I’m very excited to share an interview with Dr. Alex Lickerman as the 2nd post in our series of creative ways to contain health care costs. Dr. Lickerman is the founder of Imagine MD, a direct primary care practice based in Chicago. He was kind enough to answer some questions to help explain the concept of direct primary care.
PM: Can you tell me a little bit about your background?
AL: I’m a University of Chicago trained primary care physician, author, speaker, entrepreneur, and founder of Imagine MD, a direct primary care medical practice headquartered in Chicago.
PM: What inspired you to start Imagine MD?
AL: After 20 years as an academician at the U of C, doing lots of things besides patient care, I decided I wanted to just take care of patients. But doing that full-time in the fee-for-service model was going to kill me. So I decided to create my own direct primary care (DPC) practice so I could practice medicine the way it should be practiced.
PM: How would you define DPC?
AL: It’s very simple: a pure DPC model doesn’t bill a patient’s insurance for anything. It only bills a monthly (or quarterly, or annual) fixed membership fee in exchange for unlimited and quick access to medical care.
PM: Why is DPC a better solution than the traditional primary care model?
AL: With a membership model, primary care docs can finally set the size of their patient panels at a reasonable level (no more than 600 patients, in my view). This compares to the minimum of 2,500-4,000 patients that primary care docs have to manage in the fee-for-service model. Everything good about DPC flows from that difference.
PM: How much does DPC cost?
AL: (It) varies by provider and location, but basically between $60-$150/month.
PM: Can you give me an example of a patient who really benefitted by the DPC model?
AL: I had a patient who told me he developed unilateral leg swelling one morning out of nowhere. I had him come in that day, and had my bedside ultrasound third party vendor come in as well. We diagnosed him with a deep vein thrombosis in less than 2 hours after he called and in another 2 hours had him anti coagulated. (The risk of deep vein thrombosis is that these clots can travel from the leg veins where they form into the lungs and kill you. Speed is of the essence in treating these to prevent this from happening.) In the fee-for-service world, I could never have made that happen as quickly and efficiently.
PM: How can DPC fit into the employer benefits space as employers try to contain rising costs?
AL: By being willing to spend more money upfront (on direct primary care), study after study shows you save even more money on the back end because DPC dramatically reduces healthcare over utilization (decreases ER visits, specialty referrals, inpatient hospitalizations, and tests, all of which are often unnecessary).
PM: Is the monthly fee for DPC typically paid by the employer or the employee?
AL: Typically by the employer, but all sorts of cost-sharing models exist.
PM: Can you give me an example of an employer that implemented DPC and saw really tangible results
AL: Mark Watson of Union County, NC. See his YouTube presentation about the results here: https://www.youtube.com/watch?v=pqmNHvhaPm8
PM: Is there anything else that people should know about Imagine MD or DPC in general?
AL: We (and other DPC providers) are committed to returning primary care to what it used to be but with 21st century science. Bringing the relationship back to the doctor-patient relationship is crucial. Providing white-glove customer service isn’t just a nice thing: it’s a crucial thing if you want to be able to provide the best care. When employers figure out en masse not only that they can promote us as a benefit to their employees but also save money, there’s going to be a massive shift and mass adoption. I firmly believe DPC is the model of the future.
I hope you found this discussion as fascinating as I did. The story about the vein thrombosis is so powerful! If you’d like to learn more about Dr. Lickerman, this link will take you to his LinkedIn profile: https://www.linkedin.com/in/alex-lickerman-md-96566330/
Here is the link to Imagine MD: https://imaginemd.net
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