Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep169: What most physicians get wrong about direct primary care, with Josh Umbehr, M.D.
Transcript
- Speaker 1 0:00 We spend more on coffee in the waiting room than we spend on EKGs. So I think that's a good example of putting the hospitality back in healthcare. Austin Littrell 0:22 Welcome to Off the Chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Latrell. I'm the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, I sat down with Dr. Josh Umber, a family physician and co-founder of Atlas MD, a direct primary care practice in Wichita, Kansas. He finished residency in 2010 and moved straight into DPC before the term had much currency in medicine at all. And Atlas has since grown into a software platform and consulting operation aimed at helping other physicians make the same move. By now, most physicians know the basic DPC pitch: drop the billing, charge a monthly membership and keep a smaller panel, spending real time with patients. The harder question, though, is whether the economics hold up once you're actually in it. We get into the real math behind the model and why Dr. Umber argues that practices who charge the least tend to make the most. What actually happens when a DPC patient needs a specialist, and why he believes the window for insurance-based primary care is closing faster than most people realize. Dr. Umber, thank you again for joining us. And with that, let's get into the episode. Dr. Josh Umber, thank you so much for joining me today. Speaker 1 1:37 Thank you for having us. Austin Littrell 1:38 How did you arrive at that decision to open a DPC practice, and like, when did you know it was the right move? Speaker 1 1:44 Long story short, going back to about 2000 I started working for a plastic surgeon in undergrad as his biller and coder, and he was an amazing surgeon. But no one ever taught him how to bill insurance, and so you saw the sausage get made on that side of it. That it didn't matter how good of a of a surgeon you were, it in terms of how you got paid, it was really can you play this game of coding and modifiers and submissions and all this other stuff? And growing up, my dad was a trash man. He's a lawyer now, so we still tell people he's a trash man because it's less embarrassing, and he's he's our lawyer. But that was a great business. You paid once a month. We picked up once a week. So I had that kind of idea that this should just be simple. And I've seen a good business run. And then healthcare didn't seem like that at all. And that started the journey of finding doctors who did anything different, whether that was insurance-free fee-for-service or the concierge model was just in its infancy, and and really watch that movement for the next 10 years, and collected the experience of what was working and what wasn't. So I think that was our plan all along. Is well, the model is broken, and I wrote my personal statement for med school and residency on this doom and gloom, the sky is falling idea that family medicine was was especially dying on the vine. It was not supposed to be around past 2010, and we just never really believed in that. Is there was a better way to do this that would be an improvement for patients, for doctors, for the system, so yeah, we we were all in from an early age. Austin Littrell 3:26 So you've been running it for you said since since 2010 What does the financial model actually look like day to day for any doctor that might be you know kind of considering DPC? And is there anything that surprised you the most about the economics of of DPC? Speaker 1 3:40 I wouldn't say it was a surprise. the The interesting thing is maybe how easy it is, and that's where people get hung up. Patients sort of get this very quickly, right? They hear like a consumer does a product that's better, faster, cheaper, easier. They're used to people presenting new ideas to them like that. It's the physicians that get more hung up on all the noise that they're used to. What about macra MIPs, insurance regulation? What about coding? What about stat? All this other noise, and it just seems too easy to say, "I just take care of patients, right? Too good to be true, kind of thing. I'm a big Elon fan, but there's a good example from a recent book, The Algorithm, by John McNeil, and he talks an example where the the Tesla side of the business was able to get the car buying contract down from 44 clicks to one, and I think that what was so interesting is is they challenged a long-held belief that all of those were important. Everyone who did contracts did 40-four clicks at least, right? The lawyers just kept adding clicks because it felt better, and you know they realized well this is just 40-four ways to say the same thing. I'm responsible for this loan, and. And that fresh take on it. The problem with healthcare is, I think, we're not creative enough. We we get frustrated at the wrong things and don't fix them. And and physicians are so used to being a brick in the wall. We we've kind of lost that entrepreneurial spirit or innovative spirit in the business side that says, no, why am I doing it this way? Well, because generally the hospital or the insurance says you won't get paid if you don't. So they haven't been trained that there's options out there, and and the simplicity is 600 patients times $50 a month times 12 months, 360,000 to a doctor used to the economics of running a big practice where they have five to seven staff each and 345, rooms, that doesn't seem like that's enough. In this model, 2020-5% overhead, one staff per one to two doctors, one room, one or two rooms each. It's you end up keeping the vast majority as your salary. Add on another 100 patients, or change your prices by $10 That's another 60, 70,000 right? There's so the math works so well: 600 times $1 amount times 12 that you don't have to even charge a lot to be a very successful physician in this space, and and I think that could be one of the many things that draws students back into primary care. Austin Littrell 6:30 Great, and you mentioned it there about a panel size. What is your panel size, and and how did you arrive at that number? Speaker 1 6:38 Well, we arrived at that number because in the beginning of all this, concierge medicine always threw out a number of like two to 400 to compare to the normal two or 3000 patient panel, and we just knew that that math was geared towards the high end version of this, and what we saw from being involved in that movement from 2000 to 2010 was that most concierge practices struggled to grow. Now they might have been profitable, but at 25,000 per person per year, that was unaffordable even back then. That wasn't the one percenters; that was the point something percenters. But if you got eight people to do it, you were doing pretty good. But it was never really, you know, a takeoff model for the masses, and and 200 was just a low number. Realizing that the standard rule is you see 1% of your patients a day, well, two patients a day was was on the low side. Like, well, if we max out this algorithm, this calculation, more patients means lower fee means more patients can get covered, but right size to the amount of work a doctor can do in a day. So in the beginning, it was mostly guesswork, but at the same time, the math led us to I think you know the best close answer, which was fair price for a lot of of patients. Austin Littrell 8:04 How do you structure pricing in DPC? How do you set like membership fees and then go about adjusting them over time? Speaker 1 8:11 Pricing tends to be probably the most complicated thing we do, or at least the most debated, because it depends so much on what your goals are, and we we never try to tell people what to charge because I think there's a lot of sensitivity around that, but at the same time we try to guide them down an objective truth. Is you know one if you want to be in the top 10 percentile of family physicians in terms of income, you're going to have to do the top 10 percentile of work, or be rural, or emergency room, or procedures, right? I kind of reference as an independent source. What are hospitals paying? Because they're charging you the most per patient and having you see the most patients. If we can get close to that rate, again, the math is flexible, but do you want to be full time, part time? Do you want to have a physician partner? Because if you do, that cuts your overhead almost in half because you don't need that much more space or more phones or more staff. So that makes you more profitable, and you're figuring that all out. But the average physician is looking for you know somewhere between 250 and 300,000 for primary care, and and that math works out really well. We say your your patient panel size times what you want to charge times plus 30% for for overhead just to give you some wiggle room. But some doctors want to be part time. I think the the trouble comes where we see practices, and I see this as a weird compliment. 15 years ago, no one knew if this would work, so a lot of the OGs really maxed out the affordability and the value, and then because doctors were terrified this wouldn't work. At all, and they were just going to leave medicine. Now that it's so successful and growing and doubling, maybe every two or three years, then I think they see a lot more flexibility. But we're also getting looser at the edges of the business model, so we see more growth than we ever have. But we also see more closures than we ever have too, and that's probably an inevitable part of any movement. But it's the clinics that sort of want to make full income on 100 patients or 200 patients. Not that you can't do it; it's just much harder, right? Cost dictates so much of this, and then speed. So if it takes you two years to get full, you know the rough math is it takes you six to eight years to make up the lost revenue. We're always trying to help doctors look at that and say, "Sure, everybody wants to maximize their financial potential, but also at what risk and at what volume. And and if you set your prices too hard, it can be hard to grow quickly or reset your prices and adjust all your marketing and take a new angle. So there's there's a good, better, best way for most doctors to to look at the math. Austin Littrell 11:10 What does lower overhead actually look like in practice? What did what did you cut and what did you keep? And where are the real savings there? Speaker 1 11:18 There's a great book, The Lean Startups, and speaks to this effect, and we try to explain this to docs in the beginning. Is in beginning, all you need is a shoestring and a stethoscope, right? You are the product, and if I had $10,000 to spend, I'd probably get an EKG machine, a pill counter, and a vitals machine. The rest is a little bit optional, because even if you start with no staff, the patients kind of love that because it's all you. If the phone rings, you get it, and that can be a little intimidating to doctors. But patients are so used to a phone tree and bad customer service and not seeing the the same people that the more steps you take out of of that process, the happier they are. And there's, I learned this from the surgeon who was kind of funny. I jokingly say, kind of a grumpy guy. He was a surgeon; he was busy. But if the phone rang and he picked it up, he'd grumpily answer and then hand it to me. And people were shocked that the doctor answered the phone. I said, "Yeah, but he was grumpy, and they were still impressed, right? So the best marketing is the first ring. The doctor picks it up. I mean, people already know this is different. But then, as you get into full practice, it's a reasonable size office, generally 700 to 1000 square feet per doctor, one full time. We say RN. Some will choose MA or LPN, and one exam room worth of furniture, phone, EMR, malpractice, but just the basics, right? You don't need a whole billing department. You don't need MACRA and MIPS reporting. You're not trying to comply with the next Medicare rule changes, the our EMR, but most of the EMRs will automate the billing so that you're you're spending 5% of your time on administrative stuff and 95% on patient care or relaxing. Right, you don't have to be busy. Even with my 700 patients, sometimes I'm a no hitter where I don't see anyone in the office in a day. I still call, text, email, but you just change how they need to get it, so that that overhead ends up being really marginal. We spend more on coffee in the waiting room than we spend on EKGs, so I think that's a good example of putting the hospitality back in healthcare. But it's in a very efficient model. Austin Littrell 13:39 Awesome. One of the biggest challenges that DPC physicians still face when their patients need specialists, hospitalizations, or other care outside of the practice? Speaker 1 13:50 You know, in a lot of ways, it's it's some parts are way better, and other parts are you're just in the system, right? In in this model, you have more time with your patients, and a patient who's kind of a VIP interview and asks, "Well, are you a good doctor? And I jokingly said, "No. And he was expecting like, "Oh, top of my class, but I don't. I don't have to be. That's the point. I think I am a good doctor, but it's an anti-fragile model where before a good doctor had to see you in seven minutes, make you feel heard, ask all the right questions, make the diagnosis, explain the treatment, wrap it all up, and then go chart and get paid for it. Right? I can spend an hour with the patient, and and then we can talk with a specialist afterwards and email the patient back, or now with open evidence, ask AI and and get all of these tools at our disposal. You know, the kind of the the fallacy was that all the care happened in one sitting in the exam room. With that addition to the way we can practice medicine means just fewer referrals, keeping the patient out of. A broken system is the best thing we can do. Then more meds, more labs, more resources to do things cheaper and easier, and explore deeper. But then, when we need to ask a specialist, we can use doctor to doctor telemedicine consult features. I can get a derm consult for 30 bucks in usually one to two days. Right? It takes me more time in staff. Takes me more than $30 in staff time to fuss with our local dermatologist, who's scheduling out six months. Whereas now I can ask a dermatologist, and if I need to biopsy or shave or an excision or change medication, that transaction happened right away, and we cut out all the other pieces. So then you're taking big chunks out of the hassle there. But when they do need to go to the system, they're not any worse for it. They're still just in the system, right? If you're paying cash, ironically, you're almost a better customer for a lot of doctors now. And I think that's the revolution we're seeing. Is if I have to fight your insurance for this, I'm not going to be as eager to schedule you for that. Imaging is a good example. If you have back pain and we need a CT, you know, meets clinical guidelines, etc. But if we're waiting for insurance to pay, it's going to be a one to two week process. If we're paying cash, and I can get you in today, right? Because that's just a better experience, less hiccups in the middle. But then we do our best when we do have to send you out, send over the report, call the practice, see if we can get on their wait list, and just guide the patient through that so they know what to expect and be more available in the interim, so you surgery would be another good example where if they're using their insurance, great. Find out if their copay is deductible is manageable or not, or use Surgery Center of Oklahoma as a reference to say, could you get this for less than your deductible? So now, do you want to use your insurance or not? And and that kind of reaches out to the employer group of helping employers say, look, this is the most expensive year in the history of healthcare for employers, and next year is going to be 30% worse. The employers are also coming to us and saying, you know, help us solve this problem before, during, and after. How do we get better insurance to save money, but not have a lack of primary care, urgent care, ER care, specialty care, and DPC gives us the time and ability to help out in kind of each of those areas. Keith A. Reynolds 17:38 Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60 seconds, we deliver proven real-world tactics you can plug into your practice today. Whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way? I want to be true. Shoot me an email at kreynolds at mjhlifesciences.com with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next P2 Management Minute. Austin Littrell 18:32 For a primary care physician in a traditional practice who's burned out on things like prior odds, administrative burden-I mean, a lot of the things you talked about aren't necessarily a concern for DPC. What's the honest timeline and financial runway they need before making a jump to DPC? Speaker 1 18:47 Yeah, I'll say kind of best case scenario and then a more normal scenario. A doctor converting a practice panel of you know let's say 2000 over to direct care. I hesitate to do say correct, but correct for the goal of growing quickly, you set your prices well. We see clinics routinely recruit two or 300 patients in six to eight months of marketing in advance of that switch. Right, a 1020, $30 difference per month, though per family member has a disproportionate impact on that slow growth, and and so we're always trying to explain to doctors like these are the best patients you have to recruit. They know you. You know them. It already works. Everyone else, you've got to go market and find. Be aggressive in in recruiting those patients so that you can come over and start sustainable. Now, other clinics will be, you know, moving from residency, starting in a new location. They don't have that option. Good growth is, you know, 40 to 50 patients a month, basically. So you'll be full. You'll be profitable in six months. You'll make your full doctor income in 12. That's really. Good. the The dangerous part is the 10 to 20 a month, where they feel like that's good enough. But if you map that out, you're not full for two two and a half years, and that's where you know you yeah it's deceiving. You you need to see that steady growth, and it's the practices that charge the least that make the most, and that counterintuitive point is very difficult for doctors, is because it's not how much you charge, it's how many patients you have, and $10 more about 100 patients less makes a difference. And I think there's there's a tendency to take the easiest path or the echo chamber path of well, I looked at a lot of websites and I saw a lot of high prices, so I'll do that or more, which I don't quite understand. But there's a lot of practices that have high prices and don't have high patient number. So we're in that era of the direct care movement where we want to focus on the fundamentals. It's not just copy someone else's model unless you really know that that's a what you want to do and b it's working, right? It's not just enough to grab someone else's pricing. How does that relate to the type of medicine you practice, right? Not everybody wants to do the same medicine. Some is more marketable than others. Some want to have part time. Some want to focus on a larger patient panel. Some are good at tech. Some are not. Some want to be an employee, right? And in which case, if you're going to be an employee and work with an already successful practice that's growing, they may have a wait list or be able to help recruit patients for you, so that you're coming out of the gates, and eventually, what we'd like to see is that this transition is, if not instant, you come on, you're hired, and the growth is so fast that the the clinic is paying you right out of the gates. In you know, two to six months, you're back to where you were. We're not there yet, but I think in 2027, we're going to be at record highs, and then again in 2028, it's that that's not stopping. I think we're at the verge where insurance beats itself, and we see a big shift of doctors and patients to this model, and that'll help everything just move faster and easier. Austin Littrell 22:18 I guess it's it's 2026. This question comes up in every conversation. What role does AI play in in DPC? I know you mentioned open evidence, but is it helping in the exam room? Otherwise, Speaker 1 22:31 I I love it. I'm a technophile by default, and I I think it's really interesting in the way that it's not. I would joke it's not actually special. This is in the same vein of spell check or grammarly. Is I heard this phrase about AI two two and a half years ago, and I think it's still very true. At its core, it's decreasing the work of work, and and that's where physicians, and we've talked about this before, are actually going to embrace AI and be happy it's taking their job, because it's taking the parts of the job that aren't helpful, right? It's not the parts that are are adding value to the patient are often the communication, the availability, the back and forth, the the relationship, not necessarily going off and completing the chart, right? Like note taking doesn't add value. The hour long conversation with the patient, where you're you're keyed in and not typing and not trying to juggle what to remember and what not to, that's high value. That then you know the tool is only as good as the data you put into it, but open evidence. What we're seeing is you know significant drop in referral usage because what used to be a difficult specialty question is now very easy to get an excellent answer and share it with the patient, so they see a trust. And I bias because I like tech and I'm a family doc, but I can really see the future is you know family medicine, Peds, internal medicine, primary care, powered by AI, and in all due respect to my my specialty colleagues, I think it'll it'll be interesting to see what pieces of the low lying fruit we take where I can get a fiber optic otoscope and take a picture and show the patient, which is just great in general. But I can also use that to get an electronic consult with a specialist. So in some way, I think we get a lot more because it's so cheap, so fast, so easy that we want to double check and provide more comfort to the patient, and we get to skip all the scheduling noise. I think you know dermatology. I could be like radiology soon, where they just have two large screens and they're reviewing a lot and instructing a physician to you know here's where you biopsy, here's the follow up, etc. But so I think we'll actually get a lot more care, but doing a lot. Less of the annoying work, right? We're dopamine driven, and there's no dopamine in doing a note because there's no right way to do it. You either spend an hour summarizing an hour conversation that's still not as good as the audio or the transcript, or you shorten that and miss a lot. So, but then that power of well, here's the other thing you you know maybe forgot, or also think about this. Remember, they had their kidney out a year ago. That that level of assistance, or you know, a cardiology AI agent living inside your EMR that you just turn on, like yeah, this you know this patient's a little more complicated. Keep keep paying attention to that. So there's a lot of doom and gloom, understandably, because the current system, I think, pits AI against the doctors. Where if we help you chart faster, then we just make you see more patients. But also, then we just use AI to compete against the AI notes you wrote, so that you are trying to build more, and we're trying to block more, and it just is this cold war that doesn't actually help the patient. When all that breaks and we get to primary, you know, insurance-free model for most of outpatient care, then that lens is going to shift, and it's going to be focused on how do we just make the doctors as good as possible, providing the care that they can do, and then a lot of things will get easier. So rough, like any new technology in the beginning, but ultimately probably change the way we practice medicine for the better. Austin Littrell 26:32 Where do you see the biggest misconceptions among physicians about what DPC actually requires? Speaker 1 26:38 I think there is the we're very risk averse people, right? We deal in risk with for patients and their health all day long, and we're not trained in business. And so there's a concern that either you have to be you know somehow very good at business to make this work, that society will judge you because now you're focused on the money, which doesn't make sense to me directly, those sort of things where the branding needs to be that this is the most patient-focused care you can get, right? And I talk to my med students about this all the time. That if we take our oath seriously, do no harm. It should mean do no financial harm, and we're doing financial harm to them in a broken system where they have to have insurance premiums that are more than their mortgage every month to get their metformin. That's a penny a pill, right? Keep them out of the hospital. You know, keep them healthier long term. Show them how cheap the meds can be, so that they feel comfortable investing in their healthcare. But also, there's this perception that a it's still just concision medicine, and and I have to find the rich people and give up on the poor people, or I just assumed you're doing you know what I'll say is bad medicine, right? Where that if you're paying cash, there's still a connotation that the patient gets what they want, and you're a pill mill for benzos or Adderall or other things, and I think you see that we've seen that in medicine. It's always been profitable to do bad medicine, unfortunately. Bad medicine is very popular, but but that's not the case. The the successful models here are successful because now they have a relationship, and I can tell a patient no, antibiotics aren't the right answer. I'll joke. Look, I'm the right answer machine. 20 years of academic training, I just want the right answer. And if it's a UTI, antibiotics is almost always the right answer. And if it's a cold, it almost never is. And I want you to know that you can trust me to give you the right answer, even if it makes you unhappy. And that professionalism and and confidence, or knowing that you can come and do this model, make great money, helping you know great patients get great care while still doing evidence-based medicine, is a fear that they have that that's not the option. The the alternative is so as they see this, and and that was more true in 2010. And every year that they you know the current model gets worse, and well, the the current model gets worse, and the knowledge of direct care model gets better, and so at some point, you know, it's just easier to jump ship and leave a broken system for a better system. Austin Littrell 29:29 So you kind of talked about it there, as far as that that trust that patients have in you. Could you, I guess, talk about the patient relationships and how that has has changed in, you know, in in working in DPC, Speaker 1 29:42 I I think because not to use a rep too cliche too often, there is no barrier between. There's no nurse knocking on the door every seven minutes. There's not an insurance company to blame or this boogeyman of sorts out there. In a weird way, it's wrong. It's an hour or more if they need it, explaining to them, you know, about their care, answering their questions, and then it's calls and texts and emails afterwards. So you can't just rest on your laurels and say, "Well, that's what I said in the office. Maybe you misheard me. My my joke about emails is I have to make sure I'm right. You know, I'll usually reference Mayo or someone open evidence because if I'm wrong, they can send it back to me and say, "Well, that's not right. And now with the advent of AI, they can highlight and search that even easier. So I think it makes you elevate their care, but it's also a more honest level of, "I don't know. That's a great question. I don't know if we have an answer for that yet. Or let's do the labs. Why haven't we done these labs yet? Well, normally we're trying to be, you know, judicious on costs. But yeah, that crawl, walk, run. We didn't didn't know we needed it until we've got our first abnormal. And so they, I think they trust you more now because there's it's such an opaque system that they're they're inherently defaulting to distrust, which is weird. But I joke, doctors are really good at the the pathology of psych, not the application of it, and and using what we know about good psychology to get good patient behavior change or to build trust, and so they'll say something like, "Well, I I don't trust big pharma. It's like, okay, but here's the data on Crestor. Like, oh, but it's so expensive. Well, it's six cents a day at the max dose, and and that alone. Oh, well, that's not so bad, right? They they're bracing themselves for a reason to be distrusting, and then you can spin that to be like, no, it's actually not transparency. Just they can come to you, and they're not penalized. There's not a financial barrier. Like, boy, I'd love to really understand why I don't need antibiotics, but it's 100 bucks an email, so I'll just be mad. No, it's full, full access, and at some point they hit a steady state where they're like, okay, right, you know, there's nowhere to hide. Now we have to trust each other, and I think that means a lot because it's just time. I think that on the simplest Moneyball stat, the more time they get with you, the more likely they are to trust you. So seven minutes isn't enough. 10 staff between you and the patient is a problem, etc. The fact that there's so few steps and so much transparency, trust becomes the default. Austin Littrell 32:30 Where do you see DPC headed over the next five years? Speaker 1 32:34 There's a a joke in nuclear physics that, or in physics that we've been 10 years away from cold fusion for the last 80 years, so I'm guilty. I probably said this since 2010. That I think the the the peak insurance is just right around the corner. I believe it now more than ever, though. Just looking at the pricing and and whatnot is the system is going to break, and I think when it does, it'll break kind of quickly, because as soon as a patient and we're seeing this now record events in 2026 people just strata. I'm dropping my insurance mid cycle. I don't want to pay for it. I can't pay for it anymore. But then when they do, they're instantly hundreds or 1000s of dollars richer every month, so we went from cash poor and insurance rich to flipping, and they make excellent customers. And now they they want the max value, they want transparency, they're they're going to drive the model to the best version of itself, and and everyone I think will accommodate. So I really do think in three to five years, insurance-free primary care will be the default. I think that that will be the assumed model, and when it happens quickly, it'll happen because insurance no longer wants to offer coverage for it. So there'll be an aspect of most doctors choosing it, and then kind of the tail end of the innovation curve will be doctors that there's no one to bill. They don't. They don't cover outpatient services anymore, and so I have to convert to this model. Maybe that's a little bullish, but I hope to see it. Austin Littrell 34:13 Those are all the questions that I have. Is there anything that we haven't discussed that you want to share with the audience? Speaker 1 34:18 I think maybe a very interesting spot will be how doctors grow, evolve, and connect these models. How they work with employers. There's we've we've moved mountains in a lot of ways, but we're still at the foot of the Rockies, and there's a lot of mountains to move. We're not going to run out of anything, but that innovation, when it hits, it starts to pick up quickly. I think that'll transfer over to doctors doing, you know, hospital at home or starting their own small hospitals or outpatient ERs. As as soon as the game to play isn't how much money can you squeeze out of insurance, but how how good of a model business do you have to be, I think a lot of stuff will change. So. I'm I'm very eager to see between the tech of AI making the barriers to innovation fractional and the business model leaning towards insurance free by default. I just think we'll probably see more change in healthcare in five or 10 years than we have in the last you know 20 or 30. Austin Littrell 35:20 Excellent. Well, Dr. Josh Umber, thank you so much for taking the time today. Speaker 1 35:24 Thank you. Absolutely. Austin Littrell 35:39 Once again, that was a conversation with Dr. Josh Umber, co-founder of Atlas MD. And before you go, if this episode has you wanting to dig deeper on direct primary care, take a look at the latest edition of Medical Economics Insider, our free online interactive issue. This one's called DPC 101. It features a panel of direct primary care experts. You'll find it linked in the show notes, or you can read it any time over at medicaleconomics.com. My name is Austin Latrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you subscribe so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. And if you'd like the best stories that medical economics and physicians practice publish, delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the chart, a business of medicine podcast is executive produced by Chris Mathelini and Keith Reynolds, and produced by Austin Latrell. Medical economics and physicians practice are both members of the MJH Life Sciences family. Thank you. Transcribed by https://otter.ai