Beyond Insurance — The Healthcare Model That’s Changing Everything

It's not about patient care anymore, it's about dollars from pretty much all angles of the system right now. And that's really frustrating for patients It isn't to say that insurance doesn't have a role. Having some kind of catastrophic insurance plan makes sense for that scenario. The problem is it's it's intentionally complicated, so we don't really know what we're getting. So there's ways to pair Things with that catastrophic plan to get really good care and save a lot of money and and re indirect primary care I think we're a helpful solution for that Today we're here with Matthew Simone of Homesteady Health.

Matt has been in healthcare for over 25 years, the last 19 of which have been as a nurse practitioner. Family practice trained, he has cared for patients in the Alaskan bush, in fast-paced urban trauma and ER environments, in clinical leadership roles with startup urgent care groups, and most recently in his own private practice Homesteady health care, direct primary care, here in Ithaca. Matt serves on the board of the Nurse Practitioner Association of New York State, Region 2, where he has served as president in the past And he was named Nurse Practitioner of the Year for twenty twenty five.

Congratulations and welcome, Matt. Yeah, thank you so much for having me. It's uh it's a real honor to be here on what is gonna be maybe you know your earlier episodes uh and and uh Congrats for for launching something new and different and giving us uh in Ithaca uh some insight into the local economy and all the great businesses that are out there. So I appreciate having the opportunity to come on today and chat. Okay, well thank you so much. So let's just start right right off the bat here with what what you're doing. So most people when they do healthcare they have health insurance, right? and they go to the doc they pay a monthly fee, whatever it is, hundreds or maybe now thousands of dollars a month, and then they go to the doctor and they have a copay and they have a deductible that they have to meet before insurance kicks in.

This is what we're at right now. And then there's surprise bills sometimes too, right? This is sort of the standard model. Now you're a little bit different. You do direct primary care. So tell us a little bit about what that is. Yeah, um so direct primary care is a model that's been around for quite a while, actually, but uh and has has been a proven way to get excellent health care Uh but it's really taken off a lot more recently as people become more and more frustrated with the insurance system and and corporatized medicine. Um, you know, as you even kind of just described right there, insurance is just incredibly complicated and very difficult to navigate. and nobody really knows what they're paying or or how it all works, to be perfectly honest.

Sometimes insur your your employer's paying for a lot of it. You may not even realize that a big chunk of it's coming out of your paycheck So yeah, you pay this high premium every month and you think you're covered and then there's all these other crazy costs that come in and if you're not well versed on that that you can get blindsided by a lot of it. So direct primary care kind of cuts through all that nonsense. Um you pay one low monthly membership fee, almost like a gym membership. In my in my case here, my practice, it just kinda pulls out like that uh out of either your bank account or a credit card.

And we never really talk about money again. There's no additional cost. There's no additional uh co pays or coinsurance or deductibles Um, you know, you just get that high quality care and and with direct primary care, it's you know approximately 80 to 90 percent of your health care needs are all covered in that very low monthly membership fee Uh so you know with the the the 60 second elevator pitch is is essentially that money comes out and you get unprecedented access to me as your provider. So that what does that mean? That's Essentially same or next day appointments are guaranteed.

Appointments are as long as you need them to be. It's really unlimited visits in a month. Um, and you could text me directly, call me directly Uh so uh once we build that relationship and sometimes it's a little heavy up front on the intake process, really getting to know and building that relationship with my patients, everything gets easy from there. And it's a very convenient way to access your care. And very affordable when you think about it in comparison to the system. So it's uh really a great way to get care and in in in my practice that includes all of your primary care, all of your urgent care needs, all of your sort of lifestyle management and guidance.

So it's um really offers quite a bit compared to what you might get trying to navigate the system. Wow, that's that's great. So absolutely unlimited. If I if I needed to see you every day because I was really sick, that would be that would be covered. Yeah, absolutely. So the I use the Netflix analogy is sometimes an easier way to do it because we all have these streaming services. Money comes out each month, right? Some months you're gonna watch a ton of movies Some months are going to go by and you're not going to watch any movies at all. But when you press play and you want that movie to come on, it does.

And it's the same way with this here. When you need that healthcare, we're there for you. That's great. Well, so what happens if there's an emergency or I need lab tests, for instance? Uh well those are a couple different scenarios. So I'll start with the first one. Emergencies, I'm not an emergency room, right? So Um, you know, I encourage my patients, if you have a true emergency and you're confident that's what it is, call 9-1, get there right away, don't waste time chatting with me Um, however, I do have an emergency background and an urgent care background, so there are a lot of things that I can do for my patients that might save them a trip for the to the emergency room.

So For any of that on the fence stuff, even after hours, I encourage my patients to call me and we can kind of talk through it. If it's something that I can manage, it might be actually, you know, that that's not that big of a deal. Let's get you on the schedule in the morning. Uh I got an opening at 9. 30. We'll see you then. Uh, it might be we're on a telemedicine call and I can resolve that problem right there on the spot and save them the trip to the emergency room. So That's a big part of the savings that come with this that people don't really think about is like it's saving you costs by not having to go to the emergency room unnecessarily, not having to have uh those needs addressed.

Some people use the emergency room for all their primary care needs, which is a big challenge for the whole system, and all that just sort of goes away with this. So Uh from the emergency perspective, that's how that would work. Uh when you talk about things like labs, um I should say that uh Probably 75% of my patients have insurance to some degree. A lot of them are on high deductible plans, so this is a cheaper way to do it. Some people have HSAs, which you can use your HSA dollars to pay for this monthly service, which is a great way to do it.

And then in that case, the insurance would be utilized for things like labs and and um And medications and things like that. So if you're already paying into something, we try to use it as much as we can to continue to save you money. In the cases where they don't have insurance I can offer much cheaper services than what you would actually be paying through your insurance. So very uh cost controlled labs that are insanely cheap compared to what the system would charge you. You know, maybe uh You know, a full workup might cost $1,100 or $1,200 using your insurance through Quest.

Maybe they cover it. Maybe you have to be responsible for some of that. That same package costs about $130 with me So there's huge savings there. We can find ways to get discounted medications, um, discounted services for imaging, for example, working with private um imaging centers that are outside of the system or at least w operate with cash pay prices. And oftentimes again they're cheaper than what you'd be paying through the system. So Right. Uh it's a great alternative. It doesn't have a solution to every single problem, but we're always hunting for ways to help my patients navigate the system and save money where they can Yeah, I uh well I full disclosure here, I do have a a DPC physician as well.

She's based out of Syracuse. Yeah, and um I'm I've been with her for a number of years. It's been wonderful, yeah. One of the things that I was really shocked to learn is that you can get tests like an MRI or something and pay out of pocket and they're not that expensive. You know, when you see the insurance bills they're always in the thousands of dollars, but if you pay out of pocket, there may be just a couple of hundred. It's not, you know, it's really much more reasonable Yeah, that's actually a great example of how this can work. I had a patient that was struggling to navigate with the system and felt like his problem was misdiagnosed. uh needed an MRI, or at least thought he needed an MRI, and uh it was ordered by the provider, but the insurance wouldn't pay for it and wouldn't authorize a prior authorization.

So Uh, he went a long time with what we believe was the the not the correct diagnosis. We were able to get an MRI for like four or five hundred bucks and get that diagnosis like immediately. Yes, this is what I suspected was going on, but what not what he was getting care for. They wanted to do surgery on him Once we got the diagnosis right with just this with the the MRI, we're able to get him some physical therapy and back on his feet and as far as I know that problem's resolved, you know. So it's a great example about how the the barriers to access can sometimes be problematic for a patient.

And I think that's yeah, I I think it's really important for people to to r think to remember too that insurance Is often really a barrier these days. They say no to so many different things that the provider and the the patient want, and yet they're they're just sending up roadblocks because they don't want to pay for it. So we we might have this mindset that insurance is is gonna save us, it's gonna cover things, you know, cover those big expenses, but then we hear all these horror stories about people needing actual care and not and just getting denied left and right for it.

I don't know if that happens so much here, but unfortunately where where we're kind of at with things, it's not about patient care anymore. It's about dollars um from pretty much all angles of the system right now. And that's really frustrating for patients. Um it isn't to say that insurance doesn't have a role, you know, um Having some kind of catastrophic insurance plan, whether that's insurance-based or health sharing, which is another option I talk about with folks, is probably a a good thing to have. Um and that's what insurance was designed for, uh, when it when it became a thing, right?

To help you in these uh uh catastrophic scenarios where where, you know a cancer diagnosis or a car accident is gonna keep you hospitalized or excessive bills for long periods of time. Makes sense for that scenario. The problem is it's been legislated into every aspect of it. So now you have a middleman controlling and dictating sort of all aspects of your care. So um, you know, you can we all sort of have the the responsibility of trying to figure out what's going to work best for us in our financial situation, but the the um the guidebook for that is doesn't really exist and it's it's intentionally complicated so we don't really know what we're getting.

So there's ways to pair things with that catastrophic plan to get really good care and save a lot of money and and rein direct primary care I think we're a helpful solution for that. Yeah it sounds it's alternative I should say. It does sound like a really a really great solution for for a lot of people, maybe not for everyone, but definitely something that that people should look into if they're health insurance has suddenly skyrocketed. Right. F for instance. Or they've lost it recently. This year, yeah. Yeah, exactly. Exactly. So you've been practicing in Ithaca for five years now.

Is that right? About five years? Yeah, that's correct. Yep. Uh we came uh moved up here from Philadelphia. Uh Uh we had planned to move up here before the pandemic, but the pandemic sort of expedited uh as it did for a lot of people, some pretty dramatic life changes. So um You know, it took us a little while to get our roots here and uh I was working a a few different jobs, all with the intention of kind of uh figuring out what kind of practice I wanted to open. So I was doing several different jobs, sort of test driving some different things that I liked in my career and say, well, can I put that as a part of my practice?

And and you know, I did that for a few years and now I've been open as uh homesteady health for Um well what uh two plus years now or so, um give or take, maybe a little bit more. I've been in the o I I started out sort of, you know, out of my house, so I was doing things from there. So I've been in the office for Probably around two years now. So um and it's great. I th all those other jobs really helped inform the way I wanted to to have my own practice and the way I wanted to do things differently. Been in healthcare for a long time. I've watched it sort of uh decline, you know, and and and dramatic changes over the course of of my career that um were not just bad for patients, but really tough for providers and for for nursing staff and for everybody involved.

So um I really wanted to start something that got away from a lot of those challenges and got back to why I you know, wanted to have a career in medicine. So how how is this different for you as a practitioner? Um, you know, and and do you think that the direct primary care model is something that more practitioners will be moving towards or if I mean I think it's a no-brainer personally. I mean honestly I'd been burnt out from healthcare several times over from from some of the different challenges. in my career, uh, you know, that stuff's all pretty well documented, so I'm gonna get into details there, but you know, there there'll be places and and times where Um, you know, where where I was in urgent care seeing 70, 80 patients in a day.

Like that's insan insanity. No breaks. A lot, yeah. I'm not really present um for some parts of that. Or my patients are not uh given the time to really explain what's going on with them for me to help figure it out, you know. And so I I kind of can't move up to here thinking I'd open a cheese shop or something where I was done with medicine, you know It it just it just wasn't a great place to practice anymore. And providers are being squeezed on on so many different angles. It it feels like we're just the machine and patients are just the widgets And the more widgets you can get through the machine on any given day, the better it's often there's all these metrics around it to make sure that you're put passing as many widgets as possible.

It's just been very corporatized and very industrialized and it's really not about patient care anymore and I just didn't want to be a part of that. So Um, you know, when I kind of heard about direct primary care, it just sounded like uh such a solution to all my challenges. I mean, one I could get back to being myself again and and being able to spend time with patients and really have the m the not just the time but the mental energy to really digest what they were bringing into the into the office space and to have time to kinda sort through complex problems and really give them the opportunity to feel heard that the system doesn't offer anymore, right?

So f for me it's brought back my passion for caring for people, which was all the dead, which is really an exciting thing. So I feel like when I'm here every day. I'm excited to be here and and my patients get the best of me every day. And it allows me to have the life that I want, which is a very active life, which is raising two kids, which is being a family man and and being um you know, uh strong present member of my community. And that book is really difficult to do in in modern medicine, not just for providers, but for anybody out there. that is kind of sacrificing a big part of who they are for other people.

So um we've gotten away from that being rewarded and and this sort of gives that to me in a lot of different ways. So my patients get better care. I'm a better provider. Um is a no-brainer. Is there anything that you miss? It sounds like it's it's just a much better situation, but Um yeah, I'd I'd say the only thing I miss is is the team. You know, I've been in ERs and traumas and places where Uh even in urgent care where like you know uh you have a great team that's really necessary to to to provide the best care and working together and b bringing like all kinds of diverse skill sets from from your techs all the way up to your surgeons, you know?

Um that'd probably be the only thing that I miss about it. I really enjoy that. I am kind of the people person, so I I like that camaraderie. Like we've got a difficult challenge. How are we gonna come together uh to meet that challenge and take care of our patients? And that that was always rewarding. I I hope to build my practice to someday get back to something similar to that, but you know, for now it's you know, me and my patients. And I happen to work in a in a place with other providers that have shared office spaces, you know. And so I get a little bit of that.

We've got like a multi politisciplinary sort of approach to care. We're all separate providers, but we can sort of refer to each other and bounce ideas off each other. There's some alternative practices in here too, which I find very valuable to my patients' care. So it's a I get some of that, but um but yeah, I do miss that part of it That's great. If you if if you were talking to somebody who was burned out and wanted to start this, how is it is it how hard is it to start a their own primary care practice or to to join another? I don't know Join another one.

It's I I would think that in some ways it's not as hard as you think, right? So a lot of the things that a lot of the barriers that that people have uh like the mechanics of starting something are not that difficult. Uh you do have to have the right mentality. Uh you do have to have like sort of a fair amount of financial runway in some ways, at least some money saved or you know, good family support or whatever the case may be to be able to weather the storm. Um if you're savvy about it, you keep your overhead really low and you're not having you don't really need a lot of capital, I hadn't I had nothing to start this with.

Just just a little bit of m you know, probably ten K, you know, which isn't a ton of capital to start. I realize some people don't have that, but um, you know, the way you can sort of bootstrap it and piece it together that really tunes well to direct primary care versus say something like urgent care where you need a million dollars to just to to get a building up and running, you know? So there are a lot of ways to do it. I I think, you know, the ma the biggest barrier is probably just doing it. And for me, like that was sort of my challenge.

You know, having some some savvy in the startup world and some experience from some of the past places that I've worked for, I felt like I could do it. So the confidence part wasn't there, but it was like, what do I want to do? You know And and that was holding me back for a long time. And eventually I'm just like, well, this seems good. I'm going to just start this and figure it out from there, you know? Uh build the plane as you fly it, so to speak. uh address the needs of the community as they come and that's how it's kind of been. So I've got the direct primary care practice, but other things have spoken to me.

Um the community has you know sort of asked for certain things and and I'm meeting that with the the other services. that I'm offering. So Oh, so what else are you offering? Yeah. What what are some of the services that you offer through your practice or or externally? Well, uh one of one of my favorite things about the practice is I do a lot of men's health work and part of that is uh testosterone replacement therapy uh where there's a lot of men that aren't really getting their needs addressed by the system and I can and and the treatment can be life changing.

So that's really rewarding. Along the same lines Um, I've had a lot of women asking for hormonal uh therapy as well, or you know, um as they go through the different uh challenging aspects of uh midlife, for example, perimenopause, menopause. And you know, the the landscape has changed dramatically around that. The system hasn't really caught up to it quite yet. So That was like, well, this is the need. My patients are telling me they want it. Let me figure out how to offer it and and and deliver that care to high quality. So those are some big examples.

Um One big thing that's probably worth mentioning for this podcast is trying to uh meet the needs of employers that I only want to take care of their employees and offer them health benefits, but the reality for a small business is that The insurance landscape is really that's not a sustainable thing for their model. Most people, it's not in the budget. So, you know, we just see a lot of workers out there that don't have any kind of healthcare benefits and are kind of left on their own. So I've offered models that uh along you know the the all the services I offer for direct primary care to employers uh on a per employee per month basis that's you know sort of volume based uh cheaper than my normal rates to be able to offer something to their team.

So maybe it's not a full spectrum of care, but eighty to ninety percent of their needs could be covered and you know you're offering something to your employees that is a whole lot better than nothing, you know. I think it's a great, you know uh way to get care. So and I think I'm a perder. So I know you're all you know I'm offering that kind of stuff to folks Um you know, that's fantastic, yeah. Yeah, so from the employer perspective, they're getting patients back to work faster when they're sick. Um they're preventing chronic disease that might keep somebody out for a long period of time.

They're um, you know, uh now sort of separating themselves in the recruitment marketplace by offering something that really a lot of other industries don't offer, especially if you're in like the service industry or the trades or, you know, artists and things of that nature where most of these folks just don't have coverage and they deal with all those consequences. So At least we can get, you know, eighty to ninety percent of their needs met at a very reasonable price point, you know. Wow, that's yeah, that's amazing. We've got so many people in the service industry here in Ithaca that I'm sure don't have health insurance.

And employers certainly can't afford, you know, what it is today. So and what I love what what strikes me about your model and the the direct primary care model and especially the way that you're practicing Is uh you just sound like an old fashioned kind of country doctor. Yeah, that's funny you mentioned that. I mean uh I start when I was early in my career before I was even a nurse practitioner, I had the opportunities to work in some of those places out in Montana and Alaska. And I was really drawn to that kind of care. I I don't Some people don't like to be that close to their patients in the sense of like seeing them at the grocery store and things like that.

And that that has its challenges, but it's never really bothered me. I I really enjoy being able to try to elevate my community in whatever way I can offer and and this is a skill set that I have to offer. So I was really uh privileged to have some exposure to some really amazing doctors and nurse practitioners that were doing this in small communities and and really just being everything for them and and that always inspired me and and Even in when I was working out in the Alaskan bush, having the opportunity to do like home visits and really be in the patient space, really truly understand who they are and the environmental challenges that are sort of sculpting their sort of healthcare journey and it it just elevates my ability to provide care to them to to a higher level.

So that that sort of stuff spoke to me when I came back to this. And I even do home visits as a part of of my practice here. So I have a a home visit exclusive sort of membership where those patients I kind of go to their home for everything. They can't get to the clinic for one reason or another or they choose not to and You know, that is really rewarding me. Um I like to go do the first visit in the patient's home if if they're regionally close enough and and they're and they're welcoming to that. And it just Accelerates the relationship building process in a way that sometimes fifteen office visits can't show you, you know.

Right, right. Well, and that's what what we want to do here on this podcast is help people to envision an economy that is more based in care, that is more, you know the economy that we've got right now, the that we're functioning under that isn't working for everyone, is very much about slicing and dicing and selling the s the smallest pieces that we can To the highest bidder. And as a result, we get we end up with less good care sort of all around and With your model, we're returning to the old-fashioned way, which is just a person offering care, a person who's needing care, and you meet and and you do it.

And it is kind of old-fashioned. But it's worked. It's worked for thousands of years, you know, right? What's so complicated to me is like when what other industry do you provide a service? that you get paid by a third party months down the road if you even get paid at all. And if they can find any way to not pay you, you don't get paid. Like what how that mob So and I don't blame providers. They're doing everything they can to keep the lights off, especially in primary care where it's not really incentivized in the way that other specialties are So, you know, they gotta do all these different things just to make enough money to keep the lights on for their patients because you know, they're just not getting paid in a way that makes any sense.

You know, right. So why not return to something? I'm offering a service, you're willing to pay for it. Pretty straightforward. Seems like uh basic Just make it simple. You know? Right. What it should be, not what we developed in. Exactly. Exactly. We're calling it the new economy. It's it's uh of course there's still money exchange, that's always gonna be a thing, but uh It's not about selling everything for the highest profit. That's prop it's people over profit, right? For sure. Uh I think people wanna pay for things that they wanna pay for service they values.

You can in places where I've worked where they have like, you know, around the world where I've had the opportunity to engage uh healthcare. They want to provide something. They don't want it for free. If they've only got chickens or eggs or something in some of these communities, they want to provide that because they value your service and that's really the way it should be. Right. Yeah, we'd as human beings we're not we're not takers. We we ha we want to give back as well. So having a good reciprocal relationship is is so important. It's central to who we are as humans.

And it it's wonderful to see you here in Ithaca and doing this. I think it's just Just fantastic. Um, if somebody wanted to follow up with you and uh, you know, maybe become find out more about becoming a A patient, what would they do? Yeah, there's it's pretty straightforward. There's a lot of different ways actually. So I've got my website, which is homesteadyhealth. com, which is probably the easiest way to engage. And there's you could um You know, submit an inquiry there. Uh you could schedule a free meet and greet there. So anybody that is interested in the practice can schedule a free meet and greet with me in the office, or we could do it telemedicine-wise. um and really just get to know me and understand what the practice is.

Um I have a newsletter that anybody can follow and you can sign up for that on the website. And I put out some health information once a month, announcements, uh let them know what I'm doing in the community. Um we have Facebook and Instagram, which is a great way to to sort of follow along what's going on. Or they could just call me at 607-883- Right now I'm pretty much a one-man show. So you're gonna get me on the phone and I'm gonna get back to you as soon as I as soon as I can and and that's reflective of the service that we offer. Again, I hope to build this to be a bigger, you know, and get more people out of the system and and working in a place that they're happy to do their job again.

But, you know, I'm still in the in the building process. It's going great. But we're s you know, right now you're gonna you're gonna talk to me. So Excellent. I love that. Pretty easy to do, I think. I love it. If you know if you've heard if you've liked everything you heard, you can just go to the website and sign up and I can get you in on your intake as early as next week. Perfect. Okay, so that's homesteadyhealth. com and the number is s what was the number again? 607-882-6001. And it's homesteady with a little Y in there, homesteadyhealth.

Home steady health. Very good. All right. Well, thank you so much again, Matth, for meeting with us and uh I wish you all the best. I hope we'll maybe we'll see you out in the community. I'm out there. You can certainly see. I like to do um different presentations. I try to get out and table at a lot of events. So if you ever see me out, feel free. Don't hesitate to come up say hi and I really appreciate the opportunity to come on and talk about uh homestead health and to uh just let people know about this great way to receive care. And if you happen to catch this and you're in other states, it it's out there.

It's all over the country and I think it's taking off. Thanks for listening to the Ithaca Local Economy Lab. If you liked us and want to hear more, please be sure to share, rate, review, and subscribe so you don't miss a single episode. It's noisy in the podcast world, and we need you to help us find more listeners You can read the show notes, get on our mailing list, and download your own free copy of Practical Resources for Healthcare Beyond Insurance at Ithacalocaleconomylab. com. And if you know of a local business, nonprofit, or program that you'd like to hear on the show, please send them my way.

The Ithaca Local Economy Lab is produced by Practically Real LLC. And brought to life by an amazing team, including technical advisor Jake Gribschaw, Associate Producer Stacey Cornelius, content strategist Sonia Simone, and creative advisor Erin O'Shaughnessy. Yen Ospina is our artist, and the music is by Carsie Blanton. Until next time, take good care