Healthcare 3.0 or ZDogg discusses Direct Primary Care

Healthcare 3.0 or ZDogg discusses Direct Primary Care

ZDogg, well known by those in the medical field for his musical parodies, has talked about something called Healthcare 3.0. He calls Healthcare 1.0 to be the old time family medicine, without clinical guidelines, and a paternalistic relationship between doctor and patients. Healthcare 2.0 is how many offices are functioning now – owned by corporations, driven by quality numbers and productivity goals, they may lose the relationship with the patients they aim to serve. Medicine becomes more of an assembly line, neither the doctor nor the patient are in charge and their healing relationship is disrupted.

Healthcare 3.0 is a combination of Healthcare 1.0 and 2.0.  Healthcare 3.0 provides personalized care that recognizes the needs/wants of the individual patient in the context of the greater whole. It is a partnership between the physician and patient that recognizes the mind-body connection and helps the patient work towards goals that are important to them. The video he created “Healthcare 3.0” was to inspire those in the medical field to dare to try something different that may allow us to create a better future for our patients – as well as ourselves as practitioners. It is the type of care that many of us wanted to be able to provide when we went to med school. 

ZDogg had a practice called Turntable Health from 2013 to 2017 that was his attempt to create a Healthcare 3.0 environment – while they ultimately closed due to multiple factors – large overhead and depending on venture capital funding being two  major ones, they improved medical care, touched many patients lives and inspired many physicians to work towards creating their own version of Healthcare 3.0 – Direct Primary Care being one of these versions. Click here to see an article about his practice.

One of the things that Turntable did was allow patients to have access to many services that would improve their health – nutrition, yoga, health coaching were just a few of the things they could access. I would have loved to join Turntable if it had been located in the Cincinnati/NKY area. I have no venture capital and am trying to keep my overhead low, but I am trying to figure out a way to incorporate nutrition and mental health care into my DPC practice over the next year – as these are two areas that a lot people would benefit from having better access to.  Stay tuned for further updates as I work through this thought process. If you have thoughts on ways for me to do this, or know people who may be interested in working with me –  contact me via email

ZDogg recently did an interview with Dr. John Bender who has a DPC practice in Colorado, and is on the board of the American Academy of Family Physicians.    Click HERE to see the interview.

Colorado is the other state, that along with Kentucky, doesn’t allow patients with Medicaid to pay for direct primary care memberships with their own money. Yes, you read that correctly.  If you have Medicaid through the states of CO or KY, you can spend your money on things that damage your health, but not healthcare. KY is having problems paying for their Medicaid expansion – but won’t allow for patients to pay for things they want to improve their health. Direct Primary Care provides better access and longer appointments for patients and this helps decrease ER visits and improve health outcomes.  All of this would help patients, and provide the state considerable potential savings. I went to Frankfort last week with 2 other DPC doctors from KY to try to change this. I find it ironic that the coverage that is supposed to help patients obtain medical care, is preventing their ability to obtain medical care on their own. Hopefully as we go forward with this conversation, we will be able provide care in a way that doesn’t discriminate against people based on their insurance status. 

Everyone I know who has opened a Direct Primary Care practice has done it because they want to provide better health care than they are able to do within the current system.  We are moving towards Healthcare 3.0 – come join us!


***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

So you didn’t sign up for ObamaCare, what now?

So you didn’t sign up for ObamaCare, what now?

Direct Primary Care meets primary care needs – how to pay for other needs outside of insurance…

Did you decide that you could’t afford to continue with your health insurance and are looking for another way to help pay for catastrophic health issues?  Unfortunately, you are not alone. While Direct Primary Care is an excellent way to get your primary care needs met – it doesn’t provide help with paying for catastrophic health problems where you may need to be hospitalized or have surgery.  Many people will opt for a high deductible plan and pair it with DPC – but even those plans prices have risen out of many people’s reach.  Joining a health cost-sharing plan is a solution that can help pay for serious medical issues.

What are Cost Sharing Health Plans?

Cost Sharing Health Plans may be either faith-based or not faith-based.  Some of the faith-based ones (also called Health Sharing Ministries) have been around for many years, and people who had them were exempt from paying the penalty for not having ACA compliant health insurance. Newer plans, like Sedera, were not grandfathered in and do not exempt people from paying the penalty – although this is a moot point now for individuals.  Some plans, like Sedera, can be provided by employers to help care for their employees and can be paired with another insurance product – called a MEC plan (minimal essential coverage plan) as well as direct primary care.

Limitations/ Considerations on Cost Sharing Health Plans

Since these plans are not insurance, they are not required to cover all the same things that ACA plans do.  Pre-existing conditions may not be included – or only partially covered for several years,  people with specific health problems may not be accepted, mental health coverage is unfortunately poor, and some of the plans require participants to sign a statement of faith.  However, for many people the price difference, as well as a different philosophy, make it a desirable alternative.  There are different levels of coverage available.  A membership for a family with $1,000,000 coverage is generally under $500/mo with most of these plans – instead of well over $1600/mo with the plans that are found on the marketplace. There are programs with less coverage, but I would be hesitant to suggest people consider them. 

Another DPC physician I know put together a chart that lists some of the major Cost Sharing plans and wrote a recent blog post.  Click HERE to link to his chart/blog.  PLEASE read the plan specific sites well and ask questions before signing up – they are not right for everyone – but for many people is a great way to get help when you need it.  These plans are based on principle’s of individual responsibility and helping others who are in need.  These are member to member payments – either directly or indirectly – to help each other – instead of paying a large corporation whose motives may or may not be aligned with the patients’.  Also, as I said earlier – this is not insurance – but a great alternative to investigate.

Health Sharing Plans and DPC

Some Health Sharing Plans may partially reimburse or discount monthly sharing amounts for people participating in a direct primary care practice.  Sedera is only available for individuals at this time who are affiliated with a direct primary care practice.  That is why there is an enrollment link on my sign-up page – not that I am endorsing them over any other plan.  They are simply the only group that has reached out to the Direct Primary Care community to make it easier for patients to enroll and and include it in their monthly bill from DPC Practices. You can sign up after you join, and it is definitely not required. 

If you are a patient of mine and are interested in learning more about health sharing plans and whether or not they would possibly meet your needs, please contact me to talk about this further.  

***Note *** This post, like all my other posts, is for general information only and is not to be taken as direct advice.  Please consult your personal physician, insurance agent, or financial advisor for more information.  


Happy Thanksgiving!

Happy Thanksgiving!

One thing I sometimes recommend to people is that they make a gratitude list to remind themselves of all the good things that they have going on in their lives.  There are several things that I am particularly aware of being grateful for this year.  Probably the top 2 things are my family and the strength I have found in the Direct Primary Care community.

Most Primary Care physicians today are employed by groups or hospital systems.  As a former employee, I can attest that this is a difficult spot to be these days.  While as an employee I did have the relative security of having an income, I lacked much control over the process of how I cared for patients. Even though I became involved in leadership teams, I was a piece in a much larger system and did not have the authority to make many decisions.  It was frustrating to have ideas about how I could better care for my patients and create a better environment to practice in, and not be allowed to implement any of my ideas for a multitude of reasons.  I found out about Direct Primary Care while reading a practice management magazine – and a light bulb went off. I had a choice.  Patients had a choice.  There was a better way to do things. 

As an independent DPC physician, I am responsible to make sure my office runs the way I want it to as well as providing excellent patient care.  I am a small business owner – something I received precious little training on in residency – which was 16 years ago… I have had so much to learn in this area and I am truly thankful for those who have helped me along the way.  From DPC physicians who opened their practice for me to visit them, to people who coached me on how to write a business plan and sagely advised me to make it for 3 years and not 1; from SCORE mentors advising me on commercial real estate to other members of the Chamber and BNI who have given me suggestions on marketing and bookkeeping.  I am part of a tribe of over 1000 physicians nationwide who are going down parallel paths in opening independent businesses and the support we give each other through Facebook groups, and conferences has been amazing.  I am blessed to have my family who has listened to my ideas, gone to conferences with me, and helps me keep things in perspective as I go through the rollercoaster of being a new business owner.

I am thankful that my mom has completed chemotherapy this month and that my sister and I are living in the same metro area for the first time in 30 years.  I am thankful that my daughter is still able to enjoy her dance and that my son will be graduating from college this summer.  I am thankful that my husband is able to remind me of where I have been and where I am trying to go and WHY I am going there when I get bogged down with daily challenges. And I am thankful for the unquestioning love that our furry friends give us on a daily basis. 

I am privileged to be able to share people’s journey towards better physical and mental health.  Patients open their lives to me and we are able to talk about their goals, dreams and hopes – and how they can try to achieve them.  They share their pain and grief – and I am allowed to counsel them, or just be present with them in the moment. Being a doctor is not a matter of just writing a prescription or a referral – it is much more than this – it is a calling where one human is able to care for another to try to restore and/or maintain health – by drawing on their previous experiences, research and knowledge and melding that with what the other person wants and needs. 

It has been a crazy year and I have much to be thankful for and I am looking forward to what the next year brings.  It’s quite a journey!  Thank you for coming on it with me!


Affordable Care & MLK Day

Affordable Care & MLK Day

Martin Luther King Jr. on Healthcare Injustice

As someone who has worked at a Community Health Center since before the implementation of the ACA, I recognize how many people have benefitted from it.  In Ohio, with the expansion of Medicaid many people were able to obtain help that previously hadn’t been able to.  I have had patients have cancers detected and treated, and hypertension brought down from dangerous levels due to having access to health care. On the other hand,  I have also seen people get health insurance through the marketplace and end up with plans that are essentially worthless – they may be paying $1000/mo or more for a plan that they then can’t afford to use. That doesn’t really help them get health care – it helps them have insurance.  There is a big difference between having health insurance and having health care.  I do believe that access to health care is a basic right and it should be available to all.  Direct Primary Care may be one answer – if someone can pay 50-75/mo for a monthly fee, they may be able to have their primary care needs met and be less likely to have to end up in the ER.  If someone has low enough income where they really CAN’T afford it and would qualify for Medicaid – Medicaid could help fund a HSA for patients – like some employers do currently – and patients could use that money to purchase care through DPC offices or other health care needs.  I hope that whatever this next government decides to do, it will keep the parts about not excluding people with pre-existing conditions and letting young adults stay on their parents health insurance.  It’s still really hard for me to believe that a nation that has as many resources as the United States, hasn’t been able to figure out a way to make sure that people’s basic needs are taken care of.  We need a system where patients have the freedom to choose their care, and physicians aren’t expected to sacrifice their physical/emotional well-being to take care of others.  The system is broken with or without Obamacare.  I don’t know what the answer is,  I just hope that things don’t get worse.  I pray that our elected leaders hold love and compassion for others in their souls, and that their motives are true as they move forward with changing/repealing/replacing the Affordable Care Act.

Getting Started in Direct Primary Care

Getting Started in Direct Primary Care

Hi! I’m Cynthia Villacis, and I have been practicing Family Medicine for the last 14 years. While I have learned a lot over this time, one thing I have not learned well, is to stay on time with the 15 minutes I have been given to see you. Honestly, most doctors struggle with this. The only way NOT to do this is to limit visits to 1-2 concerns at a visit, and not deal with complex patients or mental health issues. This also leads to you having to come back to finish the visit another day, or to me running behind. While most of my patients tell me they don’t really mind waiting because they know I care and will take the time with them if they need it, I always wonder – I mean who really WANTS to wait at the doctors office? Wouldn’t it be better for both of us if I could just schedule longer appointment times? Unfortunately, as an employed physician I am not in charge of my schedule – and administration hasn’t allowed me to do this.

I was feeling frustrated about this last summer when I found out about Direct Primary Care. Direct Primary Care is a new model of providing healthcare for a monthly membership fee. It is not the same as concierge medicine. By paying a monthly fee that is less than a cable or cell phone bill and still NOT charging your insurance, I will be able to lower my overhead, have visits with you for 30-60 minutes instead of 15, address some issues over the phone if we both want to, and keep medical decisions between you and me. I will be able to provide discounted generic medications (not controlled substances) and refer patients for labs/tests at reduced prices. This model works great for someone with a high deductible plan who typically doesn’t meet their deductible, someone who doesn’t have insurance, or someone who wants to have less rushed visits with their doctor and better access to them.

I went to a conference on Direct Primary Care with my husband in October and what I learned there, coupled with ongoing support from some awesome mentors on Facebook, has led me to believe that this is the best way for me to practice medicine. I have resigned from my regular practice effective February 28, 2017 and will be focusing my efforts on opening a practice on my own. I am still searching for an office location in Kenton County but am planning on opening my family medicine office in the next several months. I am very excited, and a little nervous, about making this leap but have confidence that this change will be a win-win!

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