The New Face Of Healthcare
It’s a message replayed constantly—our healthcare system is broken. Unsustainable, expensive, complicated, impossible to navigate are the most common descriptors. And yet despite intensifying industry obsession with efficiency and evidence-based guideline adherence, the prevalence of chronic disease and healthcare costs both continue to rise.
But a small and growing number of independent primary care physicians in Utah are seeking to reverse these trends by choosing to practice healthcare differently. Focusing on prevention through effective, lower cost primary care and integrative medicine is a convincing solution to slow the epidemic of chronic disease and trend of rising healthcare spending.
An Alternative To Conventional Primary Care
Direct Primary Care (DPC) is a membership-based delivery model in which patients pay a monthly or annual fee for comprehensive primary care services and direct access to their physician. Payment is simple: no coinsurance, no copays, and no hidden fees or confusing bills. These practices are limited to a smaller panel of patients than typical primary care practices to enable better access, longer appointment times, and extended services. Similar in concept to direct primary care, concierge medical practices are often distinguished by higher fees and billing patients or insurance for additional visits and services.
Doctors Are Adding Integrative Treatments—Such As Acupuncture—To The Menu
Dr. Eric Overton brings an exceptionally visionary approach to medicine and wellness to Utah. His integrative medical practice in Salt Lake City focuses on delivering both full-spectrum primary care and progressive preventative medicine in a contemporary space. With a smaller panel than typical primary care physician practices, Dr. Overton can spend more time with patients, offer same-day appointments, and provide truly thorough medical care that includes acupuncture and other integrative treatments. Board-certified in Family Medicine and trained extensively in acupuncture and Traditional Chinese Medicine, Dr. Overton’s well-balanced approach to healing doesn’t lean towards conventional or traditional medicine—he comfortably oscillates between the two in pursuit of what actually works for individual patients.
Initially, Dr. Overton was drawn to medicine through art. Fascinated by the connection between science, medicine, our physical environment, and overall healing, his medical practice feels inspired by each of those elements. Stepping into his office immediately signals a very different kind healthcare experience—his office feels more like a comfortable gallery than a traditional doctor’s office. Just as his art, featuring the body and Utah landscapes, reflects Eric Overton as a whole person, patients are encouraged to bring their full selves to the office, not just their medical symptoms in isolation. He engages patients conversationally during each visit, and typically makes compelling connections between physical symptoms and the broader context of everyday experiences before delivering stunningly precise assessments and effective treatment plans.
Integrative medicine combines modern medicine with a broad range of evidence-based healing approaches to address the biological, psychological, social, and spiritual aspects of health and illness. Stanford, UCSF, Duke, Cleveland Clinic, and Mayo Clinic are among the many top health systems that have established centers for integrative medicine. Locally, integrative medicine has been used at Primary Children’s Hospital since 2011, and integrative treatments are available to patients at the Huntsman Cancer Institute.
But integrative medical techniques can be applied beyond the acutely ill at large inpatient facilities. Acupuncture has been recognized by the World Health Organization as proven effective through controlled trials for treating chronic pain, acute and chronic gastritis, effects of chemotherapy, allergies, headaches and migraines, depression, rheumatoid arthritis, hypertension, and many other conditions. Bringing integrative medicine into primary care is highly effective, not only for prevention and wellness but also for treating chronic disease and managing common conditions without costly pharmaceuticals and specialist referrals.
There’s No Quick Fix—How Doctors (And Their Patients) Are Embracing Slow Medicine
The concept of practicing “slow medicine” means that physicians take time to evaluate patients in the context of their environment and carefully review evidence to support diagnoses and treatment plans. This is particularly critical in specialties like internal and family medicine, where patients often have wide-ranging and multiple conditions. Physician and author, Victoria Sweet describes the slow, methodical approach to medicine: “establishing the correct diagnoses and then getting them off all those unnecessary medications, with their side effects and adverse reactions, took a lot of time, but in the long run it saved way more money than it cost. It was slower but it was better.”
This concept is not new. In fact, it’s a timeless fundamental of good healthcare. Patient-centeredness, slowness, and genuine connection have been proven effective in improving health outcomes. Over twenty years ago, Dr. Anthony Suchman authored an article in the Annals of Internal Medicine defining the idea that, “therapeutic contact takes place within a connexional, or transpersonal, dimension of human experience, within which basic human needs for connection and meaning are met. Although seldom explicitly recognized, connexional experience is basic to medical care.”
For Dr. Overton, slowness is absolutely essential, and the practice of healing is much broader than medicine. “This practice is about creating a little more peace. I try to slow people down when they come into the office so we can prioritize and dedicate time to what’s important. The atmosphere provides an example for how patients live the next day, the next week, and hopefully it makes them think about what really matters,” he says.
Less Is More—A Business Model That Allows Doctors To Spend More Time With Their Patients
In a healthcare environment that incentivizes physicians to see more patients in less time, order more testing, prescribe more pharmaceuticals, refer to more specialists, and perform more procedures, many are worried that the practice of medicine has moved towards fragmented and impersonal transactions and away from connection-based actual healing.
“The way the system is set up for primary care makes it very much volume dependent—you need to see 20-30 patients a day to have a financially viable practice,” says Dr. Mike Kagen of KagenMD, a concierge practice in Park City. In a conventional primary care practice, a physician may see 24 patients per day for about eight minutes each. As an internal medicine physician, Kagen says, “I specialize in diagnosing, and 90% of diagnosis is listening. If you can’t do that and can’t have time to do that, you can’t do your job in internal medicine well.”
Although primary care can address the majority of health concerns, it accounts for only about four to five percent of overall health care spending. This is, in part, because of the time constraints most primary care physicians face. Spending an average of eight minutes on each visit, it’s common for primary care physicians to use their limited time almost entirely administratively—medications are refilled, routine screenings ordered, and referrals to specialists made. Instead of spending an extra ten or fifteen minutes removing an ingrown toenail, for example, a primary care physician in a conventional practice might refer the patient to a podiatrist and go on to see two more patients in the time they would have spent saving the initial patient a referral, the hassle of another appointment, and the stress of another bill.
Because of the decreased panel size, DPC or concierge appointments can be three to four times the length of a conventional primary care visit and provide time for a physician to understand and know each patient genuinely. This model removes many of the barriers that plague conventional medicine—rushed visits, endless phone trees, inadequate access, complicated billing structures, wasteful duplication, unhappy patients, and burnt out providers. In this model, accessibility saves patients countless and costly visits to emergency departments, accurate diagnoses prevent countless avoidable specialist visits, and a comprehensive approach to treatment reduces unnecessary pharmaceutical spend. Beyond that, patients report significantly higher satisfaction.
Combating Rising Healthcare Costs By Bypassing Insurance Companies
Annual insurance premium increases have become unsustainable for many individuals and small businesses. In a recent national report, Avalere Health estimated that Utah’s average premium—for the mid-range individual gold plan offered on the ACA exchange in 2018—costs $997 per month. That’s $11,964 each year. By contrast, assuming a direct primary care membership fee at $90 a month, and a high deductible health insurance plan premium to cover catastrophic or unexpected events at $60 a month, a DPC patient may incur costs of only $1,800 each year.
In a DBC or concierge practice, patients pay physicians directly for care. Bypassing insurance companies creates operational efficiencies and drastically reduces overhead expenses that are passed onto patients in the form of significantly lower healthcare costs. In this way, the DPC model is especially attractive for self-insured groups eager to reduce costs and for small businesses looking to provide an attractive and affordable health care option for employees. Several DPC physicians in Utah have partnered with local businesses to provide services. “Employers want the best talent, and employees perform better when they feel listened to and valued. If they feel their company is investing in their wellbeing, they will personally invest significantly more back into the company,” says Dr. Overton.
Employers can elect to cover membership fees fully or split the costs with employees. In addition to considerably lower costs and transparent fees, most DPC physicians also offer ancillary services like lab work, generic medication, and imaging at cost or at a steeply discounted rate.
Alternatives To Painkillers—How Integrative Physicians Are Addressing The Opioid Epidemic
The rise of prescription opioids has catalyzed a public health crisis that is severely prevalent in our own state. Utah has one of the highest death rates involving prescription opioids in the country. Avoiding opioids where possible and treating addiction where necessary are both challenging and time-consuming—not ideally suited for an eight-minute office visit. Chronic pain, such as low back pain, is one of the most common reasons a patient will visit their physician. “Understanding the root causes of chronic pain is complicated, and requires careful consideration of each individual patient,” Dr. Overton says.
Writing opioid prescriptions is a common practice in conventional medicine, used to address severe pain quickly, acupuncture and other non-pharmacologic treatments are actually recommended by the American College of Physicians as the first line of defense for conditions such as lower back pain. Dr. Overton frequently uses medical acupuncture to treat chronic pain but also practices addiction medicine. Using a multidisciplinary approach, he combines behavioral health resources with medical acupuncture and Suboxone, an outpatient treatment designed to ease detoxification from opioids. This approach and practice model that honors the patient-provider relationship through adequate time and connection is uniquely suited to address the complexity of chronic pain and addiction.
A Return To The Fundamental Goal Of Medicine: Healing People
Physician burnout is a mounting concern, especially as primary healthcare faces shortages. Rising pressures of electronic health records and complicated billing and coding processes mean physicians are spending more time behind a screen and less time with patients. With a straightforward approach to billing, DPC practices can use drastically simplified electronic health records. The simplified process frees up physician time to be spent on what is most valuable in the practice of medicine: actual patient care. “There is no doubt that more and more physicians will be attracted to this model,” Dr. Henriksen says.
Found in physicians practicing these new models, there is a shared commitment to building a better community. Outside his regular practice in Park City, Dr. Michael Kagen volunteers at the People’s Clinic, providing services to the uninsured residents of Summit and Wasatch counties. He also serves as a team physician to the US National and World Speed Skating teams.
Dr. Rick Henriksen of Kestrel Wellness in Salt Lake City sponsors a local cycling team and frequently hosts public lectures and events. “I think direct primary care is really a community-based movement—as people get healthier and happier they can bring more to their friends and neighbors; as we build that healthier community, we build a better community.” This convergence of small business, embracing slowness, and a return to patient connection in medicine is improving the health of our community beyond the physical.
In many ways, these innovative physician practices actually mark a return to medicine as it was practiced a century ago by family doctors who made house calls and spent considerable time with patients and their families to carefully diagnose and treat. This deliberate simplifying and slowing down presents a compelling model of care that’s better for patients, better for providers, better for the economy, and better for our community. That is good medicine.