Joining Forces in Louisiana: Infinity Health DPC

Today Dr. Karl Hanson and Dr. Samia Suleman of Infinity Health Direct Primary Care in Kenner, Louisiana share about their DPC journey. They share their experiences transitioning from insurance-based models, and the evolution and benefits of DPC. Dr. Hanson and Dr. Suleman discuss the challenges of establishing and joining a DPC practice, their personal motivations, and the importance of physician autonomy. The episode also covers the partnership between the doctors, the structure of their practice, and their future plans, including efforts to educate medical residents about DPC. Additionally, the formation and goals of the Louisiana Direct Primary Care Coalition are highlighted, emphasizing the potential of DPC to transform healthcare across the state.

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Transcript

Dr. Maryal Concepcion: 1:25

Direct 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 fingertip. 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 Conception. 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. Samia Suleman: 2:13

DPC means to me, freedom, autonomy, and having the best care for my patients.

Dr. Karl Hanson: 2:22

Direct primary care has the potential to change medical care in the United States, like no other institution or facility can. Primary care physicians have the unique ability to break away, to start their own practice, to reject the notion that big hospital systems are necessary, big insurance companies are necessary, and maybe even that they're hurtful. That we can reestablish the relationship with the patient on an individual basis. And we as a group of primary care physicians in the direct primary care model, can guide the country to the healthcare that we think is best. We know best. We see people every day.

Dr. Samia Suleman: 3:09

I'm Dr. Samia Solman

Dr. Karl Hanson: 3:11

this is Dr. Carl Hansen of Infinity Health Direct Primary Care, And this is our DPC story.

Dr. Maryal Concepcion: 3:17

Welcome to my DPC story this week, guys. I'm so excited because I am doing this interview in person with Dr. Carl Hanson and Dr. Samia Suleman, who are at Infinity Health, DPC here in Can Louisiana. I have not been to Louisiana before this trip, and it is so exciting that we get to chat right after the energy of the DPC summit. So thank you both so much for joining us today.

Dr. Karl Hanson: 3:40

Thank you for having us.

Dr. Samia Suleman: 3:41

We're so happy to be here.

Dr. Maryal Concepcion: 3:42

Dr. Hanson, I'd love to start with your story of the, the, the day that you opened DPC in Louisiana. What was the environment like? Because there's a lot more DPCs now than there were when you opened

Dr. Karl Hanson: 3:56

it. It was an adventure. It was not a common thing in Louisiana. There may have been just one other DPC practice that was opened a few months before I opened Infinity Health. Wow. So there was, some discussion about it. But quite honestly, at the time I opened my practice, literally the previous year, I knew nothing about direct Primary care.

Dr. Maryal Concepcion: 4:16

And what year did you open?

Dr. Karl Hanson: 4:18

2016. Yeah. Is when I converted from my insurance based practice to direct primary care.

Dr. Maryal Concepcion: 4:23

And your insurance based practice, was that a private practice where you part of a group?

Dr. Karl Hanson: 4:27

It was private practice. I was in solo insurance based practice. Yep.

Dr. Maryal Concepcion: 4:31

And what was your scope of practice and how many years were you in that private practice before transitioning?

Dr. Karl Hanson: 4:38

I've been in solo practice since 1990. Mm-hmm. Spent a couple years outta residency working for a, a multi-specialty clinic and then got irritated at that and went solo. And I've been in the insurance based practice ever since. Yeah. As a solo practitioner.

Dr. Maryal Concepcion: 4:53

because of that history, especially with you going from a multi-specialty group to solo. What did you see in terms of how insurance was changing over time at your practice and for your patients before you went to DPC?

Dr. Karl Hanson: 5:09

Well, there's a, a big story to that is I'm actually one of the founding physicians of a Medicare Advantage plan in the state of Louisiana, and that started in the late nineties as we built that plan. In the process of being part of that plan, I was witnessing more how the sausage was made. About the different regulatory burdens that are gets placed upon us. And how it kind of became a, a behemoth, and then that just amplified some of the. The, the game, I never got involved in the RVU game. Because I was never employed, but I did get to see more and more that the whole CPT challenging game was just not something I wanted to continue to do.

Dr. Maryal Concepcion: 5:52

Absolutely. And how did you see it affecting accessibility for your patients once Medicare Advantage went live and once insurance, did what it did over the last couple of decades?

Dr. Karl Hanson: 6:04

Well, accessibility. I even at the insurance days, I had a relatively small practice, so I was able to see people whenever I wanted to remember I was my own boss. So I could do that whenever I pleased. So accessibility was not a big concern of mine. the major concern was that I really wanted to do primarily patient care. Yeah. And not even be concerned about the the administrative game that we've all acquiesced to.

Dr. Maryal Concepcion: 6:34

Absolutely. So now I'll turn the mic over to Dr. Soloman because I'd love to hear your, your foundational story when it comes to what was life before life at Infinity for you?

Dr. Samia Suleman: 6:47

Well, so I had the good fortune of meeting Dr. Carl relatively early in my career. After residency I spent a year, my husband and I in Ireland. I spent two years practicing medicine out there. So that was quite the change and, it was a great learning experience for the both of us. Returning here I again, had the good fortune of meeting Dr. Carl and I was doing insurance-based practice as well as dabbling in a little bit of DPC. Mm-hmm. Having a hybrid practice a little bit. Wow. So we shared an office and I got to learn a lot more about DPC, how it works and I could see firsthand all the troubles of the insurance based practice the hassles, the, chasing after trying to get paid, things like that. So, um, it was a, a great learning experience. We joined forces about a year and a half ago. that was a great turning point for me. I enjoy what I do so much now.

Dr. Maryal Concepcion: 7:38

I would love to hear what you saw and if anything that you saw overseas in a different healthcare system also impacted the way that you looked for how you would continue to practice when you went back stateside.

Dr. Samia Suleman: 7:52

Well there was a lot of autonomy, so I thought that was great. There was a lot of room for learning Where I was working. I was at the University Hospital Limerick. And it was an acute medical unit. It was a mixture. You would have some people that had insurance and then some people that were funded by the state. You really didn't turn people away which was great. That included, seeing patients for DBTs, seeing, working up mis it was a hospital-based practice.

Dr. Maryal Concepcion: 8:16

And when you talk about that you knew Dr. Carl early on, I would love to hear what you saw from your eyes and your perspective, because I think that this is a time where medical students and residents are really seeing what we're doing because there's so many more of us. It's easier to find resources compared to when, when you opened Dr. Hanson. So I would love to hear what it was that was impactful for you to see. Especially for those listeners who are new to this movement whether they're, talking to their friends or seeing their attendings do DPC, what did you see that helped inspire you to eventually be a DPC doctor full-time?

Dr. Samia Suleman: 8:54

During residency you had the option of rotating with Dr. Hanson. I graduated 2014. It was a new concept. It was enticing. It was, can this really happen? So it was, it was a lot of different emotions

Dr. Maryal Concepcion: 9:06

Dr. Hansen, I wanna turn the mic over to you now because this is fascinating to hear. And you're you went to LSU for residency yourself, correct?

Dr. Karl Hanson: 9:13

I did. I went to LSU Medical School and then LSU Family Medicine Residency. Yeah. Yeah.

Dr. Maryal Concepcion: 9:18

And so I'm wondering similarly how I asked about the insurance over time engaging with residents over time. What have you heard from them in terms of what am I going to do after residency? What is out there? Am I able to be, you know, a full scope doctor if I wish to? What are, what are some of the things that you've heard from residents because Dr. Soloman was one of your residents before?

Dr. Karl Hanson: 9:40

Yeah. In, well, when I talk to residents and, and I'll go to residency programs and give a talk and I don't talk about. Thrombocytopenia. Sure. Or Antiga. I talked to them specifically about how to start a practice. Yeah. Talk about the, the, the joys of private practice and owning your own business. So that's actually been my focus with interacting with residents. The, the, what I tried to transmit to them is, again, a lot of times as we're getting close towards the end, they talk about finding a job. Yeah. And I just reiterate, reiterate, you do not define a job because you make your own job. That we have to quit looking at ourselves, coming from a, from a sense of, of barrenness or helplessness, et cetera. Mm-hmm. That we need to assert ourselves because we are the main cog in, in, in taking care of patients. So that has always been my focus. Biggest obstacle is that of course, these guys and gals have probably never run a small business. Sure. They're petrified, they're, they have debt overhanging. There's nobody else that surrounds them, meaning in academia or their hospital rounds, who is giving them information on how to start a private practice. Yeah. And the fact that not only is it possible, but it's ideal.

Dr. Maryal Concepcion: 10:54

And when people are, mentioning these fears about finances, about, I don't have an MBA, how do you start breaking down that, that mindset of I'm just a physician. I, I'm not a business owner.

Dr. Karl Hanson: 11:08

Right. Yeah. I, the main thing I say to run a small business, you don't have to have an MBA. Mm-hmm. You just have to be able to pay attention to detail. And the fact that you've made it through pre-med med school and a residency. Probably one of the things in your talent stack is it'll be able to pay attention to detail. And know also that probably some of the people that you went to high school with went, didn't go to college and right now are running their own small business. Totally. So don't, don't diminish yourself, don't mean yourself. And then just giving them the realization that, to become a physician, you sort of have blinders on. You're not paying attention to some of these business things out there. It doesn't mean though that you can't pick it up in short order. The first bit of advice I give to them, when you're thinking about doing a small business, don't think about the small business and that fine detail. Yeah. Do baby steps. Start a process first. Think about what do you wanna call your practice and your logo. Sure. And that's all. Yeah. And don't think, and once that seed sort of gets planted, then you're gonna start. Inching up and learning bit by bit what goes on. Then also I, it, I have an open invitation if any of them want to start a small business, small practice, I'll personally help them. With no consult fee or anything. Just to walk through everything. Yeah. So

Dr. Maryal Concepcion: 12:26

that's incredible. So, Dr. Soloman after coming back from Ireland, what made you go the route of leaning more and more into DPC versus opening your own DPC versus just going fee for service? Urgent care? There's so many pathways that we can take as physicians, and I also intentionally say that because if you are worried about DPC financially, definitely having a side gig is one of the ways to help finance A DPC. But for you, what was your journey in how you made the decision to become a doctor at Infinity? So,

Dr. Samia Suleman: 12:58

I also come from a family of physicians. My father's a surgeon. My mother's a pediatrician. My sister's an ob, GYN. they all were in, very much in support of me being in an independent practice. Sure. My father's always been in private practice throughout, and he has kind of been the held out, not being bought out by the hospital. Yeah. I do do wound care as well. So I have a side gig amazing with nursing homes and, and doing some wound care there. But the way I chose doing DPC is I had started with having some insurance-based, patients and things like that. It was just the ease Sure. And the attraction of not having to worry about paperwork. Not having to worry about all this overhead, getting all these prior auths, having all this, all this trouble with being regulated so much. And I would see the way Dr. Carl would work and and his patients everyone's happy, at the end of the day. And I would still have paperwork and stuff going on. Sure. And I was just starting. Yeah. So it was kind of, seeing so much so much ease

Dr. Maryal Concepcion: 14:00

and I'm wondering if you could both talk to, any, concerns, fears, or challenges that you had after deciding to start DPC? Because Dr. Hanson, you, at the time, like you mentioned, DPC was not as much of a thing as it is now. And Dr. Suleman, you you're, yes, you're seeing a better way to do things, but especially for somebody who's graduating residency when most people go to employed medicine in a corporate situation I, I would wonder if each of you could share any challenges or fears you had before you started your DPC journeys?

Dr. Karl Hanson: 14:33

the challenges and fears I had. The apprehensions, let's say, were that you were taking a. Steady book of business. Mm-hmm.'cause you have to run a small business, means you have to pay bills and et cetera. And I was going to just throw all those 10 90 nines away from the CCAs and, and just trust and hope. That a sizable fraction of my patients would stay, sign up with me. So some of it is a personal reflection is that if, what if nobody signs up? That's not just a monetary insult Of course. But that could be sort of a personal gut punch that nobody wants to stay with you. So when I made the decision, which was a relatively rapid decision after going to the 2015 DPC summit, after two months, I was all in. Primarily, most of the anxiety I think was my wife was. Not quite comfortable. And we were both nervous, maybe not nail biting, but there was that apprehension about taking an established business and leaving and changing the model. Yeah. I think that was a major apprehension. Otherwise the, the positive aspects of it was what maintained the drive to continue and actually pull the trigger on it.

Dr. Maryal Concepcion: 15:46

That's awesome. And I will ask here, what ended up happening once you transitioned to DPC? How many of your patients said, great, what you just tell me where I need to sign, what I need to pay and how many of those people were, asking about, like, what are you doing and how many of those people were saying. Nope, no insurance. Not going

Dr. Karl Hanson: 16:34

well, the first several months leading up to the actual check, when I put out the announcement, I would casually talk to my patients, hypothetically if somebody does, et cetera. So I was getting it a vibe or a feel for it before I really came on the final decision. So, it's hard to give a percentage Because you don't know, if you see a person once a year, once every three years, are they your patient? But I, I know it was, it was revenue neutral for sure. In other words, the income I lost from 10 90 nines. Yeah. Not coming in from Medicare and et cetera. Compared to the enrollment that I have, it was, it was a little north of actually revenue neutral. So I don't know. I never actually went back and calculated. I'd probably say maybe I had a. 35% conversion rate, maybe 30%. That's fantastic. But I never really drilled down on it'cause it didn't matter. Yeah. Just moving forward.

Dr. Maryal Concepcion: 17:25

Absolutely. And how many patients did you start with on day one? Or did you, onboard them slowly so you didn't have all of your patients just transitioning over? Because some of those, some people out there are concerned about that in terms of transferring their private practice to DPC, like Dr. Michael Chun has shared on the podcast before. But what was it like for you, because you owned your business, you owned those records, and then you just were doing a different business model?

Dr. Karl Hanson: 17:53

The bulk of my patients at the first month or first instant of direct primary care practice were patients that I already had charts on who already had a relationship that were just moving over from my prior sole proprietorship to my to Infinity Health. So these were people that. Didn't have to be all of a sudden taken in on the first month. Mm-hmm. So the people that signed up, I may have actually just seen them literally a month before in the insurance based model. I didn't face that challenge of a, a large volume of people coming in that were new to me or anything.

Dr. Maryal Concepcion: 18:32

That's really helpful because as, as we go forward, there will be people who are wearing very similar shoes as you were when you transitioned into DPC. So, Dr. Silverman, you're graduating and you're looking at your co-residents, you're looking at the classes before you you're. Probably hearing a lot of physician recruiters'cause I sure did. What was going on in your mind when it comes to challenges or fears or apprehensions about the world ahead of you when it came to DPC?

Dr. Samia Suleman: 19:00

I had done my year in Ireland two years in Ireland. And so I had come back once I had came back and so. My apprehensions before transitioning to DPC. Were, is anyone gonna join? Is anyone gonna continue? Yeah. Took a lot of deep breaths. I remember walking outside and, can I do it? Can I pull the trigger? It was, and I, I'm still working on this and it's, it's not selling yourself short. And a wise person tells me that. And that echoes with me all the time. And it's remembering not to tell yourself short. It's completely a journey. And I think you get the reaffirmation once you see your patients. Yeah. And once you get the, the affirmation from them that they are so happy. Yeah. They're so thankful. They are so grateful and it pushes you forward and it says, I am doing a great service. They are happy and it

Dr. Maryal Concepcion: 19:48

just keeps you going. Amazing. And Dr. Hanson, I'll ask the same question of you. When did the discussions with your wife change in terms of we got this.

Dr. Karl Hanson: 19:58

Well, the, the DPC summit I'm referring to was in the summer of 2015. Mm-hmm. And may mentioned before that when I was there, I was telling myself, I'm not doing this. This is not for me. And within 30 days, 60 days, that turned 180 degrees. Yeah. And of course we talked a lot. My wife and I talked a lot about it. And, fortunately she's excellent listener and, and excellent advice giver. And good advice, not just any advice. So, we came to our conclusion pretty rapidly. Mm-hmm. Within the first few months after the summit. Then there was a bit of the angst about the, the, the bells and whistles and the particulars of setting it up and how to write the letter and when to, that kind of minutia, if you will. But the, the major, the major psychological transition took place within. A few months after the summit.

Dr. Maryal Concepcion: 20:53

And I'm wondering here if now you guys can talk to us about Louisiana because Louisiana is different from Ohio, is different from California, when it comes to what the healthcare access is like, what the quality of care is like, who provides the healthcare? So talk to us about Louisiana as a state in terms of, what, what is the medical care like around here, and especially around Kenner and New Orleans area.

Dr. Karl Hanson: 21:18

Medical care in Louisiana, Louisiana's primary rural, of course you could say that about a lot of states. there's, there's a fairly significant Medicaid population. And the, in the suburban area of New Orleans, which is where we are there, there's been an adequate selection of primary care physicians. I think that that's been okay. Mm-hmm. I think the, the change has been more recently where hospital systems have, have gobbled up practices and have also changed their model to a nurse practitioner based type of primary care where it, it's difficult for patients to actually Interact with their MD or do mm-hmm. Without some layer of insulation. And then of course urgent cares pop up the, with, with, with is a poor model because you're enticing people to, to get lesser care Medicaid individuals. I would say, and, and I would preface it, Medicaid individuals are some of the most fun folks to take care of because a lot of people who have Medicaid, they may not be able to get an appointment with their, with their physician for a month. Yeah. Or three weeks at the soonest. And so, we all know in the medical world what that can lead to. So it's nice to be able to really help somebody that on the, on the day of their illness, not three weeks after their illness.

Dr. Maryal Concepcion: 22:50

Absolutely. And how about you, Dr. Soloman, when it comes to who you saw in residency? Because as Dr. Hansen's talking about more recently. Nurse practitioner, non-physician provider models. That is absolutely a thing we're seeing in most states. And when it comes to Medi-Cal and California Medicaid around the country how was it for you in residency just

Dr. Samia Suleman: 23:12

It was a mixed population that we saw in residency. Mm-hmm. But it majority were Medicaid and, yeah. And, and and just to talk about how that translates to DPC practices. We have a mixture of patients. Mm-hmm. So we have patients with deep Medicare, Medicaid, Medicare no insurance at all. So what I love about DPC is you can see a wide range. It's not just, that we are seeing like a concierge model that it, we're only seeing super wealthy patients mm-hmm. Or anything like that at all. We're seeing a wide range of patients who are interested in

Dr. Maryal Concepcion: 23:43

great care.

Dr. Karl Hanson: 23:45

Yeah.

Dr. Maryal Concepcion: 23:46

And yes, I, I love that because it really highlights how insurance is not healthcare. Right. And that is something that we are educating people about every single day so I would love if you guys could talk about new patient coming to the practice, has maybe ish heard about direct primary care. But is very much still, like, I believe insurance is healthcare. How do you guys talk to them? A lot of people are, we're practicing their elevator pitches at the DPC summit, so I love how you guys talk to new patients about this practice versus the fee for service world.

Dr. Karl Hanson: 24:19

So talking to new patients, people that have joined us somehow or another, they've already had the discussion or, or talked to, not necessarily us. Mm-hmm. But a friend or family member. Sure. Who's engaged with us. So somehow or another out there the friend or family member has already done the elevator speech for us. So at that point now when they come in for their initial visit, sometimes it's meet and greet. Yeah. But usually they'll just join. Yeah. They know. And, and now we're just sort of embellishing and enhancing what the specific details are about this.'cause maybe they have some misconception or something like that. But I, yeah. A lot of the ones that get referred by others, the, the others have done a fairly good job, word of mouth of bringing them up to speed. That's, and that's really great. Now the sale. If you will, to individuals who have no contact. Yeah. We all know that game because that's, it is sort of like three levels of elevator speech, so the one between floors one through 10, 10 to 20, 20 to 30. So there is a bit of a challenge in that. Yeah. We still have people that when you briefly mention it to, they'll say, oh yeah, I have a friend of that. You're M-D-V-I-P. And so sure we all have to face that battle as of doing that part. But yeah, the patients that come in, they've been, they've been a little education already from their friends or family member. Yeah.

Dr. Maryal Concepcion: 25:44

And on that point, the M-D-V-I-P-I, I've definitely heard that a lot more while in Louisiana compared to in California. And I'm wondering how do you guys differentiate? Because in usually we hear, oh, it's concierge, but how do you guys specifically talk to the differences between M-D-V-I-P and direct primary care through independent physicians?

Dr. Karl Hanson: 26:03

Yes. The thing is he said, oh yes, I hear Dr. Hansen that you're, I see you're in concierge. So I have to say, well, maybe the umbrella term concierge, but probably you're referring to a model that's a national company called M-D-V-I-P. Yep. And then they'll acknowledge that and I, and I'll just tell them we don't double dip. Yeah. We only get the monthly fee from, from the patient as per contract. And that includes all services. Mm-hmm. We do not do any extra billing or collecting for, for visits. And specifically in Louisiana, by law, we do not collect, we do not bill any third party. Mm-hmm. We do not bill insurances. So it doesn't matter to us what your insurance is. Yep. I'm not sure that that promotes direct primary care so much. That's kind of more of a technical definition. But yeah, we do have to address that. When we get lumped into every other form of concierge. Sure.

Dr. Maryal Concepcion: 27:02

And I think it's important, especially now with the passing of the Primary Care Enhancement Act as part of the quote, big beautiful Bill. This is where, Jake Hess of the DPC coalition has said, and I agree this is where the work starts, because now that we're, even more visible than before now that HSAs can be used without question for DPC member agreements this is where I believe we have to keep fighting for this is what we actually do. We are not the same as fee for service. We are not the same as concierge medicine. And this is for everyday Americans to access the same level of care without having a seven figure salary or without having to go through your employer. So, Dr. Sillman, how about you? Because as Dr. Hanson's speaking and, and you did have you, you mentioned the concern about like, will patients join. How has your elevator pitch, so to speak, changed over time? Because I, I'm, I'm assuming you have to have some patients who knew Dr. Hansen's model, who said, oh my goodness, like there's a new doctor. He might be on a waiting list. Like, I, now I have a chance and I'm sure is heck gonna take it.

Dr. Samia Suleman: 28:09

Yeah. So my elevator pitch is ever evolving but essentially it's it goes with we provide the services that you need. I'll start off with the issue. Are you having trouble speaking to your, getting in with your physician? Are you having trouble? Do you find that it's hard to get an appointment when you need an appointment? And we present the problem, to them and they'll say yes, actually. My mom, I can't get her in. And by the time it is time for her to get in, it's, she has to be admitted. So, I start with, I start with that, and then I work around, well do, with, with DPC what we can do is, you have access to your physician seven days a week. You have a personal physician. It's bringing back the, the doctor patient relationship essentially. Yeah. And they're very attracted to that. And most of my patients love the fact that they can message me, Hey, Dr. Tillman, I'm having sinusitis. Sure. I'm having, I feel like I'm having an ear infection or, and I will respond to them right away. You can come in. We have same day, next day visits. We have a very affordable membership fee and along with that we include our labs and we also dispense. So there's so many perks and. They are just, they, they love that.

Dr. Maryal Concepcion: 29:20

Yeah. And when you talk about membership fee, how did you Dr. Hanson create the membership fee and has it changed over time? Because nowadays people say like, oh, the, three clinics around me they charge this much, so that's about what I'm gonna do. But how did it work for you

Dr. Karl Hanson: 29:36

At the time that I was doing the, the transition into direct primary care? I recall seeing some published data, what the average fee was throughout the country. Mm-hmm. And I was, as I recall, it was$77. Mm-hmm. Something to that effect. And then I factored in. Okay, well that also includes places in the northeast and the coast and stuff like that, where just things are more expensive. I chose less than that. Mine was$65 a month. Mm-hmm. I maintained that for a long time. About two years ago, I increased it to$75 a month. And I don't want to go more than that because part of this, I, I do know that I, that we could be charging more. I do know that. But part of the concept is that, do you want to keep this at the level that is attractive to people? That separates us from the typical concierge model and that the average person would find it clearly affordable. Mm-hmm. And anyway, so I, that's how it started. It was probably because I looked at the, what the average was in 2015. Sure, sure. Whoever published that, I don't recall who that was. Yeah.

Dr. Maryal Concepcion: 30:51

And in terms of the concern about affording direct primary care, we've had Dr. Stephanie Phillips on the podcast, she's in the poorest region of all of Georgia, and her patients are paying on average$75 per month to make sure they have access, as Dr. Silverman talked about to their doctor who they know, versus one trip to the ER is more than 12 months at$75. So, can you guys talk to us about the, the money conversation when it comes to the patient who says I, that's too much. I, I can't afford that.

Dr. Samia Suleman: 31:22

definitely talk about how your Netflix bill, your your electricity, just, just things that you do or going out to dinner or things add up and you don't even realize it. But also there are payment plans. There are things we can do to, to prioritize and we try to make sure that we emphasize that your health is a priority mm-hmm. For patients. And once they realize, what the benefits outweigh, saving a little bit more so that I can spend on my health, it makes a big difference and it goes a long way for them.

Dr. Maryal Concepcion: 31:55

Mm-hmm. And. Have you guys heard the, well, healthcare's too expensive because I usually have to pay$200 for a thyroid lab. Like, I, I, I can't add another membership fee on top of that. What do you say to those people? Because they aren't necessarily aware that you can purchase lab and imaging at, prices that are wholesale like you could at the grocery store.

Dr. Samia Suleman: 32:14

Right.

Dr. Maryal Concepcion: 32:15

So we,

Dr. Samia Suleman: 32:15

we do have contracts with, with the labs and we do let our patients know that. And a lot of times our patients, that that is a big draw for them. But there are people who do have an issue with the the comp, the, the monetary aspect. And for them it might not be a good fit at this time, but they're always, they always have you in the back of their mind. And that's the other thing is that. Not everybody. It's not for everybody. Not saying that, I mean, we do, do, we do will make concessions for people and like, again, like payment plans, things like that are always options. But if someone truly has a problem and, and can't, it's nothing that we had to force on them.

Dr. Maryal Concepcion: 33:12

Yeah.

Dr. Samia Suleman: 33:12

And

Dr. Maryal Concepcion: 33:13

I think this is really powerful because we own our own businesses. We're able to not have to wait for, 16 committees to tell us it's okay or for some code to change to have a covered service. It, it's when I remember when I was in fee for service, I would just call a family because their family member was just diagnosed with cancer and they're the care provider and they're losing their minds as well as the patient. It's like, I have no idea what code that is, and now I'm grateful that I don't have to care. Yeah. It just do the things and you just get to be a doctor. So I'm, I'm wondering here in terms of. You guys partnering together? I love this because we need more DPC doctors out there. There's not enough and it is not that we are creating the shortage. The short is being, shortage is being created, a physicians being out there because of the system a hundred percent. If you do not agree with that, please leave me a voicemail. But when it comes to you guys partnering together this is absolutely a thing. You do not have to open up your own DBC. It is not shameful to just partner on with somebody. There's people doing just locums coverage. Dr. Brewer Everly had somebody come on at Fisher Health Clinic and cover as a locums while he was waiting to graduate residency. And so, I'd love if you guys could talk to us about how you guys made this partnership at Infinity Work and decide to do it. Take that,

Dr. Karl Hanson: 34:36

yeah, I'll take this. The. So I really believe in direct primary care and that it's a wonderful privilege to be able to take care of somebody. Yeah. And I did want to see direct primary care expand mm-hmm. To have more offerings. And technically I wasn't what I would consider full, but I knew, I knew Dr. Samia from before. Mm-hmm. And their, her work ethic and her just ethic in general. And even though she didn't have a, this large subset of patients to import to the practice, I said I wanted to get somebody that was, that was conscientious Sure. And kind of understood, what the problem was out there. So that was really the genesis of the of the partnership. You want to get somebody who's a partner that you can trust who shares the same ethic. That's kind of more important as. As opposed to what residency they came from or this kind of thing. Yeah. So that was the genesis part. So we could, we could expand the offerings of, of, at that time, my company, infinity Health, expand it to, to other people out there in the world. So that was, that was really the genesis from me.

Dr. Maryal Concepcion: 35:49

Yeah. And how about for you, Dr. Soloman? Because when a person is looking to join a DPC I, I, I wonder what your thoughts were. Oh, I, this apprehension is less because he's already open. What, what, what were examples of things you were thinking about when you were when you were looking to, and when you finally decided to partner on an infinity? So, I, I brought over maybe eight

Dr. Samia Suleman: 36:15

patients from when I transferred over. And but having a great mentor like Dr. Carl was, was. Is key. Absolutely.'Cause I could see how how he was working with his patients and how his patients are extremely loyal and, he has a great following. And for me it's an inspiration to work with him and to, to share, to be partners and be in this partnership with seeing the work ethic and seeing how, how I treat my patients. And it didn't, it's, it's taking, it does take it, it is taking longer than I had expected, but my panel is growing and I'm happy to say that my patients are very satisfied. And, they give their testimonials and they, they're very pleased with the model. It is just a lot of more of awareness that we have to get out that DPC does exist and that there are different options other than the insurance based model. And I think that's something that we all need to work on. Yeah, absolutely.

Dr. Maryal Concepcion: 37:12

And I would love, because you are partnering I would love if you could talk to the audience about what things do you recommend people either think about when they're joining on or think about when they're hiring.

Dr. Karl Hanson: 37:27

it's like EMR software. No matter how many times you look at the demo, you never really know until you're three months into it. And then you say, what just happened? And, and that's the same way with with finding out who's a good partner. So again, my advantage was, is that I had known Dr. Samia for years one way or the other before this. Mm-hmm. So you, you get a better sense. So I would say in looking for a partner is to look somebody who shares the work ethic and the ethic towards patient care. Mm-hmm. And it's, I, I, I didn't give her a quiz. I didn't have her take the uh, licensing exam again or anything like that. So you can't really go with that because it's a direct primary care is a mindset, it's an attitude, it's an acknowledgement of what's wrong with the system. Yep. And who the players are who are degrading the system. Mm-hmm. It's a bit of a rebellious attitude. So you, you're looking more for personality characteristics in, in my opinion,

Dr. Maryal Concepcion: 38:35

and how about you in terms of what questions would you recommend people asking if they're looking to partner on at an existing DPC?

Dr. Samia Suleman: 38:43

Again, I wouldn't say there's questions to ask, but more is it a good feel? Is it a good mix? Do you, do you get along? Do you feel like there's a mutual respect? It's more of a feeling.

Dr. Maryal Concepcion: 38:54

I think that, than any questions. And I'm wondering if you guys can Talk to us about the legal structure of the DPC partnership. Did you guys partner or is one of 10 99

Dr. Karl Hanson: 39:05

it a full partner? Yeah. The, the, when I invited her in, it was the full partnership. There, there were those, and, and I did research employee 10 99 type of relationship. Mm-hmm. But I, I felt that. I, I just felt like it was better just to demonstrate that, that confidence and that trust mm-hmm. By taking, taking, creating a full partnership. And, and I'm glad it it's been that way. I mean, I, I, I don't, but that again, that's because I've had a chance to know her before, wasn't an acute situation where I had to take time to assess somebody's character, if you will.

Dr. Maryal Concepcion: 39:47

Absolutely. And Dr. Tom White, very similar situation as he intentionally looked for partners and not employees. Just because that, that's also what he believed in, in terms of somebody having a career that is literally just DPC and they have the autonomy same as us who open our DPCs on our own. When it comes to benefits for yourselves health plan benefits retirement, how do you guys address that at Infinity?

Dr. Karl Hanson: 40:12

Well, I am. 66. So I'm a Medicare. Before that I was on a health share Uhhuh. I used to be on, my wife and I used to be on one of the typical Bcca policies. Yep. And we jettisoned that several a few years ago. Mm-hmm. And joined one of the health shares. My wife has still on the health share, but I aged into Medicare. So, and I have not joined a Medicare Advantage plan. I'm just trying Medicare. So, that's, that's how I handle

Dr. Maryal Concepcion: 40:43

And what about savings for retirement?

Dr. Karl Hanson: 40:45

I'm A-D-P-C-D doctor, why would I wanna retire? The saving, well, I've long had as a solo practitioner, a simple IRA and that's what we have here. Yeah. So now we're all, we all are in the, the simple IRA.

Dr. Maryal Concepcion: 41:00

Yeah. Fantastic. And how about you, Dr. Silverman, for your healthcare? And also did it provide you a sense of security knowing that there was this addressing of an IRA? Because some people are coming on and they're like, we don't offer a 401k, we don't offer any retirement. We don't offer healthcare. How was it for you? Yeah, for my

Dr. Samia Suleman: 41:17

family we do have insurance currently not very happy with it, but you know, we're looking at health shares and things like that now. Mm-hmm. As far as of course there's security and, and the having a retirement plan and things like that. So that, that's always an attraction also. It gives you a sense of security. It gives you a sense of this is something that I'm working towards and this is for my future and for my family's future. Yeah. Awesome.

Dr. Maryal Concepcion: 41:43

Now, this weekend, not only was it the DPC summit, but also the Louisiana Family Academy of Family Practice Medicines state Summit, which is Dr. Hanson and I talked about this before that, this is probably unusual that they have a state and a national event at the same weekend, but you were going between the two. And I'm wondering if you can talk to us about. What it's like on the LAFP, I almost said CAFP, the LAFP side of things because I wanna like envisioning, just asking you that I'm like, there's stranger things and then there's the upside down. So I would love if you could tell us your experience.

Dr. Karl Hanson: 42:24

Okay. So this would be the the second podcast. The, the LAFP. So I've been a member of the Louisiana Academy of Family Physicians for 41 years, and I'm involved with them, not administratively, but I'm actually in charge of a program of developing a module, kind of a go-to module for people that, that physicians that wanna start an independent practice. Fantastic. Whether that's coming outta residency or whether it's leading, leaving the, indentured SI mean, employment. So I, I have a lot of involvement with the LAFP and lots of friends over there. And it's kind of my home organization, if you will. It was kind of fun going back and forth between that and a direct primary care conference.'cause there's quite a contrast, quite a contrast. The everything from the exhibitors to the atmosphere to the presentation. Now granted, one's a national organization, one's a state organization, and the state group does a very good job at their, at their assembly. But yeah, it's a different vibe. There's so many ways to describe it as a different vibe, but both are valuable. But the, the DI Direct Primary Care summit just kind of has a way different energy. Yeah. But that's probably the best way I could describe it. I, I, I, I think that. There was just a mistake with the A FP that they scheduled it the same day and it's never happened before. Sure. And it's not that way next year. Yeah, they're separated next year. Yep.

Dr. Maryal Concepcion: 43:57

And how about you, Dr. Soman, because clearly you were at the summit as well, but when it comes to talking to colleagues it, it is a very different conversation. Sometimes it's really uncomfortable to have talks about DPC because some people I've heard, like they literally will say it's because of DPC that we don't have enough physicians. It's because of DPC. And I'm like. Say, say all the things, say all the things, and we can prove as a movement that these things are not correct. I actually have not

Dr. Samia Suleman: 44:25

run into that at this point yet. People are actually fascinated by our model and, and what we're doing. So I get a lot of positive feedback and I'll get a lot of questions about how does it work and, how does one transition and things like that. A lot of a lot of doctors are fed up with the system. Absolutely.

Dr. Maryal Concepcion: 44:43

Yep. So, Dr. Hansen, this is definitely a question for you because of your involvement 41 years at the as an LAFP member I, I definitely see now, way more education on the California side of things of what DPC is, especially for the people who are, very seasoned in fee for service. Very, we only do fee for service. We could never do DPC. Kaiser will never shut down the naysayers. When it comes to. The challenge of getting DPC representation at the state level. When it comes to even inclusion in conferences, how do you bring the voice of representation of direct primary care physicians and what direct primary care physicians in existence means for this academy. And how do we help DPC doctors in addition to you creating education resources about the model at your state level?

Dr. Karl Hanson: 45:40

I think the major hurdle at the Louisiana Academy Family Physicians is, is for them to weave DPC in as a, as a forefront model. Mm-hmm. There are, there are certain things that would be in conflict with, for example, the typical sponsors mm-hmm. That are at that, for example, of course at the LAFP event, some of the exhibitors included insurance companies, employers, et cetera. Obviously there was none of that at the Direct Primary Care Summit. Yeah. And I think. Sponsorship may play a role in that. Sure. I've tried to address that and probably I should be a bit more aggressive in a polite way with, with the local academy about bringing up practice models more. However, like I said the resolution that I presented to the academy two years ago to develop this independent practice model, it was well received. That's great. And it was, it was embraced, I would think. And we're working on it. It's not ready for prime time yet. And I wish I probably could have done it on my own in less than a year, but you have to go through this system. So I think it's getting there. Also recognize there's a lot of docs in employed practice that are in the Stockholm syndrome. Mm-hmm. And, and part of the Stockholm syndrome is that you almost deny the existence that there's something better to do. Yeah. And. You certainly don't wanna, at no time do I demean anybody who's an employed practice.'cause it's almost a compassionate empathy Sure. About what they're going through. So you, you don't want to be aggressive. You kind of want to just keep yourself out there, offer yourself as a resource. It's kind of like, I'm here if you need me. Mm-hmm. Type of thing in private. And I had, I had two employed physicians come talk to me at the LAFP in private about what is this? Yeah. And what can I do to get there? So that's kind of what the level is now that, we're there for you if you need us. I'm not gonna berate you. We understand we've been there. So, that's kind of the level of position I take.

Dr. Maryal Concepcion: 48:02

Yeah. And I, I love this because next I wanna ask about the Louisiana Direct Primary Care Coalition, because I think that what Oz, we are resources out there. I think that there's such a swell in the desire to know about DPC from physicians, new existing attendings, attendings who've been in practice for decades. And this is why, like we created our California DPC summit. Extremely important to know how do you do DPC in your state. And so tell us about the Louisiana Direct Primary Care Coalition and where do you see that going in the future?

Dr. Karl Hanson: 48:36

When I started infinity Health in 2016, the following year, I created a coalition. We only had probably half a dozen DPC doctors in the state at that time. And so I, I created the organization but did nothing with it.'cause I felt like we didn't have any critical mass. Mm-hmm. And it, I converted to a a 5 0 1 C3, but it's still, nothing has taken place with it. Well, right now in the state, we have 20 physicians that provide direct primary care to their patients. Probably 17 or 18 practices, but some of those practices have, a couple or few physicians. And then also with the fact that the, when the big beautiful bill was debated, there was a discussion about Medicare. Mm-hmm. Medicaid, excuse me, and DPC. Mm-hmm. And then of course there was the whole HSA insertion into that law. And so this year I felt it was worthwhile to actually, that we had the critical mass to get that going. So the coalition it and we're forming our board as we speak, the coalition is, is there to promote direct primary care. In Louisiana to demonstrate to Louisiana Department of Health that we can provide excellent services to the Medicaid population and make their health better and save the state money. And also to promote the proliferation or adoption or education of direct primary care within our academic facilities. So it's not a coalition that's gonna be setting rates or telling what DPC doctors do. Mm-hmm. That's not our vibe. Yep. We're, we're, we're all lions and cats, not sheep, so we don't want people telling us what to do. Sure. The coalition's certainly not going in that direction. But anyway, the major focus is to promote DPC in the state. And to offer our services and demonstrate to the state. And finally, in Louisiana, we have a, the Department of Health is very friendly to that and very look forward looking. Was really great to talk to the Surgeon general and the assistant surgeon general amazing discussions and we want to go ahead and promote that.'cause we think we have a lot to offer.

Dr. Maryal Concepcion: 50:51

Fantastic. And where do people go to learn more about specifically the Louisiana Direct Primary Care Coalition and does it also accept medical students and residents?

Dr. Karl Hanson: 51:02

Right now we don't have membership. The website is a d pcc.com. But, and we, we, we don't even do dues or anything like that. So, there's gonna be more to come, if you will. Once we, once we have some. Sort of strategy meetings and figure out where we want to go. Mm-hmm. But the, the website is open, I mean, any, and there's a contact email address, et cetera. So, And people have contacted me through that to discuss direct primary care in general.

Dr. Maryal Concepcion: 51:33

That's great. And I think it's so important, especially now because. That was lovely that two people talked with you in private at the LAFP summit, but it is so important to have resources out there. So many people find rotations just networking through our cali dpc.com site for our California Direct Primary Care Coalition. So I think it's so important that if you're listening and you, are having these discussions anyways, it's really great to come together because I think that even more so in the future, again, like I mentioned, the work really starts now. This is how we really come together as physicians protecting the physician patient relationship. So, I would, I

Dr. Karl Hanson: 52:12

would love to graduate to where you all are, where you're having a California DPC summit. So I'll be reaching out to you all to figure out what I don't need to reinvent the wheel, what tips and tricks that you may have.

Dr. Maryal Concepcion: 52:25

Absolutely. So can you tell us what do you see for the next, year, three years, five years at Infinity Health DPC?

Dr. Karl Hanson: 52:33

once, once our panels get full or are starting to approach that I would like for Infinity Health Direct Primary Care to be more involved with, with teaching residents. Mm-hmm. To create a center of excellence of some type here where, where residents can rotate with us in more depth and detail. Of course, a lot of that's controlled by the the graduate medical age education board how much, what residents have to do. And some of that's actually gotten, we're a little bit worse this past year. So we're gonna be, have to fighting that battle. But it's, it's the same thing about talking to other practicing physicians, talking to residents and just say, look, hey you, you don't have to just start signing up with big boxes. There's a real option that you can go through, and there are a ton of people out here, including Infinity Health and myself and Dr. Samia, that we will help you every step of the way in developing your business and developing your practice

Dr. Maryal Concepcion: 53:38

Incredible. Dr. Sullivan had to step out, but thank you so much on behalf of my DPC story for both Dr. Hanson and Dr. Sullivan. Thank you guys so much for sharing your story today.

Dr. Karl Hanson: 53:46

Oh, thanks for having me. This was, this was excellent.

Dr. Maryal Concepcion: 53:52

Thank you for listening to another episode of my DBC story. If you enjoyed it, please leave a five star review on your favorite podcast platform. It helps others find the show, have a question about direct primary care. Leave me a voicemail. You might hear it answered in a future episode. Follow us on socials at the handle at my D DPC story and join DPC didactics our monthly deep dive into your questions and challenges. Links are@mydpcstory.com for exclusive content you won't hear anywhere else. Join our Patreon. Find the link in the show notes or search for my DPC story on patreon.com for DPC news on the daily. Check out DPC news.com. Until next week, this is Marielle conception.