Here at SigmaMD, we've been conversing with dozens of Clinicians every week to better understand their reasons for leaving the system and starting new Direct Care Practices. We listen to their needs, challenges, motivations, achievements, and what makes them feel alive.
This is a guide that synthesizes what we've learned from various interviews with those who are seeking to provide more empathetic and personalized healthcare.
I've endeavored to write as if we were having a coffee together in your medical office. By the way, nice to meet you! I'm Malu, and I am part of a team that is fascinated by the Direct Care Model. That's why we hold a strong vision and have been creating a lasting solution and experience in this field.
And I should mention that we may have something in common: we both believe that healthcare should be more human.
After years of experience leading diverse teams in the healthcare sector across various geographical and cultural contexts, I noticed that starting and building a solid Direct Care Practice requires balancing 3 main dimensions: I / WE / IT.
First, let’s discuss the 3 individual levels:
Here, we explore your identity, your background, how you perceive your world, and how you feel about yourself.
This level focuses on the relational connection between parties and how we feel about each other. In this case, we’ll encompass the patient-physician relationship.
Here, we address the “thing” we’re discussing, I mean your DPC practice. A strong foundation is essential for any company's survival, so we'll delve into business plan, marketing, finance, technology, legal aspects, and more.
Imagine this as a book organized into strategic chapters, each designed to support you in starting and succeeding your Direct Care Practice. Check it out!
Do you remember the day you decided you would like to study to work in the healthcare sector? What was the main “Why” behind your decision? Answer this question.
From a renowned doctor, I heard something like:
“I have been fascinated by medicine since I was a child. As a doctor, I try to not lose sight of why I chose this career.”
She made me notice one thing: remembering the reason behind the important decisions of your life can guide us in our next moves - and help a lot on the hard days throughout the journey. Try to keep it in mind!
In the dozens of interviews I’ve conducted with clinicians, a common sentiment we often hear is:
“I was entrenched in the traditional fee-for-service model of care for about 20 years and I got tired of it. So, I left it and decided to start my own DPC practice.”
Imagine the following scenario:
“Below the traditional healthcare system, I used to see from 20 to 30 patients a day, and deal with a lot of paperwork. So somehow I had to find the time to do that and not get crazy.”
“Now I usually see 6-8 patients a day. So I can know their stories, and spend more time with each one. I also have a proper time to follow up, answer emails. I have the freedom to lead my life my way.”
From the 'I' perspective, we can notice there are 2 significant benefits to making the transition:
I know you've already studied a lot to be here. You completed at least a four-year Bachelor's degree, followed by an internship, then residency. And you will always be studying medicine, whether by reading recent researches in your field, attending conferences, etc.
But a remarkable aspect of transitioning to Direct Care is that this decision demands you study topics related to business, finance, marketing, technology, and much more. So, yes, embracing your role as a DPC Entrepreneur is part of the process. Change requires a lot from us, right? Such is life.
When you run a DPC practice, you'll often find yourself needing to wear different hats at the same time. Juggling multiple roles is part of a DPCpreneur day. A typical day could be:
Lots of things, right? But remember, at the heart of all this hustle is the rewarding journey of building something distinctly yours. It's challenging, but the payoff is a venture you can proudly call your own.
I’ve heard from a Direct Care Physician that when he decided to embark on this journey, he invited other colleagues to do the same. However, they refused due to various concerns, especially those connected to the business side of things, like 'I'm not sure I have the profile to be an entrepreneur.'
Come on, you've already accomplished many challenging things in life. You are certainly intelligent and capable enough to run a business. Believe in your ability to manage a business effectively and study hard for it. Be prepared to step out of your comfort zone and be open to developing new skills. It can be a very rewarding journey.
Remember, you are not alone. There are thousands of people facing the same challenges. Be curious to reach out to them and learn from their experiences. Having the right mindset to seek help when necessary is crucial.
In this chapter, we will explore how the patient-physician relationship changes when transitioning from the traditional healthcare system to Direct Primary Care (DPC).
By removing the insurance element from your relationship, you will find an opportunity to build stronger, more meaningful relationships with each patient.
This change allows for longer appointment times to:
“I believe I can do a better job if I am able to build a relationship with each one”
This new scenario indicates that the patient will:
From the financial perspective, the benefit is also very impressive, as your patient will no longer have to deal with surprise medical bills.
Patient success is a philosophy that must pervade your Direct Primary Care practice. The relationship does not represent only the appointment; it encompasses every touchpoint and interaction that a patient encounters throughout their healthcare experience.
Did the patient see a great review about you, learn something new?
Did you offer a convenient online booking option and provide clear guidance for the upcoming visit?
Did you have the right protocol for urgent needs or when same-day or next-day appointments are needed?
Did you offer an easy check-in process and make them feel comfortable in the waiting area?
Did you actively listen to them, addressing any concerns or questions they had?
Did you check if the patient improved after taking the medication and provide emotional support?
Did you send a patient satisfaction survey to collect their feedback?
There are so many touchpoints that affect the patient experience, right? Understanding and optimizing the patient experience journey is crucial for you to deliver high-quality, patient-centric care that meets the needs and expectations of your patients.
It's time to cover some key pillars that will serve as the foundation for establishing your Direct Care Practice.
Writing a business plan for your Direct Care Practice is a crucial step. It not only provides you with a clear strategy and vision but also sets the stage for successfully adopting the Direct Care Model.
Think of it like building a house:
At the base of your structure are your Practice Values. These are the core principles that guide every aspect of your practice. They shape how you interact with patients, collaborate with your team, and make decisions, ensuring that integrity, compassion, and excellence permeate every facet of care.
Moving up, we find your practice Mission. This is a reflection of why your practice exists and should mirror your unwavering commitment to achieving excellence in Direct Care.
Above this foundational layer are the Strategic Objectives, the pillars of your Direct Primary Care practice. These could include goals such as:
And finally, at the roof, is your Vision. This encapsulates the ultimate health outcome you strive for in your practice. Your vision is what drives and guides all your efforts, fostering continuous growth towards grander goals in healthcare.
When shaping your Membership Plan and Service Line, it's important to allocate time to clearly define what you'll offer.
Typically, a Direct Primary Care plan ensures seamless communication with patients through phone, text, or email. Such a plan often encompasses a range of benefits, including:
Additionally, you could offer other services or products at cost. These might include affordable lab tests, discounted imaging services, and reduced prices on supplements.
For those specializing in Direct Specialty Care, it's advisable to incorporate services unique to your specialty. For instance, if your specialty is Endocrinology, you can cover treatments for conditions like Polycystic Ovary Syndrome, hormone therapy for delayed or late puberty, management of hypothyroidism, and medically-supervised weight loss programs.
Exploring payment models reveals 3 primary methods of operation:
Determining the appropriate fee for your services is an important step. While there's no definitive right or wrong value, it varies based on several factors:
Nicholas Shiver, a Financial Advisor specializing in Direct Primary Care Practices, emphasizes the importance of striking a balance. It's about making services affordable for patients while ensuring the financial health of the practice, thereby guaranteeing both respect for the service and its long-term sustainability.
Your business plan should also encompass various facets of your practice, including financial considerations, market analysis, marketing and patient acquisition strategies, and legal notes. These topics will be explored in upcoming chapters.
Dr. Michelle Cooke, the founder of Sol Direct Primary Care, has a very didactic way to explain how Direct Care empowers patients to achieve individualized healthcare goals:
"When we visit the doctor, we usually have our own concerns in mind. We might want to discuss weight loss, stress management, or handling anxiety. Unfortunately, many times the doctor has their own set agenda. In the insurance-based system, that agenda often involves a lengthy checklist that needs to be addressed just for billing purposes, which can sometimes leave little time to address the issues that truly matter to you.
This is where Direct Primary Care comes into play. Yes, we, as your doctors, have our agenda too—to ensure you're taking all necessary precautions for maintaining good health. However, we dedicate ample time to our patients, allowing us to focus on what matters most to you. We value the opportunity to have conversations with our patients about their health aspirations, the goals they aim to achieve, and the tools required to reach those goals."
Dr. Harpreet Tsui, the founder of Coronado Direct Primary Care, discusses more about the patient-centric approach of Direct Care.
"Have you ever called your doctors only to be told it will require months of waiting before you can get in to see them? Or have you seen someone else in the office who knows nothing about you?
Direct Primary Care is different. Here, the focus is on you, the patient. The relationship we build with you is what ensures you receive the healthcare you need. Many of us offer longer appointments at every visit, and some even provide queue care appointments. If you wake up in the morning feeling unwell or experiencing something concerning, just give us a call—we offer same-day appointments to accommodate your needs. Additionally, many of us provide access after hours and on weekends.
We genuinely prioritize the patient-doctor relationship, which is incredibly important in today's healthcare landscape. Our goal is healthy patients. If we can craft a personalized plan to meet your needs, there's nothing better than that. Direct Primary Care represents the future of medicine."
"In Direct Care, you have direct access to expertise, empathy, and excellent medical care. Direct Care enables me to focus on treating the patient rather than just their chart. It allows me to concentrate on the patient's needs rather than clicking boxes.
At my clinic, we offer streamlined, affordable, and personalized specialist care. Here, my patients are more than just another appointment; they are individuals in search of answers and relief. I place a high emphasis on clear, direct communication, ensuring that every concern raised by my patients is thoroughly addressed."
As seen in those examples, by focusing on personalized care, patient empowerment, and streamlined processes, you can articulate the true value that patients will gain from embracing Direct Primary Care.
As a Direct Primary Care Entrepreneur embarking on a new Direct Primary Care Practice, it's crucial to consider several financial aspects during this transition.
If you were previously part of a hospital system with benefits like health insurance and retirement plans, remember these responsibilities are now yours. Ensure you continue contributing to individual retirement accounts and maintain appropriate insurance coverage.
Previously, you might have had a fixed monthly income. Now, prepare for variable earnings, particularly during your practice's initial growth phase. If you have student or personal loans, it's prudent to plan ahead to manage these expenses.
Understanding the costs associated with starting and running your practice is vital for maintaining healthy finances. Optimizing cash flow is a key strategy for Direct Care Clinicians. Financial Advisor Nick Shives advises physicians to ask themselves:
Ensure your budget includes costs related to setting up and maintaining your medical office, staff salaries, technology platforms, and other critical elements. Operating with a focus on cost efficiency and avoiding unnecessary expenditures will undoubtedly help in minimizing expenses.
A robust financial forecast is essential and acts as a guide for your next steps. Knowing you're aligned with your financial plan provides peace of mind, grounding, and confidence in your strategy.
A key financial goal should be reaching the break-even point, where your profits match your costs. Managing overhead costs and growing your patient base are crucial factors in achieving this milestone. The upcoming will delve into attracting new patients, a vital element in reaching your financial goals.
Seth Godin, one of my favorite authors, wrote a book titled “This is Marketing,” where he states:
“Marketing is the generous act of helping someone solve a problem. Their problem.”
In the realm of Direct Care, effective marketing involves understanding your patients' worldviews and desires to connect with them. Then, you can create honest stories, offer solutions to your patients, solve their problems, and move forward.
I need to tell you one thing: in the initial stages, you're likely the best marketing director for your practice. Even as your practice grows, learning how to delegate while staying involved is crucial. Who better understands WHO your patients are than you? Who better understands HOW to communicate with them than you? And who better knows WHERE to find your patients than you?
A persona represents your Ideal Patient Profile. Create this by conducting interviews with current and potential patients. Build your character from these findings, quotes, and observations. The persona should include several pieces of information. For example:
Next, identify your persona’s main healthcare challenges. For Barbara’s example, let's say we identified 3 main pains according to the interview:
Consider how Barbara would interact with your practice. Identify topics that interest her, the best ways to approach these, and the most effective platforms.
For instance, you might launch an Instagram video series discussing the Benefits of Direct Care, with a different topic in each video: preventive care, personalized healthcare goals, no surprise bills, same or next-day appointments etc.
Having a clear persona guides how you build your brand, your tone of voice, and the marketing initiatives you prioritize. Remember: authenticity is key. Don't try to cater to everyone. Sometimes, specializing in a specific niche makes your practice more attractive, as patients seek solutions to particular problems and trust those who can provide them.
When discussing patient experience, we covered that many different touchpoints are involved in the relationship. Today, a widely used concept is PHYGITAL, a combination of physical and digital channels. The first front may include your medical office or events you attend or help organize to be closer to your community. The second front is digital channels, which may include websites, social media, reviews on Google, and other marketplaces you are part of.
Regarding social media channels, it might be beneficial to have a presence on multiple platforms, but always be aware of the social media platform where your persona is. Selecting the right platform and adjusting the content for it is an important step in your marketing strategy. For example, if your Persona Study reveals your patient spends a significant amount of time on Instagram, focus there. If you plan to start partnering with employers soon, LinkedIn may be a good choice. Be intentional about the channels you are in.
Here, I'd like to share some key pieces of advice for running your marketing plan.
The first experience of a potential patient often happens via a website. Since first impressions matter, let's leverage this important channel for your practice.
Creating valuable content regularly is an essential part of your strategy.
Remember, we are in the era of videos. So I encourage you to be in front of the camera for your patients. This can be a powerful way to engage your audience, making them feel closer to you.
Word-of-mouth referrals are among the most potent tools for your Direct Care Practice to attract new patients. A happy patient can advocate for your practice and bring many others to you. Therefore, regularly engaging with them is key to strengthening these relationships.
Partnering with other healthcare providers can also be a great strategy. Establishing partnerships with local businesses, such as personal trainers and dentists, can open doors to new patient bases. Setting regular meetings with these partners allows for mutual promotion and referrals, functioning as a local support network. Keep this in mind!
When talking with various Direct Care Clinicians, I noticed that they recognize the importance of technology that meets the needs of their practice. At the same time, most have already faced some traumas throughout their journey.
There are 3 main criteria identified from Clinicians who are just starting their Direct Care Practice:
A common complaint is that most tools are overly complex, making it difficult to navigate and causing them to waste time. You may have the same feeling of wanting to have a healthcare platform that works for you, right?
Decision Point: A key element when choosing a DPC EMR solution is the ease-of-use criteria in every single action. This may include various points, such as step-by-step of each feature, user experience when navigating through the platform, customer support, etc.
We have identified that many physicians have been using a set of 4 tools or more to run their practice. Generally, these tools are separated into EMR, Billing/Membership Management, Scheduling, and Communication.
This scenario brings 2 main problems:
Decision Point: Opting for an All-in-One Platform can streamline your operations. SigmaMD, for instance, integrates 6 essential elements, comprehensively addressing all Direct Care needs: 1. EMR, 2. AI Copilot, 3. Membership & Billing, 4. Employer Solutions, 5. Communication Tools, 6. Practice Management.
As we've seen before, in the DPC startup phase, it's important to be even more mindful about each dollar spent. So, when choosing your platform, beware of hidden fees or surcharges on payments. This can significantly affect your financial planning.
Decision Point: Partner with a technology that has a transparent pricing model. Affordability can go hand in hand with quality. It's just a matter of looking at the big picture of what you're hiring.
And remember: An excellent platform can save you a lot of time on administrative burdens, allowing you to focus on the most important thing: your patients!
I hope you've taken several notes and gathered insights to apply to your practice from today onward! And, of course, count on our SigmaMD team for the next steps in your journey!
By the way, it's so nice to talk about something we like, right? I have this feeling with this guide. Thank you for the coffee and for supporting the Direct Care Movement!