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NO CO-PAYS, NO DEDUCTIBLES...OH MY! · The Rogue Recap with Lynda

0:01
Speaker 1: Welcome to the Rogue Recap. Hot takes, cold facts and
0:05
Speaker 1: zero respect for the official narrative. Sit back, roll your
0:09
Speaker 1: eyes and let's recap rogue style.
0:15
Speaker 2: What's up, everybody, and welcome to the Rogue Recap. I
0:18
Speaker 2: am Linda McLachlin, your host. Please follow us at Roague
0:20
Speaker 2: Recap at Lindamickrogue recap dot com. I have an awesome
0:24
Speaker 2: guest today. This guy's a friend, but he's wicked smarts.
0:26
Speaker 2: We brought him on. I know I say that about everybody,
0:28
Speaker 2: but this time it's true. I swear so. Doctor Josh
0:31
Speaker 2: is with us. He has a super weird name, so
0:33
Speaker 2: we don't say it. But his company is the more
0:35
Speaker 2: important part. It's called Atlas MD, and he does concierge
0:40
Speaker 2: medicine and now has over a thousand practices across the
0:44
Speaker 2: United States. Partnering with all these other physicians, they're really
0:48
Speaker 2: helping people. And for those of us that have families,
0:51
Speaker 2: have kids, you know, care about the cost of healthcare, care,
0:54
Speaker 2: about affordability, accessibility, don't want to make an appointment to
0:58
Speaker 2: have an appointment, to have a conversation about the appointment,
1:00
Speaker 2: we couldn't get This is the solution to all those things.
1:04
Speaker 2: So doctor Josh, welcome the show.
1:05
Speaker 3: What's up man, it's great being here.
1:07
Speaker 2: Thank you, You're welcome. So doctor Josh has this amazing concept.
1:13
Speaker 2: It's called actually practicing medicine. It's a new thing. I
1:17
Speaker 2: think it's really going to catch on. And he sees
1:20
Speaker 2: his patients, he talks to his patients, he has twenty
1:24
Speaker 2: four to seven accessibility, he does telemed. He also has
1:28
Speaker 2: access to his own pharmaceuticals, so he can give you
1:31
Speaker 2: the prescriptions for pennies on the dollar as opposed to
1:34
Speaker 2: you getting some jacked up costs that you don't need.
1:36
Speaker 2: He can mail them to your house. All these interesting,
1:40
Speaker 2: unique narratives that are about patient care. And for those
1:44
Speaker 2: of you who remember the book Patient Power by John Goodman,
1:47
Speaker 2: if you haven't read it, I suggest that you do.
1:49
Speaker 2: It really is all about that. It's putting control of
1:52
Speaker 2: your body, your health, what matters to you and your
1:54
Speaker 2: family back in your hand. So doctor Josh kind of
1:58
Speaker 2: personifies this. And as we head into the midterms and
2:01
Speaker 2: people are talking about the issues that matter, I said
2:03
Speaker 2: to joshuamac you should come on and talk to the
2:05
Speaker 2: audience so that they can hear that there are people
2:08
Speaker 2: out there that have real answers, and whether you're a
2:12
Speaker 2: Republican or a Democrat, you still need a doctor. You
2:15
Speaker 2: are still a patient, and doctor Josh does not care
2:18
Speaker 2: about your politics, but he does care about his patients.
2:20
Speaker 2: So I wanted him to talk a little bit about
2:22
Speaker 2: this and explain how he is able to do this.
2:26
Speaker 2: He's going to tell you what he charges a month.
2:27
Speaker 2: I'm going to let him give you that big bang moment,
2:29
Speaker 2: because it's ridiculous how he does it for that cost,
2:32
Speaker 2: what the subscribership is about, and what he offers, and
2:36
Speaker 2: what he thinks about medicine today. So go ahead, tell
2:38
Speaker 2: us about your practice.
2:40
Speaker 3: Well, you know, this was a dream of ours. You know,
2:43
Speaker 3: we saw going through training how kind of broken the
2:46
Speaker 3: system was. And the story I like to tell is,
2:48
Speaker 3: growing up, my dad was a trash man. He's a
2:51
Speaker 3: lawyer now, so we still tell people he's a trashman
2:54
Speaker 3: because it's less embarrassing, you know, shout out to all
2:58
Speaker 3: the lawyers out there. Now he's our lawyer. But the
3:02
Speaker 3: funny thing is it was a great business model. You
3:04
Speaker 3: paid once a month, we picked up once a week.
3:06
Speaker 3: It just made sense. And then as I went through
3:09
Speaker 3: the med school and undergrad and residency training. You saw
3:12
Speaker 3: how the sausage got made and it made no sense.
3:15
Speaker 3: Patients weren't happy with it, Doctors weren't happy with it.
3:17
Speaker 3: Employers weren't happy with it. So it was funny that
3:20
Speaker 3: it wasn't working for anybody, but we kept doing it
3:22
Speaker 3: in a broken way. So we were watching, you know,
3:25
Speaker 3: other practices that are doing interesting things, whether that was
3:30
Speaker 3: concierge on the very high end no insurance, or fee
3:33
Speaker 3: for service on the very low end no insurance, and
3:36
Speaker 3: we wanted to kind of make the best of both
3:38
Speaker 3: worlds there. We wanted to have our proverbial cake and
3:41
Speaker 3: eat it too, So we created this in twenty ten.
3:44
Speaker 3: We had no idea what we were doing, but that
3:46
Speaker 3: was nice because it was the imperson new clothes. We
3:49
Speaker 3: didn't know what we were supposed to do, right, and
3:52
Speaker 3: it gave us that flexibility to really design a new system.
3:55
Speaker 3: But yeah, it was It's fifty dollars a month for adults,
3:58
Speaker 3: ten dollars a month for kids, or unlimited home visits,
4:01
Speaker 3: work visits, office visits. All the telemedicine is free because
4:06
Speaker 3: it's just an extension of the office. So calling, texting, emailing,
4:10
Speaker 3: video chat. The goal really is to meet patients where
4:13
Speaker 3: they're at. It was kind of this broken idea that
4:15
Speaker 3: you only got paid if you brought the patient through
4:18
Speaker 3: the door, because then at least insurance had some sort
4:21
Speaker 3: of bottleneck on how much money could be spent. But
4:25
Speaker 3: we appreciate that so much of the care happens outside
4:28
Speaker 3: of the exam room, and we eliminated copays. We don't
4:32
Speaker 3: need them. They're not part of the financial business model.
4:35
Speaker 3: They're more of a psychology business model. It was the
4:39
Speaker 3: insurance giving you a speed bump before you spend their money,
4:43
Speaker 3: and so we just kept innovating on ways to bring
4:46
Speaker 3: more value to the patient. The doctors don't like billing insurance,
4:49
Speaker 3: they don't like red tape. It doesn't help the patient.
4:51
Speaker 3: So yeah, we just and you know, twenty or sixteen
4:55
Speaker 3: years later, it's still going strong.
4:57
Speaker 2: It's interesting, you know that you talk about the copays, right,
5:01
Speaker 2: because I feel one of the things that I hate
5:05
Speaker 2: the most as a mom and as a patient myself
5:08
Speaker 2: when I have to go in for myself is when
5:09
Speaker 2: they say, well you're going to need a referral. That
5:12
Speaker 2: drives me bananas. So I feel like many of us.
5:17
Speaker 2: I'll speak to two examples. One is the referral. You
5:20
Speaker 2: need a referral to go see this doctor. Yes, I know.
5:23
Speaker 2: That's why I'm here seeing you because I don't know
5:25
Speaker 2: where to go. I think we're I think we're doing
5:27
Speaker 2: that right now, right, That to me is such talk
5:30
Speaker 2: about bullshit, right, talk about just billing to bill. And
5:34
Speaker 2: then the other thing, to your point is the accessibility.
5:36
Speaker 2: Like you're like, you can text me, you can call me,
5:38
Speaker 2: you can email me. That's why I'm your doctor, That's
5:41
Speaker 2: why I'm here. Being a doctor is not a nine
5:43
Speaker 2: to five job. You know, people don't get sick within
5:46
Speaker 2: the you know, normal business hours exactly.
5:48
Speaker 3: Yeah, they don't schedule it, no, yeah, No. It takes
5:52
Speaker 3: a lot of patience to be a patient, or it
5:55
Speaker 3: kind of sucks to be a patient, right, yeah, it's
5:58
Speaker 3: not a virtue, it's a bit.
6:00
Speaker 2: Yeah.
6:01
Speaker 3: So yeah, And I think that you would never redesign
6:04
Speaker 3: this model if you put the patient first and like
6:06
Speaker 3: put all these roadblocks in. And if I went to
6:09
Speaker 3: a hotel while traveling and I said, oh, well, you
6:12
Speaker 3: need a pillow, you know, you need to go to
6:13
Speaker 3: the pillow store. Of course I need a pillow. That's
6:15
Speaker 3: why I'm at a hotel. I need all the hotels things,
6:19
Speaker 3: you know, and then somehow that's my responsibility or nobody knows,
6:22
Speaker 3: you know how or what. But it's broken. For like
6:26
Speaker 3: if it's the system is working even though it's broken. Right,
6:31
Speaker 3: the Affordable Care Act and the way that it's set
6:33
Speaker 3: up is the systems get paid for volume, and they
6:37
Speaker 3: if they got paid one price for all your care,
6:40
Speaker 3: they would streamline that and not create as many visits.
6:44
Speaker 3: But they're like a lawyer being paid by the word. Right,
6:48
Speaker 3: So oh yeah, now we get another co pay. Yeah,
6:51
Speaker 3: the family doctor could take care of your psoriasis, but
6:54
Speaker 3: if we refer you on to dermatology, then we get
6:57
Speaker 3: another doctor visit and we get to build dermatology. It's
7:00
Speaker 3: not family doctor price, and we you know, squeeze money
7:03
Speaker 3: out of the system. And you know, so you have
7:06
Speaker 3: this very competitive care system against the insurance system, and
7:12
Speaker 3: they're trying to get as much money from each other
7:13
Speaker 3: as they can and the patient gets stuck in the middle.
7:18
Speaker 3: So when you say, look, I'm paid one price for
7:21
Speaker 3: the month, I might as well be as efficient as possible,
7:24
Speaker 3: make it as easy. I don't need to schedule you
7:26
Speaker 3: unnecessarily if you can text me, and that's faster and
7:29
Speaker 3: better for you, it's faster and better for us. And
7:32
Speaker 3: I heard something recently. You know, if you flip it
7:36
Speaker 3: on its head, you would never see a fee for
7:38
Speaker 3: service gym, right, you would where you have to pay
7:40
Speaker 3: every time you go in, because that's not the psychology
7:43
Speaker 3: of people don't want to go to the gym, or
7:45
Speaker 3: at least most people don't, and most people don't want
7:48
Speaker 3: to go to the doctor. So you build a system
7:50
Speaker 3: with fewer barriers, not more. And like, Okay, I'm at work,
7:54
Speaker 3: the kids sick, they just send a picture of a rash.
7:56
Speaker 3: I don't want to add all this to my day.
7:58
Speaker 3: But I can order anything I want from Amazon, but
8:01
Speaker 3: I still have to drive across town to see my doctorate.
8:04
Speaker 3: It's it doesn't make any sense of outdated and there's
8:07
Speaker 3: better ways.
8:08
Speaker 2: Yeah, and I think to that point. Right, So you've
8:10
Speaker 2: been practicing medicine for two decades, if not more, right,
8:13
Speaker 2: because you're not we're not including school and residency and
8:15
Speaker 2: all the things. So you're talking upwards of two decades,
8:20
Speaker 2: and you've probably seen a lot of the same things
8:23
Speaker 2: as I would hope you would as a professional in
8:25
Speaker 2: your business. I think part of what we're trying to
8:28
Speaker 2: achieve here is I can do telemed for some of
8:31
Speaker 2: the basic things because of the fact that I have
8:34
Speaker 2: seen this on thirteen or fifteen other patients, maybe just
8:37
Speaker 2: in the last two days because there's something going around
8:39
Speaker 2: or whatever. So I don't need that in office visit.
8:43
Speaker 3: Yeah, the reason for the office visit was never for
8:47
Speaker 3: the quality of the care, is just for the building aspect.
8:50
Speaker 3: And I think you know, you take something like depression
8:53
Speaker 3: or anxiety. I feel the care is better when they're
8:56
Speaker 3: not in the office, right, And it's always nice to
8:58
Speaker 3: have a good crise session and the eye to eye
9:00
Speaker 3: and talk to people, you know. But if you're really anxious,
9:05
Speaker 3: you're anxious about coming to the doctor's office, you're anxious
9:08
Speaker 3: about having that phone call and juggling work and everything else.
9:12
Speaker 3: So if you just wake up at two am and
9:14
Speaker 3: type out an hour long email to your doctor and
9:16
Speaker 3: go to bed feeling better, that's care, right, And I
9:19
Speaker 3: don't have to answer it at two am. But I
9:21
Speaker 3: can take that, you know, read it through it later,
9:25
Speaker 3: build a response, you give you links, right. I think
9:29
Speaker 3: it's we've always felt the care was what was documented
9:32
Speaker 3: and build insurance. But really that's the least caring part
9:38
Speaker 3: of all of this. So to be able to take
9:40
Speaker 3: my time and give you a great answer and not
9:41
Speaker 3: feel rushed, but also provide more resources that then you
9:45
Speaker 3: can remember, oh yeah, find that email, save that link,
9:48
Speaker 3: go to that resource. It's just a much richer experience
9:52
Speaker 3: and it's cheaper, right, Like that's the it should feel
9:54
Speaker 3: too good to be true aspect of it, but also
9:58
Speaker 3: costco is too good to be true, and this is
10:00
Speaker 3: that's really just a costco model.
10:01
Speaker 2: That actually dovetails perfectly into my next question. So you're
10:05
Speaker 2: doing something that everybody should be doing, right, because it
10:08
Speaker 2: makes sense. It makes more time for the patient, it
10:11
Speaker 2: makes more time for the doctor, so you don't feel
10:13
Speaker 2: rushed because typically, whether you're billed fifty dollars or eight
10:16
Speaker 2: hundred dollars, you're getting ten minutes and so which also
10:21
Speaker 2: really stinks because sometimes it does take more than ten minutes.
10:24
Speaker 2: I mean, you know, full disclosure, everybody. I am a
10:26
Speaker 2: patient of doctor Josh's, as are my kids, and there
10:29
Speaker 2: are times when I'm on the phone with him for
10:30
Speaker 2: an hour and he is on the phone where I'm like, well, wait,
10:33
Speaker 2: I don't understand this. I don't understand that. What should
10:35
Speaker 2: I take for this? And he's like, you don't need
10:37
Speaker 2: an antibiotic, you need a sionus thing. You don't need this,
10:40
Speaker 2: you know, because I'm not a doctor, but he takes
10:42
Speaker 2: the time to talk to me. I think one of
10:45
Speaker 2: the things that is I'm trying to understand is why
10:49
Speaker 2: everybody's not doing this. It seems like a more efficient model,
10:52
Speaker 2: both economically and time wise.
10:55
Speaker 3: Yeah, I mean, if I had an answer to that,
10:59
Speaker 3: then everybody would be doing I'm glad or not.
11:01
Speaker 2: I'm glad that you're the one, and trust me, I'm
11:03
Speaker 2: happy for you.
11:05
Speaker 3: Well, but I think it's doctors are very risk adverse
11:08
Speaker 3: and the system is so big, I mean, twenty percent
11:10
Speaker 3: of our GDP. It just moves really slow. And there's
11:14
Speaker 3: a lot of people who are frustrated with the high
11:17
Speaker 3: insurance premiums but don't need a lot of care. And
11:19
Speaker 3: so it's one of those like doing your taxes, you
11:22
Speaker 3: hate it every time, but the frustration wasn't to the
11:25
Speaker 3: boiling point. And when we started this in twenty ten,
11:29
Speaker 3: there were, you know, a handful of doctors doing this model,
11:32
Speaker 3: and now there's almost three thousand clinics doing this model.
11:36
Speaker 3: So I think we are seeing a huge increase because
11:39
Speaker 3: in perspective, it took Starbucks sixteen years to get their
11:42
Speaker 3: first seventeen stores, and they're selling coffee right then. As
11:47
Speaker 3: we compete against our system that gets worse every year,
11:50
Speaker 3: and we always try to keep our prices low, I
11:53
Speaker 3: think it makes the change for the direction of change
11:57
Speaker 3: easier every year. And so far in twenty twenty six,
12:00
Speaker 3: we're seeing that this is the most expensive year in
12:02
Speaker 3: the history of healthcare, and people are saying that they're
12:05
Speaker 3: kind of just tapping out. Yes, I understand, I want insurance.
12:09
Speaker 3: I needed I've moved heaven and Earth to be able
12:12
Speaker 3: to afford it, and now I just can't anymore. We
12:14
Speaker 3: played all the games of deductibles and out of pockets
12:17
Speaker 3: and whatnot, and so but now when they drop an
12:20
Speaker 3: eight hundred dollars per month insurance plan per person, yes
12:24
Speaker 3: they actually have more money. Right now they can find
12:26
Speaker 3: an affordable insurance plan, pair it with direct care and
12:30
Speaker 3: actually maybe save extra. So I think we'll see this
12:34
Speaker 3: really start to take off in the coming months and years.
12:37
Speaker 3: Is it just a better product, and that's what patients
12:39
Speaker 3: want so to.
12:40
Speaker 2: That point, I know that you do telemed, you do
12:44
Speaker 2: an office when necessary, you'll go to somebody's house if necessary.
12:48
Speaker 2: You're able to prescribe prescriptions, You're able to send those
12:51
Speaker 2: prescriptions from your in house pharmacy. What about things like
12:56
Speaker 2: you know, if somebody needs a lab or somebody needs
12:58
Speaker 2: an MRI or things like that. How does that work?
13:01
Speaker 3: Pretty well? Right? The doctors doing this model have access
13:05
Speaker 3: to wholesale meds, but we haven't basically behind that wall.
13:08
Speaker 3: And when you cut out the middleman, now you know
13:10
Speaker 3: Walmart has a four dollars a month prescription plan. We
13:14
Speaker 3: have a four dollars a year prescription plan, a lot
13:17
Speaker 3: of meds that are a penny of pill. So you
13:19
Speaker 3: remove that hassle, that insurance bureaucracy, that wait at the pharmacy.
13:23
Speaker 3: But you kind of apply that same concept to other pieces.
13:26
Speaker 3: We have Client Bill, which is basically just doctor pricing
13:31
Speaker 3: with national labs like Quester lab Core, which patients can
13:35
Speaker 3: get anywhere across the country through a direct care doc.
13:38
Speaker 3: So a standard blood test to see if you have
13:40
Speaker 3: diabetes A one c's it's going to be around you know,
13:43
Speaker 3: fifty two dollars and fifty cents, check your thyroid for
13:47
Speaker 3: two dollars and seventy five cents check your cholesterol for
13:50
Speaker 3: three dollars. Now, when you make the care so cheap,
13:54
Speaker 3: it's too cheap to ensure you save thirty or forty
13:57
Speaker 3: percent off your insurance premiums among other changes. And a
14:01
Speaker 3: cache MRI in Kansas might be three fifty, but in
14:04
Speaker 3: Florida it's two fifty. Again, yeah, since most people aren't
14:09
Speaker 3: getting an MRI too often, just the savings for more
14:12
Speaker 3: affordable insurance helps to cover those things. But when it's
14:15
Speaker 3: built through insurance three right, So to.
14:20
Speaker 2: That point as well, if I look at for example,
14:24
Speaker 2: I have had to have you know, all my kids
14:26
Speaker 2: or athletes. Something is always broken inevitably, And even though
14:32
Speaker 2: you can have insurance and it's supposed to be a
14:35
Speaker 2: cope at the hospital, I can't get the appointment through
14:38
Speaker 2: the insurance. So I can't get the appointment for the surgery.
14:42
Speaker 2: I can't get the appointment for the MRI. I can't
14:44
Speaker 2: get that. I mean it is like these are not
14:46
Speaker 2: things like if you're going in for a cat scan,
14:49
Speaker 2: an MRI and an ultrasound, a sonograt whatever these things are,
14:53
Speaker 2: it's because something is potentially more serious and requires a
14:58
Speaker 2: deeper look. And yet we can't get you in for
15:02
Speaker 2: a month, right. But if I turn around and say
15:05
Speaker 2: I'll pay cash, you don't have to run it through
15:07
Speaker 2: my insurance. I can get you in right now. We
15:10
Speaker 2: have an appointment in an hour. I'm like, oh my god,
15:14
Speaker 2: you know.
15:14
Speaker 3: And I guess it's shocking, not shocking, right in the
15:17
Speaker 3: sense of if Amazon was waiting for my check, my
15:21
Speaker 3: paper check to be mailed, then yeah, they're not shipping
15:24
Speaker 3: anything until they get the money. And whoever pays the
15:26
Speaker 3: piper picks the tune. I think that's how good it
15:29
Speaker 3: can be with consumer driven healthcare. Of the consumer has
15:33
Speaker 3: the money, then suddenly everybody finds a way to make
15:36
Speaker 3: this work. Right. I find this sort of infinitely hilarious
15:39
Speaker 3: that Walgreens can tell you exactly what everything in their
15:42
Speaker 3: store costs. You can see the inventory, you say, you know,
15:45
Speaker 3: miniboxes of cereal are there, and what the price is,
15:48
Speaker 3: and they'll run a coupon and they just make that
15:51
Speaker 3: as easy as possible because they have to to compete
15:53
Speaker 3: against other stores. But then you get to the meds
15:55
Speaker 3: and oh, we have no idea what these things cost
15:58
Speaker 3: and we have to run your insurance and it's bloated.
16:01
Speaker 3: It's just such a huge profit center for most places.
16:04
Speaker 3: They don't want to compete. They don't you know, there's
16:06
Speaker 3: companies that sell pills online that we get for five
16:09
Speaker 3: cents that they sell for ten cents, right because they can't.
16:13
Speaker 3: And that's the issue is my dad would joke, you know,
16:17
Speaker 3: rule number one of the rat races. Everybody's got to
16:19
Speaker 3: keep being a rat. And you know we're in some ways.
16:22
Speaker 3: You could argue we're giving up a lot of profit
16:24
Speaker 3: by doing the meds. Basically it costs plus ten percent.
16:29
Speaker 3: But also then we don't need a marketing budget, right,
16:32
Speaker 3: we don't have a problem recruiting and retaining patients. But
16:35
Speaker 3: also we're I think we're building trust with the patient
16:38
Speaker 3: because they can see how transparent that is. There's a
16:41
Speaker 3: trust issue in medicine, like you're just treating my recommending
16:45
Speaker 3: high cholesterol medicine because you make money off that. And
16:49
Speaker 3: then you get the bill and it's thirty four cents
16:51
Speaker 3: a month for your your centostat and you're like, well,
16:53
Speaker 3: if he is making money on it, it's not enough.
16:56
Speaker 2: Yeah, right, right.
16:59
Speaker 3: Right, Because I think you need it, and they're like, Okay,
17:02
Speaker 3: now I can trust you because you're transparent when others aren't,
17:07
Speaker 3: or there's no reason to lie for thirty four cents,
17:10
Speaker 3: or now you kind of feel like the mister Rogers thing. Right,
17:12
Speaker 3: look for the helpers. Now the doctor who will tell
17:15
Speaker 3: you what that is, or go the extra mile. Or
17:18
Speaker 3: yesterday you had a ninety visit, ninety minute visit with
17:22
Speaker 3: the whole family and somewhere joining by zoom and speakerphone,
17:26
Speaker 3: and because everybody needed to hear this, and we wanted
17:31
Speaker 3: to just be very efficient and take the time it takes.
17:34
Speaker 3: And no insurance should pay for that, right. That's it's
17:37
Speaker 3: not what insurance is for. It's for taking care of
17:40
Speaker 3: rare and expensive events, not for what the doctor's supposed
17:45
Speaker 3: to be doing right, high touch care. And I think
17:49
Speaker 3: that's it too, is separating insurance is a great tool
17:53
Speaker 3: for the right thing. A wrench can make a decent hammer,
17:56
Speaker 3: but a hammer makes a horrible wrench. We keep trying
17:58
Speaker 3: to force doctors into, you know, doing something through the
18:02
Speaker 3: lens of insurance when really you just it's designed by subtraction.
18:06
Speaker 3: Cut all that out and what's left ends up being
18:08
Speaker 3: very effective.
18:11
Speaker 2: You know, I'm interested in how you work with hospitals
18:16
Speaker 2: and if they so, I'm assuming that you would tell
18:18
Speaker 2: your patients you have US for fifty dollars a month,
18:21
Speaker 2: ten bucks for your kids, and that covers you, you know,
18:25
Speaker 2: for everything, and then catastrophic insurance for things like outside
18:29
Speaker 2: of the boundaries. Like what do you recommend to people
18:31
Speaker 2: who have that question?
18:33
Speaker 3: Yeah, in the same way that you kind of have
18:36
Speaker 3: cash for gasoline, savings for tires, and insurance for car accidents,
18:41
Speaker 3: we would make the similar analogy that you use, you know,
18:44
Speaker 3: general cash for the direct Care fifty dollars a month
18:47
Speaker 3: membership as for two or three dollars a month, et cetera.
18:51
Speaker 3: And then your savings for the bigger stuff, maybe that
18:54
Speaker 3: MRI for three fifty, that's CT for two fifty, and
18:57
Speaker 3: then some form of health insurance. It sounds a little vague,
19:02
Speaker 3: but it makes sense. I say, we recommend the most
19:05
Speaker 3: affordable insurance you're comfortable with, because insurance is really not
19:09
Speaker 3: health insurance. It's financial insurance. And if you're young and healthy,
19:14
Speaker 3: it's easy to say I'll roll the dice and hope
19:19
Speaker 3: for the best, because statistically that's what happens. But I've
19:22
Speaker 3: got car insurance, usually have home insurance or you know
19:25
Speaker 3: those kind of things. Or if I follow in my parents' house,
19:27
Speaker 3: they have home insurance, so you're never completely abandoned. But
19:31
Speaker 3: then there's the cost sharing programs that were an interesting
19:37
Speaker 3: aspect out of the Affordable Care Act. Then you have
19:41
Speaker 3: the ACA plans if you can afford the deductible, or
19:45
Speaker 3: we work with employers to decrease their insurance premiums so
19:49
Speaker 3: that they can pay for the membership and the insurance.
19:53
Speaker 3: So there's a range of options, and of course we
19:56
Speaker 3: have one ourselves, and we built an insurance program much
20:00
Speaker 3: harder than it sounds now we know, but to build
20:03
Speaker 3: an insurance plan that fits directly with direct care so
20:06
Speaker 3: that a family of four under forty should be under
20:09
Speaker 3: four hundred and fifty.
20:10
Speaker 2: Dollars a month, because people need to hear that.
20:14
Speaker 3: Yeah, a family of four under forty, two adults, two
20:17
Speaker 3: kids would be under four to fifty a month. And
20:21
Speaker 3: you know that the national average is getting close to
20:24
Speaker 3: twenty five hundred a month, and you can do a
20:27
Speaker 3: lot of good I there's this perception that the best
20:30
Speaker 3: way to spend the money is on the health insurance premium,
20:33
Speaker 3: and I think what families are realizing is that's no
20:36
Speaker 3: longer true and they'd rather just have their own and say, well,
20:40
Speaker 3: you know, how much less anxiety would I have if
20:42
Speaker 3: I had a thousand extra bucks a month to either
20:44
Speaker 3: pay off my bills or buy a doctor, or you know,
20:48
Speaker 3: help my kid's college fund. And those are the things
20:51
Speaker 3: that I think really matter. And I talk with my
20:53
Speaker 3: med students all the time. If we take her home
20:55
Speaker 3: seriously of do no harm, that should also include do
20:58
Speaker 3: no financial harm. Doctor should be finding a way to
21:01
Speaker 3: help patients kind of throughout the whole system, from family
21:05
Speaker 3: medicine to meds, to labs, to imaging, to specialists to pathology,
21:09
Speaker 3: to hospital bills and whatnot.
21:12
Speaker 2: So I want you to speak to and you did
21:13
Speaker 2: just a little bit there about your health insurance. So
21:17
Speaker 2: at list dot MD for those of you listening, is
21:20
Speaker 2: where you can go to find out more about Josh
21:22
Speaker 2: and his partnering you know, physicians and their clinics all
21:25
Speaker 2: across the country. And then atlass Insurance is brand new.
21:30
Speaker 2: I will tell you as a friend of Josh talking
21:33
Speaker 2: to him over the past four years, he has been
21:35
Speaker 2: through it trying to make this a reality. So God
21:37
Speaker 2: bless you for sticking with it. Tell us what it
21:40
Speaker 2: costs for that and how that works and how people
21:43
Speaker 2: can find out more and get involved and get that insurance.
21:46
Speaker 3: Yeah, the insurance website is Atlas dot direct. We're in
21:50
Speaker 3: twenty states. The goal is that it's a plan that's
21:56
Speaker 3: closer to something like affleck, where we want the payments
22:00
Speaker 3: to go to the patient, not to this broken system.
22:03
Speaker 3: So it's the prices are based on age, gender, and
22:07
Speaker 3: state only. So we don't make this as a complicated
22:11
Speaker 3: sign up process because other insurances might see you as
22:16
Speaker 3: a high risk if you have high blood pressure. We
22:18
Speaker 3: don't because we know blood pressure meds are a pinny
22:20
Speaker 3: of pill and that just kind of really changes the
22:23
Speaker 3: math on this. And you have to be a member
22:27
Speaker 3: of a direct care practice. That was part of our goal,
22:29
Speaker 3: but that it still fits with the car insurance analogy
22:33
Speaker 3: of if you try to ensure family medicine, then that's
22:36
Speaker 3: when the price explodes. Everyone thinks the expensive part is hospitals,
22:40
Speaker 3: cancer surgeries. That's actually not bad. It's the daily stuff
22:47
Speaker 3: that nickels and dimes you to death. But the insurance
22:51
Speaker 3: is no deductible, no copay, no network. You're welcome to
22:55
Speaker 3: use it anywhere, and then you can enroll all year
22:58
Speaker 3: long and that covers one hundred thousand dollars in care
23:02
Speaker 3: and end up everyone. The most common question is is
23:04
Speaker 3: that enough? And by our math, it is most people
23:08
Speaker 3: they hear these giant inflated bills, but no one pays
23:11
Speaker 3: that bill. To that point, we partner with a great company,
23:15
Speaker 3: good bill dot com, and they're a hospital negotiation service
23:18
Speaker 3: that we offer their services for free for both our
23:22
Speaker 3: clinic patients and our insured patients, so that we can
23:25
Speaker 3: try to help you on the front end, in the
23:28
Speaker 3: middle and on the back end, because hospitals don't give
23:32
Speaker 3: out all the required discounts that they need to to
23:34
Speaker 3: maintain their nown. Surprise right, yeah, they will if you ask,
23:39
Speaker 3: just most people don't know to ask, or most people
23:41
Speaker 3: try to pay through insurance. And the really frustrating thing
23:45
Speaker 3: is the hospitals incentivized to inflate these prices because eventually
23:51
Speaker 3: they sell this debt on the debt auctions, so you
23:54
Speaker 3: can buy one hundred to two hundred dollars in medical
23:56
Speaker 3: debt for a dollar. What right, It's insane, It's absolutely insane.
24:01
Speaker 3: So a lot of times the direct care community to
24:03
Speaker 3: you know, do a good deed or help a charity
24:06
Speaker 3: or something. We'll get together ten thousand dollars to buy
24:08
Speaker 3: you know, you know, one hundred plus thousand dollars of
24:13
Speaker 3: medical debt and just give it away. And there's great
24:15
Speaker 3: services that do that. Undo medical debt is one we've
24:19
Speaker 3: partnered with a lot and we did that once. We
24:22
Speaker 3: did a reverse copey where we paid patients. You know,
24:26
Speaker 3: we did a raffle. I saw that bar did that
24:28
Speaker 3: that gave everybody walked it through the door of five
24:30
Speaker 3: dollars as a reverse cover charge. I thought, that's brilliant, right,
24:35
Speaker 3: And I saw, duncan this is in your necklace dunk
24:37
Speaker 3: a Donuts today, somebody had a medical problem whatever, they
24:42
Speaker 3: covered the bill, gave them coffee for a year and
24:45
Speaker 3: then bottom, you know, tickets to the baseball season. Like
24:49
Speaker 3: you know what, That's like brilliant marketing, right because it
24:52
Speaker 3: has nothing, but it makes you feel good and uh.
24:56
Speaker 3: And so when healthcare is transparent, that's that's really easy
24:59
Speaker 3: to do. And I feel feel like that's real caring
25:02
Speaker 3: and companies want to feel cared for and cared about,
25:06
Speaker 3: and that's where direct care comes in. So there's just
25:09
Speaker 3: all these great ways to look at the system and
25:14
Speaker 3: find solutions wherever they're at. Meds for ninety five percent less,
25:18
Speaker 3: laws for ninety five percent less, but hospital discounts and
25:21
Speaker 3: no copays. So it's really easy to get down on
25:25
Speaker 3: the healthcare system right now. No one it doesn't feel
25:27
Speaker 3: if you're a patient someone's looking out for you. But
25:30
Speaker 3: I think it's it's brivous before the dawn.
25:33
Speaker 2: No, I think artith. I hope that everybody listening to this,
25:37
Speaker 2: I strongly advise you to check out to check out
25:40
Speaker 2: doctor Josh. He's not, just as you can hear, the
25:43
Speaker 2: most normal, relatable person. He's not trying to overtalk you
25:46
Speaker 2: with fancy schmancy words and make you feel like you
25:49
Speaker 2: are a waste of his time. I don't think there
25:51
Speaker 2: is anything more infuriating than trying to get to your
25:55
Speaker 2: doctor to ask a question. If I didn't think it
25:58
Speaker 2: was important, I wouldn't bother you. That doesn't I mean,
26:00
Speaker 2: there aren't people out there who are like out of
26:02
Speaker 2: their minds and just you know, they're like hypochondriacs, right,
26:05
Speaker 2: They're just constantly calling about things. That's a real thing.
26:07
Speaker 2: But your average Joe is like, I just what do
26:10
Speaker 2: you think? Just like take some time and all like
26:11
Speaker 2: where am I? You know, like they just have a
26:13
Speaker 2: simple question. I am one of those people. I am
26:15
Speaker 2: not doctor Google. I'll look at doctor Google and then
26:19
Speaker 2: send it to you and be like, yeah, is this
26:20
Speaker 2: for real? Because I don't think that's not my thing.
26:23
Speaker 2: Like people are experts in their field for a reason.
26:26
Speaker 2: And part of the problem with medicine right now is
26:29
Speaker 2: while you may be an expert, I can't get to you.
26:31
Speaker 2: I can't talk to you. And your nurse or your
26:35
Speaker 2: assistant or your secretary at the front desk is an asshole.
26:39
Speaker 2: So when I call and she's mean to me, I
26:42
Speaker 2: don't want to come to your office anymore, you know.
26:44
Speaker 2: I mean, so much of the patient care has been lost,
26:48
Speaker 2: and I feel like you are like this shining light
26:52
Speaker 2: on the hill, right I'm like, oh my god, there's
26:53
Speaker 2: one guy doing.
26:54
Speaker 3: It right well in thousands of doctors you work in
26:58
Speaker 3: with suspect, I know, yes, and that's but you're right.
27:01
Speaker 3: We lost the hospitality side and this Disney does a
27:04
Speaker 3: better job of that. And you know, there is that
27:08
Speaker 3: aspect of I left the office, but I still have
27:10
Speaker 3: a question and I yes, and I think half the
27:15
Speaker 3: time I'll tease patients at their hypocontracts. But the system
27:18
Speaker 3: made them that way because they have all these questions
27:21
Speaker 3: and no answers, and like great, keep emailing. Eventually you
27:24
Speaker 3: kind of run out of questions, right, Like that's the
27:27
Speaker 3: any membership model. Netflix knows you're going to watch a
27:29
Speaker 3: lot of videos at times, but then come down at
27:32
Speaker 3: times and and you know, hey, that's our business problem
27:35
Speaker 3: to solve. But the fact we've been doing it for
27:37
Speaker 3: fifteen years across the house as a doctor, so it works. Yes, sure,
27:41
Speaker 3: and that gives those patients now, you know, if you
27:43
Speaker 3: pay a lower price, now everybody gets you know, access
27:47
Speaker 3: to everything in the gym and rather than you know,
27:50
Speaker 3: at a price that's ridiculous essentially, And this is that
27:54
Speaker 3: same way. Now if you need more, you don't have
27:56
Speaker 3: to worry about paying more. You're good. A gentleman had
27:59
Speaker 3: a weird skin infection. I saw him every day for
28:01
Speaker 3: a month by either in the office or text or email, picture,
28:05
Speaker 3: video call, just and it took you know, a couple
28:07
Speaker 3: of minutes each time, so probably wasn't an hour over
28:10
Speaker 3: the whole month. But we made sure with just the meds,
28:13
Speaker 3: you know, change dressings, do whatever, keep it good. And
28:16
Speaker 3: and to think that, you know, for fifty dollars that
28:19
Speaker 3: could have been medical. You know, I don't want to
28:22
Speaker 3: say bankruptcy, but just stress and debt and hassle and
28:26
Speaker 3: no one's.
28:28
Speaker 2: Get in, and then worrying that you can't.
28:31
Speaker 3: He was an early riser, so usually my five point
28:33
Speaker 3: thirty text was him, you know, but every mark great, Hey, wonderful.
28:38
Speaker 3: I love it. I'm a dada guys, give me data,
28:40
Speaker 3: Tell me how that fingers. You know, most patients won't
28:42
Speaker 3: communicate enough. You know, you get pink eye. Text me
28:45
Speaker 3: a picture, Text me a picture every hour. You know,
28:49
Speaker 3: let's let's not worry about this because that continuity of
28:51
Speaker 3: care is great. You're paying for that. And so when
28:53
Speaker 3: I go to Costco, I have no need to go
28:55
Speaker 3: to other grocery stores, right because I know my best
28:57
Speaker 3: value is there. And and and I love the idea
29:01
Speaker 3: you know, behind the Costco hot dog, right, like I
29:04
Speaker 3: f and murder you if you change the price of
29:06
Speaker 3: the time. Right, that CEO was committed to it, And
29:09
Speaker 3: I feel like doctors should have some aspect of that
29:12
Speaker 3: of like, no, we are committed to no copaste. Yes,
29:15
Speaker 3: you know there's inflation and other stuff, but some things
29:17
Speaker 3: we just you know, patient comes first and uh, you
29:22
Speaker 3: know if you need you know, some dressing or you
29:25
Speaker 3: know some wrap or band aids in the office, like
29:28
Speaker 3: you know, the courtesy of those things that we've we've
29:30
Speaker 3: lost that because we squeezed the profitability of clinics to
29:33
Speaker 3: the breaking point. Patients feel that, doctors feel it.
29:37
Speaker 2: Yeah, and the patient feels like a number and the
29:39
Speaker 2: doctor feels annoyed because we're all working under the same burdens.
29:42
Speaker 2: You remove the burden and you return to what Woods
29:45
Speaker 2: was patient care.
29:47
Speaker 3: Oh what's so amazing is it's so bad for everybody.
29:50
Speaker 3: But then that we're still hesitant to change, right, Yeah, nobody's.
29:53
Speaker 2: Happy with I have to say though, but there are
29:57
Speaker 2: It's to your point, right, like there are people who
30:00
Speaker 2: forge a path. I EU right, you forge a path,
30:02
Speaker 2: you try something new. Your dad is a perfect example
30:05
Speaker 2: of that, right, working in sanitation, being a trash man
30:08
Speaker 2: his whole life, and then going back to school and
30:10
Speaker 2: becoming an attorney. You know, there's something amazing to that.
30:14
Speaker 3: It is, And he had this great he had a
30:16
Speaker 3: First Amendment case that actually went to the Supreme Court
30:19
Speaker 3: was critical of the local government and became a huge case.
30:22
Speaker 3: And you know, I think we learned that it's like,
30:24
Speaker 3: if there's something wrong, you just fix it right, consequences
30:28
Speaker 3: be damned. But at the same time then you sort
30:30
Speaker 3: of realize that just because it is doesn't mean it
30:33
Speaker 3: has to stay that way. So if it's broke, go fix.
30:35
Speaker 2: Itsh I'll tell you.
30:37
Speaker 3: I hope I tell you. I me too.
30:43
Speaker 2: Yeah, we're at it, man. Thank you for listening. This
30:47
Speaker 2: is the Rogue Recap. I've been here with doctor Josh.
30:49
Speaker 2: If you haven't heard the websites at list dot m D,
30:52
Speaker 2: at list dot direct, please go, please find out more.
30:56
Speaker 2: He's wonderful. It can only help you and your family.
30:59
Speaker 2: I promise you I already do it.
31:00
Speaker 3: Josh.
31:01
Speaker 2: Thanks for being with us today. You're the best.
31:03
Speaker 3: Thank you.
31:04
Speaker 2: I am Linda McLaughlin. This is the Roague Recap. You
31:07
Speaker 2: know what to do. Roague Recap dot com at Lindamick
31:09
Speaker 2: at Roague Recap. Be careful out there, Pray for our troops.
31:12
Speaker 2: Have a good night, everybody.