"We don't want those people here."
That was the response Dr. Jeff O'Boyle got from a human resources director when he asked about helping patients with addictions through recovery. It was also how O'Boyle knew it was time to quit the large regional health care system he was working at.
"I was disgusted with the entire system at that time," O'Boyle says. "These people (with substance use disorders) are my friends, my family, my colleagues. To say they don't want them in there was not acceptable to me."
So last year O'Boyle opened Beyond Primary Care, located at 2500 Packard St., Suite 105 in Ann Arbor. His practice is one of only a handful in the U.S. to offer "direct primary care," where patients pay their caregivers directly without insurance company involvement.
Adult patients pay O'Boyle between $30 and $90 per month, following a tiered pricing model that increases with the patient's age, for unlimited visits. Children 18 and under are $15 per month when at least one parent is also enrolled.
Other items such as bloodwork and prescriptions can add up for patients, but O'Boyle's practice makes that more manageable as well by offering in-house labs and prescriptions at cost. O'Boyle says his mission is to "create time and space for my patients without unnecessary overhead from insurance."
The model also allows him to provide personalized care in a way that isn't often available through large health care systems. O'Boyle notes that several minutes of a traditional 15-minute doctor's appointment are spent on greetings, doing intake, and taking vitals.
"Then you're left with maybe 10 minutes or less of face time in front of a doctor. What can I talk about in good honesty in eight or 10 minutes?" he asks. "I have a hard time talking about a common cold in 10 minutes, let alone someone's anxiety, depression, cholesterol, or diabetes. It's a really nasty cookie-cutter approach."
O'Boyle says he wants to build trust with patients and help them feel comfortable having deeply personal conversations, which he never felt able to do in a hospital-based health system.
"If I spent an extra 20 minutes talking about a deep and personal issue with one patient, I'd be behind one and a half patients, so somebody's care was (getting shorted)," he says.
That personal connection is also valuable in treating people with addiction issues. O'Boyle says about two-thirds of his patients come strictly for primary care, and the other third come for substance use treatment. He uses a medication-assisted approach to recovery, offering oral or injected medications that help reduce cravings and assist in recovery, but the conversation with the patient is also important.
O'Boyle recently had a patient who couldn't admit even to family members how much he was drinking, hiding vodka in a plastic drinking bottle while at home and even at work. That patient told O'Boyle he was afraid his regular doctor would judge him, but he was able to open up to O'Boyle.
"Once he'd been in recovery for a little over a week, he was able to tell his significant other about the issue and work toward lifelong recovery," O'Boyle says. "It's about creating an environment of healing."
One of O'Boyle's patients, Chris Martin, says he became a patient at Beyond Primary Care after hearing a podcast about the direct primary care model. He found O'Boyle's practice through a directory on the website for the national Direct Primary Care Coalition. Martin's children are also patients with O'Boyle's practice.
"The payment model ... feeds into a whole different patient experience," Martin says. "You're not locked into a fee-for-service mentality. If I have an issue, I can contact him and talk on the phone, or text or email him. Oftentimes, that's all you really need to resolve the issue."
Martin says that's a big advantage over the traditional model where you might have to take an entire day off work for a doctor's appointment, but only get to talk about one issue during the visit.
"I don't push it on people, but if it comes up, I share about it, because I don't think many people are aware that the model exists," he says. "It not that I think it's right for everyone. It's primary care, and (O'Boyle is) not a specialist. But there's still a lot a primary care doctor can do, and that's the tremendous value of the model."
Sarah Rigg is a freelance writer and editor in Ypsilanti Township and the project manager of On the Ground Ypsilanti. She has served as innovation and jobs/development news writer for Concentrate since early 2017 and is an occasional contributor to Driven. You may reach her at firstname.lastname@example.org.
All photos by Doug Coombe.