Business Philosophy

The insurance-driven US health care system can provide people with access to life-saving care and basic disease screening services. However, its business structure and financial incentives make it so that the vast majority of dollars-spent go towards the reactive treatment of acute, chronic, and terminal disease. This makes it so that many people, especially high-performance professionals, get very little out of the money they spend on health care each year, unless something comes-up that negatively impacts their health. However, even then, co-pays, long wait times to have an appointment with a physician, time away from work, time spent waiting in the office on overbooked clinicians, medication costs, transportation costs, and the inefficiencies of fragmented care from multiple providers, all add hidden costs to utilizing services from this system. Given the astronomical costs of hospitalizations, surgeries, specialist care, disease screening, and some prescription drugs, health insurance is a necessary expense. It is also necessary to have a primary care provider who can order diagnostics and connect people to insurance-covered resources. However, my goal is to provide my clients with supplemental health- and performance-optimizing care that provides them greater value for each dollar spent. I work to accomplish this in a few ways:

• Face-to-Face Minute Pricing:  For my services, time estimates are provided in face-to-face minutes, with the time needed for documentation factored into the cost for the session. As a result, if a client books a 60 minute session with me, they will get up to 60 minutes of face-to-face time with me. In many cases in our insurance-driven system, if a patient books a 40 minute appointment, the physician will try to spend a maximum of 21 minutes in the room face-to-face with a patient because only 51% of time needs to be spent face-to-face to bill insurance for the time. The rest of the time during that session is intended to be used for documentation and other administrative needs for the appointment. This makes it nearly impossible to get 60 minutes of face-to-face time with a physician through the insurance-paid system. 

• Fair Pricing:  Out-of-pocket costs for 60 minutes with a physician at a public institution in my local area range from $235-595, with 15 minute visits costing $73-276, 25 minute visits costing $110-364, and 30-40 minute preventive physicals costing $227. The rates that I charge for my concierge, specialized services (including house call services) are inline with these costs, and provide my clients with amounts of time, frequencies of interaction, levels of access, and scheduling flexibility that is not attainable for most people accessing our health care system. Additionally, all medical client members receive an annual health evaluation and needs assessment, direct access to my services, priority scheduling, the ability to obtain answers to health and wellness questions for an annual fee that costs an average of $17 per month. 

• Fee Transparency: All fees for services are paid for up-front at a flat rate. There are no surprise fees, taxes are included, and there are no additional charges for going a few minutes over session time. Additionally, clients are only charged after a brief triage conversation to ensure they are going to get what they need from the service. This keeps my clients from wasting time and paying for services that are not going to meet their needs. 

• Client-Centered Efficiency:  The diversity and breadth of my training and expertise allows my clients to access the education, coaching, and support they need to stay healthy, perform better, and rapidly address health issues by working with a single specialist. This allows them to avoid attending multiple appointments with different professionals who may not work together in a coordinated way.  In cases where a referral to another professional is beneficial  (e.g., personal trainer, physical therapist, dietician, therapist, etc.), I work to connect my clients with people who I know and trust, and who I believe are going to be a good fit to meet their needs. Additionally, given that I do not have to follow insurance parameters to bill for my services, I have a lot more flexibility to provide clients with services in a way, and at a time, that works efficiently and effectively them. I am also able to work directly with my clients to help them figure out the most affordable ways to obtain their medications and other forms of care.

When people are initially diagnosed with a new health issue, there is often a lot of fear, anxiety, and questions. Then frustration often sets in because of how long it takes to get in for appointments, have questions answered, and get the health issue under control. It is not uncommon for it to take 2-3 months to get in to see a primary care provider after concerns are raised about conditions such as hypertension, diabetes, anxiety, or depression. Then it can take several appointments scheduled 2-3 months apart to get things under control. In some cases, it can take a year or more to get things to a well-controlled place in this system. My goal is to help my clients through these challenging periods as rapidly and effectively as possible, so they are able to adapt and move on to doing the other things they want, and need, to do to keep performing at a high-level. By implementing a business model that allows me to work with a small number of clients at any given time, I am able to be flexible with my scheduling and maintain short-term availability for close follow-ups. Additionally, given the nature of my service work, personal life, and other obligations, I am able to adapt my availability to that of my clients during critical periods in time. This allows them to access my services before work, after work, and on weekends. Ultimately, this protects their work time, keeps them out of waiting rooms, and allows them to meet their professional responsibilities while also taking care of their health and wellness needs as rapidly as possible. 

Patients engaging with physicians in most health care systems and practices often have to go through intermediaries, or wait days for a responses through patient messaging systems. This can make it challenging to address time-sensitive issues and have the depth of dialogue most people desire. Additionally, each person involved in the communication chain increases the likelihood of a communication getting lost or dealt with in an errant way. My goal is to reduce this communication friction for my clients by having all of their calls, texts, emails, and other forms of communication go directly to me. No other person is involved in triaging and responding to these communications. Additionally, my work hours, small client numbers, and schedule flexibility allow clients to connect with me and receive responses through calls, emails, texts, and Zoom within a matter of hours, and often even immediately. There are exceptions to this because I am the only person handling communications from my clients, and I do spend time on occasion in remote areas. However, I have set my rates and created this business in a way that allows my clients to have a level of timely, responsive, direct physician access that most people are not able to obtain otherwise. 

Over the last decade health care systems and insurance companies have increased the ease with which personal health information is shared between organizations. The goal has been to increase patient safety, facilitate coordination of patient care, and reduce system-level health care costs. However, an unintended consequence has been that it has become much easier for people outside the patient-physician dyad to access sensitive health information. This includes insurance companies. For many people this is uncomfortable, but for people in high-performance professions and positions of leadership, it can make accessing health care to address sensitive issues a potential liability. By not accepting insurance and being paid directly by my clients, I am able to maximize the privacy of my client’s protected health information. This business model allows my digital health record system to function autonomously, with none of my client records being automatically shared with insurance companies or inter-institutional health information exchanges. Additionally, given that I am the only person completing paperwork and prior authorization for my clients, I am able to ensure my clients are comfortable with the disclosures made on these forms. Operating in this way allows my clients to have maximum control over the disclosure of their health information and their personal privacy.

Most of what impacts individuals' health and wellbeing are day-to-day habits, exposures, knowledge, skills, and beliefs. Medications and healing practices can be helpful for addressing specific dysfunctions, but they often have a limited role in helping to prevent disease and disorders from developing in the first place. Rather, healthy practices related to exercise, nutrition, sleep, hygiene, relationships, sexuality, work, substance use, stress management, and spirituality can all have a substantive impact on disease prevention and quality of life. The impact of these factors on quality of life becomes especially important in situations where people do develop a disease or disorder. Unfortunately, it is challenging for most people to get the coaching and support they need to make changes in these domains that work for them and are sustainable in their busy lives. The goal of my work through this business is to provide my clients with the ability to leverage all of my knowledge, skills, and adaptability to collaboratively and holistically make sustainable, health-promoting lifestyle changes. Medicines, including pharmaceuticals developed as part of the Western medical tradition, will always have a role to play in the care I provide for my clients. However, I tend to utilize medications as a last resort after other approaches for addressing the underlying disorder have been exhausted, or when the situation has an urgency that does not allow for the use of alternative measures. This approach to care allows me to work with my clients to focus on promoting long-term health and wellness in a holistic way that targets underlying causes and minimizes reliance on medications.

A core feature of my approach to working with clients is my focus on impact as opposed to volume, or even retention. My goal when I engage with each and every one of my clients is to give them the knowledge and skills they need to no longer need my services. As a result, my clients pay a premium for the time they spend engaging with me, but they ultimately save time and money in the long-run because problems are addressed in a holistic, impactful way that promotes self-management and graduation from needing my services. For example, if a client wants to start going to the gym, but is not sure where to start to address their body’s specific needs, I can go to the gym with them, help them understand good technique, build them a workout, and, if they need more intensive support, help them find a personal trainer that will be a good fit for them. As another example, if a client wants to start meal prepping to eat healthier and be more efficient and effective with their time, I can help them plan meals for their unique goals and needs, figure out how to grocery shop in a cost-effective way, and teach them the basic cooking skills needed to get started. For those who are already at an advanced level with their skills, I can help to push them to an even higher level with additional knowledge transfer and coaching. The packages I offer provide a general framework, but every package is tailored to the individual needs of each client, with an explicit plan developed to promote self-sufficiency.

Everything I do is informed by my eduction, training, and experience in enhancing performance, and I am constantly working to stay up-to-date and deepen my knowledge in this domain. This performance-focused perspective allows me to help my clients meet their unique needs and enhance their performance in ways that cannot be provided by most physicians. By integrating and synthesizing knowledge and practices across all of the different professions in which I am trained, I have been able to develop insights and identify themes that underly effective techniques for optimizing performance. This allows me to work with my clients to leverage core concepts and principles, while also tailoring techniques and approaches to meet their unique situations and needs. My ability to do this has been enhanced by my medical training, but it has essentially all been a product of time and effort I have put into learning and building my skills outside of my medical training. 

I am committed to building stronger, healthier communities through targeted, intensive education, coaching, and support. Providing specialized, concierge executive wellness and performance services to a select group of leaders and high-level professionals at a premium rate allows me to keep key people in our communities healthy and effective, while also allowing me to have the time and flexibility I need to work on projects that serve to better our communities. This includes my pro bono and reduced-cost care, education, and capacity-building work. A selection of some of the projects I am currently working on can be found in the Bio section. However, there are additional individuals, groups, and organizations with which I am getting to work because the financial support from my clients allows me to be out in our communities finding innovative ways to make them stronger and healthier.