It is that time again. Time to understand Direct Primary Care Math and healthcare options for 2019.
When it comes to those already knowing membership benefits, may this serve as your annual reminder of why you are so smart. It might even provide ideas on how you can save further. If you are looking at open enrollment like a deer in headlights, may this shed light on approaching your health care dollars differently in 2020. If you are worried about your addiction to health insurance, you can read more here. It’s not that we think you shouldn’t have it (you should) it's just time to give up the 1990s notion that there is such a thing as “good insurance”. Get what you need to cover yourself in a collision with the healthcare industry. For everything else, let our membership help you save.
Every year, I go on the exchange and shop for my family of four to compare premiums, deductibles and learn the new insurance players on the market. Turns out, again, we can save you money. Here’s how it shakes out:
The caveat? For one, our family is not in the age bracket that gets the astronomical rates, the 55-64 group. If that is you, we are sorry, your rates can get close to the family of four for one person alone to get a “low deductible” plan. Definitely come and talk with us.
Secondly, looking at deductibles and premiums does not tell the whole story. When it comes to cost savings check out our article from last year, the same per visit, lab and prescription savings continue to apply. In fact, our lab costs went down this year and we now include our basic lab panel after 6 months of membership.
This year, like every other, we hear more about astronomical health care costs. Shockingly, a local hospital charged $46,000 to our patient when we had to send him for symptoms of a stroke. During his stay he was charged $16,000 for one MRI. With our membership discounts, the MRI would have been $485.80, if it had not been an emergency. Most of the time we can prevent these high cost visits all together. If we can prevent you needing the ER one time, you save your whole year of our membership (just $900 for one person). Good preventative medicine, a proactive team and your motivation go a long way to prevent emergencies.
I am a small business owner, health care savvy and cost conscious (as many of you are). So here’s what we did this year. We looked at a health share option for our employees and their families. Nextera Healthcare has been partnering their DPC with Sedera for over a year and they have had good experiences. I have been wary of health shares in the past, but Sedera seems to know what they are doing. Read more about their approach to medical cost sharing here. Having a direct primary care membership gets you an even lower rate for Sedera. Sign up with us, or if you are already a member, ask for our link to get more information.
Oh, and did you hear? Sesame Health, a cash based healthcare marketplace, is coming to Denver. Check out their Kansas City page and search to see what it will look like when they launch their network here in 2020.
What does this mean for you?
If you change your mindset and realize that healthcare is cheaper with cash, then Direct Osteopathic Primary Care + Sesame + Sedera is for you.
Direct Osteopathic Primary Care covers primary care and preventative health. Visits, labs, prescriptions, imaging and our unique holistic approach.
Sesame helps you find ways to stretch your healthcare dollars outside of our office - specialty practices, eye and dental.
Sedera covers you in an emergency. Sharing your costs if there is an accident or hospitalization. Get on the direct primary care bandwagon, it just makes sense.
Please share this article for anyone who might need us.
Our Vision at Direct Osteopathic
This week, Dr. Brie and our Physicians Assistnt Torey Ivanic PA-C talk about Direct Osteopathic Primary Care's philosophy of the doctor-patient relationship.
Fall is here
Change is among us
Leaves are dropping
Pumpkin Spice Lattes are back
What happens to you this time of year? Do you go inside and begin the first steps of the winter retreat? Do you throw the last hurrah for the rays of sunshine that remain?
In the face of changing seasons, when it comes to taking care of YOU, how can you bring the fun back?
So this weekend on 9/21/19 I decorated for Halloween with the kids. It’s a first, this early readiness. I usually dread the decorations as a working mom, feeling there is never time to do it but having unlasting mom guilt about not doing it big or bold enough every time. You know, those people that pull out all the stops—they have the skeletons and the talking heads and the fog machines and infinite fake cobwebs out front. That is not me. I hand 2-4 things tops and call it good. My kids are young, they think it is still great.
This weekend, not only did they want to decorate, they wanted to pick out their costumes. Off we went to galavant around town to get our creative inspiration going. On 1st and Broadway (where the real costume shops were that they were not interested in at all) I found the wig section. Now my birthday is in January and I will be 40. On my 21st birthday I got an electric blue wig as a gift and it transformed the winter doldrums and became my good luck charm through the rest of college. I wore it through physics tests and even the MCAT to get into medical school. My 30s, however, have been a bit of a slog. I did three years of residency, working 80 hours a week. Followed by having two babies and opening two medical practices. It’s been, lets just say, busy. Sometimes I worry I am not as FUN as I once was. Which, of course, prompted me to get this lovely new purple wig.
Sunday afternoon I got lost in a 2019 twilight zone. Suddenly, headed across town to a friend’s house I had not yet visited, my phone went on the fritz. It was completely unresponsive. Unusable. No reset possible. Just a death circle of lock and unlock and receiving calls that couldn’t be answered but no other functionality. As a doctor, on call often (and at the time) this was a nightmare. Not to mention, it rendered me completely powerless. I could not find my friend, nor call or text her my problems. I drove along the frontage road of a deserted I-70 (which was weird enough) and wandered into Northfield mall. I got out of the car thinking, I should take this wig off, I don’t even feel like wearing it.
Then I remembered, this was exactly what the wig was for. Bringing light heartedness to the situation. I found a Verizon store and waited, and waited. The wig and I struck up a conversation with several other nice people patiently waiting for their new devices. They kindly let me have a phone, a link to the outside world to reach across the Apple casm and find a repair solution. I walked into Best Buy and said to the geek squad agent, wig and all. “This is my phone it needs CPR. It is completely unresponsive. I have heard you are a doctor.” He fixed it in two minutes flat. We all left with smiles (and I in wonder, if only humans were as easy as a ‘hard reset’ when you need one)!
In the face of adulting, summer leaving and winter coming here we have arrived at fall. You can see the tidal wave of the holidays coming and smile or sink inside. You can thank goodness for the waning heat or lament its departure. You can dream of the coming snow or abhor it. At the end of the day, you can also choose to mindfully and fully dig in, right here right now.
So close your eyes. Dig into the moment. Take a few deep breaths. Think of something fun. Something silly. Something that brings a smile to your face before you have even invited it. Breathe in that lightness. If you can’t think of anything, don’t beat yourself up. Think of me, traveling aimlessly around town in a bright purple wig, hopelessly disconnected and ironically, reconnecting.
Join Dr. Brie and Psychotherapist and Hypnotherapist Victoria Bresee of Technologies of the Self to discuss how to identify if your child is suffering from stress or anxiety related to school, and the role of mindfulness activities in helping with your child's back to school anxiety
Often this is the part of the year where we become self deprecating about unsung New Years Resolutions that have not come to fruition. Ironically, it is also the time that we can start getting outside again in Colorado. The nicer temperatures are coming, sure to be dotted by snow and rain. What does that mean for you?
This quarter we are going to have a DOPC Movement focus. This isn’t to challenge you to one up your peers or become the most fit person in our practice. The challenge is for you and only you. Here’s how it works:
Each of our team members that wants to will share with you over the coming quarter.
Here is mine:
Cheers to #DOPCMovement!
This week our counselor and Licensed Clinical Social Worker Sarah Rasche joined us to talk about the concept of "self care".
Like mindfulness, diet, and exercise, self care has become yet another aspect of mental health that is the subject of paid classes, books, workshops, and special methods that all are aimed at making money off the fact that people are becoming more aware of their mental health.
But you don't need to pay to take care of yourself. Watch our video to learn about the many ways you can give yourself the care that you need without pulling out your wallet.
Using essential oils in conjunction with mindfulness practices, can be a powerful tool in supporting emotions, focus, memory retention, and anchoring in new patterns and beliefs.
Today we talked with Midwife and Health and Wellness Coach Angela Seeling, who uses different Essential Oils in her practice to elicit specific emotions and use the power of our sense of smell to access deep feelings and memories.
Angela will be hosting a workshop on Mindfulness, Emotions, and Essential Oils at our office on Friday, March 8th at 5:30pm. We'll talk about aroma as a direct pathway to to the lymbic system in the brain, and the science behind how essential oils work. Participants will make their own emotional aromatherapy blend to take home, and incorporate into daily practices. Sign up here!
Announcing DOPC's focus for Winter: Mental Health. Following up on our fall focus of Nutrition, we are turning our attention to what can we do to feel good so that taking care of ourselves is something that follows more easily. Drab weather got you down? Did you fall off your New Year's Resolution wagon? Watch today's video to find out about the programs and events coming up over the next few months.
In typical twenty first century fashion I am listening to 10% Happier by Dan Harris instead of actually reading it. Usually while doing dishes at the end of the night. Always multitasking. The thing that got me to pause and write in my journal after was his description in the first few chapters of constantly seeking The Next Big Thing.
The book starts off as an autobiography of the life of Dan Harris, a news anchor and reporter for ABC news who has a panic attack on public television. In getting to chapter three I can tell the introduction of mindfulness is around the corner. However, in the early chapters he seems to be laying the groundwork for why he needs mindfulness.
How does one really “need” mindfulness? For a long time in his life Dan describes a lot of mindlessness. Mindless chasing of The Next Big Thing. I see threads of myself woven in that story, echoing what I hear from many patients too. Everyone has their own Big Things as they go along. Some people, amazingly, are “type B” and not driven by the motor that seeks the peaks and valleys of life. They are content and “trucking along” like my best friend Jen who always answers “how are things with you?” With “Good”, and she means it. Here’s how the journey of The Next Big Thing has gone for me:
First big thing, my parents got divorced. I was two and a half and remember the moment they told me it was happening. I was in a pizza parlor. I had no real idea what it meant. My next memory is being at a stop light when I realized a parent was in each car and I could only be in one. That is when the crying for the one ensued.
The Next Big Thing, I moved to a town of one hundred and fifty people in the eastern Sierra outside of Lake Tahoe. I thought my mom and my step dad were trying to “ruin my life”. Turns out it was just beginning. I met friends I have to this day that became my soul sisters. Small town life was incredible. Also, boring.
The town I lived in was too small to have a high school, so we bussed to Nevada for a new school had four hundred kids in a class. With eight graduating in my eighth grade class it was a big transition. High school was both fun and painful, in the way that teenage years are hard. I graduated valedictorian of my class. The Next Big Thing.
Off to college, and UC Berkeley blew my mind. Academically I was swimming, and eating it up. I majored in a subject I had never even heard of before - medical anthropology. I could eat pizza at 2 AM (a true delight for a lifetime lactose intolerant country girl). I thought I would become a vet since I was a child until one day my chemistry teacher told me I was “smart enough to be a doctor”. Her husband was the town vet so I figured maybe she was trying to tell me to do something different. I also felt that humans needed more help than animals. I didn’t have any physicians in my family, in fact the generations before me never completed to college. After health challenges of my own that were helped by a chiropractor and acupuncturist, I started to explore the many directions the medical path could take me. Enter, The Next Big Thing. One could say I didn’t have a clue what I was getting into.
The journey to and through medical training is cultured around seeking The Next Big Thing. A classic carrot on the stick routine. First you need the MCAT (i.e. big test), then med school, then test after test after test for the first two years. Next the clinical experiences of third and fourth year. Enter Colorado, where I was selected by lottery to spend my third year. I landed in Castle Rock for my very first rotation, with a family doctor father/daughter combination. The older physician reminded me of Sherlock Holmes, twirling his glasses when thinking about hard cases. His daughter showed me that you could be a mom and be a doctor too. I was falling in love with Colorado and family medicine.
Love was the Next Big Thing. I met my husband my third year and moved back to California shortly thereafter to teach Osteopathic manipulation in a teaching fellowship. Enter a new, long distance relationship. Over the next three years, I traveled back and forth between California and Colorado (here’s looking at you loneliest highway in America) going between teaching and clinical rotations. One Big Thing to another. All the while residency loomed.
Residency is what they make doctor shows about. It’s when there are interns and “attendings” and life as you know it is pretty much all medicine all of the time. For “type A” carrot-on-the-stick folks it's the fact that you can’t control “the Match” into residency that drives you wild until it is settled. Residency determines where you live for three to seven years of your life AND what kind of medicine you will practice. For me, I was checking my palm pilot obsessively on a nice spring day eating crepes on 16th street mall when The Match results came in: Swedish Hospital, family medicine, my number one choice. The Next Big Thing.
After residency I started a clinic for a large corporation. We built it, they would own it (or did they own me?). Soon, I saw further to the medical system I did not want to be a part of. I wanted to do things differently. I had ideas brewing that solidified as I learned about direct primary care. I knew I could bring together the medicine I was passionate about practicing AND the people I loved to serve, my patients. I simply needed a different model. Direct Primary Care became my Next Big Thing.
Of course there were other great encounters along the way. I had my daughter literally the day after I finished residency. Between my two practices, I had my son. Parenting has been, quite possibly, The Biggest Thing I have done. Markedly the best. And sometimes the hardest.
Recently I had been fantasizing about moving out of the urban Highlands area where we have a lovely house and nice yard on a busy street. I grew up in the middle of nowhere on 6 acres and I miss quietude and stars. Don’t worry I wasn’t imaging anything drastic, but Golden and Arvada were looking nice. When I started listening to Dan Harris’s book I realized the treadmill I was jumping right back on. I see so many people do the same. As adults, we jump on the treadmill of life and start running 70-100 miles per hour. At first it seems like a lot. At Berkeley I remember feeling that pace, it felt hard and exhilarating and exhausting at times. Somehow, along the way I became habituated. I stopped realizing that running at a 7-10/10 on the stress scale wasn’t normal. Seventy miles an hour started to feel like walking and only once in a while do I realize I am moving 100 miles per hour. This is where mindfulness comes in. One day I’ll tell you more about my journey with that but shockingly I have been using some form of mindfulness to balance my “type A” nature since I was seven years old.
The next step in my mindfulness journey is to take the modified Mindfulness Based Stress Reduction class with you. This is a way to learn a new practice or cultivate a deeper one. Something that can help you change the treadmill habits. We have 3 more spots, is one yours? Register today. It really is your last opportunity to join.
It is mindfulness that keeps me grounded in my moment to moment awareness. Brings me back into my body and time checks my warp speed with the world around me. It lets me breathe bigger and deeper. It helps me to remember what it feels like to get out of fight or flight, to settle into myself. To let my nervous system calm down and stop seeking The Next Big Thing. Dan Harris chased adrenaline in war time news reporting. It is no wonder his adrenal system eventually crashed and needed the rescue of mindfulness to bring him fresh air (after boosting it up on the crutches of cocaine for a while). I appreciated the reminder that I don’t need to move houses. I can recognize the desire to move is my nervous system looking for The Next Big Thing. We start jumping back on the treadmill again because we are habituated to do so. Our adrenal system becomes wired for our stressful pace and unlearning this stress becomes the next real challenge.
I look forward to hearing more in the book about how mindfulness enters the stage for Dan Harris and how it transforms him. Are you reading along? You have until April 4 before we meet, plenty of time to start reading along. Leave a comment, let me know what you think about it so far. Tell me about YOUR Next Big Thing.
Happy New Year!
Hope the holidays treated you well and you are full with family, fun, and food! I know I am. When we started our quarter, we knew it was going to be a hard one. With high stress, lots going on, colds and flus and short days to top it all, we often seek comfort in the most familiar ways: tasty food, warm drinks and cozy blankets.
This is probably why one of the top New Year’s resolutions are some variation of be healthier, eat healthier, exercise more, cut back on (insert less than good thing we are consuming to excess). Inc. reported that 5 of their top 10 resolutions were the above, with 71% wanting to diet or eat healthier.
You probably already know this, but the stats are against you achieving your resolution. Why? Well, most likely because it’s far more complicated than the simple statement that makes up the resolution. Take healthy eating and weight loss, for example: after having read my blog on the different diets, you may have chosen to pick one and start it in the New Year. Did you also know that there are other factors that contribute to your dietary needs and weight control than just which diet you are on? Read on!
This seems like a no-brainer. When we are stressed, we don’t make the best food decisions (we can even make really bad ones). We forego our plans to exercise and we indulge instead. Most people are this way. Did you also know that when we are stressed, our body releases cortisol and this makes us GAIN weight? It does! Cortisol is responsible for regulating our metabolism, helps to regulate our blood sugar, regulates salt and water balance, our heart rate, blood pressure, our sleep, and our memory. When we are stressed, these functions alter then return to normal balance afterwards.
But when we are chronically stressed, we may see things such as poor digestion, increased blood sugar (even diabetes), increased blood pressure, poor sleep and memory, poor immune function (getting sick often), hair loss, slowed metabolism, low energy. How is this going to make it any easier to eat better and lose weight?!
While sleep is not something that comes to people’s mind with nutrition or weight loss, it is so important! The average adult needs between 7-9 hours of sleep per night. If you get less once in a while, it’s what Dr. Brie likes to call NABD (not a big deal). But many people get less than 7 hours on a regular basis. When we don’t get enough sleep, our body doesn’t sense hunger/satiety normally. We tend be more hungry and crave high calorie, high fat and high carb foods. Not to mention, poor sleep also impairs our decision making and we are not able to resist cravings/temptations very well.
Poor sleep can slow your metabolism--your body is trying to conserve energy for increased waking hours. Being sleep deprived is also a condition of stress, and you know what that means? You got it, increased cortisol levels, which we just talked about. You’re also more tired and less likely to do physical activity.
While it would be easy to say,” Work out more and you’ll lose the weight,” it’s actually not that easy. Yes, physical activity will cause a deficit in calories. But often times, when you are working out, your body needs fuel to be able to sustain the activity and then repair itself afterwards. Some people eat more when they work out for this reason. It is important to eat enough calories when you are working out so your body does not become stressed (read: releases cortisol). It is important to note that exercise alone will not result in significant weight loss, but ongoing exercise can help tremendously with weight loss maintenance (see one of many studies).
Not only that, exercise helps to increase heart, bone and muscle health (your doctors will thank you), it helps manage stress and keeps you happier (bye bye, excess cortisol), and it will help you sleep better (regulate that hunger!).
Your social life
Humans are social beings and Coloradans especially love to celebrate everything that makes this state so fun to live in: the grand outdoors and our craft beer, all booze, really. (Anyone read this article in 5280?) Even if you don’t ski, mountain bike, rock climb, etc, social gatherings are yet another time where your healthy eating plans can fall by the wayside. Call it peer pressure, call it indulging, call it what you want. It’s harder to resist the beer or bar food when you’re with a group of friends. Seeing, smelling and being able to reach out to the french fries or wings or whatever is temptation waiting to win. Alcohol also can impair judgement, make you hungrier and adds calories!
Besides work adding the obvious stress, your work situation may make it difficult for you to stay on your bandwagon. On the go all the time? This makes it easier to want to pick up fast food or skip a meal. No lunch hour? You may be more prone to snacking throughout the day or bingeing when you do eat. Traveling? Less chance for a home cooked meal or meal planning. We won’t even talk about catered lunches/lunches out and office snacks or candy/cookie jars that park themselves at the end of everyone’s desk for convenience.
Your gut bacteria
Say what?! Yep, if you didn’t know it already, your gut bacteria may be playing a part in keeping your weight the way that it is. This Scientific American article is one of many that summarize current research on this association specifically. We know that the bacteria in our gut help digest things we can’t, making more calories available to us. They also can affect hormone production, altering the signals that tell us we are full or hungry. The bacteria can affect inflammation in our gut, calming it or increasing it by releasing certain chemicals based on our diets, thereby causing us to gain weight. No, there isn’t a probiotic for weight loss yet, but having a good diversity of bacteria and eating a variety of prebiotics (foods that feed our gut bacteria, usually high-fiber foods) is a good place to start.
Your medications and your health conditions
Yet another example of why it may be more elusive than you think to maintain a healthy diet and/or weight. Certain health conditions limit what you can eat and you may only be able to choose what you can eat rather than what you should eat. Take those who are doing a FODMAP elimination diet, for example, foods like asparagus, apples and some seafood are considered healthy, but are high in FODMAPs and thus need to be limited.
Certain medications can cause weight gain too, like medications for seizures and insulin, and it would not be easy to “avoid” these medications in some individuals.
It is important to remember that while it may seem easy to modify one or several of these factors, the reality is that eating healthy and maintaining a healthy weight are not easy things to do. Because, as I always like to say, “If they were, I’d be out of a job!” This doesn’t mean you don’t try to modify one or several of the factors mentioned above, it means that you modify what you can and don’t beat yourself up over the rest of it. Just keep at it, one step at a time. Healthy eating and maintaining a healthy weight should be lifelong goals, not just a resolution for this year. And really, if getting better sleep, having less stress, being more active and having a healthy social life are things you can fold into your lifestyle and actually enjoy (who wouldn’t??), you’ll get full bragging rights on those successes, whether or not you lose weight—I promise.