Medical bills and medicine can be really expensive. That most patients find it difficult to outright pay it because of the price tag. Dr. Phil Hellman believes that direct patient care is key to a healthy life, so he created Paradox Health, a service all about direct primary care. No more middle man between you and your doctor. Just pay a monthly membership fee and it’s unlimited care all the way. Join your host, Jordan Levin and his guest Dr. Phil Hellman to talk more about his business in direct primary care. Understand why building a connection with your patient is one of the best medicines for them. Learn why Phil got into this business and what it took to start it.
Listen to the podcast here:
Phil Hellman – Owner of Paradox Health – Direct Primary Care
I have Dr. Phil Hellman. He is a one-shop-doc who truly cares about his patients. He’s taken all of his research, knowledge and applied it to his private practice called Paradox Health. I’m so thrilled to have you, Dr. Phil Hellman. Thank you very much.
Thanks for having me, Jordan. I’m looking forward to it.
We have known each other for quite some years. I have followed your journey through that time. I’m quite impressed by the journey that you have taken.
Lifespan is trying to live as long as you can. Healthspan is trying to live long while staying healthy.
We met when I was in medical school, living with my sister and brother-in-law when they were working out at CrossFit Bloomfield. We met there. It has been a long time.
I’m curious what got you into CrossFit? What is it about CrossFit and being in the health and wellness field? What are some of the things that you see that people should do, not specifically CrossFit but in terms of being healthy and as being a doctor? How do you encourage your patients about getting healthy in that sense?
I’ve got into CrossFit because I didn’t like working out. I thought it was very boring. It reminds me of your interview with Joe Degain talking about his kids, going to this and that machine, do a little bit of this and that. I always liked group sports. I played soccer and lacrosse growing up but I never wanted to sit in the weight room and just lift weights by myself. I thought that was incredibly boring. I had heard about this CrossFit, that there were these group classes. I had been doing some group fitness classes in Lansing when I was in medical school at Michigan State. I was still in medical school but I was doing my clinical in Flint and I had read up on it and was like, “I want to do this but I’ve got to make a commitment and sign up at a gym and make it happen.”
I joined that 810. Andrew Charlesworth was the guy that did my on-ramp. He and Joe were usually the coaches for the classes and I’ve got addicted quickly. Part of it was learning and learning new movements. It was fun to think to yourself like, “Last week I couldn’t do a handstand pushup and now I can do twenty of them.” Muscle-ups, a lot of the gymnastics stuff, the Olympic lifting stimulates and brings you great joy to be able to tell yourself, “Look what I used to be able to do. Now, look what I can do.” I have just stuck with it ever since. I haven’t lost that addiction at all.
That’s a very good example you have because it’s very hard to explain to people what CrossFit is and why it’s effective. As you said, you were bored with your current routine. The same exact thing happened to me before I’ve got into CrossFit. Now, I’m many years on this journey, I believe you are too right along that same time. It’s incredible the effectiveness of what being healthy means and how much work we have to do to get our bodies to be truly efficient and healthy.
It’s fun to travel around at different gyms and do the different programming because every gym is a little different. I feel like a lot of it has to do with the owners. I was at one gym and we were using a program because somebody at that gym was a CrossFit games athlete and they were using that programming so that’s what everybody else used. I went to another gym that was focused on Olympic lifting because they did the Outlaw Certification and thought it was the greatest thing since sliced bread. The gym I’m at now has a Strongman vibe to it because the owner used to compete in Strongman. It’s cool. You can pick a gym that fits you and it’s great.
The workout I did was the Jerry Rock. You do Jerry, which for those that don’t know, it’s a 1-mile run, 2,000-kilometer ergs so I did the rower and another 1-mile run on the end. I had to do all the running and carrying a 55-pound plate. It was totally different. I have never done it before. When I started it, I thought, “This is awful.” When I finished it I thought, “I finished that. That’s pretty cool.” It’s going along with the theme of your show like, “When you finish one of these workouts, you should feel good about yourself. You feel like you have accomplished something.” You started something, now it’s finished and you can feel good about that.
That’s exactly why I cannot stop. It’s a major accomplishment. For those who are reading, understand that it is a very challenging workout on whatever gym you go to. Regardless of what it is, that gym should be able to modify your workout to the best of your ability.
I even thought about just running it because I was like, “I don’t want to do this.” You can run it, do a weight fast, carry a 10-pound plate. It doesn’t matter. I try and tell people that all the time because they get intimidated. They think that they have to do the same workout. You don’t have to do that. It’s all about challenging yourself within reason and not getting injured.
Speaking of injuries, being a doctor, what I’m trying to getting out is how did you balance, not specifically CrossFit but on this state of coming from that doctor’s perspective in terms of the health and wellness aspect of what CrossFit does for individuals? What have you seen through the years?
It’s hard to find another activity that’s as efficient at getting people in shape. That’s what it does for people. They can spend one hour. Through that hour, they are going to get cardio, strength, functional fitness. It’s tough to get that unless you are spending many hours a day focusing on, “This is my hour of zone two, strength training.” You can do it other ways but I think CrossFit creates that efficiency for the modern world where everybody is too busy for everything. “I don’t have time for that or this.” In CrossFit, you don’t have an excuse. You show up for one hour, the workouts there, you don’t have to think about it. You do it. You’re going to feel better and operate better. I like it. I don’t push all my patients to it. I try and figure out what’s good for them. I rarely mentioned it to them because I don’t think that they like what I do.
Most people don’t because it’s so challenging. CrossFit can be a small activity to fitness.
EMRs don’t improve patient health. They improve clinic billing.
One of the things I have learned through CrossFit that I do encourage all my patients to do is strength training. You talk about how CrossFit translates to health. One of the biggest deficiencies I see are people that don’t focus enough on strength. That translates so well to healthspan. If you could say longevity is split into two different areas lifespan and healthspan, lifespan is trying to live as long as you can. Healthspan is trying to live long while staying healthy. I usually explain that to people as being 80 and feeling like you are 50. If you want to feel like you are 50 when you are 80, you’ve got to be able to operate like you are 50. That would involve bending down to pick up a grandchild, a niece or a nephew like a goblet squat position and standing back up. That would involve taking your 40-pound rolling suitcase, putting it in an overhead bin when you want to go travel and not needing help to do that.
A lot of people can’t do that at 80 because they didn’t start strong. I usually explain to people, “If you can deadlift 300 pounds when you are 50 then by the time you are 80, you are deadlifting 150 pounds.” If you can deadlift 150 pounds at 80, that’s pretty good. If you start only being able to deadlift 150 pounds at 50 years old, then by the time you are 80, you will barely be able to pick up a piece of popcorn. That’s the component that I have noticed is lacking in a lot of people. It translates not just to function but also to disease. We see a lot of osteoporosis, especially in our women. Besides hormone replacement therapy, strength training and loading our skeleton is the only other thing we can do to prevent it.
I asked most people that are diagnosed with osteoporosis, “When’s the last time you lift the weights?” They can’t remember. I don’t see anybody in a weight room getting osteoporosis. It’s not happening. Most people don’t know this. As many women die from the complications of an osteoporotic fracture every year, as do from breast cancer. Where are the white bracelets? Where’s fracture month? Nobody talks about it. There are a lot of things that functional fitness can help out with. Diabetes and heart disease are obvious but these ancillary things are interesting.
We are young, we are fortunate to be healthy but I’m looking at it as the longevity of it. I talked about this on my show where I’m talking about developing good habits. You need health power for you, not just on the physical but being a doctor, that’s good health over time. I can’t imagine that it can be frustrating when you have clients come in and you’ve got to help them as much as they can but you can only help them as much as they want to help themselves. That’s got to be challenging.
It is but I don’t run into that now as much as I used to. The reason is the model that I follow, which is Direct Primary Care. For those that haven’t heard of it, it’s a different style of practicing medicine where I don’t bill people’s insurance. They pay me a monthly membership fee, whether it’s a credit card, bank account, HSA or FSA. I can accept all those forms of payment. I have some people that want to pay me the cash and they can do that. I never bill their insurance.
How about cryptocurrency?
I don’t accept that yet, I need to get that setup. The incentive is that they are paying me above and beyond what they are paying for their insurance. If I have a patient who walks in and they are not doing what I tell them to do, I say, “Why are you coming? Why are you paying for the membership if you are not doing anything with it? If you are not going to take my advice, then why pay me for it?” It puts the onus on them rather than on the insurance model. They come in, you refill their medications, they don’t make any changes and they are not incentivized because their medications are keeping them alive but they are filling up the Lamborghini with regular instead of premium. They are never incentivized to switch over to premium.
They keep up their same habits. I look at it as a tool, like an argument of like, “You should change.” I have great success. I have very few patients that come to me and don’t make drastic changes when they need to. Part of it is that I live the life too. I find doctors that are unhealthier. They struggle to have patients change their health because they say, “Look at you.” It helps when you are living the same life and model what you want your patients to do. It helps a lot.
Can you give us an example of people that you have worked with that you dive into their career, they truly did take the advice and you can able to measure their progress?
I have a patient. He came to me. He’s a chef. He works the second shift from 11:00 AM to 12:00 PM and has an unhealthy lifestyle, overweight, diabetic, undiagnosed. We’ve gotten him in 1 or 2 months down to 40 pounds. He’s 340 pounds. Now he’s below 300 pounds. We get as fast as his blood sugar down from 220 to 100. We are using a few medications to help them out with that. In large part, it was just going through his diet saying, “What are you doing?” I looked at him and said, “How many Cokes do you drink a day?” He said, “If I’m on shift, sometimes I can drink six.” I said, “All you need to do is stop drinking Coke and you will have a huge improvement.” He gave it up that day. I spent over one hour with him. We went through everything, had a heart-to-heart and said, “This is it. You’ve got to make a decision.” He made it and he’s doing well. A couple more stories like that but that was a pretty drastic one that I have been through.
Do you bond clients that will appreciate your advice and knowledge to allow and help them get what they want? A lot of times, we go to the doctor’s office and we have to wait for 20 to 30 minutes, sometimes 1 hour before we get in. I always make the first appointment right after lunch because I know they are coming back in lunch. I’m going to go by then and I don’t have to wait because they don’t follow their schedule. I’ve got to follow my own schedule. The point is when I have time, I will walk in. It’s not even a five-minute consultation. I immediately try to ask questions and I love to ask questions but when I’m at the door, they are like, “Hold on a minute.” Every time I said, “Why am I doing this?”
It’s because they are still plugged into the matrix. I hear this conspiracy theory a lot that, “Doctors want to keep people sick and they are in the pocket of Big Pharma.” When I was in the insurance-based system, I’ve never got a penny from Big Pharma. They bring us lunch every now and then, try and get us prescribed their drugs. Sorry, that’s not in the pocket of Big Pharma. There’s this misunderstanding out there. Unless you have worked in a hospital and around doctors for a long time. They go into medicine to try and help people. There are few bad apples out there but what happens is you have these people who are altruistic and they get thrown into this corporate medicine system, which is all based on billing the whole thing.
We call it EMR a cash register because every time you click a box, you get paid more. That’s what it’s about. It’s not about making the patient healthier. They have shown that EMRs don’t provide better outcomes. They don’t improve patient health. They improve clinic billing. You take somebody who wants to help somebody and you put all these constraints around them. You tell them what they are allowed and not allowed to do. They have third-party payers. Insurance companies dictating what they can and can’t do at the detriment of the patient because often this is, “This patient needs a CT scan on their belly to look for an aneurysm.” The insurance company says, “I don’t think so. Aneurysm bursts. They are like ghosts because you can’t do it promptly.” What happens is these physicians get jaded. They learn to work in the system but they just become a cog. They stop fighting back and say, “This is my place. I’m going to make as much money as I can and get out.” I look at it as every physician that’s still in the old system, in the insurance-based system are just somebody who’s plugged in the matrix that I’m trying to get them to choose the red pill.
With the internet, there’s never been a time where it’s easier to start a business and earn a living.
It’s happening more and more. I have been having more conversations with doctors. They are burnt out. They can’t continue. I had a conversation with somebody who trained in sports medicine. They are a family doc. They did a fellowship in sports medicine. I was telling her that I have an ultrasound in my clinic and I do some musculoskeletal ultrasound. She said, “Did you do a fellowship for that?” I said, “No. I just bought the ultrasound, did a training course and read up on it. I bet you do because you are a sports medicine.” She goes, “No. I don’t do it at all anymore because I didn’t have enough volume and our clinic doesn’t have an ultrasound.” She spent a whole year doing something she was passionate about and she’s not able to do it because of the model that she practices under. I only have 340 patients and I can do it. She’s probably got 2,500 or 3,000. She doesn’t have the time either.
People don’t realize how many patients primary care doctors have. That’s another reason. That’s why you are seeing twenty people a day for five minutes at a pop because you’ve got 2,500 patients. That’s too much. It doesn’t have to be that way. A lot of people that train in primary care leave because it’s so bad. Do you think about if we fix the system, we would have more people going into it and we have had fewer people leaving? That would fix the problem. Instead, the answer is to make it worse and worse for them and force people into primary care. They put all these restrictions instead of realizing that the restrictions are the problem in the first place.
There are always challenges with that. What I’m curious about is did you always know the one peer doctor and what are the particular role model that you looked up to and said, “I want to do what that person does. She instinctively knows what she’s going to do?”
I didn’t have an a-ha moment. It was more of a process of elimination. When you are in high school and you start getting asked what you want to be, I had no idea but I knew what I didn’t want to be. I started thinking, “I don’t want to do this or that so what are my options left?” I was turned off by the whole idea of going into business because I didn’t understand what it was and I just thought it was boring not knowing that the whole world is in business. That’s how the world turns. I thought about medicine because I thought, “That’s the least businessy thing I could do.” I took Anatomy in high school and it came easy to me. I was good at memorizing words, Latin and didn’t have to study for the tests to do well. I thought, “I’m good at it and it’s fun. I will continue down that path.” I started enjoying it more and more. I did some mission trips in high school, went to third world countries, saw how other people live to saw the good that doctors can do for those people and the way that in healthcare, you have this cool opportunity to help people in their most vulnerable state and make such a huge impact on them. I thought, “That would be pretty fulfilling.” That’s what led me down that path.
A lot of people are always searching for fulfillment. They think they have fulfillment but they don’t. It takes a lot of time, effort and self-reconciliation that is tending to truly understand what that means. I believe from talking to you. You’ve found that for yourself. Speaking of that, you realize you want to build your own business now but you didn’t want to in the first place, right?
Exactly. Now I love it.
People are so scared of what they don’t know. The fact that you took that no on the business and they are going to be one of the risks in providing fulfillment for yourself and the clients.
Thankfully nowadays, it’s easier than ever to start and run your own business with all the opportunities that the internet provides and technology. By the time I decided to do Direct Primary Care between then and seeing my first patient, it was quick. A lot of people talk about how scary technology is, how dangerous it is, the dangers of social media with our kids and with us. It’s a double-edged sword where there has never been a time where it’s easier to start a business and earn a living, get training because of the internet. I try and look at that as a positive and something that has been an awesome development. It’s providing a ton of people with a ton of opportunities.
When you are talking about Telehealth with the technology, the fact that you would be able to see patients over FaceTime or because it’s what the knowledge, you have to have this specific setup, house, especially with the pandemic. How to see the change in that from pre-pandemic to the current pandemic in a sense?
Before the pandemic, a lot of clinics were looking into it. It was on the cost and then the pandemic brought everything forward by five years. I was telling Jordan before we started the show, I was talking to a nurse practitioner who’s interested in doing direct primary care. She was explaining to me that now with Telemedicine, pretty much is what they are doing for almost all their patients at their clinic. It’s made things efficient. They were looking into it, then when COVID hit, they went all-in on it.
I have been doing Telemedicine since way before COVID because direct primary care realized that it was a huge leveraging opportunity with our patients. I do a lot via text message, phone calls and a little bit of video because most of my patients live locally. If it’s something that I want to see them for, I usually have them come to the clinic. They don’t mind because it’s quick. They don’t wait in the waiting room. They come in, we take care of the issue and they leave. You don’t have to take half a day off work to see me. It’s quick and easy. Telemedicine is here to stay. It has its own issues but overall, it has been a good thing for a lot of people.
That’s a very important analogy because I honestly, haven’t done any Telehealth yet but I think it’s one of the apps. I find it very interesting, especially to me, I love to talk, listen, ask questions. Speaking of podcasting, it has been a great opportunity to get in front of people and talk to them this way, whereas, during the pandemic, you couldn’t meet anybody. Allowing that video, even text messaging, people appreciate the response time via text message or email through cell phone and all mobile stuff, emailing with her doctor. I would think for you, when you have time, check your phone and you will respond. For me, that’s how I like to do business. Even with my client at the gym, they all text me any time if they have questions, a question like I said but I think being accessible is a good business model that allows growth opportunities.
Much of patient care is communication. If the patient has that opportunity to get that one extra question answered, it makes all the difference in the world. It’s nice to be able to do that instead of just having that one 5-minute appointment. It’s just a running conversation. My electronic medical records all of our text messages and their chart, it’s all by date so I can see everything we have been talking about, whether it’s a note, a text message or an email. It makes it a relationship rather than a transaction. That’s the way a lot of things are going. It makes care so much easier.
Do you want to share your websites? It seems that you have a wide variety of different membership options. I’m quite impressed by the offerings of the things that you can do for a one-man show. That impressive, have not quite every test but most testing that could be done to paying cash forward. The difference is you can get the results back relatively quickly. The fact that if I’m a client of yours you’ve got every single information that’s needed to make so far grow potential diagnoses.
A big tenant of direct primary care is transparent pricing. We believe in real prices rather than these fake made-up prices. What I have are contracts with different vendors. I’ve got a contract with Quest Diagnostics, Boston Heart Diagnostics and Oakland Imaging Diagnostic Center, which is the local outpatient imaging center that I use and they give me a price menu of everything and what it costs. It’s like Costco where you are paying for the membership and you are essentially getting everything at wholesale. You are getting it for the same price they get it for. They are not making money on the items they sell you. They are making money on the membership.
We try and do the same thing where we say, “Each service that we add is just more value to the membership. It’s not costing you anything extra. It’s just another opportunity to get value out of the membership.” If you increase the value of that membership a little bit each year, it gets harder and harder for people to say no or want to leave. It’s similar to Amazon where they are just constantly adding things to the Prime membership and rarely, if ever, increasing the price. That’s our business model and it works well. Things are way cheaper than people realize. It’s $5 to get your cholesterol checked. For the price of a Big Mac or less, you can check your HDL LDL, total cholesterol, triglycerides. Your basic physical labs are $20 or less. In $20, you get your vitamin D checked. For $150, I can do fifteen different labs on you that gives you a better overview of your health and just about anybody has ever had. Imaging-wise, it’s like $40 for an X-ray, $300 for an MRI.
That is through from an honest place. I hate when I get the bill in the mail from your insurance company or the doctor’s office.
You don’t even know who they are from. You just get a bill from somebody.
I had a colonoscopy every two years and I get the bill. It cost $7,000 and the insurance company is X, Y, Z and then there are some things I didn’t buy. I’m like, “They just stick the needle in me.” That was $500. In this case, you know exactly what you are getting and there are no questions, no ifs, no buts.
For the price of a Big Mac or less, you can check your HDL LDL, total cholesterol, triglycerides, and more.
I do medications as well. 44 states allow for in-office dispensing. I can buy medications from the same people at Walgreens and Rite Aid and dispense them straight from my clinic. They don’t have to go to the pharmacy, deal with all that and pay their upcharge fees. For some stuff, it’s shocking. I had a patient come to me, she had a heart attack and had no insurance at the time. She got put on five generic medications. Generic meaning off-patent, cheap. She paid $350 for a one-month supply of these medications. Her husband called my clinic, asked about the membership, told me what medications she was taking and asked me what I could get them for. I’ve got her medications for $7.50 a month down from $350. That’s the markup on these medications at pharmacies. It’s crazy. Essentially, she got a year’s supply of her medication that was around $90.
The membership paid for itself. $75 a month was what she ended joining up as the savings were huge for them. Not everybody realizes those kinds of savings but from a medication perspective, it is shocking how cheap this stuff is. Most blood pressure medicines are around a penny per pill. They are incredibly cheap. It’s amazing. It drives me back to the whole Big Pharma thing about them gouging people for money and you are like, “They are helping you control your blood pressure for a penny a day.”
People don’t realize that. Just my thought, I put in the fitness industry for many years. I see so many people coming in with preexisting conditions. They say they want to better themselves. The consistent ones, obviously they are better with themselves. I think I can put this on YouTube, saw the TV premieres and I see the same thing over and over again. People need to realize that business, health and having the right doctor is an investment in themselves. What you are offering is an easier way, a more efficient, effective way of direct primary care. They are fortunate. That’s a very important point. I don’t know if they talked to me afterward. I think I’m going to have to come to your office.
I’ve got free Topo Chicos in the lobby for you if you like Topo Chico.
Do you have any specific offerings you want the readers to know about that you haven’t mentioned?
I started doing PRP injections for people. For people that don’t know what that is, it stands for Platelet-Rich Plasma. It’s where you get your blood drawn. It’s spun down in a centrifuge, and then we can draw off a specific portion of it that helps with regeneration and healing. I have enjoyed doing that because I have had some great outcomes with people. I haven’t advertised it very much, mostly just talking to patients about it that I think would benefit from it. It is like a side moneymaker for me but mostly I just want to help my existing patients and it’s super effective for a lot of different things. I do it at a fraction of the cost of most people around here. It’s just another great value add and another way to help people and have helped them to avoid a steroid injection in a joint, which we know is not good long-term.
I know that a lot of people would love to had that. I see it all the time at the gym, it keeps making an injury, it keeps coming back and they keep getting the steroid. I keep saying stop the steroid because you know what happens if the chip doesn’t become effective anymore. People do the PCR and they have had some pretty good results too.
I have enjoyed it. That’s the last skill I have added. We will see what’s next.
Two more quick questions for you. One is, what did you do to recalibrate? You are busy. You see a lot of patients, you’ve got your family and kids. What do you do daily to recalibrate?
I don’t recalibrate every day and I should. Some days I ended up skipping that and it’s not good. My brother-in-law and my sister, faith is a big part of our lives, keeping a grounded marriage and being around my kids. I’ve got a barrel sauna at home at the beginning of the pandemic. I enjoy doing that 30 minutes at 190 to 200 degrees will do it for me, especially if you follow it up with a nice cold shower after. I’ve got some different tools and it depends.
A big part of it is balance. I don’t have any patient appointments for the rest of the afternoon so I have got to do some emailing and texts, catch up on that. We do a lot of regular dinners with friends. I don’t know what I do without that social activity. Being around people is so important. This pandemic and the lockdowns have screwed over America and turn up in terms of mental health. We have kept that up through the pandemic for the most part. We love getting together with people and being involved in their lives.
You answered my last question which was, what brings you joy?
All this stuff that I had said. When I was single, I probably would have said travel but now that I have 3 kids, 4 and under, we don’t do a whole lot of that. It’s a lot of getting together with people and sharing a meal with them, enjoying time and doing some crazy workouts on the weekends.
Let’s let readers know how they can get ahold of you.
My contact info is all over my website, which is www.Paradox.health. I’ve got my email and phone number all up on there. My email is [email protected]. All the info about my clinic is up there. You can reach me easily.
I had a wonderful time and I hope you did too.
It was awesome, Jordan. Thanks for having me on. Always good to talk to you.
About Phil Hellman
Originally from Troy, MI, I did my undergrad at Grand Valley, and went to medical school and Michigan State University. I did a residency in Family Medicine in Greeley, CO where I received great training in broad-spectrum family medicine. I was trained in surgical obstetrics and practiced obstetrics for a year and a half out of training. My first job out of residency was in Oregon.
I was in a group practice there for just a year and a half. When my wife and I started having kids we realized we needed family around and they were all in Michigan, so we moved back, quite quickly. It was at that point that I decided to start a direct primary care (DPC) practice. I learned about DPC from a colleague in Oregon who was doing it. I knew I wanted to have my own practice at some point, but I didn’t know how it would be monetized, and the membership model of DPC made a lot of sense to me. So I started Paradox Health just three months after moving back in March of 2018.