Imagine if the cost of your monthly healthcare coverage was comparable to a gym membership…
For many, the idea is a fantasy. A dream, yes, but a seemingly impossible one. For Dr. Heather Bartlett, the idea people should be able to afford professional healthcare isn’t a fantasy, and she and the team at The Bartlett Medical Clinic & Wellness Center are making the dream come true for her patients.
We interviewed Dr. Bartlett and asked about her clinic and the unique model that is direct primary care.
So tell us about the clinic. What is it that you do and who are your clients?
I help people afford unlimited monthly access to my doctor’s office as well as access to discounted labs, and prescriptions by providing Direct Primary Care memberships, an alternative solution to expensive traditional insurance premiums.
Healthcare, specifically primary care, needed to be reworked. It has been an area of healthcare that has been overlooked, taken for granted, and more recently underutilized. It has been starving for an disruptive innovation for years.
That’s where my business comes in. The Bartlett Medical Clinic and Wellness Center is Columbus, Ohio’s first true direct primary care clinic. Direct primary care is value-based medicine with cost transparency and improved access to your physician. Say that again. Do you believe it? Most don’t believe it. But it is real and it is making a difference by improving the health of patients, saving them money, and creating a relationship with a physician that they may have never yet experienced in their lifetime.
People join my practice and pay a simple monthly membership fee, similar to a gym, to have markedly improved access to me, the physician, while the majority of their visits are included at no additional cost. My patients have the ability to email with me, text with me, and even videoconference if necessary to improve the speed of their care. The national average for direct primary care memberships range from about $50 to $100 per individual per month.
Now, hold onto your hat, I know what you’re thinking – I’m healthy, why would I want to pay for care that I may or may not need? Very simple. That’s the point with healthcare: you don’t know you need it until you need it. And if you don’t have somebody on your side — somebody who knows you and your health, somebody who is actually accessible and affordable to you — you could end up with a costly ER bill, one that would pay for a few years of a direct primary care membership. It’s been estimated that the majority (90%) of healthcare services rendered are with primary care.
Further, as Steve Jobs famously said, customers don’t know what they need until you show it to them. Welcome to direct primary care. You need it, you just don’t know it yet.
We do not accept any insurance, rather we instruct our patients to use insurance as it was initially created — for catastrophic care. We don’t use car insurance to fill our gas tanks, change our oil, and replace our tires. We don’t use our home warranty to pay for a paint job. Why do we use insurance for simple maintenance of our bodies? Because we’ve been told up until now it was the only way. And you know what, it costs too much. It doesn’t have to. People aren’t getting maintenance because they’re worried about costs. And I don’t blame them. But they’re getting sicker, and we have to do something to turn this train around to get healthcare costs under control. Early intervention through direct primary care accomplishes that.
By leaving the insurance billing world, I’ve been able to break down barriers of access for my patients to their physician, negotiate markedly improved laboratory rates, offer wholesale prices on prescription medications (sometimes for pennies on the dollar, better than even a $10 copay for a generic), and work with local community organizations to lower costs for some imaging procedures. An example of laboratory cost: a complete blood count (CBC), which most people are familiar with, costs my patients around $5. You read that right. Five dollars. Even Healthcare Bluebook thinks it should cost, at best, around $21. And the reality is that it is billed between $40 to $120 depending on where the lab work is done (outpatient private lab versus an outpatient hospital-affiliated clinic).
Let’s be real, most people pay for many things they really cannot afford with their credit cards, etc. But, interestingly, people are not interested in spending money on their healthcare.
What they really can’t afford to lose is TIME.
If there’s one thing that healthcare takes for granted, unfortunately including physicians, it is a patient’s time. Some think money is the most valuable resource, but time is truly the most valuable resource. If a patient can’t leave work, which usually has to do with time, they can’t be seen by a physician. If a patient has to travel by public transportation, with a limited amount of time off from work for an office visit, time becomes a more valuable resource – and unfortunately the patient may not make it to the doctor’s office. Even worse, they may even be late and turned away at their doctor’s office as a result. That’s not right. Some families have both parents who are working, sometimes on a different schedule than the usual 9-to-5, working second and/or third shifts. What healthcare is available to them if something happened during those hours, or even available to them first thing in the morning, other than a pricey urgent care visit or an ER visit? Not much. Unless they happen to be a member of a direct primary care practice — then they’re covered.
The current way that most of medicine is practiced has nothing to do with a demand on the way medicine has to be practiced. Medicine is practiced in a way such that insurance will reimburse healthcare providers’ energy and time. And that reimbursement is only possible with face-to-face office visits.
I’m sure you have experienced, or know somebody who has experienced, a scenario like this: you get a friendly phone call from your physician’s office saying it’s time for you to come in to talk about what bloodwork needs to be drawn. They draw your blood. You go home. Then they ask you to schedule another appointment to come in to talk about the blood work results. You go to the doctor’s office, they tell you everything is normal, and they send you home. And you scratch your head and think, couldn’t this have been done on the phone or an email? And the answer is yes.
But the problem is your doctor will not be reimbursed by insurance for anything other than face-to-face office time.
So let’s rework how our physician gets compensated. Let’s imagine the physician actually works directly for the patient, not the intermediary — the health insurance company. Let’s imagine the physician works the math backwards, to see not how much they can charge you at each visit, but how little they can charge for a low monthly cost to give as much value to each patient as possible while making a living. That’s direct primary care.
So imagine if those people who have limited time (plus, anybody, really!) had improved access to their doctor. Clearly telemedicine has not only realized this, but they are becoming a market force to deal with because of the convenience and the ability of time savings of patients. And most telemedicine is paid directly by the patient. But here’s the unfortunate thing: telemedicine costs individuals between $40 to $100 per virtual visit to a doctor that is unknown to the patient, who does not know their past medical history, and at the end of the consult, who may or not be able to actually help the patient. If somebody utilizes telemedicine three times a month for various reasons for various family members, that could cost them as much as $300, plus no guarantee that the outcome can be resolved. Wow. An unpredictable $300. But, for example, with direct primary care in my practice, a family with two parents and two kids have unlimited office visits with me for $160 a month.
So what does this all mean? It means that most of primary care is actually affordable for patients when physicians leave insurance to go into free-market medicine, unencumbered by insurance contracts, to negotiate lower costs for patients. Doctors are willing and able to get to know their patients because they have a small panel of patients, usually around 600 per physician.
This allows insurance to actually be used the way it was created, for big expenses such as specialists, major procedures, and catastrophic instances. Talking with a colleague that works in retirement planning, he told me that an accurate estimate of people that actually hit their deductible year-to-year is only around 13%. That’s crazy. That means 87% of people are paying high premiums for care that can’t be utilized because of such high deductibles, and then, they will pay for their actual medical care directly out of their pocket.
When people can actually access a primary care doctor in a timely manner, usually same or next day availability for office visits, it allows people to get care sooner rather than later, so that minor things remain minor, rather than turning into major events. Too many people hope symptoms go away and will wait a period of time because they are too afraid of what I call the blank check syndrome — that every time they go to the doctor they write a blank check — they never have any cost transparency for how much something is going to cost them, only the fear of what insurance may or may not cover. Most doctors can’t even say how much their services or procedures or medications will cost.
Can you remember the last time a physician said they were going to try to save you money?
And let me interject that direct primary care and concierge medicine have some similar goals for improved patient care and access; however, true concierge medicine requires a retainer paid by the patient only to ensure that the physician be their doctor. The retainer does not include any of the medical care, which is then billed to their insurance. Concierge medicine is not affordable for the masses. Direct primary care, however, is. And that’s the beauty of it.
The fascinating thing is that when most people hear of this concept, they immediately think that the only people who could benefit from this model are people who don’t have insurance or are socioeconomically challenged. Interestingly, more 95% of my patients have health insurance. They come to me because they want a different experience. And I would argue that most of them feel like their experience has been different and better. Further, this model benefits everybody – the uninsured, under insured, and insured.
I’m so excited about the potential for direct primary care across the nation. I’m hopeful this could be a way to prevent physician burnout, lower rates of physician depression and suicide, and encourage young medical students to enter in to the noble profession of primary care physician that so many have shunned for too long for many reasons that I completely understand.
What made you choose this path? Is it a family legacy or are you a pioneer?
Well, I do come from a family heavy in medical heritage, so to speak. There were multiple attempts of dissuading me from going into medicine, as many of them had seen how medicine had changed and how unfriendly it seemed to become for physicians, with increasing burdens of paperwork and regulation. Nobody in my family has specifically trained in family medicine before. Nobody in my family has done or had any experience in direct primary care before. In fact, direct primary care has only been around since 1997 when it was started in the Pacific Northwest. In that regard, I do consider myself a pioneer in many ways. Further, I’m not just a physician, I’m a small business owner, and I’m a woman. Thus far, I’ve been self-funded and have felt the full impact of starting my own business. Also, I’m participating in a grassroots movement toward direct primary care, which is a disruptive innovation that requires a lot of education, a lot of convincing people to trust when you say that this is a good model of healthcare. It takes a lot of effort and a lot of energy. And for me, it’s somewhat challenging as I tend to be more of an introvert. Don’t get me wrong, I love my work, but explaining the concept over and over again, which is exactly what’s needed right now, takes a tremendous amount of energy. But I know it’s worth it.
They say that to be successful you have to be passionate, so share what drives you every day. Why do you love what you do?
Unfortunately, it is more common than uncommon that when I have new patients visit, they tell me they’ve never truly been listened to by their doctor before. They feel like they’ve always been rushed. They feel like they’ve never been able to say everything, to describe their symptoms completely. They feel like they’ve been overmedicated. On that first visit, I let people just talk without interrupting them, and usually about 10 minutes into it, I’ll see teary eyes or even full-blown tears because they can’t believe a doctor is actually taking the time to listen to them. Again, time — time means the world to everybody. In medicine, as a physician, time is especially powerful, because it allows you think, to process, to properly examine, and to create a worthwhile plan for patient, one that does not simply end in a referral that isn’t needed. Studies have shown that more than 43% referrals are medically unnecessary. Can you imagine how many healthcare dollars are wasted in America? Especially when specialist charges can be, at a minimum, at least double what a primary care physician visit is? All this, on top of all the other procedures and imaging they order? Absolute waste. It’s a shame, just because primary care physicians don’t have the time to do what they’re supposed to do — and they don’t have time because insurance won’t reimburse them to actually use their medical degree, to use the time needed to give a proper history and physical. That’s my passion. Medicine. Really helping people, using my skill set, listening, and giving them time. Sometimes just being heard is healing to them. I love when that happens. And did I mention that my new patient appointments are usually two to two and a half hours in length?
Has it been smooth sailing or have you overcome adversity to get where you are?
I think everybody has adversity in their life. How adversity becomes scaled to each individual, and what makes things worse for another person, are completely unpredictable from person-to-person. I will say this, I have overcome adversity in a multitude of ways not only including in medicine but in my personal life. But truly, if you can find the silver lining in anything, you are winning. After all those years of training, and the amount of medical school loan debt that would likely pay for two small family homes, my real adversity lay in the fact that I was completely disenchanted in the way medicine is practiced and how I was forced to move through the cattle gates along with my patients. Quantity, not quality was rewarded. Quantity was demanded. Rising costs of processing insurance paperwork forces primary care physicians to increase the quantity to make up for the losses in the amount of staff they have to hire just to simply process insurance. This leads to having too many patients in a practice, seeing them too infrequently, not being able to see them in a timely manner for acute illness, and never having cost transparency for them. That’s real adversity. Not just for me, but for my patients. I’m thrilled that we are turning this thing around in primary care with the help of direct primary care.
We all know that crazy happens. What’s the wildest thing that’s happened on the job?
I initially started my medical training as an intern in general surgery at the Jewish Hospital in Cincinnati. While I could relive a certain night when patient with a ruptured aorta was life-flighted into our hospital in the wee early hours of the morning, and my senior resident and I scurried around getting everything prepared, and then actually took care of that patient upon arrival — I still wouldn’t say it was as impressive to me as to what I encountered in my first year as an attending physician doing outpatient family medicine in Seattle.
As a courtesy to my office partner, I worked on one of her patients — a five-year-old girl who was coming in for bilateral ear pain. Her mother, father and slightly younger brother were all in the room with her. This was a working family. Both mom and dad worked blue-collar jobs at opposite times, so that at least one of them would be at home. The fact that both of them were there meant one of them took off work because this doctor’s appointment was that important to them. Clearly they were involved parents and wanted what was best for their young daughter. She stated both her ears hurt. She had gone to the ER three separate times in the previous four weeks and was given antibiotics two out of three of those visits. Further, during a primary care physician visit, she was prescribed antibiotics again. I asked a number of questions. It seemed suspicious because nothing they were describing seemed infectious. No fever. No drainage. No fatigue. Just bilateral ear pain. Finally it was time to do my exam. No sooner that I stuck the otoscope near each of the ear canals, it was obvious that both her ear canals were full to the brim of wax. I couldn’t believe it. Three ER visits, a total of three rounds of antibiotics – for ear wax?
I was so shocked and, even more so, angry. This family took on ER bills that they didn’t need to because somebody was too lazy to do their job. Somebody didn’t want to take the time, couldn’t take the time, or just didn’t give a damn, to give her a proper ear examination. That little girl got too many antibiotics for absolutely no reason. She was a trooper. I worked for about an hour, and with careful microscopic loop guidance and a headlamp illumination, I was able to carefully remove the wax. Interestingly, right near both of the eardrums a small little object was found. On closer inspection, each ear canal contained a small crayon paper ball – almost like a spit wad. She had immediate relief of her pain in both ears.
What do you do with your time off? Are you familiar with that concept?
Time off? What’s that? No, in all seriousness, starting your own business, being a physician, along with literally doing everything else in the business to keep costs low so that you can pass on the savings to patients, takes a lot of time. I do the bookkeeping, the inventory tracking, the phone answering, the ordering, the organizing, the cleaning, the marketing — you name it. But I’ve learned a lot, and I don’t think any physician, unless they’ve done this, truly understands how easy it is to spend too much money that is absolutely unnecessary. I like the saying, “Hardwood floors and granite countertops never cured anybody.” It’s important for patients to understand that. Good healthcare doesn’t have to be grandeur. Good healthcare has to do with time and value. I can honestly say, because I pay my own bills, that I know for a fact I would be overcharged approximately 10% to 20% every month if I was blankly writing checks. However, I catch the errors because I know what I paid the month before. If I left these tasks to somebody else who wasn’t as invested, I’m not sure if my doors would be open right now. But, I love it all, and I’ve learned so much – it’s like an entire other (business) degree I’ve earned.
Now, with my time off, I enjoy gardening when the weather’s right. I spend time with my family, our dog, and our two cats. I like drinking wine and eating stuffed bell peppers and taking bike rides in the summer. When I get a bit more free time, I’d love to join our local CrossFit.
This is the age of the social network. How important is social media to your business and how do you make it work?
With direct primary care, most physicians have found that traditional marketing methods don’t work. It takes somebody who gets the concept, wants a different experience, or needs a different experience to get on board and try it. They estimate it takes about one to two months of somebody knowing about direct primary care before they actually engage and decide to look into it and join. That’s a long waiting period when you’re starting a business! Word-of-mouth is by far the most popular way to grow your practice with this method. Literally, the hard work is telling others that direct primary care is indeed real and a great value. It helps when patients enjoy you, not just as a physician but as a human being — that’s what makes this business go. Along with that, you have to go where people are. And let’s be real, most people are on social media. I spent a fair amount of time trying to post articles on Facebook that I think would be helpful about healthcare, but not many people are interested in reading these articles it seems. We just had a huge election, and one of the talking points was health insurance — and yet nobody wants to actually read articles from Forbes and Inc.com about health insurance affecting our economy in business quality and absenteeism, etc. I find it fascinating. The truth is this: most people get excited about insurance, but are truly disillusioned about healthcare. I try to bridge that gap by explaining the difference in how they can have a better experience with direct primary care through social media. Most of the social media posts that people engage with surprise me, such as pictures of events that I attend or meeting new people at community forums. People love those pictures, man.
I also engage on Twitter quite a bit. But I understand that Twitter seems to a world of talking mostly with and at colleagues rather than talking at a new audience, and that’s kind of funny to me.
How are you involved in your community?
I try to be as active and supportive in my local community as I can. Again, when you’re wearing so many hats in the business, and still working on achieving goals and benchmarks, you don’t have a tremendous amount of time for socializing beyond working towards those goals. That said, every chance I’m able to talk to the community, or am asked to, I do. I’ve given talks to local universities about direct primary care to public health students. I’ve donated urgent care visits to silent auctions. I’ve participated in and sponsored health fairs. And when I can give a few dollars, I’m happy to participate in a 5K for a charity that’s worthwhile. The bottom line is that I’m trying to be, and want to be, the local old-school family doctor that people know and trust, and that truly is all about community.
What does supporting local mean to you?
It means everything. Supporting local means local sustainability. When people have livelihoods and they are healthy, communities grow. We want communities to grow in healthy ways, not in stressed out, panicked ways. When you invest your time and money locally, you actually get to see the fruits of your labour, which is amazing. I’m so proud to be a member of not only the Columbus, OH community (which is experiencing tremendous growth in a number of amazing ways), but also the smaller, diverse community of Clintonville, where both my office and home are located. Columbus and Clintonville are two communities that are known for being very forward thinking and innovative. I’m thrilled that I get to be a part of these communities, especially in an innovative way that affects the general populous in the healthcare segment. Who knew healthcare could be small and local? Direct primary care makes it that way and I love that.
What does the future look like for you and your business?
Quite honestly, the future for my business is very optimistic. There’s no such thing as having too much access to healthcare in the present world. There’s no such thing as having too many doctors that care too much about their patients. There’s no such thing as too much cost transparency in healthcare. And here’s the best part: if there does become too much of that, then we’ve finally moved the needle in the right direction and I’ll welcome that day. But until then, I’ll continue to be the groundbreaker, the trendsetter in the first direct primary care clinic in Columbus, Ohio.
Do you have any advice for aspiring business owners just starting out?
It’s fascinating, because the people that are the most cynical about this movement are actually other physicians. It taught me that if I only listen to my peers I would not be innovating, creating, and changing the game in healthcare. I would still be a hamster in a wheel, feeling burnt out, feeling hopeless, and feeling like I was not helping people the way I was meant to as a physician. There’s a saying that a direct primary care colleague mentioned, and I believe it’s true. It goes something like, “Do not give the task to a man who knows everything on how to do a specific task because they will say it cannot be done any other way; but rather give it to the person who does not know everything about it, and then they will go and do it differently.” My point is, if your gut says there has to be another way, and you think you found another way, go and investigate it. Don’t wait. Don’t have regrets that you didn’t look into it. Investigate it. And if your passion moves you that way, follow it. They say that the businesses that succeed most frequently are the businesses that must succeed, because their owners have so much at stake that they must make it work. If you feel that passionate about something, that you will do whatever it takes to make it succeed, then you should go and do it.