The Home Health Care Today Show: S1, E17: National Diabetes Awareness Month - Guest: Paul Thomas, MD.

In Season 1, Episode 17 of The Home Health Care Today Show, Dr. Paul Thomas, MD., of Plum Health, DPC visits the show to discuss National Diabetes Month, the value of Direct Primary Care, and Plum Health DPC's affordable subscription-based model to effectively close the gap to access quality healthcare for adults and children in Detroit. The show's goal is to inform, inspire, influence, and educate Metropolitan Detroiters on the importance of Diabetes awareness, treatments, and best practices for living healthier lives.

Dr. Thomas Paul is a board certified family medicine physician practicing in Corktown Detroit. His practice Plum Health Direct Primary Care is the first of its kind in Detroit and in Wayne county.

His mission is to deliver affordable accessible health care services in Detroit and beyond. Dr. Thomas has been featured on WDIV TV channel four WXYZ channel seven Crain's Detroit business and CBS radio.

He has also been a speaker at TedX Detroit. Dr. Thomas is a graduate of Wayne state university, and he is now clinical assistant professor. In addition to being a professor and a physician, Dr. Thomas is also an author. He’s an author of two books, one of which is titled Direct Primary Care to assist patients with better understanding what primary care is all about.

A. (Question #1: Dr. Thomas, please shine a little more light on your background. You're here in Detroit, right in the heart of the west side, near downtown. Talk to us a little bit about your passion for patients in this area, providing them with primary care and granted it is Diabetes Awareness Month, some of the patients that may struggle with diabetes.)

Dr. Thomas Paul:

“We really believe that healthcare should be affordable and accessible and there's a huge gap in access to primary care in Detroit. So if you're in Detroit, there's a hundred primary care physicians here for 600,000 residents. So that's one primary care doctor for every 6,000 residents. If you go north of eight mile into Oakland county, there's one primary care physician for every 600 residents. There's a 10X disparity in healthcare access between Detroit residents and Wayne county residents as it is. And the there's several reasons for that. But the main point is I didn't want to be a part of that bad system. And so I wanted to create my own practice, where I could practice, where I wanted and not be employed and put somewhere in the suburbs. And so I started my own practice called Plum Health and we charged people $50 a month to be part of the service, $10 a month for kids.

Our patients can call text, email anytime, and come through and see us anytime. I really did this to lower the cost of care and make healthcare more accessible for people here in Detroit. The specific neighborhood didn't really matter to me. I was just looking to be in the city period. And I actually landed at a building on the other side of the train station, the Michigan central station. I was there for about two and a half years, and then I needed to grow into a larger space. I came across this building and I started leasing this out and serving people out of this office.

Cleamon Moorer:

Dr. Thomas, I appreciate how intentional you were in selecting to serve Detroit. To serve individuals that don't have as much access to quality healthcare. And then taking that disparity into consideration and saying, this is where I want to position myself to close that gap.

When we host our show and open it up to listeners and viewers around Detroit, we have multiple audiences, some are patients or potential patients. And then some are just the general public, which happens to have students in that general public.

B. (Question #2: As you identified the site and said, I want to serve in Detroit, have my own,?primary care practice for Detroiters. What were some of the obstacles and some of the challenges in doing that? We look at you more than as a physician, but more so as a community advocate for healthcare in Detroit.)

Dr. Thomas Paul:

“There's so many obstacles. Number one, there aren't that many medical spaces in Detroit to lease. If you're a doctor and you want to lease an office in Detroit, it's very difficult because you have big corporate health systems who will not lease to you if you're independent. That's why you see so few primary care doctors and so few specialists there's even fewer independent specialists in the city of Detroit, just because to build a class, a medical space is very expensive. The space we're sitting in now was very expensive to build. That undertaking looks like a loss to a lot of doctors, so they don't want to do that. So they'll just practice where a medical space already exists. So that was a huge barrier. I started my practice by subleasing in the office from an old police precinct.

In the art gallery, which became a school for digital technology, at least when it was the school of digital technology, I had a lease on an office that was about this size. It was like 12 feet by 16 feet. So about 180 square feet total. This office is now 1700 square feet. It has enough room for three doctors, our medical assistant. We now have over a thousand patients. So when we built this, we had to build this from the ground up because if you build a medical office, you need a lot of sinks and a lot of plumbing. And to do that in an existing building, you have to drill through concrete, which increases your costs sometimes like $50,000, it's like $10,000 per pipe that you play in or something crazy astronomical. So we were looking for a building that was being built so that we could jump on in the build-out phase so that we could give them our floor plan and have them include our plumbing before they poured the concrete for the floor. That was a very energy intensive process to go around and find the perfect building to pop up.

The biggest obstacle was when people ask, what is primary care? What is direct primary care? Why don't you take my insurance? And so we have to answer the community and that's why I go out and speak on different media outlets. That's why I take interviews like this. That's why I do TEDx talks because we really need to educate the public and help people with their health literacy to understand why it's important to have a family doctor.

My primary care is so crucial and can help them to live a healthy life. And so that's what I'm all about as well as that education piece. But again, that's really time and labor intensive to do that kind of work.”

Cleamon Moorer:

Dr. Thomas and then the transparency that's required in view of a person that says I have insurance, and I believe my insurance will pay X amount for visit X amount for care. And then I have a copay, or I have an office pay, but it looks as though from the direct primary care model that you've been able to delineate some of the ambiguity in terms of straight pricing. $50 a month for our program for adults, and then $10 a month for children, which is affordable for a lot of families in this area. I say, if you can afford a cell phone bill for yourself, you can afford a direct primary care subscription.

If you can afford a cable bill for your family, you can afford a direct primary care subscription or a Plum Health subscription for your family. I am loving the motives and the direct approach to providing quality care to people in a way that's transparent, affordable, and accessible.?

C. (Question #3: Going back to this being American Diabetes Awareness Month and speaking of diabetes in its various forms, how have you been able to assist patients as well as some of your colleagues here at Plum Health with the illness?)

“Diabetes is pervasive and about a third of our country has pre-diabetes. 88 million people in America have pre-diabetes meaning that they have really high blood sugar. It's not quite diabetes, but they're getting just about there and they don't even know it.

Part of what we do is that we educate people. We screen people appropriately, for a lot of folks,?if you're overweight or obese, and if you have high blood pressure, other underlying medical conditions and you're, let's say 35 or 30, you need to be screened for diabetes because the obesity overweight status puts you at a higher risk for developing diabetes. So we screen people every year when they come through for an appointment, as they are members of our practice, we do at least once a year screening for diabetes. Here's the crazy thing, if you had a hemoglobin A1C test, which is a screening test for diabetes at the hospital, they would charge you or your insurance $150 for that test. The actual cost of that test is $6. So we run that test for people here at the office for $6.

Now I take care of a lot of folks in the community and a lot of people have been delaying care for their diabetes because it seems out of reach it's too expensive. If you're uninsured, it's $250 to visit the doctor, they might run $300 or $500 worth of labs. And then your medications at the pharmacy might cost a fortune. In our program, you're paying about $50 a month. And then it's maybe $10, $30 every few months to check your A1C. Then it's $10 a month sometimes for your medications. We give people insulin for free that might cost them $300 at the pharmacy. We literally give it to them for free. Then if you take Metformin, you might have a $10 copay for that Metformin also known as Glucophage, it's 30 cents at our office for a month's supply.It's 1.20 cents a pill. So we might pay 36 cents a month for your Metformin.”

Cleamon Moorer:

“This is wonderful and outstanding information. We're going to do our best to get it out across all the channels, including YouTube. We're going to talk to our own roster of homebound patients who have diabetes as a diagnosis, have the signs of it, about the offerings here at Plum Health. This is great. It appears that you all are repairing what I would unfortunately like to call a broken system, a system that doesn't have enough access to let alone healthcare, but information, and then transparency in terms of a pricing model.

D. (Question #4: Is there anything in particular that the clinic is doing this month, as a call to action for patients in the area, in the community, or is there anything that we could do to assist in getting more patients in the door that have some of those signs of diabetes?)

“Well, that's the thing, there's a robust program in Detroit around diabetes that I've seen. In doing my research for our meeting today, I looked up the Greater Detroit Area Health Council, and they have a diabetes prevention resource center. I clicked through the link on when we can meet up and all their dates are for 2019. That's the last time that they updated that. unfortunately. And so my answer to that is this is why it's so important to have a primary care doctor who can take time and a thoughtful approach to your care as a person. If you're 30 or older, if you're overweight at any age or obese at any age, it's time to screen for diabetes and you need to have that conversation with your doctor. And for our part,?we do outreach to the community.

We speak at community groups. We talk about how we can screen people for different conditions, diabetes being one of them. But mostly, we focus on that relationship with our patients when they come in, getting them screened appropriately and testing them for diabetes, because it can be a silent disease. You can have no symptoms, you can feel great and still have diabetes. The problem with that is that as your blood sugar gets higher, it does damage to your retina, does damage to your eyeball, does damage to your kidneys, can put you on the path for early dialysis. It's the number one leading cause of blindness in the United States. Those are the things that we need to work on, allowing doctors to have the time to have these conversations.”

Cleamon Moorer:

E. (Question #5: Dr. Thomas, talk to me a little bit about the vision that you have for the practice, as well as for Detroiters.)

Dr. Thomas Paul:

“We want to make sure that everybody has access to affordable health care services. I envision us growing over time. I've been doing this for five years. We have three doctors now,?going from one doctor initially to three doctors now is a tremendous step. I want to keep growing that by bringing on more doctors who are enthusiastic and passionate about serving the community and uplifting the health of Detroit and the Metro Detroit community as well.

My goal is to keep growing, keep serving people, wherever and whenever we're needed. My vision is that everyone has access to kind, compassionate, physicians who can really take their time and help people through their medical problems.”

Cleamon Moorer:

“That's where I believe our missions and our visions align because at American Advantage Home Care, we also would like to ensure that homebound patients are able to receive adequate care in the comfort of their own homes under physician orders.

F. (Question #6: When you think about diabetes and some of the other chronic illnesses, do you see home health as an adequate means to provide support to patients who are home-bound and that cannot make it physically to an outpatient clinic?)

“Yes. The most challenging thing about diabetes is that it's a condition that needs daily attention, hourly attention really, because you have to check your blood sugar. Every time you wake up, you get a fasting blood sugar level, and then you want to check your blood sugar with each meal. So you get a mealtime blood sugar and if you're insulin dependent, meaning you need to give yourself insulin every day or sometimes four times a day, you're gonna balance the amount of insulin you give yourself based on your current blood sugar readings.

That takes a lot of time, education, resources, support sometimes in health, in house, home health aid supplies. Like you mentioned, you need not only the insulin, but you need the needles and glucometer tests and the test strips. And so there's a lot that goes into it and there are some people that are really savvy and can manage it themselves with the help of a physician.

Other people need a family member to give the insulin or to test the blood sugar, or they might need a home health aide to do it as well. There are a lot of things that go into that. In short, this is where teamwork in medicine becomes really paramount. The coordination of care between not only the doctor and the patient, but also perhaps a home health aide, perhaps sending the patient to a virtual meet and greet with other diabetic patients where they meet maybe weekly and talk about the challenges around using insulin, etc.

There's a lot that goes into it and working with a pharmacist to make sure that the medications are delivered. We mail some medications to our patients. We deliver some medications to our patients as well. If that's a gap that needs to be closed, we can assist with that. Oftentimes it's going to be the pharmacy that's sending out the medication. So there's a lot of coordination to go around to make this manageable for people.

I think that having other people with the condition that you're able to talk to and conference with is so powerful because it can help you make sense of the condition and help you feel like you're not alone. It can help with management strategies. Maybe they thought of something that's helpful in managing their diabetes that you hadn't thought of, or that your doctor didn't describe to you.”

Cleamon Moorer:

“Your description of it is spot on, it's more like an ecosystem of primary care providers, such as the direct primary care group here at Plum Health. It is that home health care community. You mentioned some of the opportunities for virtual conferencing between individuals, more so of a think tank or a venue where folks could share ideas. This is really good and it is out of the norm. It's totally out of the norm of a lot of the ways that healthcare is even described and or discussed.

It’s a community of practice and you take the group of patients that are perhaps in a waiting room in a clinic, but you put them in a more of a virtual environment that's dispersed, that's much more diverse across a number of different zip codes to be able to discuss best practices.

Maybe as we look at a silver lining or that vision that we have, we're creating that environment of wellness or the mental habitat for wellness, but also putting in the resources and the tools that folks could use.”

G. (Question #7: Dialysis is obviously used for patients that do have kidney disease. Are there any clinics, any additional resources that you would recommend for patients that are either in the stage of dialysis or pre dialysis that we did not quite touch on or speak to today?)

Dr. Paul Thomas:

“Yes, I think there's a couple of things. Dialysis is not always the end stage of diabetes. In fact, if you have pre-diabetes or even diabetes, your condition can be reversible with diet changes, exercise changes, weight loss, working with your doctor on a management plan to lower your medications gradually over time. You don't need them anymore when combined with lifestyle changes. So dialysis isn't always the end point. First, you have to find a primary care doctor that you can work with, that you trust that has the time to help you manage this condition because you do have options and you should be asking, is this all that I can do? Can I be doing something else, help me manage this condition? Next up you want to work with an endocrinologist. If your diabetes is really difficult to control, it's time to speak with an endocrinologist.

I don't think I really want to name specific people, but you want to find someone that's going to work with your insurance or work with you on a sliding scale payment plan, or that has a personality that works well with yours. And then from there, they can set you up with the dialysis resources that you might need, but I don't think that's not for every patient. Not every diabetic patient is going to need dialysis because our kidney function starts off usually around 120. If your kidney it's that's as measured by a GFR or glomerular filtration rate, if it does get below 60 that's time to see the endocrinologist or the nephrologists that kidney doctor, and then if it starts getting below 30, that's where you're starting to look at the need for dialysis. And so people usually have a long runway before they get to that point. And there's a lot you can do on the front end to prevent you from getting that point.”

Cleamon Moorer:

Very good, Dr. Thomas! We're ending on an extremely positive note here where dialysis is not the end all be all for patients who are struggling with diabetes. Then the things that we could adjust is diet, exercise, and rest. We capture identifying a good primary care physician where Plum Health is currently accepting new patients. Consider Plum Health as a direct primary care provider. Dr. Thomas mentioned the endocrinologist, so in the event that a person needs that specialized care, there are a number of groups and individuals out there.

Dr. Thomas, you've been more than gracious and helpful today. Thank you so much for your time and helping us to share insights with Detroiters, pertaining to diabetes and other chronic illnesses.

Dr. Thomas Paul:

“It's sincerely a pleasure and I want everybody to live their healthiest life possible.”

?The Home Health Care Today Show was launched in 2021 to inform, inspire, influence, and educate viewers and listeners about a variety of health and wellness topics important to home health care clients, caregivers, and family members in Metro Detroit and beyond.

Sponsored by American Advantage Home Care, Inc.

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