Insight: All In the Family (June 2017)

For Carly Brown, M.D., founding Ashewell Medical Group wasn’t simply establishing a local practice—it was fulfilling a mission.

When you think “primary medical care,” what comes to mind first? Convenience and ease of access? Quality of care? Affordability? It’s unfortunate but true that not everyone can check off all three boxes, and therefore it’s a perennial issue for many patients. That’s the issue Carly Brown, M.D., wanted to address with Ashewell Medical Group (AMG) when it opened its doors this past March..

Brown and her family had moved back to North Carolina in 2016, and as she recalls now, “After months of research and reflection I decided that I had found a better way to practice primary care. This was a model called direct primary care. My experience in caring for patients in the traditional model was highly impactful in my decision to leave that model. I was quite successful in practice, but I just knew I could give more. I wanted to focus more on prevention, counseling, nutrition, and wellness.”

Brown was concerned that because most internists care for upwards of 3,000 patients, the level of care in the traditional model was compromised. Whereas the direct primary care (DPC) model limits the patient panel size to a much more manageable 500-800 patients, allowing for adequate quality time between patient and physician. DPC additionally provides an alternative payment model that eliminates fee-for-service medicine (“volume over value,” and marked by copays and insurance plan complexities) and replaces it with a flat monthly fee that covers comprehensive primary care services.

“At AMG,” Brown explains, “I see only 500 patients, and as we hire more physicians, they, too, will only see 500 patients. This gives our patients six times the access compared to traditional doctors. Additionally, you have to give people access to affordable medications, labs, and medical imaging. We do all three. We have an in-house wholesale pharmacy [and have] negotiated lab prices and medical imaging prices for our patients at a fraction of the cost of what they would pay at a traditional medical office or imaging center. We pass these services and goods on at cost. We don’t mark them up. For this reason, we deliver primary care at significant savings.”

She adds that this model also means care at AMG is unlimited—no copays and worrying about filing insurance claims, no additional charges for follow-up visits and preventative care. “We are particularly big on transparency and simplicity at Ashewell. That is why you always know exactly what you are being billed. We went with four simple tiers of care, based on age. This has been shown to be the most effective way to maximize access.”

As one might expect, educating the public about the benefits of a different approach to health care is not necessarily a simple task. (Brown: “I think our biggest hurdle is getting the word out that there is a better way!”) But AMG and similar practices around the country are increasingly successful in that regard, because when people realize that they may need traditional insurance for specialty care, hospitalizations, and surgery, but they don’t need it for primary care, they ultimately can get better overall care while paying far less.

At the moment, AMG—part of a cooperative of 300 practices nationwide that work together to negotiate prices for goods and services—is just Brown, a board certified internist, and office manager Kelsey Jones (an RN and nutrition specialist). Brown says she hopes to hire two more physicians who are committed to the direct primary care model.
“Our biggest success has been seeing our patients thrive. I love that I can practice medicine the way I think it should be practiced—direct care is particularly suited for people willing to think out of the box. Hey, Elon Musk said, ‘I bet I can put rockets in space myself.’ In a way, direct care is the same. We take the middle men out.

“Really, we are a good old-fashioned doctor’s office. We just keep it simple and fair for everyone. I would describe it as a family, really. I treat every one of my patients as if they are family.”

Complete details on Ashewell Medical Group, including a detailed FAQ, are at www.Ashewell.com. 

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