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Why We Built This — And Why We Never Quit
What pushed us to build something different wasn’t a business idea. It was what we were seeing every day in the emergency department. A huge number of patients who come through the ER are there for one simple reason: they don’t have access to primary care. Not because they made poor decisions. Not because they didn’t care. Simply because access didn’t exist. Some arrive poorly treated—not from neglect, but from delay. Others wait four, five, sometimes six hours in an emergency department for minor illnesses that could have been handled safely and efficiently through telemedicine if access were available. That stayed with us. We weren’t trying to replace emergency medicine. We were trying to protect it—by keeping patients out of the ER when they didn’t need to be there, and by creating an economical, accessible way for people to get care earlier. From the beginning, we knew Direct Primary Care was the direction we wanted to go. But we also knew access alone wasn’t enough. Telemedicine had to be part of the solution. Not as a shortcut. Not as a replacement for real care. But as a way to remove unnecessary friction. We don’t believe doctors are “getting it wrong.” Most are overwhelmed—buried under red tape, documentation, and systems that make meaningful care harder every year. The intent is there. The time is not. At the same time, both of us were still working roughly 150 hours a month in the emergency department. We were very intentional about keeping those worlds separate. As tempting as it might have been from a business standpoint, we never pitched our clinic to patients in the ER. That line mattered to us. We wanted this built the right way—or not at all. There are plenty of colleagues who think we’re crazy for taking this path. That’s fine. What’s driven us hasn’t changed: an undying drive not just to be successful, but to create something better. Staying clinically grounded has always mattered. Emergency medicine keeps you honest. It also makes it clear that better access and longer appointments create space—for conversation, for prevention, and for alternatives before defaulting to the usual pharmaceutical path.
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Total Healthcare Replacement Model
Why we stopped trying to “fix” healthcare—and built something better. For years, healthcare has been optimized around billing, not patients. Higher premiums. Narrow networks. More friction. Employers pay more every year. Patients delay care. And the ER becomes the default access point. This post outlines how we built a true healthcare replacement model—not a theory, not a pilot—while still working full-time as emergency medicine physicians. Where This Started (The ER Truth) A massive percentage of patients we see in the emergency department are there because: - They can’t access primary care - They don’t understand their benefits - They’re “covered” but afraid of the cost - Or they’ve been bounced around a broken system Insurance wasn’t failing catastrophically. It was failing quietly—through delay, confusion, and avoidance. That’s when we realized: Insurance is a poor tool for delivering everyday healthcare. So we stopped trying to optimize insurance—and built around it. The Architecture of a Real Replacement Model This only works if every layer is intentional. 1️⃣ Direct Primary Care (The Foundation) FirstCall DPC became the front door: - Same-day access - Longer visits - No billing friction - No visit limits - No prior authorization for basic care DPC handles 70–80% of healthcare needs when done correctly. But DPC alone isn’t enough. 2️⃣ Community Concierge Navigation (The Missing Layer) Most healthcare failures aren’t clinical—they’re navigational. This is where PatientPAL became critical. PatientPAL functions as the human guidance layer, helping members: - Understand benefits - Navigate imaging and specialty care - Resolve billing confusion - Coordinate follow-ups - Avoid unnecessary ER visits This isn’t a call center. It’s advocacy + continuity. When combined with DPC, this layer alone demonstrated ~$1,000 per employee per year in modeled savings, while improving outcomes 3️⃣ Claims Intelligence & Network Optimization
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Zocdoc Isn’t the Problem. Misusing It Is.
This may be one of the most important conversations we have in this community. Zocdoc gets blamed a lot in DPC circles: - “Low-quality patients” - “Price shoppers” - “High no-show rates” - “Terrible ROI” Some of that criticism is fair. Some of it misses the point entirely. Let’s start with an honest question: What kind of patients actually use Zocdoc? In our experience, they tend to fall into a few buckets: - People who are frustrated with access - People who are new to the area - People who are used to transactional healthcare - People who believe “covered = cared for” (until it isn’t) - And yes—some are price shoppers That doesn’t make them bad patients. It makes them uneducated patients—and that distinction matters. Where practices get Zocdoc wrong Zocdoc is not: ❌ A relationship platform ❌ A loyalty channel ❌ A long-term acquisition engine Zocdoc is: ✅ A discovery tool ✅ A moment of intent ✅ A chance to redirect the patient journey The mistake happens when practices treat a Zocdoc booking like a win—when it’s actually just step one. How we re-framed Zocdoc inside FirstCall DPC We never built Zocdoc into our system as “marketing.” We built it as a controlled intake valve feeding into GoHighLevel. Here’s what that looks like operationally: 1️⃣ Zocdoc → GHL (email-based trigger) Since Zocdoc doesn’t fire webhooks: - Appointment emails route into GHL - GHL creates the contact - The workflow begins immediately 2️⃣ Immediate expectation setting Automatic SMS + email: - Confirms the appointment - Clearly states: This is Direct Primary Care We do not bill insurance Membership is required - Encourages early cancellation if it’s not a fit This alone filters a huge percentage of misaligned patients. 3️⃣ Speed + human touch - Staff attempts live contact quickly - Education > selling - If no response: 3 attempts Then cancellation No chasing. No begging. 4️⃣ Payment before care - Membership payment links sent via GHL - No payment = no visit - Automation handles reminders and cancellations
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Medicare, Direct Primary Care, and the Rules No One Explains Clearly
One of the most misunderstood topics in Direct Primary Care is how DPC physicians interact with Medicare. Not because it’s shady. Not because it’s forbidden. But because the rules were written for a healthcare system that no longer exists. So let’s talk about it clearly. First: The Big Picture Medicare was designed around insurance billing. Direct Primary Care is designed around direct relationships. Those two models don’t naturally fit together—which is why Medicare has specific rules about how physicians can participate, opt out, or limit what they provide. Understanding those rules is critical—for doctors and patients. The Core Medicare Rule That Matters A physician who is enrolled in Medicare cannot charge Medicare beneficiaries cash for services that are otherwise covered by Medicare. That’s the foundation of the entire framework. From that single rule, everything else flows. The Two Legitimate Paths for a DPC Physician 1. Opt Out of Medicare A physician formally opts out and enters into private contracts with Medicare beneficiaries. - The physician does not bill Medicare - The patient agrees not to seek Medicare reimbursement - The relationship is entirely private - The opt-out lasts 2 years at a time This path is legal, structured, and commonly misunderstood. 2. Remain Enrolled, But Limit Scope A physician stays enrolled in Medicare but does not charge Medicare patients for covered services. - Medicare-covered services must be billed to Medicare - Non-covered services may be offered privately - Membership fees must be carefully structured - Boundaries must be extremely clear This path requires discipline and precise compliance. Why the Rules Feel So Rigid Medicare is designed to: - Prevent double billing - Protect beneficiaries from coercion - Maintain standardized coverage What it is not designed to do is accommodate innovative care models. So the rules aren’t malicious—they’re just outdated. Common Scenario Questions (And How DPC Doctors Stay Compliant)
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Who FirstCall DPC Is Not For
Direct Primary Care isn’t for everyone. And that’s intentional. FirstCall DPC may not be the right fit if: - You’re looking for the cheapest possible option - You only want care when something is already wrong - You prefer quick, transactional visits - You want unlimited access without boundaries - You expect your doctor to work around insurance rules This model works best when: - Patients value access and responsibility - Prevention matters as much as treatment - Decisions are shared, not rushed - The doctor–patient relationship is respected We don’t try to be everything to everyone. We’re built for people who want: - A real primary care relationship - Clear communication - Thoughtful decision-making - Continuity over convenience-only care If that resonates, FirstCall DPC tends to feel like a relief. If it doesn’t, that’s okay too. Good care starts with alignment.
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