Speaker 1: 0:00

Direct primary care has been a slow-growing flower in the healthcare garden. What are the strategies and practice models that will create faster growth and adoption of this valuable service? We'll find out on this episode of Shift Shapers.

Speaker 2: 0:16

Change either energizes or paralyzes. The choice is yours. This is the Shift Shapers podcast, bringing the employee benefits industry interviews with individuals and companies who are shaping the industry shifts. And now here's your host, david Saltzman.

Speaker 1: 0:38

And to help us answer that question, we have invited Dr Bernard Bubanek, CEO and President at Integrated Source One, who's been working on solving some of these very challenges. Welcome, Doctor. How are you today?

Speaker 3: 0:50

I'm good, David. Thank you for having me. It's a pleasure to be here.

Speaker 1: 0:54

It's our pleasure to have you as we talked off the air. I'm a big proponent of direct primary care, love it, love it ever since it came out, loved it through it, kind of morphing into an HMO, and then the HMO is killing it and all of that kind of stuff for all the reasons you and I know. But it's been a slow adoption and I want to talk about that as we get along. But first, what's your journey? How did you get to be doing what you're doing?

Speaker 3: 1:19

Well, it's kind of funny. It all started back in working in 30-some years in private practice. In professional hockey, athletes would come into the training room that either have an injury or an ailment, and no matter who on our team was available, the player got the care they needed without reaching for an insurance card number one and number two. They didn't have to wonder if they had enough money in their wallet to cover the copay or buy shoes at the end of the month for their child for baseball practice. So myself and our CMO got together and said hey, you know what? Shipping and receiving clerks, teachers, bricklayers they're just as important as goalies and left-wingers to the companies in which they work. Let's find a way to allow them to have access to health care without having to play the money game, as I like to call it. So we said we want to be a little different. We're multidisciplinary, obviously, and give the average Joe the care that our pro athletes get.

Speaker 3: 2:29

And it's kind of funny because two of my partners are professional athletes. One was one of the reasons why I founded Integrated Source One with Dr Callisto is John DeSalvatore. He was a NHL hockey player. And then I have an ex-Pittsburgh Steeler who also same thing. Those guys would walk in a training room and get whatever they need including their families, by the way and so they love the concept, and that's where we are today.

Speaker 1: 2:59

Well, it's especially important. I use this phrase often on the podcast. I wish I remember which guest coined it.

Speaker 1: 3:05

But with high-deductible health care plans and the like, we've created, especially among middle management people and you know, people on the on the lines who are building stuff and whatnot we've created people who are functionally uninsured.

Speaker 1: 3:18

They have a card in their wallet but they don't feel as though they can use it, and you know, then we see, besides them getting sicker, you know they defer care and we see cases like you know, little Johnny, who started off with a cough and ends up being $75,000 for a five-day stay in the PICU or someplace. So I just and I'm just old enough, I'll confess to remember when Dr Lenz used to come to our house with his little black bag and I liked that model and I don't like the model of walking into a regular physician's office and I thought for me DPC was a great compromise between those two, but it's having trouble catching on and I know there are DPC deserts and there are other places where there just aren't options for people. One of the things you're working on you don't like calling it direct primary care. I think you prefer the term direct patient care. What's the difference?

Speaker 3: 4:12

Well, the difference is because we're multidisciplinary, we do have primary care as an option, but we also take health coaching seriously as well. We have musculoskeletal options, we have behavioral and mental health available. So we incorporated a true multidisciplinary platform of providers and offered it as direct patient care. So the concept of direct care in other words, you know a membership fee as opposing to play the insurance game we adopted that and we run with that and we embrace that. And here again, that's the premise of which we have been moving forward in our plan.

Speaker 3: 5:01

We started out originally as doing on-site, near-site and mobile offerings, and that was like around 2015. And the concept caught on. It was great. Owners loved it. And then when they went to their broker, they were like, yeah, but that's not what you know. And then it got pushed aside. So you know, as I always say, you know we're a lot of companies are out there saying that they want to, you know, control better access to care and mitigate problems and do all this. But we're actually doing that in a way that we're bringing better access. And then when, of course, when COVID started and we had the lockdowns, telehealth became very popular and we wanted to get into the tele and virtual vertical, but we decided that we don't want it to be the same. We don't want a call center. We don't want people calling in and still having to present a card and then ask for a group number and then wait for the credit card to clear before we would see the patient. We wanted a true brick-and-mortar experience in the virtual mode, and so that's what we developed.

Speaker 1: 6:11

So, going back to the brick-and-mortar, are you still incorporating on-site, near-site clinics and those type of delivery arrangements into everything else you're doing?

Speaker 3: 6:20

Absolutely. So what we did was we took our on-site, on-site, near-site and mobile offerings and then we layered the virtual and telehealth part of it. So even for the companies that have for example, we have an on-site clinic at a university in Marietta, georgia so for their employees and the students of the university, when they're using our services, it all starts with a phone call. And that when I say by the phone call, it's not just a scheduled appointment, because when you call Integrated Source One, your call goes directly to one of our nurses or CMAs and that visit then starts as if they were sitting in the room with you in a brick and mortar. You know, david sees you're calling in today. You know what's going on. How long have you had it? What makes it worse? What have you tried? And all that starts. And while what's going on? How long have you had it? What makes it worse? What have you tried? And all that starts.

Speaker 3: 7:15

And while that's going on, our doctors that are on that day have a ping saying that there's a patient in queue. So then, once they determine, for example, if it needs to be seen on site, then they say come over to the clinic at 10 am. And when they walk through the door. One of the unique things about our clinic there there's two chairs, that's in case somebody came along for the ride. We don't have a waiting room. So when you say 10 o'clock and you open the door, you're going right back into the exam room and because the triage already started, that chart note's up on the screen and the providers then be able to start the care. You know the minute you walk in. So you don't have the waiting room and you know and care is pretty much immediate because, as you know, instant oatmeal takes 60 seconds to make, so it's really not instant.

Speaker 1: 7:58

You know, I'm still intrigued by the notion of being multidisciplinary. So if that same person made that initial call and your intake folks determined that they needed I don't know an obstetrician and you didn't have one of those at the clinic, how does that get handled? Does that turn into a telehealth visit?

Speaker 3: 8:19

It does. Obviously we are connected with DPC and then there's obviously direct specialty care associations as well, so we align with them and we're able to handle that type of situation. Same thing with musculoskeletals, you know. We have chiropractors on board so that we can do a visit that way. And then we also partnered with an orthopedic group that can do orthopedic consults for us virtually, which is really cool and it becomes very timely for the patient. Number one. Number two they're not going to waste money by making an appointment at an orthopedic surgeon for a sprained strain.

Speaker 1: 9:04

You know, one of the things that I'm thinking about here is, as you talk about near-site or on-site clinics, you're talking about employers or groups of employers. So I suspect that you've been able to take your model and make it fit with employer need, which has been one of the difficulties. For advisors who go out and start talking about direct primary care, the answer is always okay, cool, can you show me a demonstrable, repeatable ROI? And because most traditional DPC practices don't have access to the kind of coding, software and whatnot, they can't really do that. Have you overcome that and, if so, how do you go about doing that? Because that's a big lift.

Speaker 3: 9:39

Yes, when we started, we used a software that's very, very common to direct primary care and it's very good one that's very well recognized. And what we did is we wanted to make sure that when we saw a patient, not only was the diagnosis made, but also let's provide a CPT code for our internal numbers. So we took those CPT codes, assigned a, obviously for billing purposes. If it was somebody that would be in the Cigna network, for example, we knew exactly what that CPT code would render on the paybacks. So what we did was we would just month of May, we saw 220, 99201s exam, brief exams, whatever it might be. Our value was this this is what it would have been through Cigna or whatever, and there's the difference and there's your savings. So it was very, very, very crude in the beginning.

Speaker 3: 10:40

But now we have a new platform that we just rolled out about 15 days ago and we're able to pick those things up as we go. Yeah, because doing it manually is a chore. It is, it is. And we have a couple of people that are here in the office that roll their eyes when I say I need a utilization for this and that. But now, with the new platform, that's going to be happening in real time and it's going to make it accessible not only for us but the HR person when they get part of the portal and they're able to go ahead and actually see utilization numbers and it can be broken down whatever's valuable to them and to the advisor.

Speaker 1: 11:22

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Speaker 1: 11:43

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Speaker 3: 12:52

Yeah, very good question. So what we do one particular company that we work with and they have a substantial book of business and we're on every plan right now with them automatically and the broker knows it. So how they do it is, if you go to almost use this scenario, as you have choice A or choice B, choice A is, you know you could do your traditional thing, you could still go to Dr Dreamy because he's your favorite, and if you do so you're going to be subject to the traditional stuff. You're going to have your copay deductible and all that, or you can use Integrated Source 1. Okay, if you use integrated source one, you don't have a copay or a deductible. It's already built in.

Speaker 3: 13:38

The nice thing is, too, the relationship that we built over the five years that we've been with this particular company. If they know, if the TPA knows that they're going through us, it basically eliminates prior authorizations because they know we're going to be out there with the relationship that we're establishing. And remember you said it in the beginning here about the doctor coming with the doctors back to the house we like to have that relationship in our brick and mortars as well as our virtual thing. Establish it with our nurses. Our nurses and our doctors are all W-2 employees from Integrated Source One. We're not contracting out so that one day, you know in the morning Dr Smith works for one of the other telemedicine companies and then at lunchtime he switched shirts and he's not working for us.

Speaker 3: 14:28

So you have true continuity of care within a practice that's large enough to cover you know the states in which we work and we're able to give that reassurance to the patient. And that's some of our biggest aha moments. The patient goes wait a second, I just talked to Dr Smith yesterday and I get to see him again tomorrow. Yeah, and we're going to follow up on, you know, the script that we gave or whatever. That's one of the big differentiates that helps us even with care navigation, because if you can remember back in the day with the old-fashioned doctor, it would say hey, dr Smith does a great job on inguinal hernias, I'm going to send you to Dr Smith. Those are the type of things when you have that trust factor with the patient, you're able to make a better recommendation and have the follow through.

Speaker 1: 15:18

How do you deal with continuity of care issues? When somebody's problem outgrows your guys' capabilities and they have to be transferred, do you stay involved?

Speaker 3: 15:26

Absolutely. We make sure that, obviously, with our new platform, we have the ability to push and pull our notes and our findings to whoever we refer to, and vice versa, so that's going to make a big difference as well. And yes, we do follow up. That's one of the advantages of having your nurses have that commitment to your patients. They're able to say okay, david, I saw you had your exam yesterday with Dr Smith. How'd everything go? Was everything okay? Did you like Dr Smith? How'd everything go? Was everything okay? Did you like Dr Smith? And all that. And we get the feedback on that.

Speaker 1: 16:00

So let's talk a little bit about measurements, because we touched on this before. What in a ballpark setting, could an employer expect to save by adding your practice on top of what they've been doing and writing their plan of benefits, so that there was that incentive for employees to go through you guys.

Speaker 3: 16:22

Yeah, that's another great question. So one of the things that we found and it's played out very well in our success cases is being able to have a provider at the table when you're designing the plan. Being able to have a provider at the table when you're designing the plan Because a lot of times we found that, just like I said in the beginning, when we had originally just going to an owner of a small business and saying here's what we do with your broker, your advisor, and how we work it, he says, wow, that's great, but if the broker doesn't know how to write the plan and do it the correct way, then it could be a problem and it gets really sticky. We know that it's a two to three year play before you start to see substantial savings and a good return on your investment. Because, like with anything else, we find that the engagement in the first year is around 14 to 15 percent. You're going to have the people that will follow and say, oh, yes, it's a great idea, I'm going to try it.

Speaker 3: 17:20

Year two, the water cooler talk takes over and that doubles, usually 30 to 40 percent, and then doing the good job that we do. Then your third year we're looking at like 70% using us, even if it's for a tele-virtual urgent care visit. You know, we always say Dr Mom is the doctor of the family and unfortunately she's the one who has to take care of the earaches of the little ones, and it never happens between 8 and 5. Earaches usually happen at 3 am right and it never happens between 8 and 5. Your aches usually happen at 3 am right. One of the nice things about the way we have our program set up is our CMO is a board-certified pediatrician, so it's attacking a lot of those things that you know. That comes through on the claims Dependents, child dependents are usually, you know, the ones that we can make significant savings on.

Speaker 3: 18:19

And then, like I said, follow-up is very important because that engagement there, as you said earlier in our conversation, you know some people put off going to the doctor and now you're only setting yourself up for more expenses. Where you have the access, where you could just call and say, hey, I'm trying. I saw something on the internet where eating carnivore is supposed to help me get better. Should I do it? Well, because they have the relationship with us, we're able to jump on and speak. We have one of our doctors who's researched that type of a program and he's an expert in it. So we just say, hey, we're going to have Dr Troy get a hold of you and he's an expert in it. So we just say, hey, we're going to have Dr Troy get a hold of you and he'll answer all your questions.

Speaker 1: 19:02

And that's one of the benefits of having the relationship you have with us In terms of plan design. What are you seeing in your practice so far? Is this a benefit that employers are offering to families, or to employee only, or is there a mix of both?

Speaker 3: 19:12

Well, because the way we set our program up, the employee gets it, but we also cover their dependents at no additional cost. There's the big difference too. A lot of times, when you're in a situation and you're using a community DPC, a direct primary care, the rates are going to be a little bit higher. Obviously, that's normal business. For the visits, our model allows us to be able to have the volume to keep prices that are affordable to the plan, which makes it affordable to the employer, which makes it a lot easier for the advisors to sell it.

Speaker 1: 19:52

That makes sense. That makes sense. So, as we wrap up here, putting on your crystal, looking at your crystal ball, what do you see changing in the next couple of five years and what are you working on that will help make this practice even more pervasive?

Speaker 3: 20:09

Well, obviously we're expanding. We're always looking for new technology you know we're looking for. You know AI is becoming very popular in healthcare and we have some really exciting things coming in the next, actually in the next quarter. Here we're. You know we're always looking for ways to improve how we handle the day-to-day patient experience. That's the most important thing to us, because we find that the better the communication with the patients, the better the results. That results in lower claims, which and then, if everybody does their job, lower premiums the following year. You know we have a school district in Western Wisconsin, for example, where they've been with us for five years. Each year. Not only has their costs go down out of pocket for their employees, but their premiums are going down, and in today's market you don't see that quite often. And even if it's a 5% decrease, that's huge when you're talking for small businesses.

Speaker 1: 21:13

Yeah, there's no question, and that's a great place to end our conversation for today, but we do hope you'll come back, dr Bernard Bubanek, ceo and President at Integrated Source One. Thanks so much for a very interesting conversation. Thank you, david. I want to give a quick shout out to our sponsor and our producer, hatcher Media. Hey, if you need podcast production or professional graphic design, josh Hatcher is the expert to contact. For more information, visit him at HatcherMedianet. That's H-A-T-C-H-E-R Media dot net.

Speaker 2: 21:49

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