Revolutionizing Healthcare: Exploring the Direct Primary Care Model with Dr. Mike Freedman

Imagine a healthcare model that emphasizes meaningful relationships, provides quality care without delays, and saves you money on essential services. Our conversation with Dr. Mike Freedman brings you just that as we uncover the revolutionary concept of Direct Primary Care. Dr. Freedman, a trailblazer in primary and urgent care, shares his inspiring journey from his work at the Stanton Center, one of the nation's busiest free clinics, to pioneering the Direct Primary Care model.

Join us as we discuss the potential of Direct Primary Care in revolutionizing healthcare by offering an alternative to the insurance paradigm. Through Dr. Freedman's experiences and insights, we'll explore how this innovative model fits seamlessly with holistic services such as therapy and classical Chinese Medicine. Learn how doing away with long waits and unnecessary visits allows for more accessible, patient-focused care that empowers individuals to take control of their health.

Don't miss our deep dive into the advantages of Direct Primary Care, even for those with insurance. We'll explore how this model can help reduce costs, improve access to care, and offer a more patient-centered approach to healthcare. We also touch on the role and challenges doctors face to insurance companies' requirements and the ongoing research that further demonstrates the effectiveness of Direct Primary Care. Tune in for this enlightening conversation with Dr. Mike Freedman and gain valuable insights into the future of healthcare!

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Transcript

Speaker 1: 0:11

Welcome to a therapist in Buddhist in you, the podcast where we embark on a journey of self-discovery and collective growth. I'm your host, luke Deboe, a therapist passionate about all things health and wellness. Joining me on this enlightening adventure is my co-host and beacon of serenity. How's?

Speaker 2: 0:28

that for a couple. What an introduction, zomal. What's going on, luke? This is Zaw Good to be here again.

Speaker 1: 0:33

Zaw is a wise and compassionate Buddhist practitioner, and together we explore the intersections of psychology, spirituality and basically, all things health and wellness, offering practical insights and, if not by us, our guests will offer, i think, some profound wisdom to enhance your overall well-being. So thanks for turning in and joining our community. Please communicate with us through all the platforms, whether it's Facebook, instagram and YouTube. We'll make sure to put links in the description notes, so we're here to provide you with valuable tools and perspectives that can transform your life. If you find our podcast helpful, we greatly appreciate your support and, since we do not have a donate option yet, please feel to rate and share our podcast and with others. It's a wonderful way to support us. So please subscribe, comment, review, follow and any of those potential options, depending on the platform you're on. Remember it's through our collective efforts that we can uncover solutions to all things related to health and wellness. So thanks for listening and let's embark on this transformative adventure together, where holistic well-being is within everyone's reach. Sounded pretty good, didn't it? Great, yeah.

Speaker 1: 1:42

I felt good about it. So today we have the privilege of speaking with Dr Mike Friedman. I certainly I certainly see him as a trailblazer in the field of primary and urgent care. Dr Friedman is the owner and visionary behind Evolve Direct Primary Care and Urgent Care in Annapolis, maryland. It's a health care practice that is transforming the patient experience. With a remarkable career spanning, i think, well over two decades, dr Friedman has earned a reputation for his unwavering commitment to delivering high quality, patient-centered care. See a pattern here. Yet, as a passion for revolutionizing the health care industry has led him to pioneer the Direct Primary Care model, offering patients a more personalized and accessible approach to health care. Join us today as we delve into Dr Friedman's incredible journey, explore his innovative contributions to the field and gain viable insights into the future of health care. Dr Friedman, thanks for joining us.

Speaker 3: 2:37

Thanks for having me.

Speaker 1: 2:38

Yeah, thank you for joining us. So before we get into the potential flaws of the health care, kind of tell us about your professional journey a little bit.

Speaker 3: 2:49

Yeah, so I started out from fairly humble beginnings. I was the first person in my family to go to college. I really wasn't sure that I wanted to become a doctor who had a medical school. Towards the end of undergrad I eventually decided to get a master's in physiology and while doing that I really fell in love with medicine and the science of medicine.

Speaker 3: 3:14

Somewhere through the course of that, when I was working in Philadelphia during med school, i had an opportunity to work with a lot of homeless folks. Just walking back and forth to school every day I crossed dozens of people in Philadelphia to Center City. I just couldn't walk past people without finding out who they were and what was going on and how they got there. So I really got to know some people pretty well. So I got my first taste of helping an underserved community in that setting while I was there.

Speaker 3: 3:51

And then I went to residency and when I came back here I started practicing more of a traditional medical practice a matter of fact, a block from where we're doing this podcast right now and was pretty standard four or five people an hour and just rushing people through. But I found another underserved community that was there was a clinic that had opened up ones at the Stanton Center at Clayton, washington, and so I found that I could go there on Thursday afternoons, which was my day off, and take care of folks, and it was just much more fulfilling than feeling like I was working for the insurance companies And then fast forward to about 2012 to 2014 timeframe, when it just became unsustainable to practice traditional medicine for me And I ended up moving into this new area that I guess we'll talk more about.

Speaker 1: 4:55

So, besides the active service at the Stanton Center, why did that feel so rewarding?

Speaker 3: 5:01

Yes, the Stanton Center. first of all, there was no insurance. no one had insurance, And so there was no strict time limits on how long you could be with someone. We didn't have guidance of what we could or couldn't do, just had to be affordable, which was easier to do than stay within the insurance framework, But you just felt like you could do what you're trained to do. You didn't feel like you had all the constraints and barriers that are built into a busy medical practice.

Speaker 1: 5:44

Now, I don't know if you're downplaying it, but did you develop that program?

Speaker 3: 5:49

Yes, so I started. A couple of guys Bernstein and Rich Colgan had started a year or two before me And I think it was the first year that they actually had a. I can't remember if they had or we started, but shortly after that I joined them. We ended up expanding it pretty dramatically.

Speaker 1: 6:16

So much so, even though, compared to other centers that weren't free, you got to spend this time with the clients a lot more than in your private practice. But wasn't it one of the nation's busiest free clinics? There was Over 6,000 patients per year, correct.

Speaker 3: 6:34

Okay, yeah, 6,500 per year, all free. And the nice thing was we had a community on both sides. We had the community of folks that needed help, but we had this awesome community of the local docs from Anarundal And almost everyone was willing to donate time, whether it was to do a hernia repair, an orthopedic surgery, a dermatology consult, whatever we needed. We had someone that was willing to see one of our patients for no charge.

Speaker 2: 7:15

If you don't mind, i'd like to hear a little bit more about that experience that you had when you were in Philadelphia before we get into what you do today, because I have a sense that that was kind of like an influencing experience for what you do, and wanted to hear more about your interaction with homeless folks and some kind of empathy from within.

Speaker 3: 7:34

Yeah, I mean it was. I still kind of don't understand how people can just walk by people every day. I mean I shouldn't I take that back, because I'm a busy person now And I think life heartens you the more you see that kind of thing. But it was new to me coming out of suburbs and where I'd gone to school it was university in Arbor, michigan. It was cold. There wasn't a lot of homeless people there, not to Philadelphia, it was much warmer.

Speaker 3: 8:16

But just that constantly seeing the same faces as you're walking home and then starting to talk to people and getting to know their stories, it's just, you know, there, before the grace of God, go I number one. And number two is just, you know most of these people who come to realize there's a segment of our society that would say, oh, you just need to get a job and work harder. But if you live outdoors and you don't have access to a shower and you don't have clean clothes, it's not that easy to get a job. And even if you could do all those things, chances are, you know there's a good percentage of the population that have, you know, mental health issues, substance abuse issues, things of that nature that you know really requires some help. In the 1980s Ronald Reagan deinstitutionalized all the inpatient psychiatric places. So we used to, you know, have these big psychiatric inpatient places where people would stay for their life if they couldn't function in society, and basically all these were shut down and without a plan as to what to do with the folks.

Speaker 1: 9:37

They didn't reallocate services for them.

Speaker 3: 9:39

Correct. Yeah, yeah. So these guys, you know a lot of them. You know they either fell in a hard time, they got caught between rock and hard plays, or they, you know, may not have had enough of, you know, functional stability to stay stable and pay their bills regularly and be able to keep their place. And you know, i think a lot of us have gone through periods of time in our life where we weren't the most stable or the most mentally healthy. And, you know, particularly in privileged communities, a lot of times you have a family, brother to mom, dad, brother, sister, someone that comes in help you out. You can go, stay at their place, something like that.

Speaker 1: 10:31

Yeah, i think it's fair to say in my experience, whether it's been personal or professional, what I can look back at all my successes I've had some sort of support and help. It wasn't just driven just by me, that's for sure. And being able to do that and it sounds like you shared that you felt like you were able to give a certain level of care, whether it's in Philadelphia at the Stanton Center. That might have been even better or more quality time with these clients at the time. So how did that help direct you with your creation?

Speaker 3: 11:07

Yeah, well, i mean that hits the nail on the head is that every Thursday afternoon I'd go to the Stanton Center and I just would love it. I'd love the time I was spending with these folks and it I felt like they were getting much better care, because I could spend the time to listen to them and get the correct diagnosis and explain the diagnosis in a way that they understood it And in a way that they were motivated to do something about it, instead of just saying you have high blood pressure and you're going to die if you don't take this pill. You know you can explain what high blood pressure is doing specifically and you can give them options. You know you can lose 40 pounds. You can walk.

Speaker 1: 11:56

You know you can see a therapist for stress.

Speaker 3: 11:58

Right, that's right. That's right, there's a lot of, there's a lot of other options. But if you're not going to do all those, then you're between two options die prematurely or take what I got. But. But when you can sit down with someone and explain to them why you're recommending a course of action and give them options, it's a whole different thing than just the traditional medicine where you oh, you got heartburn, here's a pill. You got depression here's a pill. You got this, here's a pill.

Speaker 1: 12:30

Isn't it unbelievable? it's come to this. It's almost like the human interaction and I'm generalizing in the healthcare industry has become paperwork. Yeah, it's a number.

Speaker 3: 12:44

Yeah, and it's the providers and the people doing it are really good people, you know they're. just you end up with like six minutes of time with the person and in that time you have to document your visit thoroughly enough to justify whatever code you're sending to the insurance company to hope that they'll reimburse you, which they automatically don't 30% of the time, just to make things difficult.

Speaker 2: 13:11

So you can work for it.

Speaker 3: 13:12

Yep, and and you also have to document it well enough that you don't get sued, or, when you do get sued, that you can cover yourself. that's right. And so there's a lot of other factors that have nothing to do with the interaction and the well-being of the person.

Speaker 1: 13:35

So do you feel part of the paradigm shift is the insurance, is I don't know if you'd say it this way mandating the type of treatment as opposed to the professional, or is it just part of the context?

Speaker 3: 13:50

I, yeah, I think that the insurance is the, is the outfit in the room, the culture of it at least. Yeah, yeah, i mean they're well, they're reimbursing a rate, of say, $30 a visit and in order for a standard primary care practice to cover their overhead, the overhead's around $100 to $120 an hour. So that means you got to see four people an hour to break even, and if you're running real lean you can maybe do it at three. But real lean means when you call their office the phones ring, you can't get anyone, that no one returns your calls, and if they're seeing five an hour, that means you rush through.

Speaker 1: 14:43

So the whole business aspect behind it.

Speaker 3: 14:45

Yeah there's. it's a no win situation. This is what I finally came to understand. There's just no way of doing it in the insurance paradigm.

Speaker 1: 14:55

The way you would like to treat and we're able to treat.

Speaker 3: 14:58

The way anyone would want to, quite frankly.

Speaker 1: 15:01

Good to know.

Speaker 2: 16:17

Yeah, i really like what you said about your experience at the center on Thursdays. You know, which also makes me appreciate what we're doing here too, is that I truly believe the stories inspire people. Stories connect people And when you connect at that level, you don't need to like motivate them or force them to do something. They just feel inspired to do that. And which is also what I heard in Luke's description about what you do, about the direct primary care focusing more on the patient, oriented Like what do they need?

Speaker 1: 16:47

and then fulfilling the need, finding out instead of like oh, here's the formula that I will use and then make it fit, you know so I really like that And which kind of fits with what we do with recovery collective too, in a way that yeah, Collectively, we want to help these people, whether it's seeing myself for therapy or Zoll or Jonathan of classical Chinese medicine, that we get to spend quality time for them to help themselves. You know, it's a good model.

Speaker 3: 17:19

Yeah, yeah. So I think, at the end of the day, if step one is, you have to want to help yourself, but we, you know, all of us can help people get to that place where they because sometimes you have just been beaten down so much by life, you know, you've kind of given up, and so I think we can help people get to the place where they want to help themselves, and then we can, you know, at least lay out a path for them. We can't walk it for them, but we can, you know, and lay out a few paths, you know. So, hopefully, something that's palatable, that isn't like a terribly high cliff or burning coals, do-able.

Speaker 1: 18:02

Do-able. Thank you, and we need help to do that sometimes.

Speaker 2: 18:06

Yeah.

Speaker 1: 18:07

So how would you define direct primary care, this model?

Speaker 3: 18:13

Yeah, so so direct primary care. When I first started it, there was a couple in the nation doing something similar. I later found out, and subsequently the concept is, which is really interesting. It's just it's sprouted up in a lot of different places almost independently simultaneously, which you know is a good idea when that kind of thing is happening.

Speaker 3: 18:42

Absolutely. But. But yeah, i looked at it and I saw you know places, like you know I'd be driving home and there's a nail salon, or you know I don't know a place selling art. You know I'm like they're not moving a hundred twenty dollars. You know an hour of goods. There's got to be a way to do this in a way that's affordable, and so the idea of, instead of structuring it, that I get paid or the provider gets paid by doing more, seeing you more often, i wanted it to make it as easy as possible. I didn't want to feel like I was doing what I was doing to boost my income A la carte. So, in other words, if you've got high blood pressure and you're checking your blood pressures with a good cuff at home, you should be able to email me that or text me that And I can see the numbers. They look great. You don't need to come in for me to.

Speaker 1: 19:48

You're in the range. You're a red flag right now.

Speaker 3: 19:51

Yeah, you don't need to sit in somebody's office for an hour or two hours waiting and, you know, pick up some other disease while you're there. You said as a billable code Yeah right, you take off a half a day. You know it's a hassle. A lot of us don't have time for that, you know. Likewise, if you've got a thyroid condition and you just have to get your blood tests every four months, six months or something, we're cholesterol And you know you don't necessarily need to sit down with someone and go through all that regular And you may not have the time to do it. So I think a lot of people end up not getting the care that they need because of the hassles. So a membership model where it's just a monthly amount transitions from, you know, pay a la carte, pay for increased visits to a value-based, you know so you're just.

Speaker 3: 20:53

You know it's similar to Netflix or streaming services or the gym, yeah, you use it as much or as little as you need And there's just no penalty for doing that. So those that need it more at different times, you know, might use it more, and those who need it less at different times can use less. But we also don't have to coerce people to come in. You know someone has a urinary infection and they know it's a urinary infection and they've had 20 this year. You know they don't. And nowadays CVS sells urinalysis kits. You can find out if you have a urinary infection.

Speaker 3: 21:38

But most offices you know my old office we couldn't have treated you for that because we're not getting paid And it's not. It's not. I want to pull my hair out, yeah, but it's not it. And it's not an insult to that office, because that office could spend literally you could have a doctor spending all day long just doing that and not getting paid a penny for all the work. And just like none of us want to go to work and not earn anything, Because what the insurance would reimburse the office wouldn't be enough.

Speaker 3: 22:11

They don't reimburse at all unless you have a face-to-face visit with somebody. Yeah, So since COVID there's been some more virtual work. But if you have a phone visit, if you drop the video from the audio, then you can't get reimbursed. If you have an asynchronous virtual visit like email or text, you can't get reimbursed.

Speaker 1: 22:36

What about the platforms that your community, that doctors communicate, or nurses, or yeah, does that count? No, yeah, yeah, yeah, yeah, it all makes sense.

Speaker 3: 22:47

No, it has to be it has to be.

Speaker 1: 22:49

That's the back and forth, the unspoken Yeah.

Speaker 3: 22:53

Right, you have to have a video component, apparently, to make it a virtual visit. And even then a lot of insurances are covering virtual visits at a steep discount compared to in-person visits.

Speaker 1: 23:07

It almost makes me think that they don't want their clients to get better at the insurance companies. That's just me saying it, yeah.

Speaker 3: 23:17

I'll abstain from that comment.

Speaker 2: 23:19

I do want to hear more about the part of the. I know because the beginnings are always difficult, especially for what you are doing, because it's kind of against the stream, right. It's not like a standard we are doing, but also probably very valuable challenges as well. So were there any experiences in the beginning days where it was quite challenging but also, in a way, reassure your unwivering Desired to make this successful?

Speaker 1: 23:45

and, if I can piggyback off that, the example that we just gave a monthly membership seems to be Valuable to do that with, like the analysis. But then there's the The perspective of wait. I got to pay a monthly membership right, so that must have been one of the Hardships. We'll go ahead.

Speaker 3: 24:04

Yeah, so You know, at the beginning it was really difficult. So if you come up with an idea that isn't being done and people have, never heard of it.

Speaker 3: 24:14

It's very difficult because not only Are you having to try to recruit people to come join you, you know, as patients, but at the same time you're you're trying to Educate them about how this entirely different thing works, and I think you know people associate What they know. The next closest thing, and so unfortunately the next closest thing to What we were doing, where you're paying a X amount cash Separate from your insurance, is concierge medicine. So everyone there's still a lot of people who think that what we're doing is concierge and the difference There is concierge is more like two thousand to four thousand a year. It's it's a much more expensive undertaking and They also will then still charge your insurance company and You know, bill you for a lot of other. You know procedures and whatever that you might have done.

Speaker 1: 25:21

So you're paying for the availability correct.

Speaker 3: 25:24

Yeah, it acts as in essence. But I also, you know, wanted to set a price that I thought was affordable, which we started out to way too low, and we had to eventually work our way up to 49 a month, which still seems like, you know, like a buck and a quarter a day or something like that like.

Speaker 1: 25:51

Isn't every subscription, at least that I know.

Speaker 3: 25:54

I know It is roughly the average streaming price. But you know I try to compare it with cell phone bills which at that time, ten years ago, were not what they are now, and Streaming services, which also were cheaper Yeah, cable. You know the, the many things that we have in our lives that we don't think much about spending money on in high-speed internet. You know cable. Or you know access for TV and streaming, all those things. You know we do that way, but the idea of doing it in this area was very confusing. So it was. It was very challenging in the beginning.

Speaker 1: 26:41

So with that subscription, what does that include? What does that entail?

Speaker 3: 26:46

So It it's a little different in the state of Maryland and for evolve than it is for basically the other 49 states.

Speaker 3: 26:57

So the state of Maryland has it has had in insurance commissioner and a Congressional Senate group that have not been Interested in really understanding what we're doing, and so there's strict rules and regulations about not appearing like an insurance company. So if it's, if you pay 49 a month and I tell you it's all the primary care you can eat for 49 a month, then they consider you an insurance company. So you have to be smart about it and You know so we have. You can either have a set number of visits per year or a set number of interactions per year, or you can have, in essence, you know, a charge, another amount When someone comes in, which we do, we charge 25 per visit. Okay, because the other option of trying to track how many visits you've had and say, okay, you're over your visits, like then and then what you know, and then charge them 100 hours of it, like I kind of defeats the purpose of the access that you exactly I really want to like.

Speaker 3: 28:17

We want to encourage people to call us Texas. Emails come in. Like you know, we're happy if you're using our service.

Speaker 2: 28:27

So if also a simple scenario that I have in mind is that if a patient comes and they, if there's like a specific Problem that requires specialist attention, is there like a referral system to or other specialists in the At your care as well?

Speaker 3: 28:46

So We don't have other specialists that are doing what we're doing, because it's, you know, if you need a hernia surgery, only near once, so it's harder to find those folks, but There are. There's a small Group of specialists, like there is a surgeon in Rockville that does cash only Surgery, and and and for a set amount. But we found Folks locally whether it's GI or surgery or you know whatever that have wanted to work directly with us and They're able to give us a discount of price that the patient then presents. So, whether it's you know, getting imaging done for an MRI or, you know, seeing a particular specialist, but we have access to all the specialists and a lot of our patients have insurance. It's, it's really designed well.

Speaker 3: 29:47

There are some people that don't have insurance, though we encourage everyone to have insurance, you know, for catastrophic stuff. But there's a lot of people that have a high deductible health plan. But you know folks that are Not sickly. That's, that's not the right word. You know the don't. They don't have chronic medical illness. It's they're not spending six thousand hours a year in an average year to meet that. Yeah, so they're not getting anything out of their insurance. You know they're. They go see their primary care. They go see a specialist. They're gonna get a hundred percent of that bill and they're gonna have to pay it all until they get six thousand. I remember reaching out.

Speaker 1: 30:29

Looking at it's all right now, not during peak covid, maybe. Maybe it was last year, 2022, end of 2021, covid was pretty Happening and spreading and I went to one of the other urgent cares in Annapolis, and I was there for seven hours. I remember Texting dr Friedman. I said why didn't I come to you? What was I thinking? Because I could have used your service.

Speaker 3: 30:57

Yeah.

Speaker 1: 30:58

Absolutely, because you guys are a covid testing center, mm-hmm. Take us through how that would work with one of your subscribers or not subscribers.

Speaker 3: 31:06

Yeah, just for covid, just for I mean. So Now, the way it works, and probably for the last year or nine months, you know the covid at home tests have gotten good. Yeah, so it's rare that we have to send off a covid PCR, you know, to the lab. So most people call up and they say I just tested positive for covid, what should I do? and we jump on a either virtual call, phone call Or, you know, sometimes they'll just, you know They provide enough information by text and we text back and say you know Fevers and how sick are you.

Speaker 3: 31:43

And a lot of people are Underestimated it you know, by providers. You know, i think you can trust people a lot more, so to know if they're about to die or not. You know most people say I am really so, i'm sicker than I've ever been, i'm having trouble breathing. The volunteer of these things that our textbooks say you have to ask. You know all these questions to get all these numbers, just basically see why I. But then we can just make a decision with them if they Are gonna take a medication like paxil fed or something, and then we just send it in. They don't have to leave their bed, you know so and then you know, back earlier in the covid PCR days we had a drive-through that was in the back of the building and we would just Have a virtual visit with them, have them go through the drive through, get their PCR done, and we had the result back the next day. And again, you know all that billing went through for a long time. You know the government was paying for all those tests And the same thing.

Speaker 1: 32:51

I guess the same thing goes for anything. If someone has the sore throat, they might think a strap, or you know, you have a, your protocol that is less intrusive and time demanding than, yeah, where to go to.

Speaker 3: 33:06

But it's. It's. I'll tell you, like along the specialist question. It's amazing for like, for instance, labs. So one of the benefits of being a member of Evolviva is we have discounted labs And if you were to get a vitamin D test at, you know, quest or LabCorp, it's $200. If you get it through us, it's $20. If you got a complete blood count it could be $60. Through us, it's four. Complete metabolic panel, again like 60 or so, our price is like six. So there's a.

Speaker 3: 33:50

The prescription model helps with. There's so much money that these The labs, the pharmacies there's so many ways to save tons of money. I guarantee you every one of our patients is saving At least what they're paying in membership, unless they have like Some kind of a plan where they get no deductible, no co-pay, you know no, or co-insurance. I should say a lot of some plans have 80, 20, where you know you're going to pay 20% of the bill. But we, you know, we, have ways of helping them find you know their medications for You know pennies compared to what they've been paying. And sometimes it's this identical medicine, sometimes it's like such a minor shift, like it could be going from like you know, charmin to Sure You know some other brand, you know good brand, named Toilet Papers, like no difference and nobody would care at all. And they can take it from 400 a month to $4 a month. But they wouldn't know that. No, yeah.

Speaker 2: 35:05

There's something very attracting about like meaningful relationships, right, like, especially when it comes to this healthcare system. Because you know my parents my dad was a doctor, my mom was a nurse and I have great admiration for healthcare profession. I truly believe that it's a very noble profession, and but then everybody needs access to that, right, because that's also one of the training that I get, because I work as a medical interpreter, and then one of the training talks about doctors or healthcare professionals believe that life is precious. You know so, which is true, like life is precious, so you will do anything that is within your power to keep to maintain that life, you know. But then there's also a difference between doing it as a system and doing it like with heart in it. You know, right, And that's what I'm hearing from your practice that your members feel understood and you know them, they know you, they know you, and that it creates that meaningful relationship. I suppose, oh, this is what I'm supposed to do.

Speaker 3: 36:05

Yeah.

Speaker 2: 36:06

I suppose no, this is what I want to do for my help.

Speaker 3: 36:08

Yeah, yeah, i think that you know seeing four people an hour. You know 25, 30 people a day, it's, it's really hard not to burn out and to start to get hardened because you just don't have time to be as empathetic as you want to be And you're really being taxed. You know you, most docs are feeling burn out and you know, as a statistically speaking, when you're feeling burned out and you feel like your society's, you know, squeezing you that hard, it's really hard to be empathetic and and put your heart out there for other people. You know putting your heart out there and really listening and really carrying it takes, you know your own personal wellness And I always emphasize, you know my office, like our patients are not going to be happy if our staff is not happy, if our providers are not happy, if we don't feel like we have the time to do what we need to do, if we feel like we're rushing around and we can't do what we need to do, it's not going to work.

Speaker 3: 37:23

So but it's. You know it's hard in. You know Western society as a whole to not try to go as fast as possible and jam the system and squeeze every penny out. This seems to be the I hope last century's model, but you know, maybe this will be the future.

Speaker 2: 37:44

Yeah, happiness is contagious. It can be contagious. Yes in a good way. Yeah, yeah.

Speaker 1: 37:49

I think that's part of the culture and for people I don't send links to Dr Freeman's practice, but his waiting room and we've used it for community meditations at his practice It's. It's a hybrid, it's a mix between coffee shop and art studio, so it's very welcoming and doesn't feel like a sterile, cold medical office, whether it's in a high rise or a strip mall or you know. It's engaging, it's welcoming And I also think part of the unfortunate culture is stigma, like you just said, the doctors. As someone that's seeking these services, it feels like the doctors don't care for some of the reasons that we mentioned, but to me it's so valuable. I look, i look for people that have the spirit of the heart of a teacher And it sounds like you give the time and the ability to teach these clients that might need something. And if you're not the specialist, you have this referral source that you know and trust and use. Whether it's for X-rays that I discounted rate medications, but providers that you collaborate and connect with.

Speaker 1: 39:00

So many doctors that I go see, i feel like you know if my daughter needs a specialist, that I just feel like what? either they don't care, they don't know or they don't have the time to educate me on what my child needs, and it's frustrating, yeah, but you have the ability and time and you, you do have the heart of a teacher, you do have the referral sources and the knowledge to do that, and I think we're getting so far away from that in general. In terms of the medical field, yeah, i would agree. To me that can be valuable. The subscription weight I can go to this person as an anchor and if I need something more direct primary and urgent care has the ability to refer me in a place that, oh okay, i trust that they know where they're sending me, as opposed to I better do more research. Yeah, that cycle.

Speaker 3: 39:48

Well, and it's funny because there are some, a number of things we do that you know we don't market or advertise because I think they're hard to convey. But one of the most important things I think is if we do need to refer you to someone, we're going to send you to someone that we know is the best of the best And we're going to really, if it's something that is a little atypical, we're going to research it and figure out where is the best place to go. But and if you call and they can't get you in for four months, we're going to help facilitate that when possible. Not always possible, but you know, sometimes there's brick walls at the Hopkins and so forth, but it's that warm handoff.

Speaker 1: 40:30

It's. we do it here when someone's not here, When someone calls me for mental health therapy and if they have a specific niche that I feel like I can help. but I don't specific specialize, But I know two or three people that do.

Speaker 3: 40:44

Right Really.

Speaker 1: 40:45

You want to do. of course I'd be glad to Or Zoll with these. you know they're a bit of Buddhism and knowledge, whether it's working with Zoll or outside of our practice. Yes, Zoll is a wealth of knowledge in that, why not Not? collective solution to health and wellness. That's what it's about.

Speaker 2: 41:04

Yeah, yeah. The thing I want to go back to what you said earlier too, which is a good lesson for life in general the difference between time and value that we have, like everybody has only 24 hours a day, which is, you know, all we have, but then there's a big difference between making a better value out of a limited time, which beats the money, which beats everything else, because it becomes more about that meaningful relationship. So I love that, because the value is in that meaningful essence that is created, as opposed to within this time we're going to fill in this amount of people. Do squeeze the most benefit out of it, you know.

Speaker 3: 41:44

It's funny you should say that because it's taken me five years to figure it out. But when we first started I thought, like the fact that you could do virtual visits, that you could communicate, you know, by email or text, you know a lot of those conveniences I thought would be the big draw and they weren't. I thought the fact that we would save them a lot of money would be a big draw. That wasn't. And it turns out that it was same day access, the fact that they can always get in and see us unless and we're open from eight to seven, but if they call it like six or five, then it's more challenging. Same day And you know, quick phone access, etc. So it's more the value stuff, the availability, the time, the listening. You know people seem most happy with the fact that we really listened to them. A lot of the reviews say, you know, i felt listened to for the first time in 20 years, so that probably can't be understated, how important that is, how sad it is that they're not getting it otherwise.

Speaker 1: 42:59

I think you certainly answered a lot of the misconceptions already that I noted down The lack of access to specialists. Well, you have that, you know the costly aspect. I guess the one thing that still jumps in my mind is what is the my mind? the call to action with people that do have insurances? How does it make sense in their mind in terms of conveniences there? Why would they still do it?

Speaker 3: 43:31

Yeah, so I would say, you know, with the high deductible health plans, again, you know they're going to save money with people even if they have, you know, as I said, no deductible like we have us, in addition to what I was describing, a cadre of specialists that we really trust. We also have an online service where we can consult with specialists. It's a service we pay for, but you know, we can take pictures of your skin rash Instead of sending you to dermatology. We just send the pictures and then they tell us it could be this or this. This is what I would do first. If that's not getting better, bring it back to a biopsy. You know, take a little piece of skin or something or try, you know, something else. So there's a lot that we can do to save folks even more time and add value.

Speaker 3: 44:32

But we've seen a big growth in Medicare age folks and Medicare is probably the one insurance where they stand to benefit the least as far as financially. You know, because Medicare pays well for visits, labs et cetera. But most of the folks that are coming to us, it's because they just can't access care when they need it. You know, especially with COVID, they were saying you know I was sick. They told me that they could talk to me in two days. You know where they could talk to me the next day. But you know, if you're sick with COVID you don't want to wait a day or two, or they get the message. You know we're fully booked today. So either go to ER or an urgent care, you know and you'll just. You won't hear that from us unless you know. You call and say your arm is missing. We might say go.

Speaker 1: 45:32

What percentage of your clients are primary care and what percentage are kind of that urgent care model.

Speaker 3: 45:41

Maybe 95% primary care and 5% urgent care. So we don't, it's not our focus. The problem is, as far as growth, at least in the early days. We're not so worried about it now because there's a lot of word of mouth, but in the early days, you know, just people aren't looking for a doctor unless they're not feeling well, and so it's really the only way you can, you know, build and see more people as if you're available in that way. But you also don't want to have because it's a new model. You don't want to say, well, you can join us, you know, for this amount per month. They're like well, i've just got a urinary infection, can I just get this treated? They may not want to do that, but then they come in and they get listened to for the first time And they see how different it is.

Speaker 1: 46:48

Yeah, for example stitches right.

Speaker 3: 46:50

Right, yeah, i got you.

Speaker 1: 46:53

Well, where do you see the healthcare industry going, whether it's for you or just the general?

Speaker 3: 47:00

Yes. So the idealistic, optimist side of me feels that, you know, insurance is an evil player and I hate the term evil because no one's really bad. You know these are lost in some way. That's generous, go ahead though. We won't get into that. I really don't believe it anyway. So but I do think you know the insurance system and the way things are oriented currently is very perverse. It's set up in a way that is, you know, not well functioning. And you know the latest attempt at changing the insurance industry with, you know the quote unquote Obamacare limited insurances to like six or seven percent profit, something like that per year, so they can't make more than six or seven percent. I forget how the whole thing works, but what it's skewed, what it's skewed them into doing, is, you know, buying these pharmacies and pharmacy chains so that they can bill more and create more billing. So they're actually driving up the cost at the same time.

Speaker 1: 48:29

Is that why there's shortages with medications and mental health meds?

Speaker 3: 48:34

No, that's, that's a different thing. Yeah, we won't get into that, but there's a lot of us out there now. There's over a thousand direct primary cares And we usually, you know, get together as a couple of conferences a year And more and more there are a cadre. There's now health shares, which are similar to insurance but where it's usually a fraction of the price of insurance And it will cover you for catastrophic care and usually mandates. You know that you work with a direct primary care because they know our job is to add value. Our job is to avoid emergency room visits, avoid surgeries where unnecessary, avoid unnecessary MRIs and testing. You know that's where we give the most value is is not sending you to a million different people in order to get the diagnosis, actually listening and figuring out what the problem is and figuring out how to treat you. So we're hoping that that will take over and insurances will disappear.

Speaker 1: 49:48

I guess that can certainly happen if there's research being done on it. All right part of that thousand, are you guys beginning to get in that mindset or already do?

Speaker 3: 49:57

Yeah, there's a lot of great research, you know, showing reduction in emergency room visit, reduction in surgeries, reduction in hospitalizations. So there's just it's no secret that being having access to your primary care when you need them is critical.

Speaker 1: 50:20

What sounds like this is already being skilled, because you opened up Evolve which year 2014. And how many were there then compared to you, say, over a thousand now? Yeah, it's growing.

Speaker 3: 50:33

Yeah, it's really picking up. It's pretty amazing.

Speaker 1: 50:37

It's good to hear.

Speaker 3: 50:38

Yeah.

Speaker 2: 50:40

Yeah, you didn't mention this specifically, but I gather that you know healthcare is noble, but also like there's some kind of spirituality aspect to it, the way you're doing it, especially that part about being listened to. You know which is not something visible, which is something that cannot be marketed or like described by something that can be experienced.

Speaker 3: 51:01

Exactly.

Speaker 2: 51:01

So I love that. I also want that to be part of the vision for the upcoming decades or years in the healthcare, because you know healthcare need is not going anywhere Because people are sick, people are dying. you know that's always going to happen. But if there is more of that being cared for, that connection, meaningful relationship, the more there is, the more people are going to be happy and healthy as well, you know.

Speaker 3: 51:26

Well, and I'll take another step, zaw, in that I think that you know what we're focusing on and I think the future is is not just treating sick people and not just preventing disease states, but actually helping people to find wellness, happiness, peace. You know figuring out how to play. You know this actual study of happiness and how to help people get there that you know want to get there, and even people that don't know that they want to get there. Music to our ears.

Speaker 1: 52:04

I bet Music to our ears Yeah. Well, dr Friedman, is there anything else you'd like to share with our listeners before we go? No, well, I'd greatly appreciate it. Dr Friedman has given us a great insight into the benefits of direct primary care and how it can revolutionize the healthcare industry. So thank you, dr Friedman, for joining us today and sharing your experience on this critical topic. We'll give links in our notes, but how could they potentially reach or in terms of evolve?

Speaker 3: 52:35

Yeah, they can always email us at info at EMC, the number four me me dot com. They can text us or call 844-322-4222, where our website is, emc, the number four ME dot com. So that will be in the notes, don't worry.

Speaker 2: 53:01

Yeah, thanks again, dr Friedman. Yeah, it's a pleasure, really enjoyed the conversation Yeah.

Speaker 1: 53:04

Thanks everyone for listening and, once again, please subscribe, comment, review, follow the like. If you think others would benefit from this podcast episode, share with others, as collectively we can find solutions to all things. health and wellness. My name's Luke DeBoy. This is Zoff. See you next time.