A Doctor's Warning On How Fee-For-Service Is Failing Your Clients

Was there a specific moment where you're like, that's it. I can't operate in this kind of model anymore.

The first time I knew I was in trouble was while my wife was in labor with our child. Our daughter and I was on the side couch dictating notes while she was laboring. I still get black about that to this day.

Shift your mindset.

Hey. Hey. Welcome back to the accelerate your insurance sales podcast. Andy Neary here, CEO and founder of complete game Consulting. I am excited today to have Mr. John van der Veer joining us with Exemplar Care Dr. John van der Veer. Welcome to the show.

John's fine. Thank you, Andy. It's a pleasure to be here.

All right, so you. We're doing this recording. I'm in Wisconsin and you're in Iowa. I think I know the answer, but I. I failed to ask it. Hawkeyes or Cyclones?

As hard as it has been the last month or two to be a Hawkeye fan, Die hard Hawkeye.

Okay, well, dude, I'm a badger fan. It hasn't gotten any worse.

We've had our good runs. Things are, things are not looking up right now.

You know what still blows me away? This is totally off the subject, John, but what, what blows me away? One of the stats not talked about a lot in college football is since, I don't know, late 70s, I always had two coaches. I think that's unbelievable in today's world. Let's, let's, let's talk about today. We're going to go into a couple topics. Your dream journey in medicine, direct primary care, and then what you guys are doing at exemplar care. Hy Vee. So let's start. What first drew you to medicine?

So I was 15, I hurt my back playing football. Back to that topic and went through the healthcare wringer. Met a guy who did an amazing job. He basically told me I was 70 pounds overweight, needed to quit football, start running, and really changed the trajectory of where I was at. And then at the same facility, my grandmother had her leg amputated from diabetes. And the anesthesiologist came out and had dinner with my mom and, and me while we were sitting there. And it just was a real impact of, okay, this is how you do things. So I thought I wanted to be an anesthesiologist from, like day one. But here I am in primary care and I happy I'm there.

Where did you grow up? What high school did you go to in Iowa?

Pella High school, Little Dutch. That was The.

The moniker also known for Windows. Right. Is that where Pella Windows is?

Absolutely. That is where we're from. Dutch letters. We have an annual Tulip festival, which, you know, I thought every kid marched in Dutch costumes and parades most of their childhood, so very Dutch community.

Well, well, let's. Let's just get right to it. Okay. So today you own a DPC practice, right. As a primary care physician in. We'll call it, the system. Right. Y. When did you start seeing, like, all right.

The way I operate as a primary care physician in the traditional healthcare system as we know it in the United States. Where did that start becoming kind of a. Something doesn't seem right?

I would say two or three years before I exited, I started to notice I'm seeing 20, 25 patients a day. As an internist, I took care of more older adults. My average patient panel was 76. And, you know, if you've ever sat and had a conversation with somebody in that age bracket, the last thing they want is you clickety clacking on a keyboard, looking over here at your screen and ignoring what they're trying to tell you. And qu. Frankly, the life lessons you're missing out on as. As just a participant who's younger and listening to them. So I would not do that. And I would spend hours at night doing notes that I was behind on and. And cleaning up orders. And I just became a. I met clinical burnout criteria that Mayo Clinic has used, and I didn't have any clue at the time. That's what it was.

Was there a specific moment where you're like, that's it. I can't operate in this kind of model anymore.

The first time I knew I was in trouble was while my wife was in labor with our child, our daughter, and I was on the side couch dictating notes while she was laboring.

I still get flack about that to this day, but I clearly couldn't do the work at that level. So the speed and the efficiency when I went into medicine for people, anyone who goes into medicine can do the math, the science, and learn the things, but I've always been a people person, and that's why I went into it. And that's how I ended up in primary care. I liked every specialty. Oh, I should probably just keep doing a little bit of everything. And the relationships matter, and the relationships impact the quality of the care that we can deliver.

Now, are my notes correct? You also served as a chief medical officer at one time?

I did. So I would.

How is that perspective for you to be at the primary care level, but also at the chief medical officer level.

Yeah, so it was chief medical officer at Greene County Medical center in Jefferson, Iowa's Critical Access Hospital. So then I got to see what, what the, the rural community also was going through as healthcare was changing through the, the mid teens.

And seeing how broken the system was getting people in, getting access, getting access to specialists, referrals and the slow slog and grind and to watch the quality of care degrading because people were burning out and people are still burning out. I think I had one guy say, well the burnout, that's just like everyone at their job. And there's data that shows there's increased morbidity and mortality for patients and when the people taking care of them are not happy. So it has an impact on the quality of patient care you deliver. So seeing that from an administrative level, like how do you change those environments? And ultimately you realize the financial viability of a lot of these things depends on how the product isn't an accident. Right now this is how all of the guardrails and all of the designs have put this in place. And it's a pretty good model that responds to where the financial incentives are. And like all things, you follow the money and you see why clinical medicine has become what it has. It's just a product of the incentives and the people who are tasked with running these things.

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Take the next step today. Visit TruCaptive.com and discover a special smarter way to manage healthcare that is TrueCaptive.com well, it surprises me John, that with all the, the data and the, the information that's always coming out now about what goes on in the healthcare system that how many consumers are still ignorant to it and, and almost in many cases don't believe it when a company's, when a system's job is to make money and to make money they must deliver care. They're going to deliver as much care as they can, whether you need it or not.

Absolutely. And like you said, the data is overwhelming on that.

There's just as much data that spending time with patients improves patient care and outcomes. You get the correct diagnosis sooner, you get the correct treatment sooner. But again when the dollar is the metric and you. We always get a lot of flack because we're a for profit company because started as a, as a solo entrepreneur.

And they're like well we want to support these non profit components, these bigger health systems. And it's like well they have charity care levels that a lot of them aren't living up to and other things to have that tax exempt status. And it's just, it's kind of a crazy mess that has been woven together.

It's also interesting that they call themselves non profits and at any point in time they have two cranes at their facility building a new wing.

Absolutely. They're, they're, they're doing okay.

Yeah, they're doing just fine.

That's without even getting to the insurance company.

Correct. Care delivery mechanisms so you decide to jump into the direct primary care model with a dpc and I'd love to hear from your own words, how would you, most people today know what DPC is but, but how would you best describe what primary care is and what is it not?

So direct primary care is not a full insurance product. So we start with that. We're not going to take care of you if you're in an ICU or anywhere like a hospital. That's not what direct primary care is. Direct primary care is primary care that is funded through a membership mechanism financial model that gives access to the physician and the patient directly. And in the purest sense it is the patient paying the provider that fee. As it's evolved and it was fun, I met Garrison Bliss who kind of founded all of this. Dr. Bliss started this all in the late 90s a couple months ago. And basically it's a model where my incentive aligns with yours. As the patient, you're going to pay me money and I'm going to deliver the right care for you and it's not about any additional money. I shouldn't have other perverse incentives. So it's a membership model and I say it's a lot like Amazon prime. You get it and then you better use it if you're paying for it. We're here to help people. And whether that's spending time with visits helping someone navigate the system, it's a membership like any other membership where you should get more out of it than just an in and out visit.

Once a Year I was going to, that's what I was going to ask you to do next, you know, compare the two, you know, DPC versus the traditional primary care system. In the healthcare system today, if I'm a member, what, what is that? Big difference I'm going to see.

So first off the, the data is something like 1.7 annual visits in the fee for service primary care world for patients and it's north of 4 on the DPC side. So people are engaged and getting more care, which goes against a lot of people make the argument, well, DPC is going to cherry pick just the healthiest people and they're not going to show up. That's actually not been proven out at all.

Sorry, I lost my train of thought. Where were we going?

Just comparing the traditional system to what.

I think the experience is time spent face to face with somebody if you need it. So when I was in fee for service, I had 1900 patients on a panel. They wanted me at 2500. That's 25 people a day or 1% of your panel shows up DPCs 4 to 800, really low acuity, maybe a thousand.

And so you have a lot more time with people, you can see a lot fewer people during the course of a day.

And by changing the financial model, you change the care model and you start getting to spend time with people, you know, they're, their history's inside and out, you know, their health goals. You get to dig into stuff that isn't just routine. And I think later on I'm sure we'll touch on some of the clinical care that's actually delivered, but you just get more time to educate patients and do what being a doctor really is, which is teaching people how to be healthy and take care of themselves.

Well, I think we can go there right now because when I think about our audience listening into this, it's by and large insurance professionals. And so when you think about selling health insurance, you know, it's safe to say, I hope by now, if you're in the world of employee benefits, you understand that you control claims, you control premiums, claims drive cost in the health insurance plan. Now if you're somebody who doesn't give two craps about that and you're just trying to maximize your revenue with working with the big carriers, you're probably not going to want to find, you're not going to find this conversation interesting whatsoever.

But let's, there's plenty of those.

Let's pivot this at an advisor right now who may, who could stand to use a little more education on why would I want to incent or promote DPC in the health plans I'm selling.

Yep.

Let's talk about the clinical care component because again, if I'm going to help my client save cost, save premium, I have to focus on healthcare claims.

Absolutely. So first off, whatever DPC someone's working with, if you're working with us, we have our setup. Employer rates, they obviously adjust by scale, discount wise, but you have a fixed cost. You know, there are X number of adults, X number of kids. They're bracketed out in the usual employee, family, spouse, dependent or whatever, whatever that structure is. So you have a fixed cost of care and everyone first sees that and goes, okay, well this is an increase because we have all these claims that need to be there. Well, you then have to look at all of the claims that come out. So for us, urgent care claims will come out, primary care claims will come out, lab fees, lab bills will come out of that claims bucket. Plain film imaging can come out of that bucket. App cost DME is lower than. We have an example of a gal who gave us a one star Google review because she got a bill with her great insurance that she had for just about 200 bucks for sling and she was mad that she could have bought it for 15 bucks at Walmart and we offered it to her for 20. So but she didn't want it because she wanted to use her great insurance. So that's a, that's a claim of 200 bucks that hits an employer group because of the contract they have where they could have saved tenfold on that and just bought the thing direct from us. So, so the cost buckets that are, that are claims for people come out and are subtracted away and that doesn't account for. We haven't even added in the number of people who come to an urgent care that now don't have to go to an emergency room visit, which is thousands of dollars. It quickly adds up. I saw a statistic a week ago that one of the bigger insurance brokers was counting 22,200 and some as their average ER visit. And then if there's a presumptive hospital stay, it's closer to 10 grand. So those numbers take them with a grain of salt. But each one of those you can avoid is offsetting out of that bucket by having access to somebody. And, and in our bigger markets we're building out 24 hour urgent cares to supplement the DPC. So members have access all the time.

So I'm going To share this story on, on live audio. That's probably going to get me crucified by some of my peers. But I'm going to share it because to talk about the average cost of er, right, you said 2,200 bucks and that's basically just walking in. You step foot in that, it's going to be a couple thousand bucks. A few years ago, Amy and I, my fiance and I were out, we were still living in Colorado and went out, went to the, one of the breweries, she had a couple beers and we think she may have had some bad beer. Come home and she's just, stomach goes haywire, puking. We live a block and a half from the one of the hospitals. So she's like, I think I need to go. And so I drive her over to the hospital. This is about 9:00' clock at night. And I parked the car in the parking lot of the hospital and I look at her and she's in the back kind of writhing in pain a little bit. I said, right before we walk in, I want you to know this is going to be at least a thousand bucks if we step foot in this. How bad do you need to get in there right now?

Way to triage.

And she goes, give me five more minutes.

And we, we ultimately did not go in. And she was okay. I want everybody to know she was okay. I've had people tell me that I'm an absolute ass for that, but I.

But because of that point, she couldn't go. She just had to consider.

I wanted to give her the financial implications. Right. But it is, I think people just are not aware of that. You walk foot in that thing after hours, it's the price is going to be egregious.

So, so a similar one on, on how egregious pricing can be. My daughter got a strep test and.

Strep test for us is like $3 if we do it at our cost and we just pass it through to members. But it ended up not having the insurance billed correctly and it wasn't in our clinic. And the bill came back for 935 bucks for a strep test. I just, I just laughed. I was like, these things are just nothing short of criminal.

Wow.

And those are the things that end up in somebody's claims bucket which like you said, drives the premium the subsequent year. But if this is a level funded, self funded product, which is where we're really spending most of our time.

Those are all dollars that could be back in the business for somebody.

Either back in their actual business or back on supplemental benefits that actually give employees something to cheer about.

Well, and to your point, going back to, you want to control premiums, you need to control healthcare costs. Talk to. There's a level two to that, I think, where it's not just primary care costs, you're also becoming the gateway to the rest of the healthcare system. So when I need more advanced care, maybe the MRI or the CAT scan or a surgery potentially, how does DPC help drive the right type of. Call it maybe recommendations or guidance, because people forget, too, the typical primary care doctor right now is owned by a system, and it's their job to send people and keep them in the system. How does DPC help ensure patients get the right care if they need advance care?

Yeah. So making care local and having our team members know where someone can go to get either a quality consultant or advanced imaging, some of those things really makes a big difference. You can look at the cost of an mri. This is actually one of the first stories I ever had. I went out and directly contracted to get better rates, which again, they said, well, you were a single person. You can't get good rates. I said, I got the best rates in town. And I have no doubt about it, because they're essentially 100% of Medicare, which you can't beat.

And a gal had.

Said, well, I want to get these three MRIs for her kid. So neck, brain, and then a vessel one in her neck and then kid's neck as well. And I said, well, just ask. Ask the company what the cash rate is. It was 6,000. She had just gotten insurance and had a $5,000 deductible.

And I said, okay, well, that's better. I said, ask what it is. If. If you pay cash that day. They said, if you pay cash up front that day, we'll do it for 4200. Okay, so there's some savings, which shows that you can ask people what their cash rate is. And then I said, that's great. I'll send it over. And client bill to me, it was 960 bucks. So by. By knowing who you're sending to, you can see what the pricing differences are. And that was an outpatient facility. We aren't even talking about MRI costs. If those three things had been done in a facility that charges facility fees as well for hospital care.

Well, and wouldn't you say, I mean, one of your core missions as a DPC provider is that transparency and affordability. You know, I may not like the price, even with your pricing, but at least I know what it is and I'm not given any surprises.

Yeah. And people I've, I've had people who've made decisions where I said, hey, you should get this, Mr. Like, no, I can't afford it. Well, it's going to be between this amount. I don't know the exact price, but it's going to be 350 to 400 for this. And they're like, oh, that's all. Yeah, I'll go ahead and get that.

Where I've had plenty of other people who have said no, yeah, bill my insurance. And they don't, they don't understand their own insurance product and they have a $4,000 deductible and they get a 1200 bill. They're like, well, why'd this cost so much? And we'd had the conversation. I said, hey, I can do this direct at my rates. No, I want to use my insurance, I want to meet my deductible, I want to start adding towards that. And they just don't understand that price and cost have nothing to do with each other in healthcare.

What was it like when you decided to go full into the DPC? I think you guys built your first office in 2019.

Yep, that's when I literally rented a.

Single room to start this off in West Des Moines. 1 Did you run into resistance locally from the healthcare system and what was that like attracting your first patients?

So I didn't have a lot of resistance and I think part of that was I trained in the community, I knew most of the systems, most of the system administrators, and it actually gone to most of them and said, hey, I'm going to build this. Do you want me to build it inside your company or should I go do it on my own? They all said, you're four to five years ahead of time, go build it on your own. Good luck. So I didn't get a lot of resistance. And we really do try to explain to systems and this is in all the new markets we're moving to, we're essentially a zero dollar overhead for primary care, sending referrals into specialty care. So if you're a good partner and you have good pricing and good quality, we're going to send our patients to you and you don't have to pay us to be primary care folks. So that's been a, that's been a really good part. And then how did I get initial customers? Well.

Word of mouth. I started talking to everyone, whether I was at a coffee shop getting coffee If I was at hair stylist, I talked to everybody about, hey, I'm going to do this new model and it's a monthly fee and if you do or don't have insurance, it's going to be an option for you to get care, get these labs, meds dispensed and then X ray at, at better prices. And slowly people who I'd either taken care of in the past or you know, there's non solicitation things. So I wasn't reaching out to anybody I knew specifically. I just started going to chamber events and all those little things to start saying, hey, there's a different way to do this. And there's one guy who is probably my 10th member. He probably has 40 to 50 downstream referrals of people he's referred and have referred on. So people I say, well, you don't spend a whole lot on marketing. It's like word of mouth is still our best, best weapon.

People experience and they just know, okay, this is different.

Referrals are cash. Quickest path to cash. Love hearing that. Well, so last year, 2024, you guys joined forces with Hy Vee and Hy Vee became, I believe a joint owner in your, in your endeavor. How has that allowed you guys to expand? I think what I would love for you to share if you're, if you're for as much as you can share, you guys have definitely expansion plans. What, what started out as one office in West Des Moines, you guys are starting to grow across, call it the heartland of America. What does that expansion look like in conjunction with Hy Vee?

So it's exciting. The, the relationship is a 50, 50 partnership.

We have operational control so we get to dictate the type of clinical care. If we wanted to go down like, hey, we want to open surgery centers now or something crazy, we, we'd go to the board, which is a joint board with them and have to go through that. By the way, we're not doing that, but that's the type of relationship we have. So how we build out our footprint, those pieces, Hy Vee is there to support us. They also have input on where we go. So back to the expansion pieces. And our initial expansion is inside their footprint. So that's Iowa and all contiguous states plus Kansas. And then they also have acquired grocery chain in northwest Indiana, so potentially Indiana at some point. But that was kind of the initial, initial cause of growth is we're going to go to their biggest markets in the states that are easiest to start implementing new practices and go through this piece. So we've expanded across Iowa, we're in Omaha, Kansas City, metro with a couple different clinics.

And we just keep looking at places on the other side of that expansion and this is probably most relevant for your listeners is we basically know if we can get 800 to 1,000 lives in a geography, we can go open a clinic and you can convince us to head out and actually do this. So we basically quantized, all right. This is the type of membership based we need to go and, and put up brick and mortar and start integrating a group into our community.

So if I am an advisor and let's say I have a thousand life group that is very geographically centered, you could literally come and build an office out of that workforce right there.

Absolutely. So I always say we try. Everyone goes, well, can you come and do an on site. We always say we don't want to be on site clinics. We want to be nearsight because we want to be able to take care of this employer's employees and this one's. And that's how as we grow out, we know when we can add 12 hour urgent cares, move to 24 hour urgent cares in a community. We kind of have the numbers counted out to see where we add in additional services. But yeah, so getting into a new community, we just need someone to reach out and say, hey, we've got, we've got a group that really needs dpc. Nobody's ready to move into this area yet. Can we look at it? We'll explore all of them.

Awesome. Let's talk about one thing you've done that I like is you've also gone out and built a health plan around the DPC model. And I love for you to talk about it's applos health.

When I look at people in our industry who build health plans.

I see it coming from two different paths and, and one I like and one I, I'm probably not as big a fan of. I see some people, I think some people build it for the sake of, oh, I got a revenue opportunity that I can go sell to a bunch of people and I see others who build it because it's almost like you're solving your own problem in a way. For example, our podcast sponsor, True Captive, what I like about it, it was it's built by a guy who was an HR director who ran the benefits at his company, who experienced health insurance, the good and the bad, and decided, I'm going to build something to fix it. I literally am building something to solve my own Problem. You have built a health plan as a DPC doc because you wanted to build a plan that incorporated a concept you thought was going to be very effective to control costs. Right. So talk a little bit about Applos and what your your goal and your mission is with the health plan.

Yep. So Applos is a level funded, self funded health plan. So we're basically an aggregator of, we like to describe a bookshelf and the books on there are the stop loss, the tpa, the repricing component. In our case it's reference based pricing in the background, the DPC utilization management. And we kind of went out and found partners that work well with us that want to be partners and not vendors. We try hard not to add in Franken plans and have these solutions that don't work. They don't want to talk to each other.

Good way to describe it. Franken plans. Yes.

They're there to make money and not actually provide a benefit. So this all originated out of DPC bolting it onto a fully insured product. My goal isn't to save wellmark in Iowa or United or anyone else dollars. It was to save the employers dollars so that they could invest in their employees and their businesses. So building this then they're on the hook for these things. It also allows for some of the steerage that we talked about and getting people to high quality care and hopefully aligning the incentives so the employees don't pay anything more than their premiums. When the plans are built right, which we do. Inside of applos you have $0 visits, you have $0 labs, you have if you go to referral A instead of referral B, you don't have a copay. So plan design really matters. And so Applos is a product of we want to put together something that feels like it's a fully insured product and that it's easy to implement and it's easy for people to understand. And the part we missed in year one was not having a one call center. We've since built that ourselves on the hy vee health exemplar care side to service the Applos members that we have. And it's, it's really been fantastic because it's now something brokers can actually grasp and understand and not have to cobble those pieces together themselves.

So for a point of clarity, given that it's built around the DPC model, if I wanted to offer that plan as an advisor, do I have to be in one of the exemplar markets or are there other DPC options available if I'm not in a specific market where there is exemplar hy vee presence.

Yep. So two pieces, there's. We do have it in places where we are not and they have, they have it with no dpc. They just want the, they want the rest of the chassis that we've built and you know we think the DPC part matters but it's, it's an evolution from introduction to growing into those pieces and then there are ways and we have done it. It's not always the easiest way but we can find when we find like minded DPCs who kind of get, we don't like nickel and diming for other things it's like here's how we do this. If you're willing to do that we can, we can plug it into that. So that is always an option. We've done it a couple times. Not a, not a ton though because we really look for those opportunities. Hey can we get there and help solve this problem?

I'm going to ask my last professional question and then we're going to have some fun at the end if you're okay with it. So I'm an advisor listening in. You know I think one of the things they struggle with in selling, whether it's Apple's, it's got DPC built in or just trying to bolt on DPC to an existing level funded or self funded plan is how do we get employees engaged to use it. What would be your advice as a DPC doc? How can advisors do a better job explaining DPC to the consumer, the employee so they have more engagement.

So this is a very critical piece in our belief of how this works. I think that the average DPC data historically has been low 20% engagement in a plan year and we like to start with 100% of a census. We've got some new things where we're modeling it out a little differently but our goal at the end of year one is 60% so we want three times the average engagement with our product as a, as a direct primary care clinic and that is through the three prongs of the insurance agent. Broker needs to understand it and then they need to bring us in so that we can help HR understand it. And then we like to participate in the open enrollment so we can go out and as everyone has their meetings we're there to introduce ourselves to explain. You can come see us and anything we do for you on site won't cost you as an employee or your family won't Cost you anything. When they hear $0 and free people's ears go, okay, I'll remember that one when I get sick. So that part there and then the component that HR or benefits, really the benefit advisor really drives is making sure we have contact information for ideally email and phone numbers because we are one call team that also does the issue resolution, also does active engagement. So we have series of emails reminding people to make sure they know their numbers, they're getting their cholesterol, their A1C for diabetes checked, all those pieces built in. And then we also do phone call outreach just to make sure people know that we exist. So we really want an active engagement, not a passive 100%. We've seen some DPC aggregators and they are definitely more, more passive and we just don't think that's the best way to do that.

Yeah, I think that's always been a challenge with a lot of these. Define, broadly define it as cost containment. They wait for the member patient to engage and it just, that's, that doesn't happen. And I think the more hands on and proactive the partner can be the solution to be engaging, the more engagement there's going to be.

Absolutely.

Yeah. Well, let's have a little fun if you're, if you're okay with this. I actually decided this morning on the episode I recorded before you, John, that I'm adding this to the, the show. So you're the second person with. You cool with it?

Feel like a guinea pig? Yep.

Let's get to know John a little bit. So if you don't mind me sharing, maybe you, you've actually had a pretty successful year with your own health journey. How many pounds are you down?

I am down 38 pounds on the gear.

38 pounds, which I think last week when we talked it was 35. So you're even more down.

I am, I am, I am excited with where this is heading. It's. It's a long journey and it's hard work. It's less calories in, it's more calories burned. It's passing on things I really like, but it's something anybody can do.

Well, I'm a big believer in routine, habits, discipline, consistency, all that stuff. So here we go. You ready? What does John's typical morning routine look like?

Ooh, currently my routine has gotten flipped upside down. This year it is. We have a daughter who moved into middle school and their middle school starts way earlier than elementary did. So we are up and Adam before 6am getting her ready to get ready for school.

I often am somebody who kind of tees up my day calendar wise, looking at what I've got in front of me for the day. I don't do it at night like they recommend you're supposed to. I, I like to sleep peacefully. Otherwise I get myself all excited and realize what I have to do tomorrow and don't sleep as well. And sleep is one of those three important things. Sleep, exercise and nutrition.

Are the core causes of your own health. And I do get between seven and eight hours of sleep every night. Depends on whether or not a dog wakes me up, et cetera. And then coffee. I have too much coffee. And I am actually a big fan of intermittent fasting. So I do not have breakfast, even though if I had my way I'd eat breakfast and lunch and no dinner, but with a family and kids. So I tend to start having coffee and I'm at work between 7:30 and 8:30 and the grind starts.

You talked about exercise. If you had 60 minutes right now to pick an exercise to do, what's your exercise of choice?

Ooh, big fan of my peloton. And then kettlebells. I actually finally Nike was out of the size packs of all the different kettlebells. So I found them individually and have started doing kettlebells in the last month. And I think that's part of where that extra three pounds is going. There's, there's muscles I haven't used in a long time using the kettlebells. And then pound for pound, I still say walking is still the best thing you can do. It's, it's something that keeps strength up. It also burns more calories over time, especially if you can kind of hit that Zone 2 level depending on what you're carrying and how you're doing it.

I think a walking is still the most underrated form of exercise. As a guy who loves the sweat and the grind, going for a walk after dinner, one of the best things you can do.

Absolutely.

How about this? You got an afternoon to yourself or family. You get to, you get to choose a hobby. You got the afternoon to do something where you. What are you doing?

Oh, I'm bad at it, but I'd probably go play golf. It's something that, you know, they always joke about doctors having Thursdays off to, to do that and doesn't happen. But I used to play quite a bit and was decent. Now I don't play as much but getting out and nothing, nothing beats walking. 18 actually, this is a fun story. My, my pre medical school routine was study for the MCAT for three or four hours, go walk 18 holes, go back and study and then go back to the course and chip and putt. By far and away the best summer of my life. I lost more weight walking 18 holes every day with a bag strapped to my back than probably anything I've ever done.

Probably got pretty damn good at golf, too.

That's when I was good. It's been that long. So that was like 2004 was when I was last decent at golf.

That's awesome. Last question. You're in front of an employer right now. They got a thousand lives. You're at the table with the broker trying to win the case, trying to sell the dpc. Why should this employer go with Exemplar Care? With Hy Vee Exemplar Care and the DPC model.

I'm going to quote a Hy Vee employee who has the benefit. This will be one of the truest benefits that you give your employees. They are going to get access to us. It's not going to cost them anything more. They're going to use it, they're going to love it, they're going to love you for offering it and they're going to get that kind of white glove level of care that, that just the fee for service World can't deliver on. They're going to have access, it's going to be available, it's going to be easy and you're going to have a healthier, happier workforce. That's all. We can talk about dollars and cents all day long. But it is a true benefit that we've had. We've had two cases that have the employees were going to lose us in a change the company was going to make and employees basically mutinied and said, nope, not happening. That's we want to keep this.

So that's how you know how powerful it is is when the employees say, you're not getting rid of this. Yep. Love that. Well, this has been an awesome conversation, John. Thank you for taking the time to do it. If there's an advisor listening, heck, there might be an employer tuning in. What are the easiest ways to get a hold of you or somebody at Exemplar High Hy Vee Exemplar. I should I always say it wrong if I want to know about how you guys could help me, whether it is the DPC model or the Applos health plan.

So there's www.exemplar.care.com that gets to our website applos a p l o s dot health gets to Applos John. J O N Exemplar care is my direct email and my cell phone is 319-530-3786.

Awesome. Well, I hope if you listened into this episode today and you are selling health insurance or somebody on your team is, DPC is a, in my opinion, it needs, it's a core pillar of what needs to be in a health plan today. I think knowing that we have some issues inside the US healthcare system should not be a surprise in 2025. And if you're going to try to build a better health plan for your employees or for your clients and their employees, DPC has to be a core of it. So I hope you take what John shared today. Whether you're in one of John's markets and you cannot can you leverage the DPC he offers or you're not, you can leverage the applos Health health plan. Make sure to reach out to John right away. John, thank you.

Absolutely. Thank you very much. I appreciate it. You all have a great day.

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