Putting The Patient First: Making Healthcare Affordable for All with Dr. Isaac Engholm
Meet Dr. Isaac Engholm, a direct primary care physician with Deploy Health Family Practice in Minneapolis. Dr. Engholm is one of the first physicians in the Twin Cities to bring direct primary care at an affordable cost for middle and working-class patients. He speaks of direct primary care and the difference between the direct primary care physician and the typical employed physician. Dr. Engholm also talks about what he is allowed to provide as a primary care physician catering to direct care. Learn about how X-rays, CT scans, hospitalizations, and the other options available when getting care from a primary care physician. For more, visit DeployHealth.Clinic.
Shownotes:[00:00:06.630] - Candi Broeffle, Host
Good morning and welcome to Green Tea Conversations, the radio show that delves into the pages of Natural Awakenings magazine to bring you local experts who share their progressive ideas and the latest information and insights needed so you can lead your best life. I'm your host Candi Broeffle, publisher of the Twin Cities edition of Natural Awakenings magazine, and I am honored to bring these experts to you. Today on our show, we have Dr. Isaac Engholm, a direct primary care physician with the Deploy Health Family Practice in Minneapolis. Dr. Engholm is one of the first physicians in the Twin Cities to bring direct primary care at an affordable cost for middle-class patients as well as the working class. He provides this cost-effective option that gives you the freedom to choose optimum medical care on an individualized basis. Welcome to our show, Dr. Isaac.
[00:01:02.070] - Isaac Engholm, M.D., Guest
Thank you, Candi. So good to be on.
[00:01:04.680] - Candi Broeffle, Host
And I can call you Dr. Isaac, right? A little less formal than Dr. Engholm.
[00:01:09.150] - Isaac Engholm, M.D., Guest
That is fine. I prefer it.
[00:01:13.890] - Candi Broeffle, Host
Alright. So, to get us started, there's a lot that we want to get into today. But I think the first thing I want to ask you to explain to our listeners is what exactly is direct primary care?
[00:01:27.870] - Isaac Engholm, M.D., Guest
Direct primary care is a very simple model of delivering health care to patients in which the patients hire their physician directly. And this leaves out using insurance and billing and all of the premiums involved with that. And essentially, you just subscribe to your physician for a monthly fee and different providers may have different fees. Mine, for example, is $75 per month. And you subscribe to the physician and then everything that that physician can do for you with that, with his or her skill set is available to you at that cost. And often direct primary care providers will be available after hours, before hours, and even on weekends for phone consultations. And it's sometimes described as having a doctor in your family where you can just call or text for even little things or what is this rash, but essentially the direct primary care model, it removes the insurance or the payer from the transaction between the patient and the doctor.
[00:02:46.740] - Candi Broeffle, Host
And so, in your practice, and I do want to let the listeners know that Dr. Isaac is actually our primary care physician now, my husband and I and we'll talk about that, too, a little bit. But in your case, you really, don't have any nurses or office staff. When people come to see you, they're going to see you directly.
[00:03:11.460] - Isaac Engholm, M.D., Guest
That is correct. Right. I like to keep staffing to a minimum. And if I need a staff member, for example, a sensitive exam, then I'll bring one on. But for the most part, I like the relationship to be extremely pure, which just means when a patient calls me, then they call me and they don't need to talk to three different nurses or staff members to get a hold of me and vice versa. I can just respond back to the patient directly.
[00:03:44.380] - Candi Broeffle, Host
You have different ways that you actually see your patients and so, you have a couple of office spaces.
[00:03:50.790] - Isaac Engholm, M.D., Guest
So, I have an office space in Downtown Minneapolis in the medical arts building, and I also rent some office space at the Bhakti Wellness Center on France Avenue in Edina.
[00:04:06.100] - Candi Broeffle, Host
And you also see people by telemedicine and sometimes even in their home, if that's what's needed.
[00:04:13.840] - Isaac Engholm, M.D., Guest
Absolutely. And probably that's my favorite way to see patients is to see them in their natural environment and learn about their character and their personality through their home.
[00:04:27.370] - Candi Broeffle, Host
My husband and I recently became patients of yours. And one of our deciding factors I can let our listeners know is it feels to me, very similar to how it was back in the old days, I guess you'd say, where you had a town physician who you would see. And that's the person who ends up you know, you came in, you took our blood tests. You drew blood for us. Even though we could go to a lab to have it done as well. But you were able to do that right in our home and just being able to have that connection. So, both of us have insurance outside of this. But we both felt that it was important to really have a good connection with a physician here in Minneapolis. And so, when we heard about you, we were really excited about it because that was what we were looking for. We were looking coming from a small town where I had the same doctor since I was 16 years old, who had retired just before I left. It was, it's really nice to feel like I can have someone, who I will develop that relationship with and be able to contact if needed. So, that's really kind of the philosophy behind your practice, correct?
[00:05:48.820] - Isaac Engholm, M.D., Guest
It is. I mean, the most notable difference between the direct primary care physician and the typical employed physician is that it is the relationship that is built and the trust that follows from that. And I was the same way, my sister and I were both born with the same doctor up in North Dakota. And we knew Dr. Wagner well and my whole family saw him. That's a really traditional model. And that's how medicine has been for actually centuries, was these really in-depth relationships. But we've come to this place right now where the relationship is not as important as the bottom line. And so, you really have to get through your office visits very quickly in the traditional practice setting these days, which was something that I just, I couldn't do it anymore.
[00:06:44.590] - Candi Broeffle, Host
And that actually leads us right into my next question, which is what was it that made you decide to go into this type of practice, to have this type of practice?
[00:06:57.480] - Isaac Engholm, M.D., Guest
There are many factors, and one of them was the fact that in my previous job as an employed physician, some of my patients were coming to me throughout the weeks and were asking if I could just refill all of their medications for the next year. Because, you know, Doc, I can only afford to see you for this many visits or my employment is changing. Or Doc, did you know that when we talked about my blood pressure at my annual physical, then they charged me double for my exam, and now I can't afford to pay the bills for the rest of the year, etc. All of these awful stories about bills that I was creating for my patients and it was causing this really huge financial burden for them. And I realized that my own practice was causing harm to my patients. And that was the opposite of what I wanted to do. I wanted to deliver meaningful care to folks at an affordable rate, but using insurance and billing was just not something that was feasible. And so, I called around to some of my friends and asked them what kind of models were working for them. And this was in the middle of the pandemic. And one of my friends was running a direct primary care practice down in Missouri. And he said, yeah, my patients are doing well through the pandemic, and in fact, I'm growing my business because everybody wants to be seen and they want to have access to their physician. And I really recommend you look into this and so, I learned more and more about the model and I realized that especially in this global pandemic, as well as just this modern surge of medical reform, that we had to put the patient-doctor relationship first. And so, I did. I also, at the same time, wanted to be able to take care of patients without any fees and to be able to provide care to the homeless community, especially during the riots. And so, the only way for me to do that was to jettison traditional insurance payers so that I could go into relationships with patients for zero dollars. And there's really no other model that allows that for legal purposes, actually. And so, that was the other reason why I really needed to jump off into direct primary care so that I could determine the terms of each patient-doctor relationship because some patients just simply could not pay.
[00:09:47.040] - Candi Broeffle, Host
Now, one of the things you kind of briefly mentioned was the membership, and just so people understand, this is a monthly membership. So, though it's not insurance and it's not anything like insurance and your insurance will not pay for it, this is actually a private paid membership that you do. You have it every month that each adult pays $75 a month. And then you also have $25 a month for children, correct?
[00:10:16.530] - Isaac Engholm, M.D., Guest
That's correct. And I do have a family maximum of two hundred dollars per month. So, you've got 10 kids then I'll see them all for, you know, $200 maximum.
[00:10:28.920] - Candi Broeffle, Host
Oh wow. That's incredible. I didn't even know you did that, so...
[00:10:33.240] - Isaac Engholm, M.D., Guest
Yeah. I don't advertise all the time because, you know, but for families that are larger, I do. I cap it at two hundred.
[00:10:41.300] - Candi Broeffle, Host
It's very affordable. People can just go right on to your website and get signed up with a membership with you. It's simple to do. And then they get to have that first interaction with you, kind of get to know you and get to know what you're about.
[00:10:58.610] - Isaac Engholm, M.D., Guest
It is. It's so simple. It takes just a few minutes to sign up and then instantly, you know, can have access to your own personal doctor.
[00:11:09.560] - Candi Broeffle, Host
And there you go. So, for people who want to learn more about direct primary care or if you want to sign up as a patient with Dr. Engholm, visit, DeployHealth.Clinic. When we come back, we're going to continue our conversation with Dr. Engholm and learn about the other things that he is doing. To read the online version of Natural Awakenings magazine, visit NaturalTwinCities.com. You can find the podcasts of this show on AM950Radio.com, on Apple and Google Podcast, Spotify, and anywhere you get your podcasts. You're listening to Green Tea Conversations on AM950, the Progressive Voice of Minnesota and we will be right back.
[00:12:01.620] - Candi Broeffle, Host
Welcome back to Green Tea Conversations, where we delve into the pages of Natural Awakenings magazine and talk to the professionals who share their expertise on natural health with you. I'm your host, Candi Broeffle. And today we're talking with Dr. Isaac Engholm, a direct primary care physician with Deploy Health Family Practice in Minneapolis. So, just before the break, you were starting to tell us or you told us about kind of what prompted you to decide to come into this business and or to offer your practice as a direct primary care physician. And one of the things that I found really interesting on your website was just what a difference it can make in people's health and what some of the benefits are to having a direct primary care physician as compared to maybe having a doctor that you might see in the clinic.
[00:12:59.180] - Isaac Engholm, M.D., Guest
Sure, I think having access to a primary care physician is really, really valuable in the sense that if you're always worried about the cost of how much will the payment be for going to see my doctor for a regular checkup or to get this, you know, skin lesion looked at or, you know, pains here and there. A lot of folks put off health care for those cost reasons. And it ends up on the back end costing significantly more because sometimes they'll miss treating a preventable illness. And for some people, that means they end up going to the emergency room and needing sometimes surgeries for things that could have been dealt with just in an outpatient setting. And so, not only from a financial standpoint but also just for a general well-being standpoint, having access to your physician and not being afraid to ask your provider, hey, can you look at this thing for me or can we talk about this issue that I've been having and not wondering, oh, my goodness, is this going to cost me so much more money to take care of this? That really is the fundamental reason why having access to a provider is such a benefit to my clients.
[00:14:32.950] - Candi Broeffle, Host
The other thing that I was absolutely shocked by was the number you and I were having a conversation about when you were working in the clinic, setting in the traditional clinic setting, I guess you could say, what the expectations were on you as far as what your patient load should be? And so, in my mind, I always think doctors have, probably our primary care physicians have a few hundred people that they see every year. But what is actually, the amount of people that you're kind of expected to have on your list?
[00:15:10.940] - Isaac Engholm, M.D., Guest
Sure. In a large medical group for an ambulatory primary care physician, which is your typical family practice, physician expectations are typically for that provider to impanel between fifteen hundred and twenty-five hundred patients under their name.
[00:15:32.990] - Candi Broeffle, Host
So, as a primary care physician, in doing the direct care, what are you allowed to have?
[00:15:42.540] - Isaac Engholm, M.D., Guest
So, primary or direct primary care physicians, most of us subscribe to an ethical code of no more than six hundred patients in our practice. And then depending on the types of patients that you're receiving or if you have employer contracts, sometimes you can go up to a thousand patients because utilization is low. But for the most part, it is a small fraction of the impanelment of a typical, employed physician in a large medical group, which is most of the medical groups in Minnesota.
[00:16:20.690] - Candi Broeffle, Host
So, what are some of the things that you can actually as a physician that you can actually see people for as a direct primary care physician?
[00:16:31.040] - Isaac Engholm, M.D., Guest
That's a great question. I can see patients for anything under my scope of practice, which is the American Board of Family Medicine. I personally do not see obstetric patients anymore. I left that many years ago. But other than that, I see patients for routine annual checkups. I see children for the same. And I also I can talk about travel medicine. I can talk about aches and pains. I do orthopedic injections in my office and in the home in fact. I can also order tests. I can order lab tests as well as order consultation and order radiologic tests in the area. I can basically do anything that typical urgent care or a family practice clinic would see.
[00:17:29.780] - Candi Broeffle, Host
What about if you had a large gash and you needed to have stitches?
[00:17:35.180] - Isaac Engholm, M.D., Guest
So, if you called me and said, Hey, doc, I've got this big laceration, I need some stitches and if we could connect rather quickly, then I would say, hey, why don't you come in or I'll come and see you. And then I would stitch you up. I would clean up your wound for you and I'd stitch up. If you want to do it in your house, then that's fine. I always charge the cost of the materials to do each procedure, which for a laceration is about $15. So, I'd say if you want to buy the the the medicine, the Lidocaine and the syringe and the suture material and the suture kit, then it's $15 and I'll show you up right there in your kitchen and we can take the stitches out in about a week.
[00:18:30.980] - Candi Broeffle, Host
My goodness. And the rest of that is covered under your membership.
[00:18:34.850] - Isaac Engholm, M.D., Guest
[00:18:36.140] - Candi Broeffle, Host
That is incredible. So, the other thing is when it comes to labs, I find that so interesting as well. I started doing our labs and did kind of an annual exam with you and ordered a bunch of labs. And it was interesting to me kind of the difference in pricing.
[00:18:59.000] - Isaac Engholm, M.D., Guest
Yes, that is a bizarre experience for everybody. And it was a bizarre learning experience for me, too, as a physician, to understand what the true cost of many laboratory tests are typically in the marketplace, you know, you'll pay between 30 and 60 dollars for most lab tests. And there's if you look at your itemized fees, you know, who knows what all you're paying for. What I have found is that it's actually much cheaper. And I use the Lab Corp vendor and I had a company called Freedom Healthworks, helped me negotiate prices. And so, if we needed to check your hemoglobin and see if you're anemic, then we could draw your blood right in your home and the cost to you would be two dollars and eighty-one cents for that lab test.
[00:19:56.240] - Candi Broeffle, Host
That's incredible. And there was some big, I mean, I'm looking at hundreds of dollars that it has cost me every year in the past for the types of tests that I like to get, including some vitamin D and iron and that type of thing. It was a few hundred dollars. And I haven't gotten your bill yet for it, but I'm assuming it's going to be, you know, around the 80 dollars to 60 to 80 dollar mark. And that is just incredible. So, the difference in price makes it much more affordable, even better than trying to worry about getting to your deductible and having that 20 percent pain. So, for people who want to learn more about Dr. Engholm and to set up an appointment or to become a member, go to DeployHealth.Clinic. We will be back in just a moment.
[00:21:00.110] - Candi Broeffle, Host
Welcome back to Green Tea Conversations, where we meet the professionals straight from the pages of Natural Awakenings magazine who share their expertise on natural health with you, I'm your host, Candi Broeffle. And today we're talking with Dr. Isaac Engholm, a direct primary care physician with Deploy Health Family Practice in Minneapolis. So, just before the break, we were starting to talk about the difference in the lab costs. And for people who are interested, you have some examples on your website of the different costs. The whole list isn't there, but you can definitely get an idea of the difference in cost between what you may be paying now through your regular physician as compared to doing it through the direct primary care physician and the arrangements that you have made with LabCorp. The other thing is that I was curious about when I was looking into this is what happens if I need to have an ultrasound or if I need to have an X-ray or a CAT scan. How how does that work with your practice?
[00:22:07.670] - Isaac Engholm, M.D., Guest
Which is a great question. And the imaging I don't personally perform in my office. And so, instead what I've done is I've asked around to independent radiology clinics, and sort of set up a menu for the best prices around town. And so, I can tell you, if you needed if you thought that you had pneumonia and you really, you know, we felt it was in your best interest to have a chest X-ray, then we could send you to a local radiologist for about seventy-two dollars, depending on, you know, what the need was. Or, you know, if you had a fracture of your foot or of your hand, it would probably run depending on the number of images we'd need, but it would be around a hundred dollars to perform that. Some ultrasounds do cost between two and three hundred dollars for the cost because they are a lot more time-consuming and advanced than just playing some radiology. But my effort is always to help each patient or each client, find the most affordable route to achieve their goal while still maintaining a high standard of care.
[00:23:31.840] - Candi Broeffle, Host
And what about hospitalizations? If I feel like perhaps I need to go to the emergency room or I do go to the emergency room and they decide I have to be hospitalized, what are my options working with you?
[00:23:48.730] - Isaac Engholm, M.D., Guest
Sure. So, I don't, you know, perform emergency evaluations in an emergency room. I'm not staff there and I don't have privileges at the hospitals in the area. And so if, you know, if people, if my patients end up in the emergency room or in the hospital, then financially, then they will be responsible to take care of all those costs, which is why I always really encourage my patients to have some sort of catastrophic coverage, whether it's through a cost chair or whether it's through the marketplace, a typical insurance plan. But the cool thing about our relationship is that I have had patients, you know, call or text me or send pictures of themselves from the emergency room or hospital and say, hey, this thing's happened to me. You know, do you think this is a good course? Can you talk to my providers? Are there ways that you can help me coordinate care? And because I have a lower patient volume than I do have time to help coordinate care. And I can tell you the post-hospitalization care plan is much more robust because usually, I've participated in a portion of the care in the hospital. I'm already aware of the medication changes. And then I can see you, you know, very quickly after your discharge. And I'm not, you know, completely unaware of everything that's happened. So, a lot of my patients love that that's an option for them and that the transition from the hospital back to their home is much safer and there's a lot more congruency.
[00:25:35.320] - Candi Broeffle, Host
So you made a really good point. You talked about the insurance and having catastrophic care. Let's touch on that a bit, too, because we want to make sure that we don't give people incorrect information. It's important that people have some kind of catastrophic care in order to make sure that they don't get stuck with a bill that's going to end up bankrupting them; so, they can still have insurance and be able to doctor with you as well.
[00:26:09.120] - Isaac Engholm, M.D., Guest
Absolutely. The membership itself, the seventy-five dollars a month, is not recoverable in, you know, with your insurance because I'm out of network for everywhere. But the labs that you order or any of the orders that come from my office, all of those can be submitted for claims. So even, you know, if you wanted to use your insurance to pay for your laboratory evaluations, you can submit those claims to an insurance company and ask for coverage.
[00:26:43.090] - Candi Broeffle, Host
Then what about with Medicare? Because I know there is some kind of differences with Medicare.
[00:26:48.380] - Isaac Engholm, M.D., Guest
Sure, there are two different types of direct primary care physicians. There are the physicians that have opted to take care of Medicare patients, which typically means that they've opted out of Medicare in general and they won't send any bills or there are providers that stay connected to Medicare. But that means that every time you see that patient, then they have to send a bill. I am the type of physician where I opted out of Medicare completely, which means when you see me, you can still pay the seventy-five dollar fee. And then you know, there's no transaction between Medicare and my office. It's very pure. I don't submit any bills or claims. And so, other physicians have a hard time taking care of folks who transition and their life stages into Medicare. Whereas, I don't have that issue. If you are seeing me and you're, maybe you're sixty-four and you haven't opted into Medicare and then you have a birthday and you want to opt into Medicare, you can still keep me as a physician, not change a single thing. And and that's totally legal and totally fine.
[00:28:05.890] - Candi Broeffle, Host
And in both cases, if there is something that's covered with your insurance under primary care, for instance, a mammogram or a colonoscopy, you can, we can still do that. We can still go to a local clinic and have that done.
[00:28:24.190] - Isaac Engholm, M.D., Guest
Absolutely. And if you have a traditional insurance plan by The Affordable Care Act laws, then they would have to cover all those preventative measures, such as the mammogram or the colonoscopy.
[00:28:40.580] - Candi Broeffle, Host
But in all actuality, I had found that as far as the blood work went, it was actually cheaper for me to just pay it with the (28:50) than to go through to my insurance and pay the deductible, even if I had met the deductible at that point.
[00:28:55.730] - Isaac Engholm, M.D., Guest
The deductible. Yeah, and many people have deductibles in the five, six, seven thousand dollars, some of them over ten thousand dollars. And so, it's much, much cheaper to pay cash.
[00:29:06.200] - Candi Broeffle, Host
The other thing that you're doing is, one of the other reasons why you wanted to go into direct primary care was so that you could also do work, as you said earlier, with the homeless community. And you are helping a group called 612 MASH, set up a free clinic downtown. You have been doing that?
[00:29:27.350] - Isaac Engholm, M.D., Guest
Yes. They are situated on 30th in Chicago, just a few steps actually from where George Floyd died. And it's a very special place to this nonprofit, which is why they did not want to move from there. And that nonprofit and I are working together to set up a nonsliding scale, no barrier, free clinic for that community so that anybody, regardless of whether or not they have Medicare or Medicaid or their cash pay or they have Blue Cross, it doesn't matter. Anybody should be able to go to that clinic and that those doors should be opening up in the next couple of months. We're still in the building phase. But I'm very hopeful that that project will come to fruition very, very soon.
[00:30:21.020] - Candi Broeffle, Host
Very interesting. And then the other one is the Magnus Veterans Wellness Center in Dayton.
[00:30:29.660] - Isaac Engholm, M.D., Guest
Yes. WHich is a wellness center that's dedicated to veterans and their family members, which is unique because the VA only takes care of veterans themselves. But the Magnus Veterans Foundation has decided that they want to set up a wellness center that's dedicated to the total health and wellbeing of veterans as well as their family members, which means that they want to provide services for mind, body, spirit. They want to bring in psychology and chaplaincy, as well as, you know, sports and physical therapists alongside primary care to give a very broad, well-rounded health benefit to veterans and their families.
[00:31:25.400] - Candi Broeffle, Host
You said that this is a nonprofit that has been putting this together and they have so far not taken any grant funding but have raised a great deal of money already.
[00:31:38.650] - Isaac Engholm, M.D., Guest
Yes, they've raised four and a half million dollars so far. They've got a little over a million dollars to go for this first sort of capital campaign. And very soon they will likely be able to take pledges so that individuals or families can sponsor a veteran or the veteran's family member at a monthly rate. I believe they're settling on about 50 dollars a month for an individual to sponsor a veteran, which I think is going to be just fantastic.
[00:32:13.330] - Candi Broeffle, Host
And so, that will be another way that they are doing their fundraising is sponsoring a veteran or one of their family members. And it's something like 50 dollars a month. I mean, that's so doable for most people. And what a benefit that's going to be!
[00:32:30.310] - Isaac Engholm, M.D., Guest
I think it's going to be really groundbreaking and a great model, not only for for Dayton, Minnesota, but I think even to reproduce and expand in other places, in other communities, in Minnesota, or even America.
[00:32:47.530] - Candi Broeffle, Host
This, yeah, it could really change the way health care looks in our towns, in our cities, in the rural areas across across the United States.
[00:32:58.300] - Isaac Engholm, M.D., Guest
[00:32:59.410] - Candi Broeffle, Host
So, you are creating this this actual model that other people will be able to take a look at. It's really exciting. If people want to get involved, how would they contact the people at Magnus?
[00:33:14.110] - Isaac Engholm, M.D., Guest
So, MagnusVeteransFoundation.org is the current website for that foundation, and 612Mash is the website for the the nonprofit that's in downtown South Minneapolis.
[00:33:31.780] - Candi Broeffle, Host
And it's 612MASH in downtown.
[00:33:36.640] - Isaac Engholm, M.D., Guest
[00:33:37.350] - Candi Broeffle, Host
Thank you so much for being with us today Dr. Engholm. It was a pleasure getting to know you. For people who would like to learn more about what Dr. Engholm does and to become a client or a patient, go to DeployHealth.Clinic. To read the online version of Natural Awakenings magazine, visit NaturalTwinCities.com. You can find a podcast of this show on AM950Radio.com, on Apple and Google Podcasts, Spotify, and anywhere you get your podcasts. You're listening to Green Tea Conversations on AM950, the Progressive Voice of Minnesota, and we will be right back.