Bridging Specialty and Primary Care Through DPC: Integrating Rheumatology with Paradigm Family Health

In today's episode of the "My DPC Story" Podcast, Dr. Staci Benson and Dr. Elizabeth Ortiz share their unique journey as a two physicians in completely different specialties are combining forces under the Direct Primary Care (DPC) model. Dr. Benson, a family medicine physician and founder of Paradigm Family Health in Dallas, discusses the challenges she faced opening a solo micro practice in a market unfamiliar with DPC. Meanwhile, Dr. Ortiz, a rheumatologist, recounts her transition from academia to cash pay telehealth, eventually finding her place with Paradigm Family Health. The episode highlights their partnership to integrate specialty care into a direct care model, emphasizing patient-centered care and collaboration. They explore the benefits of a DPC model, such as increased doctor-patient relationships and the potential for cost savings. Dr. Ortiz and Dr. Benson delve into the importance of communication and teamwork in delivering exceptional care. Their story is a testament to the power of innovation in healthcare, inspiring others to embrace the DPC movement. Tune in to discover how they're revolutionizing patient care in Dallas through a DPC approach.

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Transcript

Dr. Maryal Concepcion: 1:07

​Primary care is an innovative, alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and, in return, builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the my DPC story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle Concepcion, family physician, DPC owner, and former fee for service doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care, direct primary care.

Dr. Staci Benson: 1:55

Direct primary care is the way that medicine should be practiced.

Dr. Liz Ortiz: 1:58

Direct care is the best way to practice rheumatology.

Dr. Staci Benson: 2:02

We are Dr. Stacey Benson

Dr. Liz Ortiz: 2:03

and Dr. Elizabeth Ortiz.

Dr. Staci Benson: 2:05

And we are Paradigm Family Health.

Dr. Liz Ortiz: 2:07

And this is our DPC story.

Dr. Maryal Concepcion: 2:15

Dr. Staci Benson is a board-certified family medicine physician and founder of Paradigm Family Health. Growing up in the Dallas suburb of Prosper, Texas, she saw firsthand how the healthcare system failed hard working families like her own, an experience that shaped her mission to provide accessible, affordable care. She earned her B. A. in psychology from Southwestern University in Georgetown, followed by a master's in health psychology from Texas State University. She then attended Arizona College of Osteopathic Medicine before returning to Dallas to complete her Family Medicine Residency at Methodist Charlton. Frustrated by the rising healthcare costs and red tape, Dr. Benson founded Paradigm Family Health to simplify care through the Direct Primary Care model the amazing ensuring her patients receive high quality personalized care without the barriers of traditional insurance, Dr. Elizabeth Ortiz is a double board-certified rheumatologist based in Dallas, Texas. She has over 15 years experience practicing rheumatology and has worked in a variety of environments including academia, public county hospitals, concierge private practice, and digital health. She currently practices via an innovative collaboration with Paradigm Family Health. A teacher and an advocate at heart, she uses the Connected Rheumatology YouTube channel to bridge the widening gap between doctors and patients by providing trusted and up-to-date information in a practical, easy to understand format. Through a collaboration, she offers specialized care for autoimmune and rheumatologic conditions to all patients in need with discounted rates specifically for Paradigm Family Health members. welcome Dr. Benson and Dr. Ortiz to the podcast. I'm so excited to have you on because as we celebrate all different types of direct primary care practices, you guys are bringing a unique situation to the fold. So thank you so much guys for coming on today.

Dr. Staci Benson: 4:05

Thank you for having us.

Dr. Maryal Concepcion: 4:07

Yeah, it's good to be here. I want to get started with the fact that you guys are in the Dallas area. Dallas is definitely more of a metro place versus a rural place. Dr. Benson, this is more towards you what was the lay of the land like and was it, friendly for DPC before you opened Paradigm?

Dr. Staci Benson: 4:23

So that's a very fair question, because if anyone knows me, I actually opened up the practice back in 2016 as a solo micro practice and there were, really no other direct primary cares at that time. There were plenty of concierge practices across the city that range from 2, 000 annually to 50, 000 annually. But there really hadn't been many direct primary care that entered. So I truly entered into a new space, even though it's a giant city.

Dr. Maryal Concepcion: 4:48

tell us about that because, you know, now and we're going to fast forward to how the practice has completely changed from the solo micropractice you opened with to now in 2025 when Dr. Ortiz, a rheumatologist is coming on board to help serve your guys's patients and your community. But when it came to. the challenges of opening and the challenges of marketing yourself and the challenges of, helping change the culture to understand what you were delivering. How did that work out for you in the first year of your practice?

Dr. Staci Benson: 5:20

It was actually a bigger struggle than I thought it would be. To me it, I grew up in the cash pay world as a patient with having small business owners for parents and a preexisting medical condition. So it felt like a no brainer that I was offering this affordable monthly membership for your all inclusive primary care. It just made sense. And so when I opened and I didn't have people just knocking down the door, I was shocked. A local networking group started spreading the word. But even after it, took about five months before I got my first patient from it and it just really was a labor of why I'm different and why you should use this model. Versus using a concierge based practice or even just paying cash at a fee for service practice. All the calls that I got when I first opened were, are you a holistic doctor? Are you a functional doctor? No, nobody even assumed that I was just going to practice traditional Western medicine. So I rarely get those calls now, which is great. I think it speaks to the fact that there are many docs across the Metroplex that now do direct primary care. But in the beginning. That they didn't exist. So I ended up having to call myself concierge but different in order to get people to finally understand what I did.

Dr. Maryal Concepcion: 6:31

Dr. Benson, let's go back to you in terms of your experience growing up with parents who are small business owners, you being used to a cash pay system. How did that influence you choosing to be a physician and to go into healthcare in the first place?

Dr. Staci Benson: 6:46

Well, my parents being business owners didn't happen until I was in fourth grade. But my mom will tell you I wanted to be a doctor since I was in pre k. It's written in my book, in the All About Me book, that it's what I wanted to do. And I wanted to be a family medicine doctor. It's just. It's just that natural calling that anybody that's in medicine is hopefully reiterating whenever you talk to them why they're a doctor. It didn't help that my mom and my dad both hated blood and hated vomit and didn't like to be around sick things and I'm the oldest of five kids. So. I got to clean up a lot and especially my brother would get hurt all the time. So I got to clean up his messes a lot. So that definitely helped push it as I got older. And then after they bought their business and got everything rolling after I was in fourth grade and I didn't develop epilepsy until ninth grade. So I really didn't even enter that cash pay space as a patient until then. But after being in it and being a mature. I'll say adult at the age of 17 and 18 and understanding what the problems were in the system. It just reiterated that I wanted to be family medicine and I wanted to be part of my community and make sure that I provided access to everyone in my community. So I actually had planned to do some sort of a concierge like practice. Cause of course this was well before direct primary care was a thing on paper. And then as I was getting ready to open. I stumbled across another podcast where they talked about direct primary care and I went, that's it. That's the piece I'm missing to make it affordable for everybody.

Dr. Maryal Concepcion: 8:14

Amazing. And Dr. Ortiz, how about you? Because, again, the fact that you are a rheumatologist doing direct care, there are so many that are like, Oh my God, this is exactly what I wanted to do, but I didn't know it was a thing, especially in specialty care. So tell us about your journey, even to become a rheumatologist in terms of the things that impacted your journey to choose medicine as your career path.

Dr. Liz Ortiz: 8:37

oh, wow. Well, so my journey is definitely a little different. I had to be a doctor. I was 16, which is still pretty young. I got exposed then in medical school to rheumatology really early, third year rotation, internal medicine. They give the student the interesting patient and the interesting patient happened to be a vasculitis patient. And I loved it. I loved the complexity of it. I loved how not everyone on the team, including the attendings didn't really know much about it. And so I, got to scratch the itch of being kind of the expert in the room and the doctor's doctor, which I really like Which then kind of explains why I stuck in academics. So I finished my school, went to training at USC and I stayed on academics for almost 10 years. And it never occurred to me to go into private practice. I didn't want to go into private practice. I liked the setting of academics for a while. I liked the teaching aspect of it. I liked the ability to do some research, although I was never a huge researcher. I did like doing, Small type retrospective studies. And I liked the patient population I got to work with in that environment, but like a lot of people, academics for many people is not what it used to be. It's kind of just a different version of private practice with the added stress of doing research and teaching. And I was. Really feeling pulled in a lot of different directions. The other element was I'm originally from Texas, but I was living in L. A. And I had been out, I had been away from Texas for about 20 years at that point and was finally starting to miss home. And so it kind of all culminated with how can I get back to Texas? Am I really going to stay in academics? Is this really the path I wanted to take? And one of the biggest thing was looking ahead at the people who had careers. five, 10 years ahead of me and realizing they didn't really have careers that I wanted and they didn't have lives that I wanted. So all of that kind of came to a head with me deciding I was going to leave LA, move to be closer to home and start my own practice. And it truly was ignorance is bliss. I had no idea what I was jumping into. I. Practicing. I first of all, I love rheumatology. I do not love practicing rheumatology in 15 minute stints these autoimmune Conditions are very complex and I would oftentimes walk out of rooms knowing I had not covered everything I need to cover Knowing that there were a lot of lifestyle things that I needed to touch on that I didn't have a chance to and so in my mind the kind of direct care space was going to allow me the time to be able to give the patients the attention I knew they needed. So that was my thinking. And when I got here and then actually started looking into it, I did open my own practice and it was a very steep learning curve. I opened my practice in 2020, which was in the middle of COVID, which by itself was a whole thing. And I was in practice by myself for about a year and a half. And then I got recruited to join a digital health startup, which I did. And I then wound down my clinic and was all in with the digital health company. And I learned a lot while I was with them, then that digital health company wound down. And I then was like, okay, what am I going to do now? And I I wanted to get back to patient care, but I had learned a lot in those four years that had passed of trying to start my own, then joining a digital health. And I now had a much clearer idea of what starting a business was really going to take. And also the way I wanted to practice, and that's kind of where, Stacy and I got together.

Dr. Maryal Concepcion: 12:17

So that's amazing. And I think that, This is such an exciting interview because it's completely two very different, stories that brought you guys together. So I definitely wanna get into how you guys serendipitously came together and how you are practicing under Paradigm family Health, but Dr. Ben said, I want to ask because you opened out of residency. And that's a feat in and of itself, where I hear Dr. Ortiz saying that was not my journey. I was not, initially ever excited to do that. And knowing you and, envisioning the like, Direct primary care tattoo, parental advisory that tattoo that you had on your arm last, last Dallas Summit. I'm like, you take names wherever you go. When it came to opening out of residency, I want to ask about that experience because That is not an easy thing when you don't have an MBA behind you, yes, you do have role models who owned their own business, but in terms of, you shared how the market wasn't, hey, we love DPC when you opened, and yet you chose that path rather than staying in, a traditional fee for service business.

Dr. Staci Benson: 13:21

I've done actually several other lectures with my husband on this and what happens. Luckily we met in college, so he knew the craziness that I was already interested in. And while I am willing to be a risk taker, I'm not. willing to destroy myself in the process of the risk, if you will. And so, opening out a residency, I still wanted to be very methodical with what I was going to do to open it. And so I actually started working urgent care. Just urgent care as I was figuring out what this would look like and trying to find people. My path from residency, like there was a time where I didn't know what I was going to do at the end of third year and then it got pulled away from me in May of my third year. So for those that aren't physicians, you finish residency in June. And in May I lost my job that I thought I was going to have. Which it was very serendipitous that it happened. And so my husband and I decided this is what we're going to do. We're going to earn money, pay off student loans and start forming the business and getting everything ready, find a space, build it out. We knew it was going to take time. And then together. We made the decision of today's the day I'm quitting my job today. And it just took just a few little things to be enough to push me over to say, Nope, we're ready. We can take the leap together. And we had our financial ducks in a row so that we were going to be comfortable for the next three years. So I gave myself three years to. Fly or fail. And our family was going to be fine with that. And if we failed it three years, I gave it my all and we'd go back to what everyone else was doing and working in corporate medicine traditional insurance based medicine, which wasn't corporate. And if I flew. Fabulous. We were on the path we were going to take and continue to grow to whatever that became. And that vision of growth has changed over the last 10 years too. There's been definite days where being a solo doc sounds like a great idea and was a great idea. And then days where we're not even big enough yet to do the things that hope to accomplish.

Dr. Maryal Concepcion: 15:59

I will encourage the listeners out there to check out there's a 2019 recording on YouTube of you and your husband sharing. And that's back in the day when I was still like, What is DPC? I'm still learning about it. And I totally remember how you guys broke it down and how specifically you planned out financially to be able to support you. And I think you were pregnant with your third at that time. At

Dr. Staci Benson: 16:22

the conference. Yes. When I opened, I only had one kid though.

Dr. Maryal Concepcion: 16:25

Yeah, it was at the conference. So I remember I'm like that she is definitely going to be a mom. And she's talking about this. business thing. This is amazing. So I remember being in the audience and, hearing how impactful and remembering how impactful those words were. So I'm glad that, you gave a little snippet there, but I definitely encourage the listener to go back and watch their talk or multiple talks, if you can find the recordings. Now, Dr. Ortiz, I want to bring you into the fold here because as you spoke about opening your own practice from academics in Texas 2020, like people just, probably have a shiver just thinking about all of that because there's been so many guests on the podcast who opened in that year and they're doing great. And for you to have the experience of academics, to have the experience of opening your own practice, to have the experience of of. being on a digital platform as a way to deliver rheumatology as a specialist. And then to now be at Paradigm Family Health, where there's multiple physicians, multiple staff, you've been through lots of different environments. So cool that you guys are bringing this again to your community collectively. How did you guys have this discussion about, Hey, you want to do rheumatology cash pay. I'm doing family medicine cash pay. Why don't we team up?

Dr. Liz Ortiz: 17:44

Yeah. So, so yeah, when I first got to Dallas first, I was like, I want time off. I was the very typical burnout doctor and I wanted time off. And I thought I'd take about six, six months off. I would travel. And of course COVID just changed all that. So I had a lot of time just to stare at the walls and think about what my practice could look like. I had originally dreamt up like this big sprawling place that would have, that would have yoga and a dietician and all these things that I think, autoimmune patients would really benefit from. And with COVID, especially in the beginning, because there was so much uncertainty, I knew enough to know that I didn't want to have a lease. I was like I'm not like, I don't know what I'm doing. Times are really uncertain right now. And I was also very, I mean, everyone was taking up telemedicine, but I was very wary of, I was going to be building a brand new panel. So brand new patients. And I wasn't sure how I could do that if I was never going to touch someone. And so taking all of that, what I did was I opened my practice that was Telehealth plus house calls because I was like, well, I don't want to leave, but I need to see people. And so let me just drive around Dallas and just knock on doors and see people. And at the time people thought I was crazy. People thought it was dangerous. It, those things never occurred to me. I was like, well, I just need to see, I just need patients. And also I was trying to figure out what my price point would be and. I wanted to have a higher price point. And so in my mind, I was like, well, the high touch of a house call will kind of validate that. So I was working that and it was working. I was, it was a struggle and to hustle for patients. And part of what I was doing was I was reaching out to other providers in the area. And my thinking was, well, I want to go to providers who already have a panel of people who are used to thinking outside the box as far as their medical care and paying cash. And so I, plus. Because I'm autoimmune, I was going for the type of provider who was taking care of a lot of my patients in a, perhaps, alternative way. So I did a lot of outreach to some of the alternative providers here in Dallas and to the concierge DPC. And that's how I met Stacy, because I basically just sent a cold email and a flyer and was like, Hey, buddy, I'm new. And yeah, again, this was COVID. So some people felt, I was like all email or zoom meetings. But you know, I was able to come over and bring coffee and kind of meet the team. And immediately I was like, Oh, I like these people. So I was like, Oh, these I like them. And, cause I've been banging on a lot of doors and, some people you click with some people you don't, and with the paradigm group, I definitely did.

Dr. Maryal Concepcion: 20:31

I think that's awesome. I think that, especially when you are going into this knowing that you want to choose your future. I think that's really amazing to find people that you're like, this is an awesome office. I'd love to shoot the S word with them in the break room. That's great.

Dr. Liz Ortiz: 20:46

Yeah. And, at the time, of course, I was just looking for referral partner. But so, so my, my, my. Goal was a little different. Then I kind of then I got swept up into the digital health world. And I then learned much more, not only about health tech, but also how to provide rheumatology care in particular 100 percent online, which had been kind of my fear in the beginning, which is why I did house calls. And the premise of the company was to be able to go into places where rheumatologists It weren't as available, which is a lot of places because there aren't that many of us and be able to provide a digital care and patients, how do you do that in a safe way when all you're ever doing is doing over the camera? And so I kind of went on that journey and learned how to do it and learned all the pluses and the minuses. And then when that ended and I had a chance to kind of step back and be like, okay, I've tried all these different things. What is it I actually enjoy doing? What is it that I like? I did notice, although I think there's a lot you can do with telemedicine I was really missing being in the room with the patient and I didn't necessarily want to go back to a hundred percent telemedicine. And especially in rheumatology with these complex conditions and when they're all brand new patients I do think you miss something when you never get in the room with them and it was around that time that Benson then was like, hey what's going on? We got notice that you're closing with this other practice. And so we just Started talking about what I wanted to do. And I was very honest that I was like, I need a break because the digital health thing it was a lot like I've likened that experience to residency and that it was working really hard. I was on a very steep learning curve. And so yeah, that break I was able to kind of think about what I wanted, keep the conversation going with Benson, and then we kind of got together. It's well, I think there's actually something here. And it, for me, from my point of view, I don't know if she'll have a different point of view, but for me, it really checks off a lot of boxes because my best experiences when taking care of patients have been when I am doing it right next to their primary care doctor. And so I was like this really is like this is the way I like to do it and I know this is actually the way I think a lot of rheumatologists would like to do it. And so, yeah, to me it was a no brainer.

Dr. Maryal Concepcion: 23:07

That absolutely makes sense. I mean, I think of, how in residency. It was very nice to know you could call your attending, even if they were a separate specialty, and have them help you. But you knew each other on a relationship base where if you, if, to this day I the nephrologist that I call I still have a cell phone from residency. I don't abuse it, but it's like, when he gets my number, he picks it up and he knows that I'm only calling because he knows that I will only call when I'm like, I have exhausted all of my ability to address this issue and I need assistance. And I think that especially when you talk about how you were frustrated that you couldn't have more than 15 minutes to address lifestyle stuff. I'm like, abso freaking lutely, that's where primary comes in. So Dr. Benson, let's hear your take on, the things that happened that, culminated in you guys partnering up.

Dr. Staci Benson: 23:53

Well, I hired my second doc in 2020. And so we had already started our growth of going from a one doc, one staff practice into this two doc practice with one staff. And we're starting our growth at the same time that Dr. Ortiz entered Dallas. And as I'm sure it is hard to find a great rheumatologist. that you can send your patients to and communicate with. So when she knocked on our door, we were super excited. She was in town and aligned with us too. And being in the cash pay sector, it was great. And she was seeing patients, which nobody was seeing patients back then. So it was a win for everybody and for the community. And then when she left and went into her tech business. We were so sad, but we were happy at the same time because now she took insurance through there. So it allowed for even more patients of ours that didn't want to pay cash for specialty care to make that step over because we knew what an amazing rheumatologist she was. And then when she left, we were horribly sad and had to work to find rheumatologists for our patients. And one day she texted and said, Hey, can we go grab lunch? And I said, yes. And I looked at Dr. Musick and I said, She's texting. It's going to happen. She's coming back. Ruth went, you need to hire her. I said, we need to hire her. And so I went into the lunch that day where we just had lunch again, the other day memories and went in and she said, I'm ready to start working again. I said, great. When are you going to work for us? She said, now I said, great. So it was. It felt like a perfect fit. And then for me as a business owner, there's not a lot of physicians out there that truly get the business world. And I am making it up as I go a hundred percent. I agree. I did not get an MBA. I did not have a business degree. And so to have someone that's now joining our team too, that has all this business background to help in this new vision of where we want to grow this model is. It's cannot be more serendipitous, which is a fabulous movie for those out there that have not seen the movie from the 1990 serendipity. You should. And that is what this was.

Dr. Maryal Concepcion: 25:56

There are certain movies on Southwest Airlines that I will watch. I don't care how many times like me before you check that off serendipity, check that off. Yes. So let's talk about, let's talk about. The transparency there, because I think that is always so important, especially when I've had guests on who have, come together to practice under direct care, direct primary care. So for you guys what did you guys remember from that conversation when it came to like, I have to have this, don't want to have this, I'm like, whatever, when it comes to this, what were some of those things that you guys. Put on the table to, back up with the business experience that Dr. Ortiz had and that you had, Dr. Benson, but also to make sure that you were building a relationship that was going to work

Dr. Liz Ortiz: 26:42

from day one.

Dr. Staci Benson: 26:43

Sorry. My family texted me asking about dinner. Did you order Chick fil A for us? So that can go in about part of being a mom and trying to double task and everything. But so I am going to let Dr. Ortiz go first.

Dr. Liz Ortiz: 26:56

Well, I think. from my point of view, it was really important up front just to have an understanding of how she envisioned incorporating a specialist. I mean, I certainly had my ideas, but this is her practice and her business. And so I wanted to understand where her mind was at and if it. Kind of jived with what I was thinking. I knew what I wasn't worried about was like the way we practice and the way we approach patients that I knew would wasn't going to be the problem or a problem. But I was more interested, especially The digital health experience I was on ended because the business ended. So I, I've been a part of a business from that started and then shut down. And so I am well aware of all the problems that can happen in a business that will cause it to not succeed, go bankrupt, run out of money. And so my, that was kind of where my mind was at. Cause it's once you've been burned one. Once, you know what to look for. And so that was kind of where I was thinking. And then like where we could grow. I also, wanted to have an understanding that, that she also understood that we were on the same page as far as like how this is a growth, that like the steps we would need to take together to get to where we both wanted to be. That was kind of how I approached the questions and the conversations.

Dr. Staci Benson: 28:20

And it took a while. It's still evolving. Let's be frank about this, right? Of how this was going to work in our billing software. How what were the prices we were going to pay? Who are we going to work with? Doctors outside of our direct primary care practice? Or are we going to work with people that weren't a member of our direct primary care practice? So we're still evolving what this looks like. I, you started with us in October. And so definitely I feel like she's with us once a week at the moment. And I feel like you're, you have patients every day now or that week at this point, so it's definitely it's going right. But it took just like any other business took a little while to get off the ground and get people to buy in. And so right now we're working on even. shoring up all of our procedures for how we get a consultation in and then get have them continue to stay on as a member in our rheumatology practice here.

Dr. Liz Ortiz: 29:11

Yeah, no, it's a constant, you're constantly tweaking the operations and I don't, that's just going to be the way it is. I think we're also still working on what you had mentioned in the beginning, which is how do you message and communicate to the population the value. that you're bringing. And, I think we each independently kind of went through that process with, Paradigm as a primary care and then Connected Rheumatology as a rheumatology service. But how do we make it clear the importance of the joint venture and why people should or how people should see the value in it the way we do and then pay for it. I think we're still tweaking that as well.

Dr. Staci Benson: 29:53

Yeah. And I can't, there's not a better partner. So if anybody else is trying to do this, let us know, because we want to, one of our visions, and then I was as a question later is continue to expand into other specialties, right? And so Dr. Ortiz has been fabulous at really helping us break down what are the problems and what are the barriers and how will some other special specialist. Encounter those same barriers where hopefully we can really prevent it from being much of a hurdle for them. Right, right.

Dr. Liz Ortiz: 30:20

Yeah. No, I mean, I worked When I was in academics the place I worked USC was at the time contracted with LA county hospital and so i've worked in these two different entities and The county and long time ago was really there was a push towards building a medical home And they would really kind of push that idea and it was really It was always the primary care, but, patients have complex conditions and need specialists. And in my mind, what we're kind of putting together with Paradigm is just a different version, I think a better version of that medical home.

Dr. Staci Benson: 30:57

Totally. That was the language back then, too. Medical

Dr. Maryal Concepcion: 31:01

home. Yep. I'm sure there are other people in the audience that can envision those graphics that were so frequently used for medical home because I sure as heck can't, like different floors and different windows. Yep. So let's talk about this. So because I think that this is so interesting, especially when specialists are coming into the fold under direct specialty care, I totally hear and I love this idea of growing with multiple specialties. I think that it really speaks to where specialists get. They get tied up a lot is how much am I worth what services would I be able to provide? How many patients would I take? Could I do membership versus, one off services? So when you guys were, thinking about how to brand this relationship and how to market it, how did you guys approach those particular questions? Because you have primary care and specialty care, specifically here, rheumatology, working together for a community.

Dr. Liz Ortiz: 31:55

Again, we're still working it out. I think that and again I'm a rheumatologist. So I'm just kind of speaking about the patients I take care of. The messaging and the communication is kind of tweaked based on the condition that you're talking to, because for some patients, it's very obvious why it would be beneficial and more than others. So, you know, you have a complex lupus lupus patient, rheumatoid arthritis patient they might understand. What I think is an interesting way to go at it is a lot of people with rheumatic conditions or autoimmune conditions, they, and they put so much emphasis on the rheumatologist. And I think that for certain people that's reasonable. But you end up seeing the rheumatologist more than any other doctor. You're seeing them every one to three months, and that's your focus. Getting your Sjogren's under control. And all the primary care they barely see them. But what patients don't understand is that there's a lot of primary care issues that still come up and that need to be addressed. And your rheumatologists, even if they are board certified internists, are not really doing it. I was just doing, I just participated in a rheumatology conference where there was a lecture on managing comorbidities and all the audience did was bellyache about how they don't want to do cholesterol and blood pressure. It's well, if the patient isn't seeing the primary care and they're seeing you most like there, there's a gap there and patients don't know that. So I think an important thing is just helping patients understand that gap. and understand how a collaboration like this can kind of fill that without them having to do anything extra.

Dr. Maryal Concepcion: 33:33

Yeah. I know. And I think I've mentioned this on the podcast before, but a vascular surgeon, good friend of mine, when he was practicing locally, he'd be like, Mariel, how do you handle. Low vitamin D. I'm like what do I do with this cholesterol option because they can't, their insurance doesn't cover this. And I was like, oh, let me tell you. So, I think it's fantastic. Because again, it's just get out of our way. Let us be doctors. Let us collaborate together. When it came to pricing Dr. Benson, I know you mentioned people who, When Dr. Ortiz was taking insurance again, we're like, Amen, let's do it. And they were showing some hesitancy when she was cash paid. How are you guys approaching the pricing? Because I know that on the website, it clearly says rheumatology membership, and it also has a discount specifically for Paradigm Family Health members.

Dr. Staci Benson: 34:23

So it's really tricky for this particular specialty, in my opinion, because so many of these patients are on very expensive meds, right? Versus like lots of cardiology, dermatology patients. They might be seeing them regularly and a membership would make sense for them, but they're not on these medications where they need to have an insurance plan to cover their Humira. For example, right? So it just happens to be a population that has a higher rate of insurance that meets their deductible than other populations within our patient panel. So because we're starting, especially with our own patient panel, and they understand that benefit of the provider patient relationship. It has been an easier discussion with them, but it's really pushing that in the marketing to that. This is not just relationship between you and the rheumatologist. This is a relationship between you, your primary care doctor, your rheumatologist, and those two. It is a triangle that we're forming here. And so that you're not going to get, which is going to see a random rheumatologist, even if it is at an academic institution like UT's Health Law Center here in Dallas. You're not going to get that at all. So, and I know Dr. Ortiz knows today we had a patient, she texted in late last night and said, I'm having a flare. She's an ankylosing spondylitis patient with some fibro. She's I'm having a flare. I have a really big event coming up. Are you, would you be okay if I did a steroid? And she happens to get steroids frequently and it was a quick ask, Hey, I'm okay with it. Are you okay with it? She said, cool. MedDraw DosePak called in by the morning, but now we had everybody on board versus her seeing her later and going, Oh, he never even told me she was having a flare. Why are we doing more steroids? So it's the perfect example of that harmony coming together.

Dr. Liz Ortiz: 36:04

Yeah, and I mean, another example is I saw a new patient today who I saw and back in my old practice who's now following me and she called and before signing up, she was like, I don't even know when the last time I saw a primary care doctor and I'm like, lady. You're a 54 year old woman, I can't either. So, so this was perfect for her. Like she's used to seeing the rheumatologist and, the best rheumatologist in the world is still not really doing internal medicine and not doing primary care. And so, yeah, it's just, she's going to benefit and she could see the benefit. The only other thing I would add to the pricing thing, and this is more from the specialist point of view, as someone who. Had my own, I had my own practice and was trying to work out the pricing in there. And I know, it's we're not many, but we do have a growing group of rheumatologist who have gone this direction, whether you call it concierge or direct specialty care and I don't know everyone. I don't know everyone's experience and there are certainly successful rheumatology direct practices out there, but I do know that it can be a struggle to get people from the fee for service model into a membership in specialty that is. It's difficult for patients to see the value of that, even though they will say and they understand they need to see you very often and all the paperwork and all the priors and everything. It's just it's a, it's an obstacle. It's a mental obstacle. And I think on top of the fact of the pricing that a lot of people choose and that it's not, it's, it can get very expensive. And I know that My practice was very expensive. And at the time I had, my rationale for why I'm worth this much. I'm a specialist. And part of what I've learned over the years with all the different experiences is the disconnect that we have to get. We okay with and understand that of what we think we're worth and what, a lot of the population and the patients kind of value their health care. And you're trying to

Dr. Maryal Concepcion: 38:03

find that sweet spot. Totally. And here I want to ask about the value because, for example, in primary care, it's a lot easier in terms of just it's clear for patients, I find, where you say, how much did you spend on the one visit to the emergency room for the cough that you could have seen. with your primary but you couldn't get in to see your primary so you had to go to the ER and oh that's more than a year of seeing a personal physician who actually knows you who you can get a hold of that is a like an easy sell in terms of primary care versus specialty. I totally see that. Have you broken down for people especially like with the cost of you know with maxing out deductibles because of medicines that are specific to rheumatology patients plus your membership And then, plus the accessibility, plus the integration with primary care have you guys Numbers wise, broken it down for people to help them understand like, wow, there's a lot of savings that I could potentially have because of not needing to, end up in crisis because I couldn't get into my rheumatologist and I still ended up in the ER or whatever it is. No, we

Dr. Staci Benson: 39:10

haven't overtly done that yet, honestly.

Dr. Liz Ortiz: 39:12

Yeah. No, I know. That's a good idea, but I will say it's not quite as clean because not everyone ends up going to the ER. They go to their PCP.

Dr. Staci Benson: 39:22

I think it's a breakdown for time savings is really in quality of life savings. And in my opinion, that for what you're saving, especially when somebody is already meeting their deductible, whether they have, a direct care specialist or not because of simply the cost of their medications and nothing else.

Dr. Maryal Concepcion: 39:39

And do you have challenges getting medicines because like in my world, it's because you don't accept this book, a plan, we will not honor your IUD prescription. And so is there anything that you guys are facing, especially in Texas and with Buka in terms of Dr. Tease writes a prescription for Humira and somebody does not get that honored because you're not taking insurance in the traditional system.

Dr. Liz Ortiz: 40:05

Not necessarily in because of the situation that you described, but generally medic getting medications approved is forever and always a headache in rheumatology and is actually one of the justifications for the higher price point on the monthly memberships and specialty especially rheumatology specialty care because of all the paperwork and follow up that's required outside of each appointment because it is so it can be so challenging to get the medications that the patient needs. Formularies change. Now we're in a world of biosimilars where insurance companies will mandate a change to a biosimilar. A patient's doing well on one medicine, no problems, and then they change their formulary, and so now it's no longer covered. And so do you switch or do you create a fuss and appeal? So that kind of stuff happens all the time, even in the best insurance plans.

Dr. Staci Benson: 41:01

For patients that don't know, it is a massive headache to deal with these from our standpoint. Massive.

Dr. Maryal Concepcion: 41:10

I wonder, just because And I don't know what is your guys's mix in terms of employer mix, but if you guys have employees who are members under their employer and their employer also offers them a BUCA option, have you guys used that to the benefit of the patient in terms of go to your insurance primary to get this? Versus you guys wearing all the hats to get the paperwork done if a person has that option.

Dr. Staci Benson: 41:40

So I'll take this question. So, that's actually one of the potential big hurdles. We're going to be facing and trying to integrate specialty care within a home like this. We do work with other employer groups, whether it's a small employer group or with third parties that are, Finding direct primary care practices within their city. So that way you have a option that's closer to you, but you have multiple groups to take care of one employer. So we've already started reaching out to them. And they have no problem with paying for a traditional fee for service visit with a specialist, but they have not yet been willing to jump on board with a membership based, which mind you This membership, if you broke it down into the cost per visit, like we're just going to do simple math and it's on our website, but depending on when you listen to this, of course, it may change, but say a thousand dollars for membership. And that includes four visits, which is once every three months, which would be typical for a rheumatology or any chronic disease patient, right? Plus two acute visits. So for. Pretend they never have a flare and never need to see Dr Ortiz. That's still 250 per visit, which those of us that understand what a visit costs to see a primary care doctor, that is traditionally what a doctor is going to be charging the insurance company anyway. So it's not like they're actually spending extra money to be part of the membership, but even though these groups have already these self insured companies, then there are some. Cigna, for example, and United both have a lot of self insured companies that are wrapping into direct primary care already. They've made that paradigm shift and seeing the cost savings and the value for primary care. They have yet to do it for specialty care. And it really does feel like I'm hitting my head against the wall because, this discussion about value and perceived value, right? It is truly a, another paradigm shift. We in healthcare are going to have to start undergoing to really pull our specialist friends into this loop with us.

Dr. Maryal Concepcion: 43:38

Absolutely. And I think that culturally as a country, I think that this is where a rising tide floats all boats, because I think that this is where us as physicians doing the work the people on our teams who are working with us are patients, policymakers, everybody. Raising their voices to say, Yep, I am a normal everyday American and I got this health care and I didn't go bankrupt. My employer actually saved money, whatever the example is, but this is what's happening. And I think this makes it easier for people to say, Oh, direct care. DPC could be palatable for me.

Dr. Liz Ortiz: 44:14

Yeah. And I would just add when we talk about value and how the cost savings that payers and employers are looking for, like that was exactly what. We were trying to do with my digital health company. It was, all, every digital health company in the rheumatology space, at least, which is the space I know the most is going after that value based play. They're trying to build a product and a solution that's going to then result in a group of, autoimmune patients who cost the system less. And the way they, the way they measure that is mainly through pharmaceutical spend, because that's my patients are expensive. That's how they get their expense. having been in that world and seeing all the pitfalls and whatnot that can happen in that world, I've now come around to think this is actually like this, what we're doing with Paradigm, this is actually how you get that value. And this is how actually how you get patients healthier and happier and less expensive.

Dr. Maryal Concepcion: 45:06

With you guys being able to, go to the break room and shoot the S word, but also talk about health care when it comes to, Dr. Ortiz, you mentioned how, you didn't have any qualms about how you knew Dr. Benson and the rest of the team at Paradigm practiced, how do you guys collaborate on patients in terms of if Dr. Ortiz, you see somebody who is a patient or who is going to become a member at Paradigm for the family practice portion, and you're like, You absolutely need everybody on planet earth encouraging you to do X exercise, eat this, not eat this, whatever it is. How do you guys collaborate for the patient's benefit?

Dr. Staci Benson: 45:42

So, to remind you, we have just started this, so while we have plenty of ideas for how we are going to do this, I, there are examples of it, I will be honest, that we have been doing this for three months, so, previous to that, we still collaborated, but we just would text each other or call each other when she'd see one of our patients or we would need help with something. So, it's really, we're using our tech. Thank you. You're welcome. We're using our tech stack to do that. So yes, sometimes we'll be in the office, like right now we could reach out and touch each other and then go, whether we're shooting the S or eating a cookie in the break room together and talking about our patients. Today I joked that Dr. Ortiz saw somebody and then our PA went and saw her and then I was curling my hair in the bathroom and. I saw her again as we interacted in the bathroom, so she had all levels of her care taken care of today, her chronic wellness for primary preventative care, her rheumatology care, and her urgent care needs, all taken care of in the one office. But with our tech stack, we're able to save messages, internal messages back and forth in a texting service that we use and then in our EMR, we're able to put like a virtual. So we're able to send those internal messages back and forth if we need to have that communication, we don't get to have a direct communication about somebody like, Hey, I really need you to push this. This is really the biggest problem here. And then, of course, just reading our own notes.

Dr. Liz Ortiz: 47:01

Yeah, I would add. And I mean, it is true that we just started. I've been a part of various different kind of multidisciplinary teams. And I do think that Where we're going, as the panel gets bigger, as we include other types of specialties and not just medical specialties, but dieticians and other things that the patients can benefit from is having regular multidisciplinary teams where you talk about those Or team meetings where you talk about the particular, particular patients who are having difficulty and kind of making sure everyone on the team is on the same page, because in a previous practice I worked in, that's what we did. And that really just, it gets the patient where you want them to go so much faster whenever they're hearing the same message from multiple different people.

Dr. Maryal Concepcion: 47:45

When it comes to a multidisciplinary team, we mentioned how Dr. Benson opened as a solo micro practice. It's very different now. You guys have Dr. Musick, Dr. Patel, you have Kristen, the PA, you have other staff on board. So when it came to bringing Dr. Ortiz into the fold and clearly like lots of different things, lots of different workflows, potentially medications potentially macros or dot phrases for your electronic health communication. How did you guys come together as a team beyond the two of you in terms of, all right, so this is now what we're doing. We're going to try to feel these things out. And do you guys have regular meetings to just really take a pause and then see if those, see if workflows and whatnot are working going forward.

Dr. Staci Benson: 48:30

So we did when we, when I informed everybody that this is what we were doing and what we were bringing in we had a small, quick meeting because everyone was like what are we going to do? How's this going to work? And then after we had a few patients roll through with what we thought was going to work, we were continuing to tweak everything. We did have a giant team meeting where we had it as a, right. We also happen to move spaces. Right. At the same time, all this was happening and had two people go out on maternity leave all at the same time. So it's been a fun last few months. But we did have a team building time where we are rheumatology and how we interact with these patients and how that affects our workflows was a big piece of that team building day. Because of people being out for maternity leave, we have not had our follow on a follow up on that, but yes, Other than having single employee talks, the goal is at least once a month, if not once a quarter to be able to have those meetings, but that's not even, that meeting's not even just for rheumatology. It's for everything, right? And making sure all the flows are working and where we'll be having problems, what do we need to edit? So we do that. We just, again, it hasn't been long enough. We'll have to have a follow up in about six months and see what changes have happened from then. Thank you.

Dr. Maryal Concepcion: 49:44

Done. So, so excited for that. So now that you guys are collaborating, even though it's been a few months when you guys think about what DPC and direct care are allowing you guys to do, give the audience some examples of what you are able to do, even as a primary care doctor and a rheumatologist who are Working in the cash

Dr. Liz Ortiz: 50:04

pay space. Well, I would say the biggest thing is that I'm no longer getting kind of the chronic stomach pain I was getting in my old life. It's not that it's. All roses and butterflies. It's still a lot of work. And especially whenever you're trying to build something that's new, like a partnership like this, it is a lot of work. And thinking and collaborating and hustling. And so it's not necessarily like every day you shut off at five and go. Play pickleball or do whatever like you still are working hard, but it's the agency that you get to have over your own time and the decisions that you get to own as opposed to having to work for someone else or. Having to kind of follow rules that you think are ridiculous and some admin and the hospital has made up. And so that's what helped with the stomach pain. It's not necessarily that. Oh, I only work three hours a day. It also has allowed me to kind of pursue other. other interests I have in the world of rheumatology, you know, I'm very interested in communication and teaching. And so I'm able to do that via my social media channels because of the time I have because I'm in direct specialty care.

Dr. Staci Benson: 51:17

And if y'all don't know, she is a YouTube star. So everyone should check out her channel. She gives great tips. Our patients will love it's getting to actually learn more about rheumatology through her YouTube channel and her other social media platforms.

Dr. Maryal Concepcion: 51:31

It's called Connected Rheumatology. And I'll make sure that's linked in the blog accompanying their podcast, so definitely check it out.

Dr. Staci Benson: 51:36

I Have to reiterate what Dr. Ortiz said, right? Like it is not easy any day of the week by any means. But I am making it what I want it to be. And then when it starts to evolve and something that I don't want it to be, which do not get me wrong has happened more than once over the last 10 years, I then have the ability to start. Seeing what's wrong, what's creating that burnout, that stress, and undo it. And it's not like a simple light switch. It definitely takes strategy to undo it. But I can, and that's the beauty of it. And even when I see it happening, I'm, I am the owner, but when I see it happening to our employed staff, I am working to try and do that same thing for them and have those open communication with them so that they don't feel that same way either. And then as a mom I do have four children in the age of age three. Five, six, and nine. It has allowed me balance take that back. I don't like the word balance. It has allowed me harmony. I hate the word balance because balance implies things are equal on a scale. Right. And things are not equal. They're never equal. Exactly. So it allows me to give more like today and having to figure out how the heck I was gonna get three kids to dance today at all different hours and from three different schools. I did it with the help of a babysitter, my mom. And a neighbor, not my husband. If you hear this bill, not you did not help today. But it allows for that harmony or that push in the poll. And I make sure that my kids not only see what mom is doing so that they can be proud of me, maybe not today, but at one point in their future. But so they can understand how, what it's going to mean for them to be a, hopefully a business owner themselves someday in the future.

Dr. Maryal Concepcion: 53:10

we are making our future paths and not. Waiting to see how many patients are triple booked on our schedules. So I think that's you know, it's absolutely for our future generations in terms of like our kids and their kids But also just for our colleagues I think that they're really able to see and identify and reflect on their own lives in part because of what we're doing. If you had to describe your personality as a type of food What would it be and why

Dr. Staci Benson: 53:37

we laughed really hard about this question and had some really good jokes So we could share with you on what food it would be but I decided that I am queso because well first off We're from Texas. So it's the most it's the food staple here And it is one of the most important things you need in your life It doesn't have great boundaries. It just slides all over your plate. But it can also change with what it needs to be depending on the day. It can be spicy. It can be bland. It's queso. And we all crave it. That was another one. We all

Dr. Liz Ortiz: 54:10

crave it. Yes. We all need a little queso in our life. Mine is kettle corn because I'm sweet and also salty.

Dr. Maryal Concepcion: 54:19

Love it. And then if you could have dinner with any historical figure, who would that be?

Dr. Staci Benson: 54:24

Let me go first. I'll go first. This to me, this was a really easy one. So I'm on, I love musicals. So I'm on a Hamilton kick again right now. It comes on and off. So Hamilton, I would love to meet Alexander Hamilton, right? How did he work with being as intelligent as he was and, but not be egotistical? Well, he was, but not egotistical where no one was willing to work with him and was able to find compromise with others without compromising his own self.

Dr. Liz Ortiz: 54:51

Oh man, that's a good answer. I don't, I can't think of anyone historical, okay. I'm going to think of someone and that person is I mean then I'll say my mom So yeah, I lost my mom about 8 18 18 years ago. So I'd say my mom

Dr. Maryal Concepcion: 55:10

I think that's super special. I am sending lots of hugs and love through the phone because yeah, it's January is the anniversary of my dad's passing. And I totally understand that one. So that's awesome. But yes I am so grateful for you guys to come onto the podcast today. I think this is fantastic that you guys are paving the way, there's no surprise there in terms of you guys have. Decided that you want to own your future through the direct care and direct primary care way. And I think that this is amazing what you guys are doing. So I hope it really inspires people out there, especially as we go into a future where, we can work together to just take care of patients.

Dr. Staci Benson: 55:49

We hope people enjoy this and they like the idea of merging and building this direct care home together. If you have any thoughts, positive or negative about it, please reach out to us. That was actually what started this conversation with Marielle was, is anybody else doing this? Because There are plenty of other thoughts and opinions out there that I'm sure we have not thought of and we would love to hear them.

Dr. Maryal Concepcion: 56:15

Thank you for joining us for another episode of My DPC Story, highlighting the physician experience in the world of direct primary care. I hope you found today's conversation insightful and inspiring. If you want to dive deeper into the direct primary care movement, consider joining our My DPC Story Patreon community. Here you'll have access to exclusive content, including more interview topics and much more. Don't forget to subscribe to My DPC Story on your podcast feed and follow us on social media as well. If you're able, I'd greatly appreciate if you could leave us a review. It helps others to find the podcast. Until next time, stay informed, stay healthy, and keep advocating for DPC. Read more about DPC news on the daily at dpcnews. com. Until next week, this is Marielle Conception.