Nurse Practitioner Provides Personalized Direct Primary Care

Nurse Practitioner Provides Personalized Direct Primary Care

Karl Lambert, ARNP Would Never Go Back to the “Sickness Model” of Traditional Medical Practice

In 2014, nurse practitioner Karl Lambert heard about the Academy of Preventive & Innovative Medicine by Worldlink Medical. A colleague told him about hormone optimization with bioidentical hormones and he was intrigued.

Karl Lambert opened a wellness-based Direct Primary Care practice and loves practicing

Karl was frustrated that his patients never really improved. He’d see them in his office, talk with them about their obesity, blood sugar, diabetes, blood pressure, cholesterol, and other risk factors. He’d prescribe medications and have the best intentions for them, but not hold out a lot of hope for their prognosis.

Karl would see the same patient, back in the office 6 months or a year later. Nothing had changed. Their weight was the same or higher, blood sugars still elevated, hemoglobin A1C creeping up – everything that goes along with “aging.”

Karl never felt a sense of getting ahead of any of his patients’ labs or symptoms. He especially felt inadequate when it came to understanding and treating the root problems underlying all these issues.

After attending Worldlink’s Part I Hormone Optimization course, Karl started implementing bioidentical hormone optimization with his patients right away. He saw immediate improvements in their health. He looked forward to seeing some of them again because they were heading in the right direction.

Karl was still handcuffed by the limited time he could spend with his patients and the sheer number of them. He was still working long hours and charting late into the night, which cost both him and his family.

When a colleague suggested they work together to start a direct primary care (DPC) practice, Karl wasn’t quite sure what that was. He did some research online and gradually started to see an exciting picture emerge.

RediMedi Integrative Clinic

Direct primary care (DPC) is primary care sold directly to individual patients, bypassing insurance (for the most part). Karl started Redi-Medi Integrative Clinic in 2014 to serve the primary care needs of Wenatchee, a small town of about 30,000 in central Washington state.

Redi-Medi’s website provides a transparent overview of Karl’s brand of DPC:

We have shrugged the bureaucracy. We have shredded red tape. In refusing to recognize any interference with the sanctity of the patient/provider relationship, we have returned family practice medicine to its root values of clinical excellence for and compassionate knowledge of every patient. In every aspect of family healthcare and custom health care, we promise accessibility, convenience, and affordability.

Redi-Medi offers care for patients from age 0 to 100, with an affordable sliding fee scale: $20/month for young children to $55/month for adults 18-50 and $90/month for patients over 81.

That’s less than a monthly cell phone bill, something almost anyone can afford.

I talked with Karl about his DPC practice and the way it has evolved into an entirely cash-based model that’s focused on wellness and prevention, rather than chasing disease and waiting for reimbursements from insurance companies and Medicare.

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My Conversation With Karl Lambert, ARNP

SG: Tell me about your practice before you got into direct primary care (DPC)

Karl Lambert, ARNP: It has always been a cash-based practice since inception in 2006, but it was much more about easy access and urgent care when I first started.  I added house-calls in 2008 and it was not until 2015 that I launched into the DPC component. I was not doing primary or hormone-based treatment when I first started out in 2006.  In transitioned slowly into primary care in 2013 after attending a Bale/Doneen course and I knew that primary care was sorely missing the mark on prevention and wellness. Attending my first BHRT course (The Academy of Preventive & Innovative Medicine by Worldlink Medical) simply cemented how far off the mark the practice of medicine has become in this nation.

SG: How do you explain the concept of direct primary care to patients or colleagues who aren’t familiar with it?

Karl Lambert, ARNP: My elevator pitch has now become is affordable concierge service for the everyday working person.  What sets our practice apart from the rest of the pack is that we practice more personalized medicine designed for the individual and not the masses.  

SG: Tell me the story of how you got into DPC 

Karl Lambert, ARNP: I truly just stumbled onto the concept when doing some research on the internet.  When I learned that I could have a pharmacy within the practice, it piqued my interest.  Ironically, I started my one office practice within a retail pharmacy, so all I was doing was reversing this concept and now having a one-room pharmacy within our bigger practice.  When I came across Josh Umbehr, MD and his Wichita Kansas practice, it was one of those ‘aha’ moments.  

SG: What’s been the most surprising thing about getting into DPC?

Karl Lambert, ARNP: WHY DIDN’T I START THIS WAY BACK IN 2006? 

It is such a simple concept and paradigm yet the tendency is to make it more complex is always there.  

SG: What’s been frustrating about your practice?

Karl Lambert, ARNP: The biggest frustration I used to have is hearing folks complain that the cost was still too much or why do I have to pay if I am not using your service every month.  I used to be bothered by this, but now I just tell those folks to go away and vote for Bernie.  

SG: Have you faced any serious roadblocks in setting up a DPC practice? How did you overcome those?

Karl Lambert, ARNP: None.

Washington State is an interesting state to live and practice in.  Washington State was one of the first States to recognize the legitimacy of the DPC concept and even helped pave the way by making it easier.  Yet–it seems to be the State that leads the way for Universal Healthcare for ALL. I don’t get it, but perhaps that is what it means to be a true politician–keep your toes in every option and go with the one that delivers the most votes.  DPC is not the solution and nor is government, but perhaps if policymakers can figure out someday, they will realize that both can co-exist. 

Unfortunately, we live in a day and age of polarization and less dialogue.  

SG: What resources and professional assistance did you rely on as you set up your practice? Consultants? Accountants? Lawyers? Other DPC providers? Associations?

Karl Lambert, ARNP: Other DPC providers, but truly Josh Umbehr, MD and his team were the primary ones that helped get everything rolling. They gave us access to their attorneys and documents as well as accountants.  I do not know his availability any longer as he is often on the Sean Hannity show and has been to the Trump White House at least a few times. Trump has been very instrumental in promoting DPC and has carved the way for this to be an even greater success for anyone interested in this model. 

SG: Tell me about your staff: How many people? What are their roles?

Karl Lambert, ARNP: 

4 Clinicians

  • Dr. Shaw, MD who serves in a consultant role and is no longer in a clinical role. 
  • Rich Edison, PAC who services our remote clinic in Cashmere.  Rich has over 30 years of experience and is coming off of 2 years of Wellness and Lifestyle Medicine.
  • Amy Wood, ARNP who services both clinics, the one in Wenatchee and Cashmere. She has over 5 years and she recently attended her first BHRT course.
  • Chris Prochaska, ND.  Chris is a brand new ND and he serves in our Wenatchee clinic. He is trained in functional medicine

Support Staff

  • 1 practice manager that oversees both practices
  • 2 full-time medical assistants
  • 2 receptionists, 1 at each of 2 sites 
  • 1 part-time RN, 16 hours who oversees the 2 MAs

So currently 5.5 staff per the 4 clinicians.  A good DPC ratio of staff to providers is about 1.5 staff to 1. Contrast this to the conventional system which I believe may be as high as 7:1 ratio and in some cases, I have heard even as high as 9:1. 

SG: Besides your monthly retainer fee, what other revenue sources does RedMedi rely on?

Karl Lambert, ARNP: We do have multiple revenue sources including

  • our [in house] pharmacy
  • OTC supplements
  • in-house labs
  • drug testing services for the community
  • confidential testing for local physicians/clinicians going through rehab for opioid addictions
  • sonographer from Vasolabs and does ECHOs, CIMT, ABIs, and Abdominal Aortic scans 3 times per year
  • annual health-fairs for larger companies
  • flu vaccine clinics
  • some physical medicine and there is added revenue above the retainer fee for this service using PBMT or Photobiomodulation therapy
  • LLLT or low-level laser therapy
  • CDL exams
  • pre-employment exams
  • labor & Industry claims
  • walk-in’s especially during our summer months when we have more tourist activities  

SG: What has been the response of patients to DPC? 

Karl Lambert, ARNP: My patients LOVE, LOVE, LOVE it! 

Some of my patients live in other States and they have simply remained.  They tell me that I spoiled them and they simply can not find a comparison in their new state. 

SG: Do any of your patients abuse the extra access to you through text or email?

Karl Lambert, ARNP: Overall, it is a bell shape curve with outliers on either end.  We have outliers that simply never use our services and seem bothered when we call them to come in.  They are perfectly fine with paying, but please do not call them. They will call us. I have some of those I have only seen once in 5 years.  On the other end, we have the outliers that LOVE TO TEXT or USE OUR EMAIL system. Fortunately, there are not too many of those and we do sometimes need to give them boundaries and they will respond.  The vast majority remain in the middle and may use our services perhaps up to 5 times in the year at the most.  

SG: You said you have about 1100 patients now and your practice is growing. Do you have data about how long patients stay with you? 

Karl Lambert, ARNP: This is a good question about retention.  I know that historically my panel has had the highest retention and I am working with our newest ‘docs’ to be sure they are attentive to the needs of their patients as this is key to good retention.  1. Moving out of the area has been the primary reason folks have left or 2. “I am on good insurance” seems to be the 2nd highest reason. I still have patients living in other states that have remained with our membership.  

SG: How has transitioning to a DPC practice from traditional medicine changed your life and the life of your family?

Karl Lambert, ARNP: This is a more difficult one because I have worked tirelessly and without stopping to bring this concept to our valley.  Getting it to this level has taken more work than I had ever anticipated. Like any new paradigm, it has been met with resistance along the way from many naysayers and those critical of a “free market” system.  

On a personal level, there is NO WAY I would ever return to the traditional model. 

I love the time I get with my patients and the time I have to research and investigate on behalf of my patients.  I know that for the others in the practice, it has changed their whole outlook on their practice of medicine and time with their family. 

My family, on the other hand,  has had to weather the sacrifices of getting to this point.  I am forever indebted and appreciative to my wife and children.  I do not doubt I was supposed to do what I did by bringing this paradigm to this valley, but I have regrets that I have missed some opportunities with my family.  This has slowly started to change and I am getting more opportunities to be with my family. 

SG: What would you say to a primary care provider who is thinking about making the leap into DPC?

Karl Lambert, ARNP: You will not regret it although if not joining an established DPC practice, then expect to work long and hard hours especially in the first year.  It is still a new paradigm, but I would say I have seen it grown from its infancy stage to now perhaps its teenage years, so it is starting to slowly and steadily become a household name.  The DPC wave is coming, so it is only a matter of time before it comes in its full force.  

SG: Do you have anything else you’d like to add?

Karl Lambert, ARNP: I firmly believe this model is a common sense, affordable and sustainable medical model that has the potential to transform medicine for years to come. 

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Major Medical Insurance

Redi-Medi still encourages patients to purchase a major medical insurance plan and to take full advantage of Health Care Savings (HSA) accounts, in order to cover all their financial and healthcare bases. Redi-Medi also has relationships with insurance industry leaders who can provide affordable insurance products for clinic patients.

The clinic offers a full range of care, including:

  • general family practice
  • cardiac and stroke prevention
  • sick & well-child care
  • women’s health
  • walk-in care
  • house calls and worksite visits
  • hormone optimization with bioidentical hormones for men & women
  • physical medicine
  • low-level laser therapy
  • counseling & health coaching

Because Redi-Medi is not contracted with any health insurance company, they can offer discounted rates for labs, imaging, and even prescriptions.

Karl has recently begun approaching local businesses, offering to help them keep their employees healthier. When Karl claims that he can help reduce diabetes in a company’s employee base, they are intrigued and give him a closer look.

45-60 Minute Office Visits

Since Karl is no longer seeing 20-30 patients every day, he’s able to spend a lot more time with each patient, up to 45-60 minutes. He gets to know and care for them on a much deeper, more personal level. Karl gives each patient his cell phone number and his email address, telling them to let him know if they have questions. His patients are often shocked at the level of access they are able to get with a healthcare provider. 

Karl feels that patients can only retain so much of what he tells them in the office, which is why he encourages them to reach out to him for clarification or reminders by text or email. They love the easy access to him and very few of them abuse the privilege.

Karl’s practice panel currently has around 1100 patients and he says it’s growing rapidly.

Karl made the switch from what he calls the “sickness model” of medical practice into a “wellness model.” He’ll never go back to practicing the old way. Direct primary care and wellness tools like hormone optimization have allowed Karl to see real improvements in his patients. The membership model allows Karl to see fewer patients and have more time for his family and other pursuits. Karl says, “I love practicing! I LOVE practicing!”

Discover Alternative Practice Models

If you’re interested in cash-based medical practice models like direct primary care, the Business of Creating Health can help get you pointed in the right direction.

The Academy’s 2 and 1/2 day intensive seminar introduces you to seasoned colleagues just like you who have created their dream medical practices. 

  • Learn from healthcare attorney and DPC practice expert Jim Eischen about where you need to avoid dangers and take advantage of opportunities. 
  • Gain insight from others who have built successful, even profitable practices that go help you get off the hamster wheel of traditional medical practice.
  • Get the tools and the confidence to transition your medical practice into something you’re excited to invest your life in.

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