FMMA Member HighlightThe purpose of our member highlights is to shine a spotlight on outstanding individuals who form part of a groundbreaking network as members of the San Antonio Free Market Medical Association. For our December issue, we chose to sit down and chat with Triple Board Certified physician and endocrinology, diabetes, and thyroid specialist, Dr. Arti Thangudu of Complete Medicine. Dr. Thangudu takes an evidence-based approach to care, focusing on the whole patient, not their disease or symptoms. At her membership-based practice, she offers her patients direct access, frequent coaching, and continuous blood glucose monitoring. Seeing thousands of patients through her practice and rigorous fellowships, Dr. Thangudu is fully aware of the skyrocketing costs of prescription medications. Her practice is designed to work closely with each patient, ensuring they take only the medications they need. She also advocates for health coaching and focuses on healthy, balanced diets to prevent, treat, and reverse chronic disease, so patients can reduce their medications. Can you explain the direct care model of operation for your practice and clinic? With a direct care practice, we're able to do several things that enhance the doctor patient relationship. I don't see as many patients as I used to. It's really hard to have a great relationship with your patients when you're seeing almost 30 individuals a day. In my practice today, I have much fewer patients, they have much longer visits. My initial consultation is 60 minutes, one-on-one, with me and we run like clockwork. With COVID, we've been doing a lot of virtual appointments but my patients always have the option, even before, for virtual visits, phone visits, I call my patients with their labs, I send them their labs in a timely way. How did you find out about the option to deliver healthcare using this model? I had heard about concierge medicine for a while there were things I both liked and didn't like about it. Then I heard about Atlas MD, a group out of Wichita that have been doing direct care for a long time. I started learning about it, early in my practice. It just made so much sense to me. The non-transparency in pricing to both doctors and patients is harmful. I would have patients come and see me and they have insurance and their co-pay is $150 or $250. Or their insurance won't cover specialists visits at all...so the access to specialists was limited. I realized, they're paying these large sums of money to see me, with insurance — what if we just let go of the insurance and I could help them in other ways — such as with labs, better service, more treatment options? Are you operating at capacity? I do have the chance to take on new patients but I do have to limit myself to only individuals with the specific issues I treat so that I can help them. I am so pro-physician-entrepreneur because it's a dying theme. So many practices are being bought by hospitals. In some ways, that might be beneficial. I do think you have to have vision and drive. If you want to be employed, that's great too because what I do isn't for everybody. But there is a space for this. I didn't think I was going to start my own practice. I just saw so many holes and gaps in the system and, also, holes and gaps in my life. So I didn't feel that there was an employed position that could fill those gaps. What brought you into the San Antonio Free Market Medical Association? Through my personal experience as well as that of my patients, I've just been, to be honest, totally disgusted by the lack of transparency in medical care. It makes me feel like, what is this system that we're working in? What I mean by lack of transparency is that when you go to your doctor's office, you have no idea how much you're going to pay until they're done. You also didn't have the option to say yes or no to particular procedures. And then, worse, 3 months later, you get another bill...and then another...and another. People don't know that, hey, my specialist co-pays $60 but I actually spent $1,000 or I have $100 co-pay but I spent $2,000 on labs. I have patients who tell me they're spending $2,000 every 3-6 months on bloodwork. It's not that expensive! The only reason we're facing this is because nobody knows what it should cost. Where do you see yourself in five years? I can't say I have a firm plan for where I want to be in five years but I do want to be a voice for this city to use technology and telemedicine. That's part of what I researched during my fellowship and I utilized it a lot. I have spoken to officials here in the city about telemedicine as a way to access healthcare. The majority of people are dealing with chronic, metabolic diseases, especially in lower socioeconomic neighborhoods. Something we could do is have a hub where we provide telemedicine services, even if there's no setup for high-speed internet yet. About the San Antonio Free Market Medical Association
Organized in 2019, Roger Moczygemba, MD and Shankar Poncelet came together with other thought leaders in the community with the goal to lower the cost of healthcare in San Antonio through price transparency, reference-based pricing, and local connection. The San Antonio FMMA recognizes the three pillars on which the national FMMA was founded by Jay Kempton and Dr. Keith Smith in 2014: 1. Price is not a product. 2. Value is mutually determined and requires transparent pricing and quality. 3. Cash is king, the equality of price is critical. The FMMA connects buyers and sellers of healthcare, educating and motivating them to work together based upon a mutually beneficial relationship built on the pillars. To learn more, visit https://SanAntonioFMMA.org or contact sanantonio@fmma.org This member highlight is brought to you by Shankx Web Development and Consulting. For more information, please visit https://www.ShankxWebDev.com
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The purpose of our member highlights is to shine a spotlight on outstanding individuals who form part of a groundbreaking network as members of the San Antonio Free Market Medical Association. For our September issue, Shankx Web Development chose to sit down and chat with Insurance Broker, Harlon Pickett. Joining the FMMA Harlon believes that health insurance is protection for everyone, and he works personally with his clients in Texas and all over the United States. He develops relationships to identify their unique needs and budget. As his clients come back during different life stages, which might include changing careers, having a baby, retiring, switching to Medicare, or even traveling, he reassesses their needs and offers a variety of quality and suitable options that will continue to help save them money. One of the biggest cost savers comes from healthcare operating under a free and open market. Harlon wants to offer more solutions that people can really use and provide the best benefits at the most affordable cost. Harlon, you have a different approach to healthcare. What would you say your mission is? I really want people to be happy with what they have. I want people to have a joyful experience during the process of getting coverage for themselves and their employees and dependents. I want them to have peace of mind. Sadly, this is not the experience that many Americans have when dealing with their healthcare. I joined the FMMA to represent brokers that are keeping Americans from falling into financial ruin through connecting them directly to sellers of health care where insurance is just not enough. What are the most common problems that people run into when hunting for insurance? Many people struggle to find affordable health insurance that meets their needs and their budget. It’s not hard to find affordable insurance, but is it what you need? Even after they find insurance, most people have trouble understanding their options. A lot of customers end up making uninformed decisions. What problems do you solve? I help people understand the complexities and constant changes in health insurance, Medicare, and related programs through my experience in the health insurance industry for over 13 years. I have been a licensed and trained insurance agent with experience working with individuals, families, and small businesses, and I’ve been doing it since 2007! Where do you get involved in the community? I’m involved in the Texas Tri-County Chamber of Commerce, Texas Tri-County Chamber of Commerce Toastmasters International, Federal Employee Service Association (FESA), America’s Health Insurance Providers (AHIP), and many networking groups across the city. I love to meet people! About the Free Market Medical Association Organized in 2019, Roger Moczygemba, MD and Shankar Poncelet came together with other thought leaders in the community with the goal to lower the cost of healthcare in San Antonio through price transparency, reference-based pricing, and local connection.
The San Antonio FMMA stands on the three pillars on which the national FMMA was founded by Jay Kempton and Dr. Keith Smith in 2014: 1. Price is not a product. 2. Value is mutually determined and requires transparent pricing and quality. 3. Cash is king, the equality of price is critical. The FMMA connects buyers and sellers of healthcare, educating and motivates them to work together based upon a mutually beneficial relationship built on these pillars. Visit SanAntonioFMMA.org or contact sanantonio@fmma.org This member highlight is brought to you by Shankx Web Development and Consulting. For more information, please email shankar@shankxwebdev.com Shankx Web Development and Consulting
FMMA Member Highlight
The purpose of our member highlights is to shine a spotlight on outstanding individuals who form part of a groundbreaking network as members of the San Antonio Free Market Medical Association. For our August issue, we chose to sit down and chat with Corporate Consultant, owner, and CEO, Allison de Paoli of Altiqe Consulting .
Joining the San Antonio Free Market Medical Association
Alison de Paoli, CEO of Altiqe Consulting, joined the FMMA in fall of this year after hearing about the FMMA from Dr. Chrissy Navejar from Dominion Primary Care and Dr. Roger Moczygemba of Direct Med Clinic.
Explain your passion and how it is represented in your company.We help employers get predictability. The happy side effects of what I do is that employees have access to higher quality care and lower out of pocket costs. I focus much more on connecting employees and employers to healthcare than I do selling health insurance." Do you feel like you are more centered on the client themselves rather than the actual insurance?Yes. We structure plans to help employers control their costs and help employees get access to care. One of the more ironic things about health insurance is the more access that people have to care, the less access you have to problems down the line. If I have diabetes and I go to see the doctor as I should, and I’m taking my medications as I should, and I get my teeth cleaned, and I get my eyes checked, I’m not a very expensive health plan. But if I do not go to the doctor and I do not take my medication then, one day, I can show up in the Emergency Room and will cost $40,000." How is 2021 going to look?For a well-managed health plan, typically that means self-insured, it should not be an issue at all. If you are not on a well-managed health plan, I have no idea. I have seen -10%, -20%, +11%, +38%, +40% it’s been all across the board. It depends, but for a well-managed health plan, it should be a non-factor. If you have somebody that had a severe case of COVID-19, that’s going to be a shock claim for you but most employees have a typical amount of shock claims every year. If someone just had to stay home, that’s not a very big health claim. If you have someone that had to stay in the hospital for a couple of days, it can be a huge expense. It all comes back to how well-managed your health plan is. What’s the value in free market healthcare?Providers have all built a business plan that is profitable for them that is generally reasonably priced. You have an organization of people doing free market which shows that it’s possible, it’s a matter of connecting consumers to the members of the FMMA. Sometimes it is easier said than done, but there is high-quality, affordable care all over San Antonio, but you have to hunt to find it." Vendors are important right now.Employers offer employee benefits. More employers are starting to understand that the health plan they created is not helpful to the average employee. If your average workforce is making $12-15/hour and your deductible is $3,500 what you’ve given them is not useful to them. They will not seek care because they're afraid of what it will cost and they can’t afford it. They’re already living paycheck to paycheck, so it’s useless. Serving the San Antonio Community
Allison tells us about the many boards she serves on and her active involvement in community engagement.
Family Service Association is one of the oldest organizations in San Antonio. They are 119 years old! Their mission is to strengthen families from cradle to grave. They own The Neighborhood Place. They keep kids in school and make sure parents are okay. They do community engagement, and more. South Texas Blood & Tissue Center is trying to get blood donations. Now that elective surgeries have started back up, San Antonio is in DIRE need. Donating blood is safe and easy. They are setting up at AT&T Center, and on social media, you can schedule your appointment so everyone is safe and protected.” What's the last book you read?I read all the time; non-fiction. I actually read a fiction book called Untamed by Glennon Doyle and I highly recommend it.
About the San Antonio Free Market Medical Association
Organized in 2019, Roger Moczygemba, MD and Shankar Poncelet came together with other thought leaders in the community with the goal to lower the cost of healthcare in San Antonio through price transparency, reference-based pricing, and local connection.
The San Antonio FMMA recognizes the three pillars on which the national FMMA was founded by Jay Kempton and Dr. Keith Smith in 2014: 1. Price is not a product. 2. Value is mutually determined and requires transparent pricing and quality. 3. Cash is king, the equality of price is critical. The FMMA connects buyers and sellers of healthcare, educating and motivating them to work together based upon a mutually beneficial relationship built on the pillars. To learn more, visit https://SanAntonioFMMA.org or contact sanantonio@fmma.org
This member highlight is brought to you by Shankx Web Development and Consulting. For more information, please visit https://www.ShankxWebDev.com
Co-founders Shankar Poncelet and Dr. Roger Moczygemba of the San Antonio Free Market Medical Association, host Seth Denson, author of “The Cure; A Blueprint for Solving America’s Healthcare Crisis” in this virtual meeting on the current state of healthcare in America.
A Broken Healthcare System and the Need For Transparency
Seth Denson, aka the “Modern-day Lorax,” believes that unless all Americans become “healthcare entrepreneurs,” not much will change with our broken healthcare system in the United States. His ideal is that our healthcare system would operate like every other aspect of our consumer life, which would include price transparency, understanding, and accountability.
On Tuesday, June 23, 2020, The American Hospital Association lost its legal bid to stop the Trump administration from requiring hospitals to disclose secret rates they negotiate with insurance companies. Even though the fine of $300 per month is minimal, it’s a great first step in the right direction! Healthcare and Health Insurance are NOT the Same Thing
To start off, it’s very important to differentiate between healthcare and health insurance. Healthcare is the care we get; health insurance is how we pay for the care we get. In two words, our problem in the United States can be summed up when it comes to healthcare; COST and PROFIT. In order to understand how our healthcare system operates, we need to identify where the costs and profits are.
“There is only one way to reduce health insurance premiums, you reduce the number of claims you’re consuming, or the price at which you’re consuming those claims.”~ How COVID Is Impacting Insurance
During COVID, the CDC basically declared that any procedure that wasn’t an emergency or life-saving procedure was considered elective, making it difficult for doctors to provide care. This has resulted in a short-term windfall for insurance companies as most Americans, sitting at home, are still paying their health insurance premiums.
So, while the health insurance trend for 2020 might not be too bad, healthcare trend could go up exponentially in 2021. The healthcare industry will be looking for a way to make up for low profits in 2020. Why is that important? If you’re a self-funded employer, you will need to start thinking differently about how your self-funded plan is structured. “Healthcare trend will be up next year. In turn, health insurance trend will be significantly up two years from now, and so those are the things that you want to start thinking about as you start thinking long-term.” How COVID Has Impacted Healthcare Delivery
Most likely, and unfortunately, COVID is here to stay. While we can look forward to herd immunity and a vaccine,--this isn’t projected to happen until sometime next year. (2021) What does this mean from the perspective of healthcare? Not a whole lot necessarily,--however, it will impact the way in which we approach the healthcare system.
“Roughly 90% of all APIs, (these are what are called active pharmaceutical ingredients), that go into the drugs that you and I take each and every day, are manufactured in the People’s Republic of China. That should strike fear into anyone in the United States. If China wanted to get really serious about having an overall impact economically or socially in the United States, they could do so without ever firing a shot. They just shut us off from our drugs.”
We must start restructuring how our drug manufacturers operate here in the United States and start looking for other ways to generate APIs! If there has been anything good to come out of the pandemic, perhaps it will serve as a wake-up call not only for our federal government to step in and take action by generating solutions to the API problem, but for every single American to seek to become part of the solution.
Expansion of Telemedicine
Thanks to COVID, telemedicine has finally made it to the frontline, and we’re realizing that doctors can actually use it to successfully help patients without having to see them in an office. Unfortunately, the way our system has been set up, telemedicine has not been encouraged. Someone, somewhere along the way, came up with a “relative value unit” measurement that stated a doctor should be able to see 4 patients an hour,--or in other words, spend 15 minutes per patient.
“As a result of Coronavirus, insurance companies who, by and large, along with Medicare have set RV units, have restructured the way by which doctors can be compensated for their work.
As 90% of all healthcare costs in the United States are generated by 6% of our population, expanding the use of telemedicine can help us achieve two very important goals. First, it can help the 6% access healthcare easier. Second, it can help prevent people from becoming part of the 6% by providing more doctor engagement.
COVID has left us keenly aware of how healthcare is delivered. We’ve been able to think about health care differently and restructure how healthcare is delivered. If Seth were Czar of Healthcare, He would...
“Insurance networks provide no intrinsic value to the healthcare system. They create an opaque curtain by which the healthcare system and the health insurance system can be in collusion….What I loved seeing as a result of the situation that we were in is, for a brief moment, nobody was worried about insurance networks, the Javits Center in New York became a makeshift hospital. No one knows today whether or not that was in-network with Blue Cross, United, Cigna, Aetna, insert-name-of-insurance-company-here, and quite frankly, nobody cared. And, that’s the way it needs to be. Solutions
The first step in any solution is recognizing the problem, and the problem here is the actual healthcare. Healthcare is a series of supply chains broken down into four components:
It’s really important to understand that discounts don’t matter; prices do. This is also why price transparency is of utmost importance. Of the four aforementioned supply chains, the two easiest ones to address are the pharmacy benefit manager on the prescription drug side and the doctor. “70% of all drugs delivered in the United States are done so through a mechanism of one of three pharmacy benefit managers. They were supposed to be the Sam’s Club and Costcos of the pharmacy industry. Instead, they have become more like the loan shark on the back end where you never know what you’re getting and what you’re paying for. The pharmacy benefit manager is the cash cow for the health insurance industry."
Numerous pharmacy benefit managers in the United States are not linked to any insurance company, so it’s important to do your research and understand the data, the drugs, and how they, (PBMs), operate so you make sure you’re getting the best deal. Also, many pharmaceutical companies offer patient assistance programs where, in certain instances, the drug can be obtained for free. This is especially important to look into if you’re an employer as if your employee gets the drug for free, so do you. You don’t have to use your claims money to pay for it. Also, beware of the new “stupid drugs” which are nothing more than a combination of over-the-counter drugs with a prescription label such as Vimovo, a combination of Nexium and Aleve. Why pay $2,500 when you can buy Nexium and Aleve for a grand total of $15? We have to be more informed, especially as employers. Employees are looking to their employers to help them navigate.
Seth makes the analogy between doctors and “milk in grocery store.” Why? Well, milk in the grocery store is often found in the far back corner and there’s no margin in milk. There’s no margin in being a doctor.
“You may ask, if they’re very thin and there’s no margin, why are hospital systems buying physician practices as quickly as they can and why would a recent financial report show that their average return on investment is eight to one? Because that’s the sales force. The doctor has become the sales force, which is why it has never become more important for you to engage with the doctor.” Takeaways
“The American citizen is not a good consumer when it comes to healthcare. We must help them along and give them the tools to be that. The second thing is everybody is self-funded.” “You need to get engaged with your insurance company whether you’re fully insured or self-funded; start understanding the pool structure. Ask questions! Get them answered! You don’t like the answers? Go find somebody else! That’s the American way. Start being a consumer and acting like it. That’s the only thing that’s going to solve this problem. Don’t be subservient to the industry. Take control of it.” WEBSITES
Direct Med Clinic on Price Transparency - https://directmedclinic.com/direct-med-clinic-in-san-antonio-express-news-for-price-transparency/
FMMA San Antonio - https://www.sanantoniofmma.org/ FMMA San Antonio Facebook - https://www.facebook.com/SATXfmma Shop Health - https://shophealth.fmma.org Seth Denson - https://sethdenson.com/ “The Cure; A Blueprint For Solving America’s Healthcare Crisis” Seth Denson’s Company, GDP Advisors - https://gdpadvisors.com/ Shankx Web Development - https://www.shankxwebdev.com/ DRUG DISCOUNTS AND INFO
Drugs.com - https://www.drugs.com/discount-card/
GoodRx - https://www.goodrx.com/ Medical Assistance - https://medicineassistancetool.org/ Needy Meds - https://www.needymeds.org/ Rock Pharmacy -https://www.rockpharmacytoday.com Rx Assist - https://www.rxassist.org/ Script Save - https://www.scriptsave.com Scriptco - https://scriptco.com WellRx - https://wellrx.com References
Armour, S. (2020, June 23). Trump administration price-transparency rule covering hospitals upheld. WSJ. https://www.wsj.com/articles/trump-administration-price-transparency-rule-covering-hospitals-upheld-11592945973
Class action targets CIBA insurance as 'Ponzi scheme'. (2018, April 19). PropertyCasualty360. https://www.propertycasualty360.com/2018/04/19/class-action-targets-ciba-insurance-as-ponzi-scheme-414-125761/ Employer-sponsored healthcare revisited. (2019, October 30). Direct Med Clinic San Antonio. https://directmedclinic.com/employer-sponsored-healthcare-revisited/ Luhby, T. (2017, July 27). What was in the failed Senate 'skinny repeal' health care bill? CNNMoney. https://money.cnn.com/2017/07/27/news/economy/senate-skinny-repeal-health-care/index.html Rep. Chip Roy on H.R. 6690, the BEAT CHINA act. (2020, May 22). Representative Chip Roy. https://roy.house.gov/media/press-releases/rep-chip-roy-hr-6690-beat-china-act
Interview brought to you by Shankx Web Development and Consulting. For more information, please visit https://shankxwebdev.com
The FMMA was founded in 2014 by Jay Kempton and Dr. Keith Smith based on their mutual desire to fix our broken system. They founded the FMMA based on three pillars.
To learn more, contact sanantonio@fmma.org.
For our May issue of the San Antonio Free Market Medical Association, Shankx Web Development chose to highlight the outstanding Dr. Ray Altamirano of Casa Salud Family Medical Clinic .
Dr. Altamirano was chosen as 'Top 40 Under 40’ and ‘2020 Man of the Year’ by the San Antonio Business Journal. He has been featured in San Antonio Current, Fox News, La Prensa, The Kelly Clarkson Show and The Doctors.
His collaboration with other brilliant leaders in the medical community around San Antonio has been featured on local news outlets like KSAT this month for helping to contact trace by delivering to-your-door COVID-19 testing.
We have a home 24/7 for those who have tested COVID positive and they can come here to get treated.
How did you become involved in testing?
I reached out to people who were in this group of creative and eager social entrepreneurs like, 'hey, let’s find another way to get tests out there.' What we did is not a matter of competition, the goal is to test as many people as possible. When you look at the objective of testing it’s to help the current system in place, which is Metro Health locally.
What do you do specifically after testing?
I help those who test positive.
How has COVID changed visitations in your clinic?
These last few weeks with this demographic, there are so many courtesy visits that I’m doing without them paying because they can’t. I think [about] doing the right thing for people.
I saw a highlight of you on Univision where you said Texas could become the next epicenter. Is that still true?
It’s hard to predict who is going to get super sick.
Is there value in people of color joining the free market?
I’m from the south side. I’m very proud to be Mexican. I’m proud to cater this demographic that doesn’t exclude anybody but serves more blue collar workers that are just working contributing to this country.
Dr. Altamirano’s Drive
I wanted to be back in the community through primary care and I knew the only way that would work is to be outside of the world of insurance, so that’s why in March of last year I formed my clinic, Casa Salud Family Medical Clinic.
Casa Salud Versus Traditional Practices
There’s definitely more liberty to treat how I see fit. There’s luxury that I have working outside of the world of the networks of insurance. For me, I like staying fee-for-service mostly to fit my demographics. However, I have the luxury of having my ER job and I see my clinic as more of a service for people who don’t have insurance and I’m able to have some staff.
‘No Insurance’ and the Free Market Medical Association
It’s a matter of creating a free market and what I’ve learned about insurance and about labs that take insurance, about imaging centers, etc., is the prices they fill out are completely arbitrary. There are numbers much less than that they’re willing to work with if you’re paying with cash, So that’s definitely what I love about my clinic and how I feel that freedom.
Teaching Cost-Conscious Medicine
The most important thing that I’m doing outside of treating patients is training mid-levels. They learn conscious medicine, putting prices on what they need to do because that’s what people are most worried about.
Casa Salud and the San Antonio Community
I really like the service in my community. I think what I’m doing serves as a blueprint for anyone who wants to do that for their own community. If they want to train under me that’d be great. I tell everyone that there is a way to make money and you don’t have to be a specialist.
Zip Codes Matter
![]() "The zip code where I grew up in, that’s where I focus my clinic. If you draw a line halfway, highway 90, in the middle of San Antonio, what you see is a 6-1 ratio for doctors in San Antonio in the south. There’s less care here for more unhealthy people. I have hope with the new medical school being nearby. If I could help capture them now and show them by thinking outside of the network of insurance, 'You’re free. You can make money. You can do it.' There’s no need to go anywhere else.”
Amar es Vivir: To Love is To Live
I ran into a patient who needed knee injections, very expensive, he couldn’t afford it, so I was able to convince a pharmacist to sell it for me at wholesale and then retail it. I started selling all my art prints to pay for him and that got on the Kelly Clarkson Show, The Doctors, national TV. We were able to sell enough of my art prints to pay for this man and beyond him that we had people come and donating for other patients.
That’s how that evolved and the art is definitely me, it’s a hobby, release, a form of therapy for me. The name of my art is Amar es Vivir, more of a motto of how I want to live and that translates into my practice. My clinic is my gallery. Interview brought to you by Shankx Web Development and Consulting. For more information, please visit https://shankxwebdev.com
The FMMA was founded in 2014 by Jay Kempton and Dr. Keith Smith based on their mutual desire to fix our broken system. They founded the FMMA based on three pillars.
To learn more, contact sanantonio@fmma.org. |