Direct to Patient Healthcare

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Stewart Gandolf: Hi, everyone, Stewart Gandolf here and glad to have you on today's podcast today, I'm going to interview an old friend of mine who has been a thought leader in healthcare for a long time, and I first met Lee when he was in charge of social media and a real innovator in social media at Mayo Clinic, and actually you were guys are like, kind of the founders of the whole movement. You guys gave the credibility for other hospitals to follow suit. It sounds crazy now, but back when you started, Lee.

Lee Aase: And it was. It was scary. Yeah, for some folks, and you know, and I think my, you know, my role was, I started at Mayo clinic in public affairs on the media relations team in 2000, and then 2003 became manager of the media relations team, and then 2005 heard about this new thing called podcasting at the time which had been invented a year before.

Lee Aase: And so that's when I used what I like to call the proceed until apprehended model of innovation. We had a 60-second radio segment that we were providing on a syndicated basis. And I said, Wow, you know, I, this is all to create a podcast all you need is an RSS feed connected to an audio file, a source of audio files.

Lee Aase: And this was about a month after Apple created its iTunes podcast directory. And so, I said, how hard could it be? I got somebody from our web team to create an RSS feed. And we had the segments already on the website.

Lee Aase: And it was about 2 months later I got a call from the Technology Commercialization group at Mayo, saying we got a request from Pharma from this Pharma company that wants to advertise in our podcast. Do we have a podcast?

Stewart Gandolf: I never knew that you never told me how this.

Lee Aase: So yeah, so I kind of had to backpedal away. I am, cause I. All I had done was taken our existing resources that were already on the web, you know, got the mail click logo put in the iTunes, podcast directory. And anyway, I went to look in the podcast directory and iTunes and our podcast was on the front page.

Lee Aase: And I went and looked at our server logs. And I found that our downloads had gone from 900 a month to 74,000 a month in one month.

Lee Aase: So, this is like 2005 and so that caused us to take a step back and say, okay, this was not the ideal podcast this is kind of a hypochondriac feed so as opposed to our extended conversation, and you having the topic all related, I mean, this was heart disease. One day, cancer, another day. You know, it was, you know, sort of great for the mass audience, but not so much for the targeted, focused audience. So, we took a step back and looked at, you know, what would it take? You know? What should we do with this new media?

Lee Aase: Because my main job was, you know, dealing New York Times, Washington Post, national TV, you know, other regional TV and newspapers.

Lee Aase: And so, it was hard to justify. So how much should we be spending on this versus the like, what I was mainly supposed to be doing, which was the big media.

Lee Aase: But we came up with a strategy, and then we just sort of nudged our way into things over time and then around 2009, just based on some of the success we'd seen with some of the YouTube videos we'd done and some of those other projects. I made the proposal to create the Mayo clinic center for social media.

Lee Aase: As a way of, you know, kind of in keeping with how the Mayo Brothers had done old fashioned analog, social networking in the 1920s, 1930s, visiting lots of countries when they had to go by ship and by air airplane and trained to get there. The fact that you could make these connections instantaneously with electronic tools. And like you could broadcast without an FCC license. And how cool is that? So, we got that approved. And we I got to add 8 new members to our team and actually create a new team. That was our social media team.

Lee Aase: And as a result of that, I got to travel to a dozen countries on 5 continents, and probably 45 States. And essentially, we were. As you said, it was a scary thing back time. Because people say, What about HIPAA? You know? What about with social media, when all this? Well, what we could say was, when people are going on Facebook, they're putting their own information out there. It's not us doing it, you know. So, it's not like it's a. And so, because I had the experience with getting people to sign releases for patient stories that we were pitching to traditional media. It was sort of a natural progression there and then there were people, you know, in other hospitals

Lee Aase: who were trying to get their leadership to say they were saying, Hey, we should have a Facebook page and their leaders would say, Well, that's stupid. Why, we want to do that. And then they'd say, Well, Mayo Clinic is, and they'd go, oh, okay. And so that's why we created what we then called the Mayo clinic social media network

Lee Aase: as a way to kind of monetize our leadership in a sense, but also to do the things we wanted to do like. We wanted to be helpful to our colleagues who were looking for guidance and help and community

Lee Aase: so that was a great time to get to do that. And we, in addition to annual conferences that we held at Mayo clinic. We did 2 conferences in Australia and one in Dubai.

Lee Aase: And it was just a really great, a really great experience, and really set the tone. And because I'm really grateful for that, because it set the tone for me to be able to do the thing that I'm doing now, which is. I took early retirement from Mayo Clinic in August of 2021 to found a company called HELPCare, LLC.

Lee Aase: And our, and this is in in collaboration with a high school classmate of mine who's a primary care, doctor.

Lee Aase: We had the idea of creating a direct primary care clinic in Austin, Minnesota, which is our hometown.

Lee Aase: and my, you know, just sort of as our vision has evolved.

Lee Aase: We want to help. I you know we so 5 years ago in in October.

Lee Aase: Dr. Dave Strobel and I got together for coffee, and he told me about this clinic where he was working that was owned by the Pipe Trades Union

Lee Aase: and where he talked about like the employee. The Union members don't have to pay for their office visits. They don't have to pay for their lab tests. If they go there for care, it's free. There's nothing out of pocket.

Lee Aase: And I said, Wow, wouldn't it be cool if we could have something like that in Austin, but well, like where anybody could just buy a membership you didn't have to be belonged to a particular union.

Lee Aase: I didn't know there was such a thing as DPC. At the time. I had never even heard of it. But anyway, I went back to school to get my MBA in healthcare management online during that time.

Lee Aase: and then took that early retirement to found this company. And we're the Management Services company for Spark Health, PLLC. Which is a professional limited liability company, because as a non-physician, I can't own a medical practice.

Lee Aase: but I am my wife and I are the majority owners of a of the Management Services company whose role is to let the doctors and other practitioners do their thing, and we take care of the membership, acquisition, and all the other business stuff, the administrative stuff.

Lee Aase: which is very much like the administrator, physician, leadership, partnership that we had at Mayo Clinic. So again, I've learned a lot of lessons from my work at Mayo. And this has given me a chance to have a third career that Lord willing, I hope, will be another 20 years where I'm able to do this and hoping for more impact in this than what we, what I had in my last career.

Stewart Gandolf: That's great. Well, again, congratulations. I've known you for a long time. And yeah, I think it's hard for people that weren't on the healthcare that are newer to healthcare now, to recognize how hard it was. I were interviewing Ed Bennett again, if you remember, Ed used to keep track of which hospitals had a Facebook page.

Lee Aase: Yeah.

Stewart Gandolf: We eventually already had it. But that was the thing. Oh, we have 2 more high like it just wasn't that way. And hospitals notoriously conservative and doctors far more so. And so it really is some of Mayo like when we would work with clients, we would you had, and I sent a couple of my people to your trainings. But you know it's like if Mayo does it, it must be okay. It's like it was.

Lee Aase: Sooner.

Stewart Gandolf: Very real.

Lee Aase: But it's American air cover for folks. Yeah.

Stewart Gandolf: But you know what we were talking before about. I'm gonna jump to what you're doing with traffic primary in a sec. But I'm gonna wrap that up. You know, it's one thing about, you know, because we were talking offline earlier about Cleveland, which is why I flub there and then, Mayo. Those 2 respected institutions. Both look at themselves as leaders in healthcare, like they really are at the forefront. They want to be pushing the envelope, which is a lot of hospitals. Don't feel like that at all right. It's not their DNA, but it definitely of all. Mayo is the respective one for that.

Stewart Gandolf: But you took some little risk there doing that. I think it must be a little like that.

Lee Aase: Yeah, it was. I mean, it was.

Stewart Gandolf: Little others over there, but I'm just like it's that you did it. We'll move on, but I'm just.

Lee Aase: Yeah, I mean.

Stewart Gandolf: All that.

Lee Aase: Yeah, it was. It was there were there were definitely were a few times when I had

Lee Aase: Well, actually, there was one time when I was I got a call from our department chair at the time, and he said, Yeah, there's a lot of talk, because the crazy story. If you got a second I would.

Stewart Gandolf: I do. I got.

Lee Aase: A little. Yeah, a little bit how this it was. Just I mean, it's just kind of fun to relive because I had a talk with so we had conjoined twins separated at Mayo Clinic, and as part of that I got to really know a couple of the reporters from the Minneapolis Star Tribune, who were covering it an extended way, and one of them called me on a on a Friday, and said or well, I said, you know you were talking about Twitter, and you were using Twitter. And how do you even do that like? What? What's that even for this, back in like 2008. Okay.

Stewart Gandolf: Yeah.

Lee Aase: And I said, Well, I'm flying out. Actually, I'm flying to Baltimore. I was, I had, you know, met up with Ed Bennett back then I was there, speaking at a conference. I said, I can stop by on the way to the airport, and we can.

Lee Aase: We. I can talk to you about it, and so I did. You know I did that and got back, and then on, I remember, it was Good Friday.

Lee Aase: she texted. She sent me a direct message on Twitter, saying we'd like to do a story about you guys using social media at Mayo Clinic, and I'd like to follow you around for a day.

Lee Aase: I was saying, oh, crap! Now I gotta find something interesting to do. And so, it's like, so we decided to hold our first Tweet camp

Lee Aase: then, so we had. It was an hour long, you know, gathering

Lee Aase: where we got some of our public affairs staff together, and a few doctors, and we just

Lee Aase: took them sort of through Twitter one on one.

Lee Aase: anyway. That was scheduled for the following Wednesday on Monday. I believe it was over. The weekend

Lee Aase: Henry Ford Hospital had done the 1st Twitter surgery like they were tweeting from the OR And so, Roger Serlo from ABC. News was calling around to various outlets today because the story had been on CNN. And he wanted to do something on ABC about using social media and healthcare

Lee Aase: and so the person who was on press call called me and said, So do we have anything I said. Well, we're doing Tweet camp on Wednesday.

Lee Aase: and so on Wednesday we had both the Minneapolis Star Tribune and A. And a camera from ABC. And I think I got an ABC World News Tonight because of it as well.

Lee Aase: Anyway, the following week I was out in Philadelphia for another conference, and I got a call from my department chair. And he said.

Lee Aase: Yeah, there's a lot of lot of talk about you being in the media. And this, you know, these stories and stuff. And I said, Is it okay? He said, Oh, no, it's great, you know, because Mayo does want to be the leader. Okay. But we at the same time we have this had I speak we in the past tense. But we

Lee Aase: as Mayo there's this. Well, the physicians are the leaders. The physicians are, you know, and you know we don't have a star system or anything like that. And so but yet what happened with that? What helped me be able to do this well is that the external credibility helped the internal credibility? Because, you know, if you are being recognized, if we're being recognized, I got a front page story in the in the Minneapolis Star Tribune, in the business section with a picture of me.

Lee Aase: And so it's like, Okay, now, we're the leaders in this. And so that gave me a little bit of momentum that we could then apply toward kind of continuing to push the envelope.

Stewart Gandolf: Okay, so I'm gonna pivot. But I just gotta say one last call to this. I love that Lee, so much. I love that because and it's funny as our agency has grown. I have a

Stewart Gandolf: Our counter. The persons in charge of all of our client service is fascinated with me, because I've always been very scrappy as an agency. We've always just like

Stewart Gandolf: let's go over there. Let us do it, and he comes from a much more buttoned up background, which is great. We need that, too, right? We have a full.

Stewart Gandolf: My God! So, I love that because he loves the innovative side of me, I love the discipline side of him, but that was a lot that was pretty. That's an even better story than I realized. And we talked about this a little. But that opening story. Because, yeah, it's really hard to relate to if you weren't around then. But it's was very different. And you know you took those risks and you jumped out. It's like, Oh, it must be okay. But if you'd ask if they probably said no, so.

Lee Aase: Right, yeah.

Stewart Gandolf: Wait a minute.

Lee Aase: Like to say it's proceed until apprehended, which is the other way of saying, You know, ask for forgiveness, not permission, but if it, if it works well, then you don't have to ask for forgiveness. So.

Stewart Gandolf: Yeah, I like that pursue until apprehend it well to remember that I love it. Scrappiness, even at the Mayo clinic. I can't.

Lee Aase: You know.

Stewart Gandolf: So, let's talk about direct to primary care. So, you mentioned earlier. You weren't familiar with it a few years ago, and I actually first became aware of direct to primary care. When I was co-writing a book with Dr. Mark Tagger, and we were writing about cash, pay, health care, and so.

Lee Aase: Back and forth.

Stewart Gandolf: I'm sorry. Oh, you do.

Lee Aase: Yeah, exactly. Yeah.

Stewart Gandolf: You read our book, Killer? I didn't know that.

Stewart Gandolf: I should have asked you to sign up for Forward back, but

Stewart Gandolf: so I wrote that book with Mark, and in that was the 1st time I really I'd heard of direct primary care, but I had to study it to speak to that, because the books brought into Cts,

Stewart Gandolf: direct primary care, it's broader. But I I'm intrigued by the model, and the reason I'm super excited that this is what you're doing. And, by the way, I was bummed when you told me you were taking retirement like no, I love.

Stewart Gandolf: and I was so excited to reconnect with you. But so my own little story on this is beyond figuring out that this exists when I was writing my book and understanding the difference between primary care which I'm sorry between concierge care which I'll come back to.

Stewart Gandolf: It's funny, since you might. You probably have no, at least read the book. And maybe you know, Mark, I asked Mark, my wife is having, you know, sort of

Stewart Gandolf: menopausal premenopausal stuff which she's not embarrassed me to say, actually wrote a book or wrote a blog post about sensitive marketing topics. So it's in my blog. But you know. So she said, I'm just not getting it with my primary care. And so Mark referred her to a cash pay only not really director primary care, but a cash pay only functional integrative medicine, doctor. True, MD, but just sort of outside of the system. And so it's been really intriguing to watch.

Stewart Gandolf: you know, like, and she's better. She's doing great. And so, you know, like for the like, all the tests. And in this case, all the tests and all the different things she had to go to a cardiologist over here, and a gynecologist over there, and

Stewart Gandolf: you know, do this and that. We did that under the insurance. So we just paid cash for her advice. She was like the quarterback unofficially, and we just, you know, fortunately, can afford to have her, too. But let's get back to. So, I love this model like I said. I've been aware of it for a while, but now I have a friend who's leading a clinic, which is all to keep in touch with what you're doing, and I know talk about later is pretty innovative. Well, let's start off by for our audience. Some of them probably know this. Well, some probably don't just talk about the direct primary care model. 1st of all, contrast it, perhaps, with traditional.

Stewart Gandolf: you know, sort of a primary care, and HMO versus a concierge medicine versus, you know whatever, and particularly with concierge, where I think sometimes it gets confused, like some of the differences, so help us there to define.

Lee Aase: Yeah. So, I mean, I guess I'll just say what our direct primary care model is. And I think it's we have kind of a special model of it, but it's

Lee Aase: The big difference is that we don't take insurance.

Lee Aase: so, there's no insurance payments. So, because of that, we don't have to have 3 people like me fighting with insurance companies to get paid, and where you're jacking up the price and to negotiate it down. And there's all this cat and mouse kind of game being played.

Lee Aase: You're getting a relationship. You're getting a relationship with a practitioner. Doctor, PA, or nurse practitioner.

Lee Aase: Who, you know, and where you have unhurried appointments. So, we have a maximum of 7 appointments per day, you know. So instead of the 15 min treadmill where you only have time to. Oh, you have high cholesterol. We gotta get you a statin. You have high blood pressure. Let's get you something else for that. We're able to have our practitioners spend the time to get to know the patient and get to know what their preferences are and what they want to do? And are they willing to make some of the lifestyle changes that can actually be much more powerful in solving the problems instead of just a pill for this, and a pill for that, with, you know, conflicting side effects.

Lee Aase: So that the nature I mean the fundamental nature is that when you have the member paying the for the membership, they are the boss like they're the ones who are in charge, and it's not dictated by now. We deal with some pre authorizations because people do have insurance still. So, we can talk a little bit later on how that relates with it. But the majority of our members have either a Meta share or a Samaritan ministries, or some kind of health sharing plan, or they have insurance through their employer.

Lee Aase: Or they maybe have an Obamacare exchange plan. But they just say, Hey, this is the kind of care that I want to get, and it's and one strategy that they might take is take a higher, deductible and pay less for their insurance.

Lee Aase: and then hope, you know and believe that by being proactive with their health and getting good primary care, they can prevent the need to get, you know to be paying, you know, retail prices through the big box insurance or big box, you know, medical centers. And we're running it through the insurance.

Lee Aase: So that's really the fundamental essence. It provides predictable revenue for the practice, because people are paying a monthly or annual membership

Lee Aase: in our particular brand of it. We don't charge for office visits, and that's pretty normal. Sometimes you'll have. You don't pay for phone visits, but you pay. Have a Copay for an office visit.

Lee Aase: but we wanted to set it up, that it would be no pay, no, no charge for office visits, and we do more than a hundred lab tests as needed.

Lee Aase: At no charge.

Stewart Gandolf: That's great!

Lee Aase: So, where we have a group purchasing agreement where we can get the labs really affordably. So, our price point, we've got a couple of different price points 3 different price points. Actually, we've got an acute care one, an acute care plus, an annual physical with a dozen lab tests that would cost a thousand dollars in the insurance based system for $99 a month, and then we're at $149 a month for what we call healthcare premier, which is our, It's mainly for people who have, you know, repeated needs things like they're managing thyroid medications or their type 2 diabetes, and we're working to help them get their medications adjusted. They need to see a practitioner more often on a scheduled basis versus just the acute

Lee Aase: and so having those 3 levels enables us to, yeah, meet the meet people where they are, and we don't have it based on age. So, a lot of direct primary care practices have a you know, 18, and under 18 to 45, 45 to 64, and 65 and up.

Lee Aase: we don't do it. Based on that. We do it based on what the members need is and what they perceive their need is going to be, and part of what we hope we'll do is some of them might start with Premier because they've got a lot of stuff to get sorted out and if we get them after a year to a place where they could get by with an annual physical, then they can downshift to the middle tier.

Lee Aase: and it's win win. Because then, yeah, we're helping them get healthier, which is sort of the like. How novel is that that we don't get paid more when we but we see a lot.

Stewart Gandolf: That's awesome. So how? So, people are probably more familiar with concierge medicine. And there's some similarities. Do you see any clear differentiations? Besides, the fact that concierge is more expensive.

Lee Aase: Yeah, I mean, I think that's the main thing is, this is sort of like a blue colla concierge medicine. It's kind of what I mean, essentially, what we're doing is giving people the Ritz Carlton experience for the Holiday Inn price.

Lee Aase: That's all that. It's the yeah.

Stewart Gandolf: Yeah, what is the like? Can you share, like, kind of rough, the rough range of monthly fees that patients pay for? Like, either you guys, or just generally, for direct primary care.

Lee Aase: Well for us. We range from $39 a month for that acute version. The healthcare, quick to $149, is the current rate for the Premier, which is the top end. I think, in a lot of direct primary care you're gonna see it in the 60 to 75, $80 a month range.

Lee Aase: But again, they're then they say, well, but we'll give you discounted lab tests, or they'll and part of what we want. Our philosophy is, we want people to not be afraid to go to the doctor.

Lee Aase: We want them to cause. There's a lot of people that have a $5,000 deductible, and they're functionally uninsured because they have the protection in case they get hospitalized. But it's all out of pocket. I'm just not going because it's gonna be $250 for that one test.

Lee Aase: And so the fact that we can wrap it into the membership takes away that barrier to being seen.

Stewart Gandolf: That's fantastic, and from the doctor's point of view, I bet they love practice. The doctors that work with you guys.

Lee Aase: They do. Yeah, I mean, it's…

Lee Aase: I'm not gonna say leisurely, because they work hard. Okay. But it's not the hectic. Oh, how am I ever going to catch up on my notes? Because I'm seeing, you know, 15 or 20 people per day, and then having to do all the documentation around it.

Lee Aase: and not really feeling like they get to, you know, have a human conversation, and really relate to the to the patients.

Stewart Gandolf: So, I've seen the American Academy of Family practice write about this. Is this a big trend in primary care? Do you see this as I mean, it's been around for a little while. But is it like exploding or is it just a kind of slow.

Lee Aase: I think it's really growing significantly. If you go to DPCnation.org that's got a mapper of DPC practices.

Lee Aase: And they say they're the 250,000 people nationwide are getting their care this way or getting primary care this way, and I think they're a thousand or 1,500, or something like that. I don't know exactly how many.

Lee Aase: but I was just at the Free Market Medical Association Conference in April that was held in Oklahoma City.

Lee Aase: and direct primary care is especially in the self-funded Health Plan Level Funded Health Plan World

Lee Aase: it really is the cornerstone, because it's the you know, having good primary care causes you to get A not need as much specialty care, but B. Then to not be already locked into a big hospital system that's going to be driving all the traffic to their own specialists. There's a chance to have a conversation about cost and quality in deciding, you know, where you'd like to go.

Stewart Gandolf: So that's this is a cool concept, like I had a I got switched to a drug during Covid. I have asthma as a kid, but it's never I go running the mountains. I'm like, it's controlled drugs.

Stewart Gandolf: and I had a new primary care, doctor. My blood pressure was up, and she's immediately telling me to go to stats like wait and my wife's like what's new. I'm like that new prescription. And when I called her, I said I did. A telehealth was before she's ready. She's like, I know you're healthy, and you're young and not young. Youngish, I guess, but.

Lee Aase: Yes.

Stewart Gandolf: Yeah, but you know your blood pressure is high and like you're probably just one of those people that has to, you know for whatever reason. My.

Stewart Gandolf: well, I have this new medication I'm taking. Oh, well, that can't be it like, can you go check? Can you look? And she's like, Oh, yeah, that one actually does cause high blood pressure. So I went off of it. And so, lo and behold, I don't have high blood pressure anymore. But that's you know, most people don't have the ability to self-advocate, or they you know. They just assume. The doctor says I'd be on statins now so like. But I think, and in fairness to her, you know I'm new to her, but she doesn't have the time to like really do that. And so, I would bet that same doctor might have been able to find out or dig a little deeper if she wasn't under that constant pressure because they didn't have to do it. The way they're doing is, there's a lot right? You've got the PAs and MPs that handle descriptions and prescriptions, and you've got the

Stewart Gandolf: scheduling. And who's acute? Who needs to come in right away? It can be an annual physical. And you know, there's a lot. So that's a.

Lee Aase: Yeah, there's yeah. There's protocols and guidelines, and they get paid based on their adherence to guidelines, you know. And if they're seeing this situation. They're saying, well, that I gotta check the box. That cause I only have 15 min or so. I'm going to check the box and say why I recommended to statin, you know, because and so a lot of conversation, what's that.

Stewart Gandolf: That's defensive medicine, too.

Lee Aase: Anyways, yeah, it's that, too. Yeah.

Stewart Gandolf: So I'm not here to complain about it. Today. I've done it before another podcast but not today.

Lee Aase: What's that?

Lee Aase: Is not.

Stewart Gandolf: So your doctors like your patients like it. Probably insurance companies aren't thrilled. I want to talk about insurance in a moment because you have some cool models you're working with. But you know one argument I've heard about concierge more, which is, there's validity to us like wait in a time of you know, staffing. Or, you know, healthcare shortages, we're doing less patients, not more patients. So how does that impact the broader population? Do you have any thoughts on that for director primary care, because you can still see a lot of people.

Stewart Gandolf: But I'm just curious, but.

Lee Aase: Yeah. Well, so you know, do you want to do? Do you want to do a good job with them?

Lee Aase: And I'll just say one of our. I got an email almost. It will be 2 years ago this October from someone who said I'm frustrated enough with my experience as a provider in the healthcare system.

Lee Aase: But I'm either going to need to. I think I'm gonna need to quit medicine altogether or come work with you guys.

Lee Aase: you know. So there's the burnout. There's significant burnout among practitioners. And one of our, you know, we did a radio program on the local radio station that we called restoring the soul of healthcare.

Lee Aase: And that's really what we're about with this is that we wanna

Lee Aase: we want to follow. The Norman Rockwell meets the Jetsons model where it's like the old fashioned Norman Rockwell doctor's office, where you actually get to know your doctor. Your doctor knows you. It's a human relationship.

Lee Aase: And we use technology when it makes sense. You know that when it's an enabler, not a not a barrier that we say, Oh, AI is going to cover everything. It's like, no people want to really talk to. Even if you think your AI is got good advice you want actually want to have a human relationship. And so

Lee Aase: I also, you know, there's the think globally act locally thing that you know, is the old saw.

Lee Aase: I'm big on, like I'm gonna try to solve the problems that I can deal with and try to be an influence and shine a light in the place where we are.

Lee Aase: and I'll let somebody else figure out what the geopolitical ramifications are for overall hospital, you know. Provider supply if this is the way that you know makes practitioners enthused about going to work and really engaged in that way, and the patients like it.

Lee Aase: there are problems that are above my pay grade, and I hope.

Stewart Gandolf: I love it, I love it.

Lee Aase: And I'm not gonna worry about him.

Stewart Gandolf: Too. I we can relate so often like back. When I was starting doing what I do.

Stewart Gandolf: I used to work with a lot of providers and look! I can't solve that. Nobody can. It's like you're holding into an impossible standard. So another question, then, is so the you know I mentioned my wife earlier, and so we ended up paying for the full boat for primary care as well, and before we talked it I was thinking, I wonder if there's a carve out now, if I said, Okay.

Stewart Gandolf: because there's still stuff like, what if they need an ablation? What if they need, you know, or whatever that's serious cost for paying out of pocket. So, it's like, yeah, the high deductible is good for catastrophic. But things that are $3,000, $5,000, you know dollars, whatever. It's kind of a different category, because for sure, you'd want to have high deductible for the catastrophic stuff.

Lee Aase: Yeah.

Stewart Gandolf: It's like, you know. Well, wait, I'm saving. If I if I committed just to go to you guys and I wasn't using my plan for primary care, but I was using for everything else. And that's where I think you guys are on the track for this.

Lee Aase: I can personally vouch for how that works, because,

Lee Aase: you know, I had male retiree insurance until just this year, and when it was finally starting to cost too much, and I think it was costing too much all along. But at any rate, I qualified for some tax credits through the Obamacare exchanges, but I was able to compare plans, and I could get a $7,500 deductible with a $50 copay for primary care.

Lee Aase: Or I could get a $3,200 deductible with a 50% coinsurance for primary care, which is, in a sense, in essence saying, Okay, my primary care is over here. Okay? And so, for about 50 bucks a month more, I was able to get a $3,200 deductible instead of a $7,500 deductible. And so, this is me on an individual basis, with my wife being able to do that.

Lee Aase: But there are also some employer group plans that we're able to put together where you know, including direct primary care as that foundation really can enable can be one of several claim reduction strategies that are being used by, you know, Health Rosetta type. Advisors to put together community health plans that are costing less and providing more care.

Stewart Gandolf: That's awesome. So, and I think you mentioned earlier, we were talking offline before we got started about having an insurance broker help put together plans. And so do you see that as a

Stewart Gandolf: is this going to be more formalized? And because, like, you know, you were smart enough to figure that out. Not everybody is so to put together plans and programs that would make sense. So it's like easy, like, check the box. Pick this option and that option versus trying to like. Get your mind around the whole thing.

Lee Aase: Yeah. Well, for the 1st year we didn't have these plans, you know. And so we were just growing retail. And we did have some employers who couldn't afford traditional insurance, and but they wanted to provide some kind of health benefit. And so they could just go with our membership, and they weren't offering insurance. They were small enough that they weren't required to already.

Lee Aase: and they could just offer our membership as a way of giving most of the care for their employees.

Lee Aase: But it was about a year ago, right now that I that I got in touch with a good.

Lee Aase: Some folks have become really good friends, Colton Starla, Bernie Macle, and Skip Low from North Risk Partners, which is like probably the 4th biggest health insurance agency in the Midwest, at least in Minnesota.

Lee Aase: And they've got offices in a few different States. But they again use their Health Rosetta advisors and they kind of break apart the Bookca

Lee Aase: type plans and have a independent have a 3rd party administrator, a transparent fiduciary pharmacy benefit manager.

Lee Aase: They have some options, for you know, some other options for drug sourcing, and then referrals, for you know, tertiary for at least for surgery and for imaging, you know, to be able to get more competitive prices on those.

Lee Aase: And they develop new plans that you know. So it's not a it's not as off the shelf as some of the others. But if you're paying off the shelf, you're getting the rack rate. You know, you're not. Gonna you're not gonna get any deals that way. If you have a good claims year, they don't typically send you a refund with some of these level funded plans, they actually do. They get refunded.

Stewart Gandolf: Check.

Lee Aase: If they've had a good claims year and so there are definitely some cool opportunities. And that's what was part of. I was just at a conference sponsored by TPAC, which is a 3rd stop loss carrier, very stop loss. Insurance group that so in these level funded plans. They set a rate.

Lee Aase: I attended a conference sponsored by TPAC, which is a twin city based 3rd party underwriter where they help do the stop loss analysis

Lee Aase: so that when with these level funded plans, they set an amount that is what the not to exceed amount is, it's monthly premium that the employer is going to pay, and then there's a claims fund. That's part of that. That. The that the 3rd party administrator pays the claims out of

Lee Aase: by having our membership as part of what gets paid out of that. We're not filing claims with the insurance companies, but also no claims for our services are hitting the pool.

Lee Aase: and if there's money left in the pool after 18 months, the employer gets a check back for that amount. Stop loss. It's like the Lloyds of London Insurance on top is like, if somebody in your

Lee Aase: 10 employee group gets cancer.

Lee Aase: Okay? Then that's why you have the stop loss policy to prevent.

Lee Aase: you know.

Lee Aase: Yeah, you know, tomorrow.

Stewart Gandolf: Our agency. We have 40 people, and we got one employee. Of course, they won't tell us when we don't want to know who, but had obvious health problems. And every we went to go to the private market. We like lost our po coverage from one employee. And that's what 40 employees. Isn't that small? Right? See how that would make a big difference? So are your. So, I can't. We have to before we couple more things, want to talk about.

Stewart Gandolf: one is just the marketing side of it, because, of course, we're marketers. We like enjoy communicating and marketing. So I'm curious about that, and then we'll finish up with just talking about the future, and where you guys are going. So.

Lee Aase: Sure.

Stewart Gandolf: I'll get to that. I would love. I mean, you are like the social media guy, and this certainly lends itself well to social media. But, on the other hand, also, it feels pretty easy that you guys could reach out to major employers. This is a heck of a benefit. If you guys were close by, I'd try to figure out how to do this with my employees.

Lee Aase: Yes, we.

Stewart Gandolf: We're virtual now, and half my employees are someplace else. But at any rate, though if I was a local employer, I'd love to have this as an.

Lee Aase: Well. And actually, we can do that. So there, we're part of a network called Hint Connect. So, Hint is our membership management platform.

Lee Aase: And we can actually rent a network of direct primary care anywhere around the country. Others who are using it. And so, we can develop a plan that has, you know, direct primary care as the as the foundation of it.

Lee Aase: So yeah, we're able to serve. You know, we have employers who don't have all their employees in one place, and we can, you know, kind of piece it together, and be able to put together one that works overall.

Stewart Gandolf: That's amazing how far.

Lee Aase: It's exciting. Yeah, I mean, it's stuff that wasn't possible, you know, just a few years ago. And now it's you know, kind of feel like we're at the right place at the right time.

Lee Aase: Employers are going to be the biggest source growth for us. We started out. The 1st year was all retail.

Lee Aase: and there was some employers, as I mentioned, the ones who couldn't afford insurance. But A lot of word of mouth, a lot of people telling their friends about the experience and then

Lee Aase: geographically targeted Facebook posts. You know, I mean, that's.

Stewart Gandolf: Sure.

Lee Aase: I mean the ability to, for not that much money to be able to have content that people in your target market and target demographic are seeing is really positive

Lee Aase: doing some earned media stuff, too, you know, like as we have new stuff. But.

Stewart Gandolf: Well, I mean, you guys, price point, like, you know, we work with everybody from urgent care to addiction to you know whatever on the provider side. And you know, with addiction, it could be $6,000 cost per patient. So that's make economic sense for you guys. But some targeted paid search and targeted social media free and paid. It did really well with that. But that feels to me it. My instinct was the employers would be the place to go, because then it's not individual sales. It's like a package, and particularly given the size of your operation. You can get pretty full pretty fast by talking to a few employers. I'm assuming, which is.

Lee Aase: Well, yeah, well, one thing I you know, highlight, though, is that we're we have practitioners who have contacted us, who are interested in joining.

Lee Aase: you know, like they want to be part of this. And so part of what we gotta do is match up the supply and the demand. And you know. So, we've got some good stuff happening, and some opportunities for some new folks to start as of the 1st of the year. But we will have a big surge. We had a big surge. We had a good surge at the beginning of last year because of a couple employers signing up.

Lee Aase: We expect it's gonna be significantly more this coming year.

Stewart Gandolf: That's fantastic. So, and to the extent that you're willing to share on a public forum here, like, what are your plans like? Where do you guys want to go? Because it's exciting.

Lee Aase: Yeah. Well, so our you know, my goal is to be a service to other practitioners

Lee Aase: who don't have a friend who went back to get his MBA. In healthcare management like they don't know how to run a they. They'd like to have a direct primary care clinic. They'd like to be the owner instead of being an employee.

Lee Aase: And but they're not sure how to do it. And so that's my management. Services Company is set up to do that, too, and now that we've done it in a couple of places in Austin and in Rochester, Minnesota.

Lee Aase: we do have a 3rd location. That's in the works right now. In fact, we just got our 1st founding member signing up this morning.

Stewart Gandolf: Awesome congratulations.

Lee Aase: But so right now we're just taking deposits there and then the plan will be. When we get 300 people signed up. We'll be ready to open, and we'll be able to have a decent enough income for that practitioner owner to be able to operate with 300 patients.

Lee Aase: but looking at a panel size of 600 as the as the max.

Lee Aase: and you compare that to the couple 1,000 2,500, 3,000 that a lot of lot of practices have in fee for service.

Lee Aase: It's definitely a much more personal. It's not exactly, you know. I know the forget is Dunbar's number, I think, is the 150 is the number of people you can have a close relationship with. So it's 4 times Dunbar's number.

Lee Aase: and I think it's Dunbar.

Lee Aase: But it's still way more personal and more relational.

Stewart Gandolf: Yeah, that's great. So, I did want to before we wrap up here, you'd mentioned your challenge. So tell us about the HELPCare Challenge. That's really fun.

Lee Aase: Yeah. So one of the things that we, you know, for we can only provide medical services right now to people in Minnesota, because that's where license, where our practitioners are licensed to a part of the practice that we're serving. We hope to grow beyond that, for sure. But HELPCare Challenge is a 13-week program that we developed.

Lee Aase: That where we do an in body composition test at the beginning and at the end set of labs, so standard set of labs that would be like a thousand dollars in the regular healthcare system.

Lee Aase: At the beginning. And then some of those labs also at the end, but things like a 1 c, and fasting insulin, and the thyroid panels, and as well as the lipid panels.

Lee Aase: and we give a money back guarantee 13 weeks we've got week weekly group sessions via Zoom with a registered dietician who lives in Washington State.

Lee Aase: but then individual sessions with her.

Lee Aase: and we do it based on our plan, which is called the Health, Energy, and Longevity Plan HELP. Which is the HELP in HELPCare. So I encourage people to go to helpcare.health and download it. We got. It's free there for you to download. But it's a 10 point plan that my wife and I use to each lose about 50 pounds and get our health reclaimed over the last 5 years or so, and that's actually part of one of those streams that came together with meeting with Dr. Dave Strobel, my classmate, is that we recognize that the food pyramid is upside down.

Lee Aase: Okay, yeah. People, that the car 6 to 10 servings or 6 to 11 servings of bread, pasta and grains

Lee Aase: that we've been told since the early 1980s.

Lee Aase: Has coincided with a tripling of obesity and a tripling of type, 2 diabetes.

Lee Aase: and that flipping that upside down is a big part of helping people to reclaim their health.

Lee Aase: So we started out. At 1st we were doing the coaching, but as we've grown, I gotta not do that. And so, Jane, who's our dietician in Washington State, does this?

Lee Aase: Anyway? We do beginning and after measurements.

Lee Aase: and we just published a post earlier this week where the 1st 30 challenge participants who've done both all the beginning and ending figures.

Lee Aase: We've reduced fasting insulin by like 25% insulin resistance, as measured, calculated by Homa Ir by almost 35%

Lee Aase: the average member. This is not a weight loss program. It's like getting healthy. And then the weight loss comes over time.

Lee Aase: but in the 13 weeks the average participant lost 11 and a half pounds and 10 and 10 and a half pounds of fat.

Lee Aase: which is the key like? Like, I said, it's not about weight loss, but you get going in the right direction, and then you just keep going in that direction long enough, and it reverses. So that's something that we're offering, you know, kind of nationally, that anybody who wants to sign up, for that could be part of. We have limited capacity for it, but that's something. We'll be figuring out how we scale up as well.

Lee Aase: but it's when you, when you recognize that, you know what we've been told for 30 years by the, you know. And again, we could try to get the dietary guidelines changed. Yeah, that's beyond my pay grade. But what we can do the folks we're working with we can

Lee Aase: and give them some guidance and how they can. And it's not just that, but some things like intermittent fasting, walking, sleep. You know the right kind of supplements that are of things that are typically deficient for most people. So it's a 10 point plan. And if you go to HELPcare.health/help. That's where you can sign up to download the plan for free, and if people take that, and if they get healthy with it, with no

Lee Aase: involvement from us. We'll be delighted because it costs us nothing, and we just want to help people with that. But for the people who need medically supervised engagement in it. That's what we do here in Minnesota. And if they want some peer support, that's what we have HELPCare Challenge for.

Stewart Gandolf: So how fun! Well, Lee, I mean, I reached out to you. We hadn't talked for a while, and I'm like, I know he's up to something fun and interesting. So.

Stewart Gandolf: Thank you for your time. It's good to connect again and you have to keep me in touch and come back and share updates with us from time to time, because I'd love to see you be successful. I think it's really I know it's gonna be just huge. So, thank you for coming.

Lee Aase: Glad to connect with you again, Stewart.