The ShiftShapers Podcast

Ep #468: The Journey and Implications of Direct Primary Care - with Dr. Kyle Rickner

• David Saltzman

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Prepare yourself to be fascinated by Dr. Kyle Rickner, co-founder and chairman at Primary Health Partners, as he takes us on an inspiring journey of how direct primary care became his answer to physician burnout and subpar patient experiences. Step into the world of evolving healthcare models as we dissect the barriers that prevent more physicians from transitioning to this progressive model. Together, we untangle the web of the traditional fee-for-service system and how it has stagnated the growth of direct primary care. We also unpack the implications of misused health insurance and sky-rocketing premiums leading to a precarious cycle of healthcare costs.

In the latter half of our enlightening conversation, we journey across state lines to understand how direct primary care physicians unite in their mission to deliver patient care. Listen to Dr. Rickner narrate the challenges and triumphs of coordinating care for a substantial client base, all while pushing the scalability model forward. We also shine a spotlight on the significance of data collection in establishing the value of direct primary care and highlight the urgent need for educating people about its benefits. Join us and share our curiosity, as we discover how direct primary care is revolutionizing the healthcare industry.

David Saltzman:

In the evolution of direct primary care. How do a bunch of practices come together and what's the impact when that happens? We'll find out on this episode of Shift Shapers.

Host:

This is the Shift Shapers podcast, connecting benefits advisors with thought leaders and entrepreneurs who are shaping the shifts in the industry. And now here's your host, david Saltzman.

David Saltzman:

And to help us answer that question, we've invited Dr Kyle Rickner. Kyle is co-founder and chairman at Primary Health Partners. Welcome, Kyle.

Dr. Kyle RIckner:

So I think my journey was a lot like many others, that we were being squeezed by the traditional fee-for-service system. The joy of medicine was being squeezed out, the time with patients was being squeezed out, our autonomy was being squeezed out. So this led to a very popular topic of physician burnout, and in 2014 was the first time that I was exposed to hearing about the model of direct primary care, and my partner, dr Robert Lockwood, was there with me and literally that day in that hallway, at that conference room, we said we're doing that and we really don't care what it takes. And I think we saw it for what it is and that is it could really be a solution for so many things.

Dr. Kyle RIckner:

The changing of the physician experience and physician burnout but could completely alter the patient experience with engaging healthcare and their doctor and then, not just as a care model but also as a business model, could make a great impact in an unsustainable pattern of cost increase in medicine. So we sort of saw that quickly and said we're going to do this. So he and I had both worked for a large health system for a number of years myself for almost 10 years and he for over 12 years and we were, I think. Fortunately or unfortunately depends on your perspective we were both executive physicians, so we saw behind the curtain, if you will, and we didn't like what we saw, and so we essentially became those doctors that got to deliver bad news to other doctors, and so we were very aware of the frustrations that our colleagues were going through and saw this as a way not only to relieve ourselves of a lot of the frustration but hopefully be able to help them as well.

David Saltzman:

Yeah, I've always had trouble conceiving the notion that doctors go to all that schooling and all that training so that they can get moved further and further and further away from their patients. I suspect that, and correct me if I'm wrong, but I suspect that the vast majority of folks who go into medicine really want to practice, in their mind's eye, in a kind of direct primary care environment rather than in a big hospital-driven, hospital-owned, no autonomy, no value practice.

Dr. Kyle RIckner:

Well, I would say that for the physicians that know about, and then, in addition to that, this generation makes me sound old, but they don't really know any different. I'm just old enough that I did know different. I knew doctors who are autonomous, and how attractive that was in the old days. And so, you're right, we never encounter a physician and are presented with what we do, and they look at us and say you know, that sounds really neat and all, but I prefer this other way. They just don't do that.

Dr. Kyle RIckner:

But there are confounding factors, because that begs the question then well, why aren't more of them doing it? And there's a lot of confounding factors, you know up front, the biggest of which is the increasing amount of student loan debt that people are graduating with sort of makes it where as much money up front as they can get would be the best solution for them. And of course, the health systems are uninschamedly offering them as much as possible to get their claws into them. And then you know, secondly, once, once they've done that and they are feeling the squeeze and the burnout, they're, they're facing a transitional risk and a transitional sacrifice in order to make them move over. And you know that's uncomfortable, and not all of them are willing to do that. I mean there's there's real world life issues like families and kids and mortgages and all of the above. So we we combat a lot of that and and we we feel sorry for the physicians and there are solutions in the future. I think to those, but we're a little ways away from those.

David Saltzman:

You know it's fascinating along that line. I don't want to go too far into this rabbit hole, but a question for you along that line. The concept of medical home has been around for a long time. Was the American Academy of Pediatricians? I think that first, first discuss that. Why has it taken so long for direct primary care, or medical home, if you prefer, to kind of get it? Start to get its legs under it?

Dr. Kyle RIckner:

Well, it's like most anything else, david, you follow the money. I mean, the reimbursement models didn't fit it. The way that most people come to their health care through their benefits didn't support direct primary care. So it was sort of an outside the system entity for much of the time. And there's been some great progress at that and I hope and we'll talk more about that in a little bit but really it wouldn't gain traction because this whole idea and I've listened to you enough to know that you understand that we have this transitional misuse of health insurance.

Dr. Kyle RIckner:

It is used unlike any other form of insurance. I mean, just in broad terms, insurance is supposed to be used for two things, and two things only the unexpected and the expensive. And in health care, for some reason we decided that it need to pay for the expected and the inexpensive. Well, as soon as you do that, it sort of bastardizes the vehicle and the expense starts to go up sharply and, as we know, the insurance companies will not allow themselves to actually be in a negative place. So premiums continue to rise and I know you're very aware of that, and so it sort of created this problem that I'm paying for this very expensive benefit and I want to use my benefit and then there's this little direct primary care thing over here that didn't use that benefit, so that created a little bit of a chasm that requires some education to get over.

David Saltzman:

Well, it's funny because I've had really great commercial insurance and now I'm on Medicare but I still pay for a direct primary care relationship. And that's the next piece I wanted to talk about is, before we get into, what kind of is going on in the shifts in the industry, what's the patient experience like? I know that, but can you explain the difference from a patient perspective? Because to me that's really the game changer. And I'm just old enough to remember family doctors who came out to your house with their little black bag. Yeah, absolutely.

Dr. Kyle RIckner:

It's funny you mentioned that because I say we're old school docs in the new world, instead of a black bag we carry a black phone. But on the patient side, what they're going to experience is having a personal physician that they actually have access to, more importantly, someone they can have a relationship with. So it sort of breaks down the barriers of access. So by controlling the number of patients in a panel, you're able to provide access either electronically, digitally or in person, same day or next day, and so patients are able to have the convenience of the technology, the easy connection or the access to the physician same day, next day. So when needs arise, needs can be met in a timely manner.

Dr. Kyle RIckner:

I'm just old enough that I remember when we didn't have, urgent cares didn't exist. Those only came out of the necessity of the inaccessibility of the primary care physicians, and so we're trying to turn that upside down. The other thing that comes out of it for the patient is coming into an unstressed environment in which medicine is practiced not relying on volumes of care, and so we rarely have people waiting in the waiting room for any length of time. So we have a a short to zero wait time and then guess what they experience? A long, nice, comfortable visit with their physician, if so wanted or required. I mean, they can get in and out if that's what they need on that day. But so it really is a stress-free, hassle-free environment where they can enjoy a relationship and unfettered access to their physician. And I think that experience like you, since you've experienced some of that, no one ever experiences it and goes. You know that's really great and all, but I prefer the other way. I think I'll go back to that other world Well, and you know.

David Saltzman:

The other piece, which maybe is a little bit more intangible and this is my experience, but as I talk to people I find that others have had similar experiences is it allows the physician the time to actually do research and to think about stuff.

David Saltzman:

I mean, I had a very strange set of conditions that for all the world looked like pancreatic cancer a few years ago and Peter Siketti up in Maine, who was my direct primary care doc, said to me I don't know what the hell this is, but it's not pancreatic cancer and it took him four months of research but he finally figured out what it was and instead of getting chemo and all that nonsense and maybe a Whipple procedure, I ended up taking a bunch of bread to his own and I was fine in eight months. So that kind of ability for the folks on the stethoscope side of the equation to be able to think and take time and whatnot without having the pressure of having to have 407 minute visits during the course of a day is also great, both for the physician, I suspect, but it certainly is great for the patient.

Dr. Kyle RIckner:

Yeah. So I mean we go through an extensive amount of investment of time and energy and finances into our training and it's actually refreshing and invigorating to be able to use that training to its fullest. So whereas in my previous life and a fee for service world, if a patient came in with a list of diagnosis, long medication list, my internal stress meter went up immediately because I knew immediately it is going to be very difficult to address everything that needs to be addressed in the time that I have. But I have to try to pretend like it doesn't stress me so and literally the proverbial can gets kicked down the road, whether that's to another follow up visit with the primary care or, as many health systems rely on a referral to a specialist for something that we as primary care could handle if we had the time. So now we sort of lick our chops.

Dr. Kyle RIckner:

So in the more difficult cases come in. It's exciting and very challenging in a good way to where we can have time to figure this out. The other thing, that sort of hasn't necessarily been talked about a lot, but because we have a nice group of physicians, we have collegial consults and people have time and so we actually can have physician to physician interactions and put our heads together and so, which is very stimulating and enjoyable on the physician side and very beneficial on the patient side. So to your case. That was a great case and I could tell in multiple cases where myself or any of our physicians have been able to spend more time and come to a solution.

David Saltzman:

But to transition a little bit, you mentioned having a group of physicians and being able to have these collegial conversations and consultations. One of the challenges in a lot of areas is that we have these direct primary care deserts. I call them and I know that's something that you're working on addressing what's happening like from where you are. How did that happen? Was it organic? Was it something that was planned? And what does it mean? Do you think for the future of direct primary care, writ large?

Dr. Kyle RIckner:

Well, I think one of the for sure early criticisms and somewhat ongoing criticisms is the inability of direct primary care to scale to need.

Dr. Kyle RIckner:

We represent still a small percentage overall of primary care physicians, and then the issue of do we have a large number of people in the general population?

Dr. Kyle RIckner:

So I see I see a couple of areas of solutions that have already been done and are being done that make a huge difference, the first of which is direct primary care doctors, even of different practices in different states, are showing that we can work together to make sure that we can work together to make sure that we may not be part of the same practice.

Dr. Kyle RIckner:

So I love telling people, with permission, that our largest client has over 2,500 lives in 14 states and we were able to coordinate the care for them and take care of the people here in Oklahoma, where I'm at, but then make arrangements with other direct primary care doctors in the state.

Dr. Kyle RIckner:

So that is a scalable process that, frankly, health systems can't even pull off. So, rather than those patients historically being linked by large PPO insurance type of system, they can all have access to direct primary care. And then the other thing is I do think what direct primary care doctors are doing is actual groups of physicians, are a single practice in multiple locations that begins to be able to grow with business clients and retail clients to a point where we can provide sort of I hate the word but our own network of providers that can take care of the products and control the processes and control the environment and, by some degree, control the quality of the product that's being delivered. So both those things are happening. It's very exciting and I think we're showing an ability to be flexible and scale in a way that has not been seen in medicine before.

David Saltzman:

Frankly, I know that there have been a couple of cases where the model under one roof, multi-state model and it hasn't hasn't really worked yet. What do you think is the challenge in pushing that model of scalability forward?

Dr. Kyle RIckner:

Yeah. So I think the challenge is to make sure that you have the right resources, infrastructure and processes in place before you outgrow those, just like with any example that's there to Look at, look inwardly and and decide what we're doing and are we doing it right? Are we? Are we doing it with excellence and everything that we do? And then how do we bridge the gap of miles so that if we open a clinic In another area, that that it looks the same, feels the same? And you know, every other business industry has figured this out. I mean, you think about all the franchise models of food and delivery, and they certainly have, have done it, and I'm not necessarily advocate advocating for franchising in in medicine, but they've. They've proven a scalability once you have a foundation of processes and Infrastructure, that then you can properly train others on.

David Saltzman:

So that's that is what we're exactly in the middle of here at primary health partners is Doing those things exactly so that, as we don't out, expand or outgrow what we have the ability to do, We've got a couple of minutes left and you know, as you know, I'm a marketer and business development guy and Something that you said to me in our pre interview just kind of struck me, and that is that you want to be seen as a better option, not just a different option. Talk about that for a moment, if you will.

Dr. Kyle RIckner:

Yeah, absolutely. I think we've kind of alluded to the fact that you know when doctors are given enough time, they have adequate training to handle an immense amount 80 to 90 percent of a person's health care needs and so I think your the patient side is getting the engagement for from a physician that actually, if given enough time, can produce better results. And we're we're actually studying that in terms of chronic disease management and some outcomes and seeing that, wow, it really does improve, people actually do get better, and I know the American Academy of Family Practice is actually Studying some of that. They're very intrigued with the direct primary care model and and what those outcomes look like, and and Milliman, the, the large actuarial house is, is participating in in that effort, in that process, and so we are on the verge of an enormous amount of data Coming into the marketplace, which, as you well know, in the insurance industry, it's really all about data, actuarial data and impact.

Dr. Kyle RIckner:

So that has been the thing that direct primary care We've truly lacked. We had a great narrative and it worked, but the data gathering process is Antiquated and has always been based on claims data and since we don't generate any claims, the system sputters at how do we actually Quantify what these guys do? How do we know what we're getting? And so we're trying to push that envelope and Help figure that part of it out, because good things are happening from a cost perspective, from a quality perspective, from an outcomes perspective, and we're trying to really Dive into that and gather as much data as possible and there are other interested parties in doing that, and I think the story is going to be told very well, not just narratively, but numerically and fiscally moving forward.

David Saltzman:

Well, I'm looking forward to that and I hope you'll come back as you push that rock up the hill, because it, in short, it's about time. I mean, I certainly think the need is there, and once people find out how much better a model it is, to me it's the biggest no-brainer in the history of earth.

David Saltzman:

But you know, there's got to be coverage and that's been. That's been the problem. Yeah, I'm with you. How written? Or co-founder and chairman at primary health partners. Kyle, thanks so much for sharing your expertise with our audience. No, thank you so much for having me.

Dr. Kyle RIckner:

David appreciate it.

Host:

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