Breaking Free from Insurance: Why Doctors Are Choosing DPC

Full Episode Transcript

Dan (00:05)
Welcome to Uninsured by Choice, a podcast where we help you navigate the healthcare system without insurance. I’m your host Dan, and we’re brought to you today by our sponsor, Zion HealthShare, a medical cost sharing community that is a nonprofit that helps you pay for your medical expenses without using insurance. Really excited about today’s discussion. We’re going to get into a topic that is very innovative, cutting edge, I guess you could say. It’s pretty new, a new trend as we talk about DPC. Joining us today is Dr. Justin Voris, a board certified family medicine physician and the founder of Core Health Direct Primary Care in Fort Smith, Arkansas. A graduate of UAMS and a champion for patient centered innovation, Dr. Voris currently serves as the president of the Arkansas Academy of Family Physicians. When he’s not reimagining healthcare or leading the Fort Smith Airport Commission, you can usually find him and join the outdoors. So Dr. Voris, thanks for being here with us.

Justin Voris (01:02)
Yeah, thank you for having me. I appreciate the opportunity.

Dan (01:04)
Yeah, of talking about DPC and you are a DPC practitioner doctor that has your own clinic for that. I would love to know first, let’s just explain what is DPC. What does that stand for? What does it mean? You know, kind of how it works. High level overview for people who are just unfamiliar with that particular acronym.

Justin Voris (01:24)
Yeah, DPC or direct primary care is exactly what it sounds like. We’re going back to simple. Simple is effective, right? We don’t touch insurance. That’s kind of the overall basis of it, but it goes more so into creating that direct relationship back between the doctor and the patient. We cut out the middleman and for routine primary care, we don’t touch insurance. There’s some things that do associate cost, but typically people will have a simple, predictable monthly rate. It’s usually lower. I tiered mine after talking with people and that just works well for our community here locally. And people do it a little bit differently across the nation. Some people do add a little this or a little of that to just make it their own flavor, but in the essence of it, we’re all like-minded in that we really just care about people and we want to do what’s right. And a lot of us were probably tired of some of the overhead stuff that we had to deal with and button clicking and such, we don’t have to deal with that anymore. So we go back to keeping it simple.

Dan (02:32)
Yeah. Love that. I am a member of a DPC here where I live. So I have a family of five. I think between us, we’ve probably gone in there seven times and usually like you said, routine type stuff, suspected ear infection or maybe a, do a strep throat test or, you know, simple, simple stuff. But I think for a long time, people feel like almost like insurance is gatekeeping access to their primary care doctor. And it really shouldn’t feel that way both sides. So you are that primary care doctor. You don’t want to feel that. And we as patients don’t want to feel there’s a gatekeeper between us. So like you said, reestablishing relationship with the people that you serve.

Justin Voris (03:11)
Yeah, in the system, I was in employed health for 10 years plus after residency and we were tasked with seeing 20 to 30 patients a day, routinely, every day. But that puts you seeing somebody every 10 to 15 minutes and that’s really not enough time. So right now I book between 30 and 45 minutes for new patients. So I’ve got access for time with people. I’ve learned more from people that I’ve known in over 10 years in the last couple of months than I ever knew in 10 years. So they’ve got that little bit of extra time to say, by the way, did you know about this? No, I didn’t know about that. Why didn’t you tell me that before? That’s because we only had 10 minutes. So instead of just having one problem at a time, we were trying to fit 10 problems into a 10 minute visit, it just didn’t work too well.

Dan (04:05)
Yeah, I can imagine that’s kind of reminds me you need to treat a service as a service, not as a commodity. And it sounds like the sort of legacy lack of a better term, traditional health care systems, treat health care as a commodity. It’s just a boom, 10, 15 minutes, you’re in, you’re out. We write you the prescription for whatever it is and off you go instead of taking the time to really understand the need of the patient and sounds to me with DPC, you probably feel more like you have patients, not customers.

Justin Voris (04:34)
It kind of is almost like a friendship in a way because you know intimate things about people is something that we highly respect. And so the fact that we get to be a partner with them, whereas before we were a partner, I tried my best to let people not feel like they had their 10 or 15 minutes with me. I wanted them to feel, you know, like a friend and a partner like that. So I would get up at four o’clock in the morning and I would pre-chart just so I could be prepared and I wouldn’t have to stare at a computer the whole time and click buttons. So a lot of that gatekeeping that you went back to, a lot of our decisions were based kind of what on insurance would or would not cover or do or not do. And if we clicked a certain button a certain way, we have got rewarded because we would get paid one day, maybe.

Dan (05:25)
Maybe hopefully cross your fingers doesn’t seem like a viable business strategy in a lot of these health care systems where more providers are just kind send a bill and cross your fingers and hope for the best. And so with direct primary care you’re talking about a direct payment direct delivery of care. There’s no middleman at any stage of this process.

Justin Voris (05:27)
No, and it’s transparent. That’s the beauty of it. People know upfront what things are going to cost. So I can tell you straight away, like, hey, this CBC is going to cost X number of dollars. This chest X-ray is going to cost X number of dollars. Your monthly membership cost X number of dollars. You can pay for it with your HSA if you want. Lab work comes once a year anyway. That’s just bundled into the price. I’ll give you an example. I had one patient, said, hey, I got this bill for $500, it was a little over $500. I said, oh man, what is that? Well, the lab people kind of messed up the billing on it, but it works out in our favor because I get to use it as an example. And it was a little over $500. I said, well, let me see how much it would cost if I charged you for that. And it was roughly $60. And so, yeah, it’s a pretty wild example. It was, the savings was over $500 to the patient. If that had gone through insurance, which it hadn’t, it had just gone through just one of the billing people with the lab service. If it had gone through insurance, people were getting billed $2,500 to $3,500 for the same exact stuff. And I’ve got pieces of paper that I have seen with my own eyes from insurance agencies and it’s just wild, the difference that you can actually save people a ton of money. And the labs is just one example.

Dan (07:08)
And you would think if we’re saving people money and dramatically improving the delivery of care, the process, the whole service, why is this not more mainstream yet? I mean, the first DPC practice is from what I’ve seen maybe about 10 years ago, really started to see them kind of up here. So this is fairly new to healthcare, I think the last time I checked about 2,600 DPC clinics around the country. So rapid growth so far, but I don’t see why we can’t be going from 2600 to rapidly as most of these go. Are there any barriers that you see? Is it just an education thing with the doctors themselves not knowing it’s an option?

Justin Voris (07:42)
Well, I think doctors and people feel trapped. As a consumer side, you feel trapped because you feel like you must have insurance. We have to have it. We grow up thinking we must touch it and we need it. And that’s not necessarily true. Your employers felt trapped that they wanted to provide you a benefit, so they must provide it in some capacity. And you must consume it as an employee too. So there’s that. And then doctors, they come out of med school with a ton of debt. So it’s easy to go work for a corporation who’s gonna pay off a portion of your debt. And so that’s great. But then you also feel a little like you’re gonna abandon people if you’ve been in a number of years to satisfy that debt, so to speak. And so I think it’s just a tough situation. But there’s enough of us in the DPC world and people that aren’t, that wanna be, that are willing to jump ship and make it happen. It’s risky. It’s not easy to start your own practice. I’m happier than I’ve ever been, but it doesn’t make it easy exactly.

Dan (08:56)
Yeah. Well, so walk us through the process for a patient. Cause it is, it is pretty easy for patients. What would they do? They, do they just walk in and I’m a member or can they go to your, your website? Do they call in advance? They have to schedule appointments. What’s the, what’s the kind of just day-to-day process of being a, a patient or member of a DPC?

Justin Voris (09:15)
So for core health, my practice, it really starts with they look at the website. I essentially direct them there. And so people go, they can sign up after they’ve read. And it’s really a very seamless process. I use a member management software company and one you’re probably familiar with. It just makes it super seamless. They click join now, they put all their information in and boom, they sign the agreement, they’re quote unquote a member. And then they call the office, make an appointment. And if somebody just walked in, which they do, and again, that happened today, somebody just walked in and said, hey, I want to be your patient, what do I do? We’ve got a couple of different options for that. And so we can do it in real time. And then for visits, if they want to schedule, I offer same day or next day visits for like urgent matters, things that we don’t need to see the same day or next day. We can usually push that out and people, they understand once you kind of set your boundaries, then people really respect that and they don’t over utilize it. I think that’s probably a big fear that people have starting a DPC practice is that if I give people full access, because it’s kind of like a gym membership, you pay a monthly fee and you can come in whenever, but I think people are afraid that if they do that, people are going to walk all over them. And that doesn’t have to be true.

Dan (10:37)
You can strike that balance. I think it goes both ways. I think if you have a gym membership, the biggest fear for getting a gym membership is, gosh, am I ever going to use this? Am I ever going to have time? Am I ever actually going to make it worth it? And so that fear for DPC is, goodness, I’m paying every month to see a doctor instead of every visit. Is that going to make sense for me? And it’s amazing. I think it’s been about a year and a half that I’ve been with the DPC. And like I said, seven times we’ve gone into visits. I mean, that’s almost every other month. And if you’re paying, per visit, that would have added up to basically the same thing we spent on, our membership anyways. It’s amazing that when you have that access, you do find using it. You go, I will just hop in there and see if I need an antibiotic for this. It might be an ear infection for my kid or something like that. But as a doctor, you’re on the opposite side and go, ooh, do I want that level of accessibility because now they’re going to walk all over me. So it’s just striking a balance of your availability and their ability to schedule with you. And so you feel like that’s not been an issue. Your patients are pretty happy with their accessibility to you and you don’t feel too overwhelmed by that.

Justin Voris (11:25)
Yeah. No, not yet. I’m not full yet. And it would be great if I was full. Here’s another story. I had a guy that said, you know, I hate this. This is the worst thing ever. I don’t know why you did this. And I said, well, why’d you become a member? And he just kind of chuckled. He said, well, my friend did. So I did. Okay. Well, fast forward a month later, he’s been in three times. This is a person I had only seen once a year for years. And he chuckled on his third time. He said, hey, look, you know, how I told you how horrible this was and how I hated it. This is the greatest thing ever. He just needed to hear that he was okay. And he needed those touch points. And I hear that often. I had somebody that came in this week and they said, I just need to know if I need something. And I said, nope, you don’t need anything. Let’s just let time take its course. And I think you’re going to be okay. If anything changes, call me back. And they just smiled and nodded and that was all they needed. And I hear that more and more often and it doesn’t happen all the time, but at least there’s availability for it to happen now. In another system, if you had a call to just get checked out, I was weeks or months away from being seen. That’s not fair.

Dan (12:52)
And then insurance would have still charged 150 to $200 just for that validation. And most people, like you said, can’t get it. So they’d have to go to urgent care, something that costs a whole lot more than that. And that’s where you’ve got kind of the best of both worlds with DPC is that you have primary care. So it’s not urgent. I’m bleeding out. I need to go somewhere. Okay. Emergency room is still there for you. But on those more urgent things, you don’t need to see urgent care and pay $500. If you’re a member of a DPC, it really does open up that accessibility and availability for you as a patient to be able to say, I really feel like I have a relationship with my doctor. They know me. I know them. I trust them. And they really are looking out for my best interests, not just trying to get rid of me as quickly as they can.

Justin Voris (13:39)
And I think I set that expectation early on in my medical practice and it didn’t matter which system I was going to be a part of. I had those expectations of myself and my staff and patients and it’s always been teamwork with me.

Dan (13:53)
Yeah, love that. I love what you said earlier too about the HSA because I don’t think a lot of people know. One, a lot of people might not even know what an HSA is. It stands for health savings account. And it’s basically a way for people to be able to pay for medical expenses in a tax benefited way. And a lot more people are getting HSAs, a lot more employers are offering them to employees. And the law changed, January 1 of 2026, that you can now use your HSA to pay your DPC membership. So now you’re a qualified expense to use for that. This should be a huge deal gets a lot more people. I mean, fingers crossed, you’re in the DPC world. I think that should help get a lot more people into DPC membership.

Justin Voris (14:38)
You would think, if they’re able to get a high deductible health plan with the catastrophic coverage, kind of wrap around and be able to get an HSA, absolutely. You’ve always been able to use FSAs to pay for it. And HSA is just another tax advantaged way of doing so. It’s been a little bit slower than I imagined because I think people just don’t know. I think that’s the education piece you were talking about. It’s really a good model for employers because now they can lower their overall costs by changing up some of their insurance benefits. Make it catastrophic the way the insurance was designed to be. And then pay or put into HSAs maybe. And then they can pay for their employees to have a membership at a facility, a DPC practice like mine. And all of a sudden their employees have a doctor all the time. I don’t advertise 24 seven access. Some of them do because at two in the morning I’m going to be in bed and that’s part of the boundary setting, right? Healthy employees come to work. And we know there’s lots of studies that show that primary care in general lowers overall health cost because we see people and we can catch things early or we can take care of congestive heart failure and diabetes. Now, obviously that’s a teamwork between the patient and the doctor, but at least we can have those decision points early on versus somebody showing up to an ER in heart failure or uncontrolled diabetes. And so now we can deliver transparent healthcare costs, to the employer and or the person if they are self-employed or no employer. And it’s much more affordable solution.

Dan (16:21)
Yeah. And I think here again, the podcast is called Uninsured by Choice. We really hear a lot from individual people who are sort of seeking their option, looks like and thinking maybe I don’t need insurance. And we haven’t really heard a lot from employers who I think are a lot more hesitant to say, hey, I’m going to go the uninsurance route with my corporate benefit. Now, if you have 50 or more full-time employees, you do have to have an ACA plan. But it’s just interesting that employers are the ones who are a little more hesitant because they think, I have to have this. This, with the HSA change, kind of gives you that first step into disconnecting from the full insurance model and saying, you know, we’ll start with this option, the HSA with our high deductible plan and let them start going to a DPC doctor and see how that goes for a while. Maybe it’s just that step towards then getting towards fully off of the insurance model there.

Justin Voris (17:14)
Yeah, and it probably takes data for them to go, okay, prove it. And so then you’ve got to be able to prove it somehow. So we went away from the button clicking, we went just to now go back to say, okay, now we really can show you the data and show you that all the claims that you were paying, we’ve knocked those down by 30% or massive goal 80%. You know, that would be really phenomenal to be able to save employers because then what are they able to do? They can reinvest in their employees or they can reinvest in their company, which allows them to grow and be more successful. So again, I think that’s the education piece.

Dan (17:55)
Yeah, there’s a, and that’s what we’re trying to do here at the podcast is, is provide that education. That’s why we have people like you on to help people understand this whole system. That’s very difficult in a lot of ways to, to be understood maybe by design a little, but, it’s nice when there’s more simple, direct options out there. Last question, what would you say to doctors who maybe are kind of eyeing this model and thinking, maybe I might want to switch to a DPC practice or be self-employed and leave where I’m at, what would you kind of have them know before making that jump or look into?

Justin Voris (18:29)
It kind of depends on where you are in the country probably. There are probably some established practices already that are seeking doctors, that it might be an easier move to go from an employed model or even somebody who’s in the traditional fee-for-service model into a direct primary care model or some sort of hybrid. There’s some hybrid clinics out there too. I researched it for a good five years before I made the plunge. Just because I think we’re kind of just fearful by nature, prove it to us too. I’m way happier than I’ve ever been in my career. And I do, I think that you just research it, you read about it, you listen to podcasts. And then you go and you tour one, just go look at one. There’s gotta be a DPC around you. DPC docs are kind of an open book and they want you to know about it too, because the more of us that are out there, the more successful we all are in taking care of patients. And so, I’m back to practicing medicine the way that I was trained. I love it. I absolutely love it.

Dan (19:35)
That’s so good to hear. And to your point about being kind of open book with these DPC docs, I went to the DPC summit in New Orleans last summer, July, I think it was. And even just on the plane ride there across the aisle, there was a gentleman who saw my computer open and saw that I was kind of in healthcare, probably figured I was going to that, asked me about the DPC summit. And we chatted for about an hour and a half on the plane about his wife’s practice. He does the marketing and just really had a great chat, saw them there, connected with a ton of people at the DPC Summit. So this is not sponsored or paid for by the DPC Summit, but just a free plug there for them. If you are a doctor who’s thinking, maybe I want to investigate this, the DPC Summit in New Orleans, a great resource to go check out.

So to wrap it up, where would someone go if someone wants to connect with Dr. Justin Voris, wants to know more about you, reach out to you? What’s the best method for them being able to do that?

Justin Voris (20:33)
Yeah, the best way to find me, I’m on the social media, although doctors aren’t great at social media, Facebook, Instagram, and LinkedIn. And then if you were looking for my site specifically, because I’m in Arkansas, maybe you’re not in Arkansas, but you just kind of want to know more about it. It’s corehealthar.com. So corehealthar.com. And that’s how you can look, read about DPC and sign up if you’re in the area. I’m really humbled by all of my patients that are here already and thankful for my family and friends that have helped to get me to where I am today because this is not a me journey. This is much bigger than me and it takes a lot of people to get there.

Dan (21:18)
Yeah, that’s great. Awesome. So reach out to Dr. Voris whenever you get a chance. Say hi, ask questions. He’s great resource, open book, like we said, and really appreciate you taking the time to come on the show today and wish you best of luck as you continue to grow your practice.

Justin Voris (21:33)
Thank you so much, Dan.

Dan (21:34)
Have a good one.

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