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Practical Advice for Those Seeking Direct Primary Care Options
Episode

Jamie Lagarde and Michael Garrett

Practical Advice for Those Seeking Direct Primary Care Options

Today, we will focus on direct primary care, its benefits, and how it adds value to healthcare.

In this episode, we are privileged to host two outstanding guests, Jamie Lagarde and Dr. Michael Garrett. We’ve had Jamie on the podcast previously and we’ve really enjoyed our conversation with him. Dr. Michael Garrett has a private medical practice in Austin. He is the founder of Direct MD Astin and a founding member of the DPC Alliance.

Dr. Garrett dives deep into direct primary care, shares amazing stories of how DPC changes patients’ perspectives on health care, and how it adds value to the ecosystem. Michael shares the importance of utilizing both cost-sharing and DPC to really enjoy primary care. They also talk about price transparency, telemedicine, having more time with patients, and many other ways of thinking outside the box. If you’re looking for better access, better healthcare experience, and lower cost, this is an interview you MUST listen to!

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Practical Advice for Those Seeking Direct Primary Care Options

About Jamie Lagarde

Jamie is a successful serial entrepreneur and seasoned executive whose wealth of knowledge helped launch Sedera into the market in 2014. He brings over 20 years of operational and information technology experience and 12 years of healthcare and medical informatics experience, working with organizations such as the Mayo Clinic, Cleveland Clinic, Baylor, Scott White, and more. Jamie served on numerous boards, most recently as the chair of the Goodwill Central Texas Board. Jamie and his wife Alicia have three very active young boys who manage to keep health care an active topic of conversation in their home.

 

About Dr. Garrett

Dr. Garrett is the founder and owner of Direct MD Austin. He is also a founding member of DPC Alliance. He received his M.D. from Indiana University in 1997. He completed his Family Medicine Residency at Ball Hospital in Muncie, Indiana in 2000. He has 17 years of full-time ER experience. Dr. Garrett loves great literature, great music, and art. He has a special interest in the work of Maria Montessori, as well as snorkeling and scuba diving. He also enjoys salt water, is an aquarium enthusiast and has a soft spot for clownfish.

Practical Advice for Those Seeking Direct Primary Care Options with Jamie Lagarde and Michael Garrett: Audio automatically transcribed by Sonix

Practical Advice for Those Seeking Direct Primary Care Options with Jamie Lagarde and Michael Garrett: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket everyone, Saul Marquez here. Today, I have the privilege of having two outstanding guests. Well, you guys have heard from Jamie Lagarde. He was on the podcast previously. He’s a successful serial entrepreneur and seasoned executive whose wealth of knowledge helped launch Sedera into the market in 2014. If you haven’t listened to the episode that we did with Jamie, listen to it. Tons of value there. Just type in Sedera on the search bar on the website, you’ll find it. But he brings over 20 years of operational information technology experience and 12 years of health care and medical informatics experience, working with organizations such as the Mayo Clinic, Cleveland Clinic, Baylor Scott and White. He has served on numerous boards, most recently as the chair of the Goodwill Central Texas board. Jamie and his wife Felicia have three very active young boys who managed to keep their health care and active topic of conversation in their home. And so the episode that we have with Jamie was such a smashing success. You guys all like that.

Saul Marquez:
We have them back on and we have another fantastic guest, Dr. Michael Garrett. Dr. Michael Garrett received his medical degree from Indiana University in ’97, completed his family medicine residency at Ball Hospital in Muncie, Indiana in 2000. And with seventeen years of full-time E.R. experience, he really is able to treat a wide spectrum of injuries and illnesses. And he does so from Austin, Texas, where he’s calling in from with his wife, Jill, and their two daughters, Max and Kate. Just an amazing person, loves literature, great music and art. And ultimately, the topic of today is, is what he does so well with his company, Direct M.D. Austin. It’s Direct Primary Care. And that’s what we’re going to be talking about today. So I want to welcome both you, Jamie and Dr. Garrett to the podcast. Thank you both for joining us today.

Jamie Lagarde:
Saul, thank you for having us. And super excited to be talking about direct primary care and medical cost-sharing a little bit together today. I want to say upfront, first and foremost, Dr. Garrett is my direct primary care physician. And I told Dr. Garrett we’re going to be talking about some things about me to make the story personal a little bit today, things that he’s been able to help me with and how it’s been such a refreshing health care experience to go this route. And so, Doctor Garrett, thank you again for joining Saul’s podcast today.

Dr. Garrett:
Thank you, Jamie. Happy to be on with you. Excited to share. And thank you Saul for having me.

Saul Marquez:
Absolutely. So really, the thing that we like to start with on the podcast is really the spark. So I love to hear from you guys. What inspires your work in health care?

Dr. Garrett:
Ok, so our system is basically broken and I think everybody knows it. I mean, everybody who’s experienced it from any angle knows that our health care system is broken. Doctors know it. Patients know it. Everybody that works in it or experiences it knows it. And what inspires me is changing that broken system. And I had previously thought of trying ways to change it from a systematic perspective. And several years ago, I just figured out I could change one little area, my own practice. And so that inspired me to start my practice. Once I heard about this model of direct primary care where people pay a monthly membership that is affordable and then they get direct access to their physician and it removes the middleman and third parties. And so physicians, it’s satisfying for them to have time for the patients. It’s satisfying for patients because they can reach the physician they call, they reach a human. They text, we respond, they email, they can communicate with us how do they want. So that’s what inspires me is sort of making change in the system. But on a one at a time basis. One person at a time.

Saul Marquez:
I love that now. Thank you for that, Dr. Garett. It makes a huge difference. And Jamie, I know you’ve said this before, but I’d love to for those that haven’t to hear what inspires you.

Jamie Lagarde:
Sure. I mean, Saul, I think we can all agree that health care represents one of the top public policy issues this country faces. We’ve been trying to fix it in different ways and small ways. And I think, honestly, we’re past that point of reform. This isn’t going to be small things that fix this. It’s going to be big, completely reinventing the way we get health care. Everyone needs access to health care and we need to reform completely change, not reform, completely change the way we pay for it. And so that’s what fires me up. I think there are ways like medical cost-sharing, like direct primary care. And maybe for your listeners, we should take a minute and have Dr. Garrett explain what actually direct primary care is. We’ve talked about medical cost-sharing last time, which is individuals coming together to share each other’s medical bills. There is no insurance whatsoever. It’s just people supporting one another in a very cost effective way, no networks, people go where they want to go and they get access to amazing health care at a fraction of the cost. And so that medical cost-sharing is we can talk more about that. But I’d love for Dr. Garrett. I think it would be really helpful just to kind of set the stage of what he and his practice are doing for people like myself every day.

Dr. Garrett:
Sure. So direct primary care is just what it sounds like. So primary care is basically your family physician. And it’s kind of like the old school family medicine model where the doctor knows the patient, patient knows the doctor. You see the same person every time. And the idea behind the direct is that the financial relationship between the patient and the doctor is direct. The patient pays a monthly fee. It’s not mediated through your health insurance, through your employer or anything like that. And what that does that that direct relationship between the patient and the doctor removes the third parties from the exam room and allows the doctor to have time, the patient, the patient, to have time with the doctor and the physician’s decision making or anything that they’re doing is not determined by someone outside that exam. So basically, direct primary care, the arrangement is people pay a monthly membership fee and that basically covers everything that we do in the office. It’s unlimited visits. It’s no co-pays when they come in. There’s no worrying about any of that kind of thing. They can come as often as they want or as infrequently as they want. It includes telemedicine. It includes what we call tech visits.

Dr. Garrett:
So you can email you can text directly to me, as you know, Jamie, but those things are all included in them. Basically, everything we do in the office, almost a hundred percent of that is included in that membership fee. And to give your listeners an idea, here in Austin, Texas. It’s basically based on age kids or thirty dollars a month. Young adults up to age 44 are sixty dollars a month, middle age up to age 65 are eighty dollars a month, and then one hundred and ten dollars a month for people over sixty-five. For that they get unlimited resources, no co-pays and all the things we do in the office like strep tests and flu tests and urinalysis and EKG, all those basic things, sutures, removing things, freezing lesions, all that’s included in that membership fee. So there’s not a nickel and diming for other things. And then it also includes discounted prices on labs and that kind of thing. So that’s the basic outline of how it works and what direct primary care is. It’s a monthly membership plan to make medicine affordable and then the costs transparent for primary care.

Saul Marquez:
Yeah, thank you for that. And I feel like the direct primary care movement has grown tremendously and I think has become a pillar of really how people access care in this country in a way that’s not financially catastrophic. And so last time, Jamie, you mentioned the importance of direct primary care. And for the members on the Sedera plans, they actually get discounts as well, because obviously it makes a lot of sense. Do you care to talk about that?

Jamie Lagarde:
Yeah. I mean, we are such a fan of direct primary care of those of our members having that type of membership as well, that we actually will lower our monthly contribution. What does that mean? So you’re basically getting a discount on your Sedera membership if you have a direct primary care membership as well. What we’ve seen as our members who have a direct primary care practice end up being healthier and needing less money from the community. And so it’s very clear. I mean, Dr. Garrett, my direct primary care doctor, that awesome relationship. And I’ll tell you this Saul. I spent more time on my initial history and physical with him over two and a half hours at the time. And I didn’t think I had that much to worry about. It makes me sound like I’m like have all these major issues, but I don’t think I do. But he was so thorough and comprehensive with me. That was more time I’d spent with a doctor than the last ten years with my previous fee-for-service doctor who I really liked and still do and would recommend in a heartbeat. But it’s a completely different way of dealing with primary care. I refer to it as advanced primary care and really think of Dr. Garrett as my quarterback for my health care experience from this point forward. So that’s how I view it. And we’ve seen the benefits and the sharing community. And so we actually promote to our members that they should go get a membership like this. It’s a really great noninsured solution. You had direct primary care plus a medical cost-sharing membership. On top of it, there isn’t insurance in any of it. And it creates a very I mean, we have three boys. My wife and I have three boys. We save $17,000 dollars in our first year of being a member of a direct primary care practice plus Sedera.

Saul Marquez:
And it makes so much sense. A lot of people go to, say, an urgent care clinic. And at the rates that you’re talking about, Dr. Garrett, I mean, just blow it away, a whole year of care potentially in one visit. So the model makes a lot of sense. It helps us stay healthier. Now as we think about the value that it provides to the health care ecosystem, it’s super clear. Let’s talk about outcomes, right. Jamie, you mentioned that the members on the Sedera plans that you see them be healthier and they need to access care less. Dr. Garret, you want to kick us off with maybe how you see direct primary care improving outcomes?

Dr. Garrett:
Yeah. So I think that there are multiple ways in which direct primary care improves outcomes. The primary one is that it really removes any disincentive for people to get care. So there’s not a disincentive on scheduling. We always have same and next day appointments available. It’s guaranteed in our membership. We’ve never failed in seven years, everyone can get in same or next day. So they get in right away. There’s no charge for coming in. They’re going to pay a monthly membership fee no matter what. There’s no copay, there’s no financial disincentive to come. So if something comes up, people reach out, they come in or if need be, I mean, a lot of times they don’t need to come in. They just get a phone consult or a telemed visit or we text about the problem. So they get that care immediately. And a lot of the friction that’s usually in the system that keeps you from getting the care is just removed so they get taken care of more quickly. There’s even been a couple of studies published about this with direct primary care, where it dropped the number of emergency room visits, it dropped the number of consultations with specialists required.

Dr. Garrett:
And those things have real costs that are substantial. I mean, to go back to what you said, Saul, I mean, the one emergency room visit or an urgent care visit where somebody gets stitches, that can be their direct primary care membership for two or three years. And we can avoid that very often. They’ll just shoot me a text, send me a picture, say, hey, here’s this cut on my son’s leg. Does it need stitches? Yes, it does. Can I meet you in the office? We do that kind of thing all the time, and it’s extremely satisfying. But, yeah, there’s been some published data that having a direct primary care relationship reduces emergency room visits and necessity of consultations. It’s not that I have any disincentive if someone wants to go see a specialist or they or I think they need to, there’s no reason not to make that referral. But a lot of specialty referrals are made unnecessarily because the doctor, the primary care doctor, doesn’t have time to manage the problem. And we do.

Jamie Lagarde:
Well, there’s so many times, Dr. Garrett, that you whether it’s you know, I was on vacation and had this, like, strange markings on my arm and I had no idea what it was. And I’m on vacation right now. I don’t really want to be messing with this. But a little bit concerned. I took my phone, took a picture of it. You responded back within the hour and said, do this. Not a big deal. That didn’t exist at all in my fee-for-service relationship with my previous doctor. The standard response was, you got to come in and make an appointment that might be three or four days at the earliest to get in. And then you’re waiting two or three hours in a waiting room with a whole lot of sick people. And it just a completely next level experience by essentially removing the middleman, which is the insurance company.

Dr. Garrett:
Yeah. If I could just tag on it, that’s that’s one of the things I have a lot of different ways that describe what we’re doing. We’re trying to make medicine twenty-first century experience like it should be, like so many other things are. If I need to get somewhere now, I don’t hail a cab. I get on my phone and I use Uber or Lyft or something like that. And the health care experience can be just like that. Again, a large part of it is removing those third-party middlemen that prevent that. I mean, one of the things that causes people to need an office visit when they really don’t need an office visit is that the doctors or offices don’t have a way to get reimbursed for that care. And we kind of remove that problem. And so that’s no longer an issue. If you contact me and it’s a straightforward problem and I can just send a prescription, I don’t have to require to the office. Of course, I love to see my patients. And so they’re always welcome to come for a visit. But often their time is so valuable to them they don’t want to spend 30 minutes driving across town and then 30 minutes driving back. So we just handle it with telemed.

Saul Marquez:
That’s awesome. Yeah. And so direct primary care was really doing telemedicine and virtual care even before the COVID pandemic. But have you found that the pandemic has accelerated the use, the virtual use of care?

Dr. Garrett:
I have not seen a huge difference in our practice, maybe a little bit, but we were already doing so much of that that it was not a big shift. I mean, certainly for traditional practices, they had to make a lot of changes and there was a big shift and they had a huge increase in the amount of that. We definitely did, especially at the beginning of the pandemic when people were still trying to figure out what was going on and or when we were really in high rates of cases here in the Austin area, we had more telemed. But we were like I said, we were already doing that. Like you said Saul we were already doing that for five, six years before that. So we can very flexibly increase or decrease that as the situation dictates.

Saul Marquez:
Yeah, that makes a lot of sense. And you mentioned the stiches situation. And so in that situation, you go in. So then do you cover the stitches as part of the regular fee, or is there a fee on top of that, I would imagine.

Dr. Garrett:
That’s just included. I mean.

Saul Marquez:
That’s amazing.

Dr. Garrett:
I want to say that, actually, so people have this perception that health care is expensive. It doesn’t have to be that way. A lot of times it’s not. I mean, in the current system, if you don’t have direct primary care and you don’t have a sharing plan, it can be outrageously expensive, but it doesn’t have to be. So to do sutures on one of my members, I think the total cost of my practice is somewhere between 20 and 30 dollars or something like that. It’s not an amount that I need to bill the patient for. So I don’t. It’s something that I can easily roll into the membership cost and almost everything like that. I mean, strep tests cost me like two dollars. A flu tests are a little more expensive. Maybe they cost 15 or 20 dollars. But those kind of things are so inexpensive and people need them on average, on aggregate, so infrequently that you don’t have to nickel and dime and charge for these individual things. We do have a few things that we charge additionally for. But one of the other things that Jamie and I have talked about a lot of times, we both have a lot of common values and interests on this. Is that price transparency? If there’s anything that’s not included in our membership, it’s right there on the website. It’s right on the member agreement. There’s a dollar sign and it tells you what it costs them.

Saul Marquez:
That’s awesome.

Dr. Garrett:
But yeah, the point is that things don’t need to be expensive. And therefore, when you have a membership plan like ours, most of those things are just included, including sutures. We don’t charge for that.

Dr. Garrett:
I mean, if I come in and do my annual physical with Dr. Garrett, he’s got the labs that he wants to see on me. But Doctor, you’ll say, well, if there’s anything else you want to get lab work on, Jamie, just check the box. They’re five bucks each right. That level of transparency, of knowing exactly what it’s going to be. And it just gets billed with my credit card that’s on file. It’s just really, really simple. And it’s if I would have run those same lab tests in my previous arrangement, in most cases, it would have cost me a lot more.

Saul Marquez:
That’s amazing.

Dr. Garrett:
Sorry. If I can just share. I have so many examples of that where people come to me and maybe they have as an example, they may have insurance, but it’s a high deductible plan. So they end up paying for a lot of the stuff out of their pocket. And I’ll do the exact same panel of labs that they had the year before they came to me and they’ll say, oh, gosh, I got balance billed for that for eleven hundred dollars. And I look at ours and I say, oh well that’ll cost eighty-eight dollars. It’s literally about a tenfold or more difference normally. Like typically is the case. And so we have people all the time who say the very first time you did labs on me for an annual physical that we’re thorough and comprehensive, I saved enough to pay for my entire year of unlimited office visits and no co-pays with you. It’s like just that savings alone. So and I could go on I’m going to have examples like that all day long.

Saul Marquez:
I love it. Yeah. And now I appreciate that Doctor Garrett and Jamie. And actually, I went on your website as we were chatting here and just like. I see. Yeah. Anything that’s not included, it’s there.

Saul Marquez:
And the tests are like crazy inexpensive, and I love it. Like, this is just so cool. All right. So as we think about some of the biggest setbacks that potentially you’ve experienced in this model or in what you do, what would you say was the key learning? And maybe this one we’ll start with Jamie.

Jamie Lagarde:
You know, saw we talked a little bit about this last time. And you actually use this phrase of people. It’s like a Stockholm syndrome where everybody is so used to the white insurance card and turning over all their health care to the big third-party payer. And we’re forgetting that we’re actually the ones that are paying for health care. And so it’s changing this mindset around how health care is paid for. It is a big challenge. It is a challenge that we’re facing. And I joke about the fact that, first of all, there’s this price transparency rule that was put in place January 1st of 2021. And we need to see more come from that, because I think there was a lot of value, as Dr. Garrett talked about earlier, and seeing what everyone’s prices are, it’s literally to the point where on one side of the street you can go get an MRI for four hundred dollars, but on the other side of the street, you can get it done. Four hundred dollars on one side, four thousand if you happen to end up on the wrong side of the street. Those kind of the lab tests that Dr. Garrett was talking about, that’s just yet another example. We’ve got cases where people go get a hernia repair and sometimes they’re billed 20 grand for that and sometimes they’re charged thirty-five hundred dollars for it. And so price transparency doesn’t solve all the issues, but it is a key to solving some of the issues. And the lack of not having that is as created challenges and setbacks, not only in the medical cost sharing world, but in DPC as well. And we’re both trying to push and change that from our own perspectives.

Jamie Lagarde:
I joke around that and I say to everyone, I said, I believe that everyone in America has a superpower, that every American has a superpower, and that superpower is that we know how to shop. We know how to use Amazon. We know how to use coupons. We know how to find the best deal we possibly can in a situation. Our economy has taught us all how to do that. We’re really good at it, but for some reason we don’t do that in health care. We turn that off and we just turn it over to that white little card in your pocket. We need people and we’re trying to teach people to use that superpower in health care. And then when they team up with a direct primary care practice, what happens is, is someone like Dr. Garrett points them in directions of where to go to get affordable health care, cash, pay, friendly prices. And I mean, there was a time where I hurt my ankle. So it came in to see Dr. Garrett. Doctor, it’s like I don’t think it’s broken. I’m really sure it’s not. But if you want to rule it out, go here and go get some x rays on it. By the way, the price over there is going be about sixty, sixty-five bucks. And I walked over there and sure enough, they saw me right away and knocked it out for sixty-five bucks.

Saul Marquez:
I love it.

Jamie Lagarde:
It was super easy.

Saul Marquez:
I love it. So thank you for that Jamie. And we are starting to see improvements in price transparency, but yet it’s not where it should be. It’s doctors like yours, Doctor Garrett, that can help us direct primary care, help us navigate those additional things, the x rays, the lab tests, et cetera. So, Dr. Garrett, what are your thoughts there specifically around the biggest setbacks and the key learning?

Dr. Garrett:
Saul, I haven’t really had significant setbacks. I’m going to reframe it a little bit to biggest challenges. I do think there are challenges and I think it ties into what Jay Holmes saying. The biggest challenge for me is a direct primary care doctor in the last few years has been getting is education. It’s basically getting people to think about things differently, both patients, getting them to think about it differently, think outside the insurance box. And doctors like I’m on a part of my crusade is not just for me to have a DPC practice, the direct primary care and that relationship with my patients. But to spread the word about that to other doctors, to get them to think about having a practice like that where they can have adequate time with their patients, they can truly love and enjoy medicine again because they’re not rushed and trying to see 30 patients a day and ticking boxes on forms for an insurance company as their means of getting paid. But that’s such a mindset change both for patients in how they see health care and how they see being a consumer of health care, that they need to be an active-minded, price shopping, price-conscious consumer health care. It’s a totally different mindset than what people are used to. And then doctors also. It’s scary for them to think about going out and doing this totally different thing and working directly with patients. So those are a couple of the biggest challenges.

Saul Marquez:
Yeah, no, I’m glad you brought those up. And the thought comes to mind of you have folks that are on Sedera plans, the cost-sharing plans, you’ve got uninsured and then you have the insured. So just curious, are you guys seeing people with insurance start to say, hey, wait a minute, with this five thousand dollar copay that I have to do a year until the insurance starts kicking in, are you guys seeing people shift toward your type of care instead of saying, I’m not going to go into the system like this. We’d love to hear your thoughts.

Dr. Garrett:
I’ve got a couple of things to say about that. So, yes, I mean, we have we’re in West Lake Hills in Austin, which is a nice neighborhood. We have a very wide variety of patients in terms of their economic background. I mean, this is a very well-to-do area of Austin. So we have people who consider us their concierge doctor and then we have people who have good insurance, great insurance, no insurance. They have sharing plans. We have an increasing number of people with sharing plans. We now provide sharing plans for myself, my second doctor, our staff here at the office, all of our families are using sharing plans because we see the kind of overlap between those two things. But, yes, we have patients who have health insurance and yet are starting to price shop and are saying, well, I have health insurance, Dr. Garrett. And you’re telling me I need an MRI. What’s the situation? And I just lay it out for as best I know it. I say, well, I don’t know what with your particular insurance it will be, but tends to be two or three thousand dollars to use your insurance. And if you think you’re going to get to your deductible this year, that might make sense. But you can get it for cash for four hundred fifty dollars. And some of them just say, you know what, I pay cash out of pocket for this because there’s no way I’m going to meet another doctor this year. We have people making those kind of decisions regularly. So yeah, we have the whole spectrum of patients in that regard. And I do see more and more people go into sharing things, like I said, because people are starting to well, we’re having this discussion every day with individual patients.

Saul Marquez:
Jamie, thank you. Dr. Gary and Jamie, do you see and the difference is huge. Right. four hundred fifty versus three thousand. Jamie, do you see do you get people with insurance joining your plans?

Jamie Lagarde:
So most of the people are picking us and they’re frustrated with insurance and they’re making the transition from a high-cost insurance product to a far more cost-efficient sharing membership. And so they’re leaving insurance altogether. And so they’re not they’re not having an additional cost. We have some people who use it that are of Medicare age, and so what, they will have Medicare and use us as a supplement. I don’t think that’s the best actually solution for folks. There are some cost-sharing solutions that are designed as a Medicare supplement.

Jamie Lagarde:
We don’t have that product today, but I think we will in the relatively near future. But the main use that we’re seeing is both for individuals and employees of corporations is they’re saying no to expensive health insurance and they’re saying yes to a sharing membership, which is, again, is a completely different way of thinking about your health care. No insurance in it whatsoever. And then we’re encouraging them to pair that with a direct primary care membership where effectively the discount is going to subsidize that membership.

Saul Marquez:
That’s fair and makes a lot of sense. I was thinking, just from the perspective of health care navigation, there could be the knowledge of Sedera and its members to navigate care. I mean, it just it’s silly to even have to think about it. But, yeah, it makes sense that it’s either or not necessarily in addition to.

Jamie Lagarde:
Yeah, it’s and navigating the health care is a critical thing. And so when you’re making this leap from insurance to sharing, you know, at first I mean, I remember my wife the first time she used her sharing membership, she was on the way to go see the dermatologist. And she’s like, now, what do I do with the Sedera membership? I mean, what do I say to the doctor, when I go in, I didn’t get a card. I’m like, no, you didn’t get a card. That’s exactly right. And she walked in the door as a cash pay patient and her fee was like ninety dollars for the office visit. And she went and sat down with the dermatologist and she had this spot on her cheek and the dermatologist said, first of all, that spot isn’t anything to be concerned about. It’s not cancerous or anything. But she said, if you want that to go away, I can give you this cream and put it on for a week or two and it’ll go away. And she asked my wife, ask the right question at the time, and she said, what is that going to cost? And she said and the dermatologist said, I don’t know, let me find out. Left there and came back of a little vial of cream, which can be about six hundred dollars. And she said, Well, look, I’ve got that amount of money, but what other options do I have? And they said, oh, well, we could just kind of freeze it off, burn it off right here. And she said and it’ll just flake off in a couple of days. And my wife said, well how much is that going to cost? And said, oh, about 60 bucks. And I said, OK, how about we go with that option? And so that was her first experience with sharing. Now, the reality is she wasn’t a member of Dr. Garrett’s practice yet because she could have gone to Dr. Garret’s office and gotten that resolved and not paid anything extra to get that frozen off, because that’s something Dr. Garreett does all the time.

Saul Marquez:
Wow. Very cool. So very exciting stuff. Just talking to you guys is energizing because it does help us think outside the box. There’s more than one way to pay for health care. And as Jamie and Dr. Garrett have said, we should be in the driver’s seat and there’s options. I’m excited to be talking to both of you about this. Let’s talk about what you guys are excited about.

Dr. Garrett:
I’m excited about the ability now that I’m doing direct primary care and I have adequate time with patients. I mean, Jamie talked about his first visit. I’ve had adequate time with patients to really get to sort of the root causes of people’s health problems, their disease, whatever problems they have, and address them with lifestyle rather than medication. And I’m super excited that I’ve started in the last couple of years, three or four years, I guess, de-prescribing medication. This whole concept. We didn’t even learn about this in medical school or in residency. It was just like, here’s the prescription you used for the rest of the person’s life, for their diabetes. Here’s the prescription you used for the rest of the person’s life with their blood pressure, cholesterol, acid reflux, et cetera. When you have time with the patient, you can actually get into these lifestyle issues and deal with them rather than just paying lip service really quickly and saying in 16 seconds, yeah, well, you need to eat better and exercise more, which is ridiculous advice. But we can go into the real root cause problems or solve those problems with helping them with their sleep, helping them with their way of eating, eating healthy for the long term, helping them with exercise and then over time, removing medication, reversing, putting into remission, high blood pressure, diabetes, type two diabetes, obesity, these kinds of things. I mean, that really is exciting. It’s super satisfying when someone makes the lifestyle change and says, I used to have diabetes, I used to have high blood pressure, and now I don’t. And now I’m not prescribing that medication for that patient. And that’s to me the Holy Grail.

Saul Marquez:
And that’s awesome. And it is it’s important that it’s this lifestyle thing and, you know, and you don’t charge any more for it right now.

Dr. Garrett:
That’s yeah. That’s what I do.

Saul Marquez:
I mean, I keep going back to that,

Dr. Garrett:
I don’t need to. It’s so satisfying. I just you know, it’s you. My head hits the pillow for me and I sleep like a baby because I know I’m doing real good for my patients. So it feels great.

Saul Marquez:
That’s fantastic! Jamie, what excites you?

Jamie Lagarde:
I’ll just make one comment about what Dr Garrett said.Dr Garrett at one point said, go read this book and make an appointment so, you know, I can talk about the book. I’ve never had a doctor tell me go read a book and then let’s go talk about it at a future point. That was awesome. By the way, I read the book and still working on implementing things, and Dr Garrett knows that.

Saul Marquez:
What book it is by the way?

Jamie Lagarde:
So that’s an active conversation between the two of us. I think the one I’m getting going to get the title wrong, but it’s I think it’s called the Paleo Cure. And for me and what I was dealing with know health issues, that was something to investigate to you.

Saul Marquez:
Specific to you.

Jamie Lagarde:
Specific to me personally. Yeah.

Saul Marquez:
That’s awesome, right?

Jamie Lagarde:
Yeah. I loved it. Absolutely. And so what excites me is, first of all, I would say there’s never been a better time for change. I mean, unfortunately, as a country and as a world, COVID-19 has just been really been so challenging on so many levels. The loss of life is just so tragic and so incredibly unfortunate. But it’s really opened, I think, a lot of eyes. And we’ve been numbed to the consequences of our broken health care system for far, far too long. And I think that’s created the COVID has created a wake up event in many ways, and it’s forced us to re-examine every part of our lives that our institutions and especially health care. And so one of the things that’s kind of top of mind for me right now, and we’re excited about changing this, is that why as a country, as our health care tied to our employer, why is that something? That’s why why are we set up that way now? There’s some history on why that was the case, but no one should lose their health insurance when they lose their job or no one should lose their health care solution when they lose their job. And right now, there’s so many people that are an extremely vulnerable situation because of that. So we’re excited to be providing people an option that’s out there that isn’t tied to their employer relationship. And so they can whether they’re with an employer or not, you know, they can take their Sedera membership wherever they go.

Saul Marquez:
That is very exciting. And so I think a lot of a lot of folks are smelling the coffee and they’re opening their eyes. And it’s because of the conversations that we’re having with you, Jamie and Dr. Guarente. You guys keep doing it. I’m excited for the work you guys are doing and then the opportunity that you’re offering other people alternatives to the status quo. This has been fun. I knew this was going to be a really, really great episode. And I’m sure, listeners, you’re getting a lot out of it. And maybe if something that you heard today inspired you, I’d say do more than just let it inspire you. Act on that inspiration and check out Sedera or check out your local direct primary care. That’s where it’s at. Before we conclude, guys, I love to hear a closing thought from both of you. And then the best way that the listeners could get in touch or learn more.

Dr. Garrett:
Sure. So, yeah, I mean, the closing thought. I think if people are not already aware before this podcast of direct primary care, they should check it out. They should find where there are practices like that in their area. And I’d like to give people a resource on that. There’s a mapper for the United States, and that’s mapper.dpcfrontier.com. And they can find it’s just got little pins on the map. All across the United States. There are thousands of practices now where they can find a direct primary care practice near themselves and investigate it and just see for themselves. It’s kind of like what Jamie said. It’s an experience. The first time they walk into an office, the first time they call. And instead of a voice mail tree, a human answers the phone and then they come in and there’s nobody sitting in a waiting room. It’s just an experience that people ought to ought to have. And I would say the same thing about Sedera. I mean, like I said, my wife and I switched from traditional health insurance when it got to be for the two of us in two healthy kids, $1400 a month for what was essentially nothing. We were getting no value from only pain and frustration. We switched to a sharing plan which cost us around five hundred dollars a month. I mean, I think everybody should check that out as well, because for a huge number of people, it’s a much better solution. So that’s that’s really all I’ve got for closing.

Saul Marquez:
Thank you so much, Dr. Garrett. Really appreciate the resource. And, you know, as I consider, in fact, when Jamie and I last spoke on the podcast, I was thinking about getting it and I didn’t. And so now I feel guilty. But you’ve made this thing like, if I don’t do it, I’m probably the biggest anyway. I got to do it. So what advice would you give us for those of us considering direct primary care? What should we be thinking about? What should we look out for?

Dr. Garrett:
Yeah, so I think just go right on that mapper and look at the practice. And they have different colored pins for whether the practice is a pure direct primary care practice meeting. That’s all they do. Or a hybrid direct primary care practice, which means maybe they have a traditional insurance based component of the practice and the doctors allowing some time for direct primary care. I think that you’re going to get the best experience if you’re in an office that is a pure, direct primary care practice, and then on each one of those pins on the map, it takes you directly to their website. So you should be able to go on that website and evaluate it before you even join or contact them. You can read the doctor’s bio and see how the practice works. And they’ll usually have a member-agreement that tells you kind of all the details. And so you’ll be able to again, start that process of being a conscious shopper, that you’re getting good value for your price and so that their website should be the first portal for that. And you can find that from that link.

Saul Marquez:
That’s really helpful.

Jamie Lagarde:
Saul, let me jump in on this point to totally agree with everything Dr. Garrett said. And obviously he’s built and established a very successful practice. So he comes from a wealth of experience here. My two cents coming up is sort of the outsider would be but a lot of our members have a direct primary care membership. And the thing that I’ve noticed is I wouldn’t go to a hybrid practice. I would look for someone who’s a pure play that they don’t take insurance at all. If they still take insurance, they’re still getting pulled in by the old system. You want someone, I think, who has built a practice from the ground up with no insurance, no fee for service built into their practice at all. So you want a pure play, direct primary care practice.

Saul Marquez:
Thank you so much for that advice, guys and listeners who hope this is helpful for you. That’s mapper.dpcfrontier.com. We’ll add that to the show notes for everybody listening to access as well as links to Dr. Garrett and the work that he does and obviously the other resource being Sedera. So I’ll transition that to your closing thought, Jamie.

Jamie Lagarde:
Sure, Saul. I would say that, look, we’d be happy to talk to you about any of your listeners, about Sedera and how that so they can learn more about what a medical cost sharing membership means. And so you can look it up, look us up at sedera.com or send us an email at info@sedera.com dot, or on Twitter. I think our handle is @SederaHealth. And I would just encourage folks to look at direct primary care plus a sharing membership. And if all that was generated was significant savings for them, where else could they invest those savings into their health and into other aspects of their lives? This is not only about better health care, but such a large percentage of bankruptcies in this country are a result of the high cost of health care. And so this is not only helping people with their well-being, but also their financial well-being as well.

Saul Marquez:
Well said, Jamie. And you know, over 60 percent of bankruptcies happen due to health care. I was actually disgusted to hear that half of those are with people with insurance. And so, like you, you definitely, at least with me, touched a nerve with that one. And if you’re listening to this and it didn’t touch a nerve, I hope it does because it’s a problem. And, you know, leaders like Jamie and Dr. Garrett are doing their part to help solve it for us. And so certainly appreciate what you guys are doing to make health care, accessing health care less expensive and a better experience for everyone. Dr. Garrett, Jamie, really appreciate you guys spending time with the Outcomes Rocket.

Dr. Garrett:
Thanks for having us, Saul.

Jamie Lagarde:
Saul, it’s always a pleasure to be with you. Thank you so much for having us. And glad you’re well.

Saul Marquez:
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Things You’ll Learn

  • Learn more about direct primary care, its benefits to patients and physicians, and how it adds value to healthcare.
  • Find out what cost-sharing means.
  • There’s never been a better time for change. COVID has created a wake-up event in many ways, and it’s forced us to re-examine every part of our lives that our institutions and especially health care

 

Resources

Website: https://sedera.com/

For more information, contact info@sedera.com

Twitter: @sederahealth

Facebook: https://www.facebook.com/sederahealth/

Youtube: https://www.youtube.com/channel/UC8wKxd_XODlNY5SpWfcjing

LinkedIn: https://www.linkedin.com/company/sedera

Website: https://www.directmdaustin.com/

Map of DPC in US – https://mapper.dpcfrontier.com/

https://dpcalliance.org/