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
To replace a system, you need data—not guesses.
That’s where Health Direct Partners fits.
Health Direct Partners provides:
- Claims analysis
- Network optimization
- Predictive cost modeling
- Transparent executive reporting
- Custom network strategies per employer
This allows employers to finally see where dollars are leaking—and fix it intentionally instead of reactively
4️⃣ Benefits Administration That Doesn’t Break the Model
A premium healthcare model collapses without clean administration.
BeneBloc became the operational backbone:
- Enrollment accuracy
- Eligibility tracking
- Billing reconciliation
- Life-event changes
- Clean data movement across systems
- Reduced HR burden
This isn’t flashy—but it’s essential.
Without this layer, replacement models fail at scale
5️⃣ Direct Health System Alignment (This Is the Inflection Point)
Here’s the part most people talk about—but few actually execute.
👉 We signed a direct contract with Ascension Sacred Heart.
That contract allows us to:
- Intentionally direct specialty and hospital care
- Reduce unnecessary utilization
- Align incentives around outcomes
- Remove friction at the hospital level
Without health-system alignment, DPC models hit a ceiling.
With it, the entire ecosystem changes.
We’re deliberately not over-explaining this here.
This is where discussion belongs.
6️⃣ Insurance Repositioned (Not Removed)
Insurance still matters—but only where it belongs:
- Hospitalizations
- Surgery
- Major medical events
Everything else flows through:
DPC → Concierge → Optimized Networks
Insurance becomes a safety net, not a gatekeeper.
What This Model Actually Replaces
This isn’t additive.
It replaces:
- Traditional primary care networks
- Copays and visit limits
- ER misuse
- Prior authorization churn
- Confused employees
- Uncontrolled cost escalation
Without asking patients to “figure it out.”
Why We’re Sharing This Here Because:
- DPC alone is powerful—but incomplete
- Navigation changes outcomes
- Data changes employer confidence
- Direct contracts change incentives
- Systems matter as much as medicine
This community exists to explore what replaces the broken system, not how to survive inside it.
💬 Discussion Points
Where do you think DPC models break down without health-system alignment—and what barriers have you seen to direct contracting?
What’s Coming Next
- How direct hospital contracts are structured
- Employer cost comparisons (real numbers)
- Where replacement models fail—and why
- How smaller DPC practices can participate
- A VIP-only deep dive into the Ascension implications
This story isn’t finished.
But it’s working.
And it’s happening now.
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Total Healthcare Replacement Model
skool.com/firstcalldpc
Direct primary care gives unlimited access to your doctor, same-day visits, clear pricing, and no insurance—medicine built on trust.
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