A World Without Insurance Claims

Episode Transcript

Speaker 1 (00:00):
Thirteen ten Wi BA and Full Scope with doctor Nicole Hamkiss,
Wisconsin's direct care doctor. Doctor Hamkiss comes to us from
Advocate MD. The website for Advocate MD, it's Advocate DPC
dot com. That's all one word, Advocate DPC dot com.
You can learn a bunch about Advocate MD. You can
learn about all four clinics and Advocate MD. You can

(00:22):
learn all about direct primary care. You can learn about membership,
the benefits, the costs, all very transplant parent in black
and white. You are a very informed patient at Advocate MD.
You can also learn about options for things that Advocate
MD and Direct primary Care pairs well with, whether it's
a high deductible insurance or a meta share. Excuse me,

(00:44):
a doctor, what's the term? I'm I'm drawing a blank
on the health share? Is there one called meta share? Now?
By the way, how are you going this morning? Okay?
That maybe why I've got it stuck in my in
my He's right, how you doing this morning?

Speaker 2 (00:57):
I'm doing well? Yes, there is one called meta share
that that's one of the ones that's been around for
a long time.

Speaker 1 (01:02):
Okay, here, that maybe why, for some reason just got
stuck in my head. There speaking of By the way,
it is open enrollment time, isn't it.

Speaker 2 (01:10):
Yes, you know, so around usually between Thanksgiving and Christmas.
Around that time, if you get your health insurance through
your employer, they're probably asking you to choose a plan.
And in some cases you might have you might only
have one choice, but in most places you will have
multiple choices. So if if you're trying to decide what

(01:30):
the best choice is, you know, for the majority of people,
if you're not someone that goes to see doctors a lot,
you're not going to specialist all the time, you're not
anticipating needing surgery in the next year, I would say
choosing a higher deductible plan, and then again the direct
primary care what we do at Advocate m D would
fill that gap. And then that's also maybe an opportunity

(01:51):
to talk to your employer and say have you heard
of this? That's how we get a lot of our
employers because their employees, you know, mentioned to their HR
person I heard about this. Is this something that you
can cover? And then that would be an even better
situation because then your employer would cover the direct primary care.
But yes, if you have the option to choose a
higher deductible that's going to save you money each paycheck

(02:14):
on the premium. And then the money that you're saving
on the premium is likely not going to be as
much as the money that you would pay just for
your direct primary care membership.

Speaker 1 (02:22):
And I know, and folks that are listening this morning,
definitely talk to your employer, talk to the folks in HR.
As you mentioned doctor, that's how you know, a lot
of a lot of referrals come through that channel. And
I think for business owners, business leaders, folks that kind
of manage the stuff, people that are concerned about numbers,
it is amazing the how affordable direct primary care and

(02:45):
Advocate MD, how affordable that is, and you really have
amazing access that you don't get with other plans. And
by telling your employer and telling those folks in HR
about Advocate MD and direct primary Care, I think it
really get gets a lot of those employees is excited
because it's a huge, huge benefit to employees, but it's
also an opportunity to get really high quality primary care

(03:08):
at an affordable cost. And speaking of direct primary care,
I mentioned earlier, of course the four clinics. The newest
clinic opened in Fitchburg of course. Of course that joins
the Janesville location, west Side and Middleton and east Side
location on South Fair Oaks have and a couple of
new doctors as well seeing patients. And I know you're
enrolling patients right now, doctor Giovanni and doctor Philman, which

(03:31):
Giovanni and PHILB. It sound like I don't know, they
could be they could do Broadway performances. It's the latest
Gavanni and PHILB.

Speaker 2 (03:40):
And Sean is actually d Giovanni Giovanni, Yes, And in
doctor d Giovanni she said it's okay to call her
doctor d G.

Speaker 1 (03:49):
Okay.

Speaker 2 (03:49):
So her her father was a general surgeon up in
Sock for many, many years, and she said that a
lot of his patients called him doctor d G. So
doctor d G is maybe just a little bit easier
to say. I I, you know, constantly tell patients to
call me doctor H because you know, my last name
is not the easiest thing. It's not a very long
last name, but you know, there's just certain last names

(04:11):
that are not easy to pronounce. So yeah, doctor di
Giovanni just started with us this week. Doctor Philbin is
going to start UH in February, beginning of February, So
we are very excited to have both of them. And
I think I had mentioned before that doctor d g
uh was from Prairie to SoC she has previously worked

(04:32):
both up in Reedsburg and she was also working at
the u W Clinic and Cottage Grove. And then doctor
Jennifer Philbin was previously working part of Fort Health in
Lake Mills. So both of them are you know, they've
been in Wisconsin in the Madison area for many, many
years and great docs, very well respected and great reputations,

(04:54):
and you know, are good with their patients, very knowledgeable,
and we're excited to have them.

Speaker 1 (05:00):
One of the things I know, and having had a
chance to meet many of the doctors at Advocate MD
is doctors that are really really passionate about what they
do and really passionate about about primary care and taking
really good care of folks. And that's a fantastic feature
of direct primary Care and Advocate md IS you actually
have a doctor that knows you that you can get
to know as well. Again, you can learn more online

(05:22):
ADVOCATESDPC dot com. That's Advocates DPC dot com. Fitchburg Clinic
now open and seeing patients there as well as, of
course at the other locations of advocate MD and doctor,
people are often often kind of perplexed to say, well,
how are you able to make primary care so affordable?
And a lot of people wonder too about healthcare in general,

(05:42):
how do you make it less expensive? What are some
of the thoughts there as far as kind of overall
ways to make healthcare more affordable for folks.

Speaker 2 (05:53):
Yes, so you know, there's things kind of on the
macro level, the big picture level, and then there's things,
you know, on kind of more of a personal level.
Direct primary care obviously is something that there are clinics
all over the country, but you know, here in Madison
we have advocate MD. You know, I started thinking about
this because there is a really knowledgeable guy's name is

(06:14):
Dave Chase. He runs an organization called Health Rosetta and
they work with employers and insurance brokers and third party
administrators and try to help them figure out ways to
save money.

Speaker 3 (06:25):
And their big proponents of direct primary care.

Speaker 2 (06:27):
But he's written a few books and one of his
books was entitled Relocalizing health Care in the Future of
Health and he believes that healthcare in order to keep
it more affordable, more accessible, higher quality that it should have.
I think he talks about three different things, so that
it should be local, that it should be open, and

(06:49):
that it should be you know, independent or private, and
so I kind of wanted to talk about those those
different aspects, and direct primary Care of course fits all
of those aspects, but it's it is something that you know, again,
as we see the cost of everything going up.

Speaker 3 (07:06):
I just heard on the.

Speaker 2 (07:07):
Radio yesterday that the inflation rate is going up higher
than what they expected. I think they were expecting it
to be like two point seven and now it's going
to be three or in the prior period it's been three.

Speaker 3 (07:19):
You know, everything we.

Speaker 2 (07:20):
See obviously, as as the listeners are experiencing when you
go to the grocery store, when you go to buy
Christmas presents, when you go to you know, fill your
gas tank, everything is becoming more expensive. And that you know,
healthcare in the large systems and the insurance based system
is obviously going to follow that same trend. We as
part of Direct Primary Care with Advocate m D, we

(07:43):
have intentionally tried to buck that system and keep our
prices very affordable, even though in of course, in in
our cost are increasing year after year, but our practice
is also growing. So we have not increased our prices
in the past six years. We are not increasing them
going into year seven. The prices have stayed the same

(08:04):
for our members are you know, individuals, families, and businesses.
So that's something I like to point out because I
say to people one time I posted this, I think
a year or two ago, posted it on LinkedIn, and
I said, give me something else that the price hasn't
increased in six years or five years. And I know
some some smart alec found something that he had an increase,
but I couldn't think of anything. So of course we

(08:28):
could increase our prices. I mean, I sometimes have patients
coming in saying to me, you're charging too little. You
need to start charging more. But we have of course
done this intentionally to you know, for a couple of
different reasons. You know, we want to appeal to people
to join, we want to keep this affordable for our
existing patients as as again their all their other bills

(08:49):
are probably going up. But it is an intentional thing
that we've We've kept the prices the same, and I
just like to point that out to people because that
is very different than your insurance premiums. If you've looked
at your insurance premiums in the last six to seven years,
I'm sure that they.

Speaker 3 (09:04):
Have gone up dramatically.

Speaker 2 (09:06):
If we know that they tend to go up, you know,
any we're from ten to twenty percent each year. So
you might be paying, you know, forty fifty percent more
today or coming into twenty twenty five than you are
paying six or seven years ago, you.

Speaker 1 (09:22):
Know, doctor. I think as we talked this morning with
doctor Nicole Hempkiss of Advocate MD, the website ADVOCATESDPC dot com.
That's ADVOCATESDPC dot com. Tell if and I'm gonna make
appointment become a member at Advocate MD six oh eight
two six eight sixty two eleven. That's six oh eight
two six eight sixty two eleven. Doctor. One of the
questions I think a lot of folks often have is, then, okay,
when we talk about making healthcare less expensive, where do

(09:45):
we cut and how do we cut to make it less?

Speaker 2 (09:47):
You know?

Speaker 1 (09:47):
What are because you think of okay, that that money
is going somewhere. Sometimes it's doing things, sometimes it's not
doing as much as we'd like. But what exactly is
able to be done there and like, are there areas
that are able to and I think people wonder adcn MD,
how are you then able to have such great access,
great great treatment and you know, great relationships, spend time

(10:08):
with your patients and still keep it affordable. What's missing there?

Speaker 2 (10:13):
Yes, So you know they've talked a lot about healthcare waste,
you know, in the governments they talk about this and
how to kind of eliminate a lot of these waste
because you know, obviously a large part of our GDP
is spent on healthcare through Medicare, Medicaid, Trycare, all the
veterans health care benefits. So so how do we you know,

(10:36):
of course make that less expensive. But you know, back
to your original question, I think that there's a large
percentage of costs that are weight or medical. You know
what we call waste administrative cost middlemen like the insurance company.
When we think about insurance companies, what purpose does insurance serve?
Basically they function as a middleman. Right, They're not the

(10:57):
ones taking care of the patient. They're not drawing your blood,
they're not taking your blood pressure. They are paying out claims.
What if claims didn't exist? You know what if we
had a very different way of paying for health care,
and we did not use the word health insurance synonymous
with healthcare, we viewed healthcare. You know, of course there
has to be some transactional part of it. In the

(11:19):
direct primary care model, we like to say that, I
like to say that it's more relationship based rather than
transaction based, because every time a patient comes into our office,
they're not transacting money with us, and we're not billing
them for that visit, which is again very very different
than an insurance based system. Because it is a membership
model with us, they have all their visits included with

(11:41):
that membership. But what if we eliminated a lot of
the middlemen and this kind of you know, goes back
to the so local independent and then open so. And
then also another aspect of that is kind of these
direct pay agreements and so that can mean many different things,

(12:02):
you know. So in our direct primary care model, you know,
we have a direct pay agreement between ourselves, the medical
physicians and the patient. We also have these direct pay
agreements between ourselves and companies that are sending their employees
to us. So again we have eliminated the insurance company
out of that we don't need a broker to be

(12:23):
involved in this transaction between the for the primary care
portion of it. Of Course, again we are not suggesting
that people do not have any insurance, that they do
not work with insurance brokers. You're going to need to
have some form of coverage for things beyond primary care.
But a large portion of what people do in healthcare
is their primary care, and I believe it should be

(12:43):
a larger portion probably, So that's kind of the direct
pay part of it.

Speaker 3 (12:49):
The local part is.

Speaker 2 (12:51):
You know, as we talked about Sean many times, and
there was an article just another article recently about mergers
and acquisitions in these multi state hospitals. And look around
here locally, of the three large hospitals, two of the
three are owned by large multi states healthcare conglomerates that
you know, are multi billion dollar healthcare systems. And actually

(13:15):
of one of those two is paired now with the
one local system. So you could make the argument that
all three healthcare systems have some kind of joint agreement
with one of these multi state systems. So we've talked
about this a lot, and why does that happen where
hospital systems in different states want to buy out hospitals

(13:35):
in Wisconsin.

Speaker 3 (13:36):
Well, it's a financial thing, right.

Speaker 2 (13:38):
They're not doing this out of the goodness of their
harder because they think they're going to take care of
people in Madison, Wisconsin better than they take care of
them in you know, Indianapolis and Illinois. You know Indianapolis
or in Des Moines, Iowa. They are doing it for
financial reasons. They want to have a larger footprint. So,
but what actually happens when when we have these large

(14:00):
and acquisitions it creates less choice. Right, So let's say
you know, of the three local hospitals we have here,
two of the three now are together. So basically you
have two choices in a medium sized city like Madison.
I mean, what if you had more choices, then you'd
have more competition that would drive down prices. So but
the local aspect of it, too, I would say, applies

(14:23):
to when you live in a community and you're you know,
the the healthcare administrators, the hospital administrators, the doctors of
course live in that community, but you have a better
finger on the pulse of the challenges of the needs
of that community. It is a very it's a far
cry from when again, the the healthcare administrators are in

(14:44):
Des Moines, Iowa, and they're they're making decisions about Madison, Wisconsin.
Of course they have people locally here, but it is
it is interesting when that starts to happen. And again,
then my argument would be, most of the decisions are
not made based on the actual needs of the patients
and the needs of the community. The decisions are made
financially right, so those decisions are kind of passed down.

(15:05):
So what if more healthcare was local, it was community based,
we made decisions based on understanding the challenges and the
needs of our community. And then this idea of independence.

Speaker 3 (15:17):
Which is sort of correlate. All these things are kind
of correlated with each other.

Speaker 2 (15:20):
So direct primary care clinics like Advocate m D, we
are not owned by a hospital system. We are not
owned by a larger healthcare system. So that means when
a patient comes to see us, you know, whether it's
for a sore throat, or they have low back pain,
they sprain their ankle, we're managing their hypertension. We will
take care of as much as we can in our clinic.

(15:41):
We have no financial incentive through higher ups to refer
these patients into the system. We have the incentive in
terms of providing great care and comprehensive care to our
patients to do as much as we can in our clinic.
That's my goal is as much as is within our
scope of practice is and we have the whatever it

(16:03):
might be, the financial needs, the resources to provide these
services in our clinic. You know, for example, halter monitors
and event monitors, and spirometry and and telemetry and doing
you know, X rays and ultrasounds in the office. You know,
we could send people out for all of those things
and it really wouldn't we would not really lose anything
from it. But I don't want to do that because

(16:26):
I would like to do those things in our clinic
because it's more convenient, it lowers the cost for our patients.
They like it. It's more streamlines, the process is more streamlined.
They can get it done faster. So that's why we
provide all those services. So that's the kind of independent
part of it. We are not incentivized or pressured in

(16:46):
any way to refer patients downstream to the large hospital system,
you know, down the road, so that they can get
their MRI and pay ten times as much. And again
with the caveat, I would like to say that doctors
are not. You know, when your doctor sees you in
your insurance based system, that doctor is not you know,
when he checks the box for MRI. It's not like

(17:07):
they're sending them a check in the mail for one
hundred dollars for referring that.

Speaker 3 (17:10):
That's not happening.

Speaker 2 (17:11):
I do hear people say that that is happening, and
that is not happening. But obviously the health system that
that doctor is employed by is benefiting from that. Right
when they're charging you these exorbitant prices for things that
do not cost them. You know, they don't even cost
them a tenth or one hundredth of that price, that
you know that that health system is benefitting, and in

(17:31):
some indirect way eventually downstream, that doctor must be benefiting
because you know, they're part of that health system. But
it is not like they're getting kickbacks or anything like that.
But again, we aren't employed by any health system, so
we don't have any incentives to send you into a
system for your specials. You know you want to consult
with an orthopedic surgeon. You know we're going to try

(17:53):
to find you. My goal usually is to find you
an independent you know, specialist to see because I feel like,
again we're kind of all operating onto the same the
same kind of motivations and the same mission.

Speaker 3 (18:07):
That we want to just take really good care of
the patient.

Speaker 2 (18:10):
And there's really not a financial incentive for us to
refer you to a specific place. So that's kind of
the the independent part of it, the open part of it.
And I I should say that I have not read
his book, but you know, when we talk about insurance
networks and and Sean, I'm sure you have an insurance

(18:30):
network that you have to operate within. And then you know,
like let's say, you know, your wife's insurance changes in
two years and they switch from you know, insurance ABC
to insurance.

Speaker 3 (18:40):
X y Z. Now you have to change your doctor.

Speaker 2 (18:43):
Now you have to go to a different you know hospital,
if you ever needed surgery or you know what. I'm
sure you've probably experienced that through the years.

Speaker 1 (18:50):
And I hear the stories as well, Yeah.

Speaker 3 (18:55):
So what if that?

Speaker 2 (18:56):
Like what if these you know, and this is kind
of in some ways a little bit of a pie
in the sky thing, but in other parts of the
country this is happening where we don't have like an
insurance network. Okay, you have this insurance, you go to
the hospital a you see this one doctor. You know,
there are parts of the country that are operating under
what they call reference based pricing, which is a little

(19:18):
bit complicated, but basically the idea is that you go
into whatever hospital you want to go to, you need
surgery done, and they're making the agreement to pay a
certain price for that surgery. That's one way to do it.
But also, you know, there's all kinds of direct pay agreements,
there's bundled pricing for surgery. But the idea behind all
of this is that we have been kind of sold

(19:42):
a bill of goods through the years that when you
have insurance, you know, whether it's Courts, Dean, Blue Cross,
Blue Shield, whatever, you know, signa United, whatever insurance you have,
that that insurance company is getting you some special deal.
And that is not the case. I would say in
ninety percent of cases, you are paying more by using
your insurance. And again I'm not arguing that you should.

Speaker 3 (20:03):
Not have insurance.

Speaker 2 (20:04):
You need to have some catastrophic coverage because you need
to have some peace of mind if something very bad happens,
like you get diagnosed with cancer, you have to have
major surgery, you get hospitalized for multiple days, those things
will be very expensive and they would bankrupt almost anyone.
So you need to have some form of catastrophic coverage.
But the misconception that your insurance company has negotiated you

(20:26):
a special deal that is false because in most cases,
whether it be a lab test in MRI, a surgery,
if you went into that same hospital and said you
were paying cash, you would be paying a small portion
of what the insurance price is.

Speaker 1 (20:43):
It's interesting, as we talked this morning with doctor Nicole
Hemkiss of Advocate MD, when you had mentioned the I
think you had said, what if claims didn't exist? And
like I have this vision of like a sunny hill
with people skipping and enjoying life, I mean, just a
mad and that's you know, we talk about what you're
able to do at Advocate MD, and then you talk

(21:04):
about kind of the history and we think about the
history of what health insurance originally was about, which was
those those type of things that catastrophic covers it was
it was there for when those when those major health
things occurred, you had something to protect you from, you know,
bankruptcy and complete financial loss. Now we're applying it to
all these different areas. You know, even something as simple

(21:25):
as you know as your annual routine physical suddenly that's
running through insurance and you're saying, why are we doing
all of this stuff? And it's it's at a huge
cost and a huge inconvenience. The great thing about direct
Primary Care and Advocate MD is you're not dealing with
insurance when it comes to your direct primary care. You know,
your your your visit. You're literally going in to see

(21:46):
your doctor. You pay a membership fee monthly. It's very
very affordable. You can learn more online ADVOCATESDPC dot com.
That's Advocates DPC dot com. As we started this conversation
out this morning with doctor Nicole Hanks talking about open
and make sure you are talking to your employer, talking
to those folks at at HR about open enrollment and

(22:06):
of course direct primary care, get that on their radar.
They may not be aware of Direct Primary Care and
Advocate MD. It's a huge, huge benefit for employees, a
great benefit for employers as well. It's also a fantastic
option for you and your family. If you're looking for
fantastic primary care, definitely check out Advocate MD. Learn more
online Advocates DPC dot com. That's Advocates DPC dot com.

(22:27):
Today is today, pickup phone, make an appointment, become a
member at Advocate MD. Six oh eight two six eight
sixty two eleven. That's six so eight two six eight
sixty two eleven. Doctor. It is always fun talking with you.
You have a great day and we'll do it all
again real soon.

Speaker 3 (22:40):
You too, Sun, Thank you.

Speaker 1 (22:41):
Certified Financial Planner Tracy Anton joins us next right here
on thirteen ten. Wiba