so starting, uh, that order of operations that way, you know, again, that's something that functional medicine has taught me, you know, in that toolbox. That's great, yeah, we like to remove obstacles to healing, right, oftentimes that's the majority of what we really need to do, to try to help somebody.
Well, and I have — I have a deep faith, and truly believe we are wonderfully and fearfully made, and we are designed, uh, to work, and if we remove those barriers, so many times, what physicians do — I — people say, you know, you're in the business of healing, I'm really in the business of observing healing, you know, and many times I have to just buy time for the body to do what I believe God designed the body to do, and then if we remove these barriers, what we're going to see is this flourishing happen, the body, you know, begins healing in — it's the way that it's designed, and so for me that's really fun to watch, and we get to do that day in and day out. Yeah, that's amazing, yeah, I also like to think of it as, I'm in the business of teaching.
Yeah, you know, well, the word doctor comes from the Latin "docere," which means to teach, so we really should be teachers, you know, we should be sitting with our patients, and we should be educating them, that's right, here's how your body is supposed to work, here's things that are maybe getting in the way, let's see if we can remove those barriers. Yeah, it really seems like to me that conventional medicine has a very parental style, I think, uh, you know, with patients, where it's kind of like, do as I say, I — you know, I'm the one that has the knowledge, and a lot of times, is true, I mean, obviously doctors and other healthcare professionals go through extensive training to learn all of these things, um, but you know, especially I see this in our patients, our patients are well educated too, for sure.
And so, um, you know, that parental style, um, I mean, if I'm being totally honest, I don't want to practice that way, I — you know, I have two lovely children of my own, that take all of my parenting, um, you know, and so I think that's also one of the cornerstones of functional medicine, is this, um, equal relationship, you know, that we have with our patients. It — I think it even goes further than that, we have patients like you said, are well read, well researched, but what we really have is, we have thousands of patients who go out and are learning on their own, they've been empowered to go seek information, and then they come back to us and go, hey, I got this article, or I was at this lecture and learned this thing, what do you know about it, and how many times have you and I said, I've never heard of it, right, give me the paper, let me look at it, let's talk about it.
And our patients are out there finding things that we, when we look at it, and you know, with our analytical minds and our medical background, we can then vet that and say, this is really exciting, you know, and so I think the physicians that say, well, I'm not going to learn from my patients, you're missing out on a fantastic base of people who are motivated to do research on their own health, who then you can help them navigate that, right. So yeah, it's definitely a refreshing relationship to have, and I would say one other benefit to the Direct Primary Care model, I know we're going kind of backwards here, but okay.
I believe we have a differently motivated patient that comes to Prairie Health and Wellness, meaning, in the past, I might walk into a new room, or new patient, and say, what brings you in today, and they would say, well, you're on the back of my insurance card, and I need to have this annual exam, and I'm like, oh, I'm so happy that you chose my name out of a book randomly. So the patient we have at Prairie Health and Wellness, they're paying to be there, and so that is a differently motivated person than one that's expecting insurance to pay for their care, so that when we're giving them information, or a plan, or a direction, or a path that we want to try, they are highly motivated to try it, right.
So it does two things, it helps — I think we have more success with our patients because of that, but we also get to learn which things really aren't working, right, because these patients are coming back and saying, hey, I want you to help me, this isn't — this isn't helping, right, and so it keeps us more accountable, I think, to serving the client's needs. Yeah, the patient's needs, yeah, yeah, that's a very good point, um, and I think you kind of touched upon this a little bit before, um, but just, I think, with that being, you know, one of the big differences, right, with insurance, um, are there any other, you know, kind of speaking along those lines with insurance, are there any other misconceptions or things that you think people should know just about insurance, or, like, what about, you know, I'm sure you get this question sometimes, of, um, you know, is there a time that I really need insurance, or that I really should use insurance, you know, that type of thing.
Well, I think if you go back and look at what insurance used to be, it used to be purely pooled risk, so you would take a monthly payment from a large group of people, and that would be held kind of in an escrow account, and if something devastating happened, then the money could be pulled out of that pool and be used for that, and then, from that, employers started to get health plans, you know, hey, we'll cover — we'll pay for you to see your doctor once a year, and then that grew into the benefits package that you see today. And so, uh, the modern health insurance plan is not truly a pooled risk benefit, it's actually prepaid health care.
And so, and that's what's made the cost of care — I mean, people say, you know, they would always say, well, we need more affordable health care, and I tell them the reason healthcare is unaffordable is because of insurance. So an analogy I like to use is that we all are required to have, um, car insurance, right, at least liability coverage, would you take your Geico card into Jiffy Lube and say, I need an oil change, they would hand you the card back and go, great, here's what the oil change costs, uh-huh, and so that — because that's a maintenance thing with our cars, that is not an unexpected expense that you're incurring, um, you know, you didn't get into a car accident and go to Jiffy Lube.
So I think there's a lot of things in medicine that would be way more affordable if we just treated them like the oil change, like, I know I need to go in for an annual exam, I'm going to have to get my blood pressure checked, my weight, my height, have a conversation with my doctor, you know, that's taking someone's time, I want them to be reimbursed for that time, what's the value of that, I mean, that's something that the capitalistic system would be able to figure out beautifully, and there would be competition that arises, and maybe you would find out, well, this one doctor I really love him, so I'm willing to pay more, but this guy's so much faster I can get in and out, so I don't mind, you know, I'm great, I pay him less, I mean, that's the beauty of that model, is you truly get to find out what people value and what people don't value.
So in the insurance model, none of that happens, you know, if you went to Jiffy Lube and they did take the Geico card, they would be like, okay, well, your manufacturer requires you to have a synthetic 10W30, but this insurance plan you're on, it only covers non-synthetic, and it's 10W40, so I'm going to have to call your insurance company and try to get your oil change pre-authorized. So meanwhile, what's happening to the price of that $39 oil change, now it's going up, because the — the purveyor of the oil change place is saying, I'm having to spend a lot of time, and then, in some cases, they do the oil change for you, and you drive away, you're a happy, satisfied customer, the insurance company then comes in three months later to the person who changed your oil and says, oh, sorry, we actually aren't going to allow that charge, and they claw that money back.
So so in many cases, the doctor is like, well, I've already incurred the expense of that, and now I'm not getting paid, so what do they do, they're just going to raise the price on everything else, and so that's really what's happened in the insurance industry, is insurance is expensive — or health insurance, health care is expensive because of insurance, right? Right, well, let me give an example, a personal story, um, something that happened to my daughter, where I was faced with this decision, um, because, uh, my family, we do carry a type of insurance, um, but you know, through learning some of these things, like you're teaching our listeners, I've learned that even with that, I can almost always navigate different parts of the healthcare system, um, without using it, even, and I think for many of those reasons that you mentioned, I try not to use it, um, because I've found that there are obstacles like that, and sometimes I even end up spending more money than what I would have had to spend.
So um, my youngest daughter ended up falling and bonking her head a few summers ago, and she got her bell rung pretty good, so she had a pretty significant concussion, and of course it happened, you know, on Sunday morning, and um, you know, it was the type of thing where I knew she needed to get care right away, and so we went to the ER, and um, you know, and thank goodness, right, I mean, this is — these are the types of things I'm very thankful for, that we have access to, right, and true, like, emergency situations.
Um, and so, you know, we kind of go through the typical thing, she gets evaluated, they determine, you know, it's best that we probably better do some imaging, just to make sure, you know, her head and her brain look okay. Um, and so as we're navigating this and doing this, I'm kind of thinking in my head already, like, okay, I know my deductible, I know what — so essentially what my out-of-pocket cost is going to look like. Yeah, and I'm going to take a bet here, and an educated one, right, because I'm in the — I'm in the system, I have a general idea of what these things really cost, um, and I'm going to actually go ahead and say, I'm a cash paying patient for this visit, instead of using my insurance.
So I think that's one thing, actually, that patients don't know, that there's a different price list — there's a different price list, but even just the simple fact that, just because you have insurance, you don't have to use it — correct — um, even though I've definitely heard stories and even experienced myself, certain places will try to even bully you, that if you do have insurance you have to use it, but to my knowledge there's no law that says you have to use your insurance. So, you know, they ask me, okay, well, what are you able to pay today, and I said, well, what's — you know, kind of the typical, do you guys have a minimum, and, not really, they don't know.
So you know, I — I mean, I knew that my out-of-pocket cost was going to be more than $200, I said, I'll just pay $200, they're like, great. So you know, maybe this is another part you can, uh, touch on, but you know, when you go into the system like this, there's, you know, different — you get billed for different things, so like the ER doctor, I got a bill for the imaging, I got a separate bill for, you know, other ER services, I get a bill for the Band-Aid, yeah, the Band-Aid, the dose of Benadryl for the procedure that she had to have, the finger probe that they have to pull out because it's now disposable, and they throw them away after the visit, is now there's a charge for that, right.
So once all of those things finally came in — and just in case anyone's wondering, my daughter's great, she's totally fine, she had dinner with them last night, she's beautiful — yeah, uh, thank goodness. Um, and so I also had learned that when I received these bills, I could call and negotiate, yeah, um, and when I have tried to do that in the past, when it had gone through my insurance, I found out I had less power to do so, yeah, there's no negotiation. And so being a cash paying patient, I — you know, there was one, um, I believe it was the imaging bill, where I just simply, by calling, and the first words out of my mouth were, I'm a cash pay patient, the guy on the phone interrupts me and says, oh great, that's fine, we can offer you a 50% discount.
Yeah, 50%, yeah, so, and you know, I mean, gosh, if I would have been on my toes, I would have said, well, can you do 60. Well, and the — you know, the imaging center isn't losing money on that 50%, for them it's an easy thing to do, because they aren't having to go and bill the insurance company and negotiate that, and maybe get a denial, so for them it's like, oh, we can get paid today, great, we'll do that. Yeah, right, yeah, so I just think, you know, I love being able to share that story, an example, because I think it does really help people see, and like you've given so many great examples of that, you know, insurance is — yeah, has some room for improvement, maybe, is a sure way to put it.
And I would say the way we've done it in our own family is, you know, we increased the medical coverage on our car insurance, so that's a very affordable way to get medical insurance, is you can increase coverage on certain things — so our homeowners insurance, we increased the accident, because you're most likely to be in your car or at home when something bad happens to you, so that just was very affordable to increase the coverage on both of those. And then in our case, in our family, we've opted to do a sharing plan, so we don't have an Affordable Care Act approved plan, we pay, um, a monthly fee to be a part of a true sharing pool, and so there's, you know, Christian Ministries, um, Liberty Mutual, uh, Samaritan Care, there's a dozen of these companies out there, Zion is one we're with now, um, and there's, you know, there's certain things that are shareable, so they're not going to pay for the chronic care, so they do, in some ways, pre-exist people for that.
Um, and you know, anything under $500 you're going to pay for yourself, but once you've met the — for a shareable amount, then they pay it, uh, until that event is over. So you know, one of our friends, um, you know, left a large company here, uh, in Kansas, and then went to be part of a startup, and he himself looked at what the marketplace was, this is ridiculous how much we're paying for this, so he did a sharing plan, and people always say, well, those sharing plans sound great, but what if you have, you know, a heart problem, or you have cancer. Well, in my friend's case, his wife had been diagnosed with cancer, and through the workup of the cancer they found out she had a heart problem, so cancer and heart surgery, and when my friend looked at what they spent, um, out of pocket for those things, and then he went back and compared what it would have been under one of the largest companies in the world — great insurance, right, good product, right — he saved money by doing the sharing plan, because he asked those questions, well, we're cash pay, what can we — how much will this cost, what can we negotiate, right.
And so that was remarkable, that in the worst possible situation you can think of, is having cancer and needing open heart surgery, his wife needed both, she's doing fantastic today, by the way, so it's not like this is a lower quality of care, right, um, and they saved money, yeah, they saved money. So these sharing programs, what's really unique about them is, they can operate with a very low overhead, because they don't have all these things that the traditional insurance companies are doing, so they're, in some cases, 10% of your fee is going to pay their overhead, which, for most businesses, is incredibly low, so they're very efficient at doling out the money that truly helps people with their healthcare costs.
If everybody in the United States did this, we would watch the prices fall almost overnight. Yeah, another thing I really like about the health sharing plans is that typically a lot of people who choose to participate in those are like-minded, they, you know, they really want to be more proactive and preventative in their healthcare journeys, versus, you know, just using the system essentially to try to manage chronic types of illnesses, so I think that probably speaks to your point too, of, um, one of many ways that they help keep the cost of care a lot lower.
Yeah, well, this has just been so great to hear, um, you know, your story initially, and you know, kind of how Prairie Health came into existence, I know, um, that not just myself but so many of our patients, which are probably even some of our listeners, um, just can't thank you enough, you know, you truly are a gift to so many people, and um, you have just blessed so many people's lives, including my own and my family's too. Um, and so, um, also, yeah, I hope people learned a few things along the way today, of just, you know, the benefits of that Direct Primary Care model, how functional medicine serves people, um, and also, you know, even how to navigate some of the just ins and outs of the, uh, insurance, you know, companies and models, and um, and how we can apply it in all different settings of healthcare too.
So um, I just want to thank everybody for tuning in and listening, uh, to the PHW podcast, and hopefully you'll join us again soon. Thank you. Thanks.