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A Southern Colorado Cure for Washington’s Healthcare Reform

Pueblo doctor John Thomas runs a direct primary care model practice, where a flat monthly fee is all that’s required for care.



Insurance is never billed at On Point Primary Care, run by Dr. John Thomas, a Colorado native who set up the practice as a first of its kind south of Colorado Springs. Photo by Jason Prescott

Dr. John Thomas, a family doctor in Pueblo, is sidestepping Washington politics on healthcare with his practice.

The back and forth between congressional Republicans and Democrats on repealing and replacing The Affordable Care Act even had President Donald Trump admitting, “Nobody knew health care could be so complicated.”

But Thomas doesn’t think the topic has to be. He wants to help simplify things by changing the way Puebloans, at least, view health care.

Thomas runs On Point Primary Care, which he describes as an “efficient three-room family medicine clinic” where he offers patients “unheard-of access … via email and text, spends up to an hour with them during office appointments and provides a lot of medical services and prescriptions at seriously discounted rates.”

On Point takes advantage of an alternative payment model for primary care that bypasses insurance companies altogether. In the model, called Direct Primary Care or DPC, patients are billed a monthly “membership” fee, which for adults runs between $35 and $75 depending on age.

“The fee covers all of their basic primary care needs, and their insurance plan (if they have one) is never billed,” Thomas says.  “The model allows for improved access, unlimited visits, discounted medications, labs and radiology services without insurance copays or deductibles.”

Dr. Thomas’s practice comes as a godsend to those unable to take advantage of Colorado’s expanded Medicaid program but who can’t afford health insurance. “A majority of our patients are hard-working citizens whose income is too high to qualify for Federal programs and who simply cannot afford even the least expensive insurance offered on the marketplace,” Thomas says. “We offer a cost-effective way for these people to get primary care. Otherwise, they would probably use emergency room or urgent care centers for routine care. That is too costly for everyone and does not give these folks any continuity of care.”

The people who Thomas treats are considered outlaws under the current Affordable Care Act, which mandates that those who do not receive government medical assistance or who are not covered by their employers buy health insurance on their own, regardless if they can afford the insurance or not, or pay an ever-increasing annual fine to the IRS.

Under the most recent GOP plan that passed the U.S. House of Representatives on May 4, the individual mandate under ACA would be eliminated. So it stands to reason the Republican plan would be a win-win for Thomas’s Direct Primary Care model and the majority of his patients should the individual mandate’s elimination remain in the Senate version. In addition, the DPC model can share its victory with certain health insurers who provide less-expensive catastrophic plans that insure against cancer, heart disease and other serious ailments that the DPC model does not address.

Yet what might or might not happen to ACA is not what has Dr. Thomas excited. ACA’s possible repeal was only a secondary legislative interest to the doctor compared to an action taken this year by the Colorado General Assembly. Gov. John Hickenlooper signed the Direct Primary Health Care Services Act (HB 17-1115) into law on April 24.

“The bill will further elevate DPC as a viable practice model to achieve the quadruple aim in health care — improving population health, increasing patient satisfaction, reducing per-capita health care spending and addressing clinician and staff satisfaction,” Thomas said. “With the possible elimination of the individual and employer mandates under the Republican federal health care plan, we have an opportunity to provide cost-effective, quality primary care to people who are in need.

“We have no pre-existing symptoms restrictions, and we welcome those who cannot afford insurance coverage. We would like to see the development of an inexpensive catastrophic care plan that would pair perfectly with the DPC model. Unlike our complex third-party insurance system, there’s no great mystery to On Point Primary Care: you simply pay for a service and you get that service. That is how health care once worked, and we are bringing it back with the human element at center stage.”

However, Thomas elaborates although he encourages his patients to have insurance coverage as a “back-up plan” against catastrophic events or in-patient hospitalizations, “it is important that our patients understand that our monthly subscriber fee is not an insurance premium and that we do not offer insurance.” Yet if his patients want such insurance, Thomas said he is happy to point them in the right direction.

Thomas’s DPC practice is not limited to patients with no health insurance and, in fact, prefers to work with patients who have cheaper insurance with higher deductibles and copays. “We also see a group of patients who participate in Medical Health Share programs. Although not for everyone, these programs facilitate sharing of health care costs among individual members. The programs function similar to insurance and are probably the best alternative to conventional health insurance for about half the cost. Some programs will even reimburse members for our monthly subscription fees, too.”

You might call the DPC model a career obsession for Thomas. A Denver native, he received a degree in Kinesiology at the University of Colorado Boulder. From there, he completed his Doctor of Medicine at the Medical College of Wisconsin in 2002.  After that, he received his board certification in family medicine through a Medical College of Wisconsin-affiliated program and later became an assistant clinical professor with that college in 2005. He opened On Point Primary Care about a year ago.

“We came to Pueblo because I had an opportunity to be at the forefront in changing primary care in America,” the doctor said. “When my children ask me later in life why we left Wisconsin, I wanted to be able to reply, ‘Because I wanted to create a medical practice I believed in.’ I’m blessed that we have opened a clinic with integrity as its foundation. I’m able to provide my patients with the quality of medical care that I was taught and that they deserve.”

Thomas’s practice is one of 620 that operate using the DPC model in 47 states. More than 10 percent of those clinics are in Colorado. On Point was the first independently owned DPC clinic to open in the state south of Colorado Springs.

“We just don’t need insurance for common medical issues in primary care. Removing ourselves from the traditional fee-for-service model reduces costs from both a business and a care perspective by 70 to 90 percent,” Thomas said. “Therefore, we are able to pass these cost-savings on to our patients by providing better care and increased services for less out-of-pocket expense.”

Thomas says the typical DPC clinic sees 700 patients per year whereas the average fee-for-service provider, which takes health insurance, sees between 2,000 and 3,000 patients per year. And that explains why Thomas can spend much more time with his patients than most other doctors in Pueblo.

“We have been well-received in the community,” Thomas said. “Our patients have been the most vocal proponents and supporters of On Point Primary Care. The clinic’s growth has exceeded my initial expectations for its first year and will achieve 50 percent of our total capacity by July.”

He adds he will stop taking new patients when he is unable “to deliver accessible, cost-effective quality care to my patients.”

Although Thomas would be content to leave his clinic as is. He is open to the possibility of expansion. “Currently, I am considering the logistics of creating satellite clinics in the southern area of Pueblo and in Pueblo West, but I think this is a few years away. Creating additional clinics to serve more people would require that I connect with like- minded care providers who share similar care philosophies. I have other ideas about establishing a multi-provider integrative clinic as well. Time will tell.”

And time will tell if a new GOP-inspired national health care plan would make clinics like On Point Primary Care more popular among patients, particularly those in Pueblo.

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1 Comment
  • Carol

    I pay Blue Cross Blue Shield $850/month for insurance having a $6000 deductible. I’m not likely to ever meet my deductible, so basically I pay out of pocket for all of my exams, drugs, and routine tests. Before I joined On Point Primary Care, I’d see my doctor once or twice a year for a 10-minute, $150 visit. I never got good care and never was given time to really talk about medical questions that concerned me.

    In contrast, for $75/month, I now receive WONDERFUL care from Dr. Thomas as often and for as long as I need to see him. Quick question: I text him. Longer question: I schedule a phone conference. Need to show him something: I schedule an exam. On Point has saved me SO MUCH on drugs and tests that my subscription has basically paid for itself. I will NEVER go back to an insurance-based doctor now that I have seen the difference that a Direct Primary Care physician can make to my health (and to my pocketbook!).


Colorado officials to focus on treatment, enforcement to curb heroin epidemic



Colorado officials said Tuesday that they hope a two-fold approach will prevent the growth of the state’s heroin epidemic.

Federal and state officials announced plans to focus on prosecuting dealers and use local law enforcement to link people addicted to the drug to treatment options.

According to an updated report also released Tuesday, 228 people died in Colorado in 2016 from heroin overdoses. That’s an increase of 43 percent compared to 2015, when 160 heroin overdose deaths were reported.

Colorado U.S. Attorney Bob Troyer said his office is working with the Drug Enforcement Agency and local prosecutors to bring federal charges against traffickers of heroin, fentanyl and other dangerous drugs. Federal prosecutions can lead to longer sentences and those convicted serve time in far-flung federal prisons rather than state prisons, sending a warning to other dealers, Troyer said.

“This is not a mass incarceration argument,” Troyer said. “This is an exacting, targeting argument on those causing the most harm.”

The second half of the strategy will encourage local law enforcement to help people addicted to the drug get access to treatment through a state hotline.

Douglas County Sheriff Tony Spurlock said local law enforcement quickly learn to recognize the difference between someone who is dealing and someone who is caught in the grip of addiction.

“We’re doing something that we haven’t done in a long time,” Spurlock said. “And that is go after the pushers but have an equally opposing force on the user and helping those folks get off.”

Under the new plan, officers can contact the hotline directly or encourage people with addiction to use it as a resource.

State health officials said the hotline operators walk callers through the process of finding treatment options.

The effort doesn’t have any new financial backing. Officials with the Rocky Mountain High Intensity Drug Area program said they will direct $4 million in existing funds toward law enforcement task forces aggressively targeting heroin dealers.

“We don’t want to become an East coast, a West Virginia or Ohio,” said Tom Gorman, director of the program. “We want to take a proactive approach and say we want to stop this in Colorado.”

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Denver seeks cannabis tax hike to ease housing crisis



Denver officials have unveiled a plan that would have marijuana buyers help pay for an expansion of the city’s 10-year, $150 million affordable housing fund.

The Denver Post reports Mayor Michael Hancock and other city officials on Monday unveiled the proposal that, if approved, would increase the city’s 3.5 percent special tax on recreational marijuana sales to 5.5 percent.

The tax hike requires only council approval since Denver voters capped the special local tax at 15 percent when they approved it in 2013.

The city’s shorter-term plan is to subsidize the building or preservation of 3,000 income-restricted apartments and other housing units in the next five years. The Denver Post reports that the proposal would allow the city to up its goal of 3,000 apartments to 6,400.

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Colorado teachers takeover Capitol demanding better school funding



Hundreds of public school teachers swarmed the Colorado state Capitol on Monday, shuttering one suburban Denver school district to demand better salaries, as lawmakers were set to debate a pension reform measure that would cut retirement benefits and take-home pay.

With the demonstrations, Colorado educators join peers in West Virginia, Oklahoma, Kentucky and Arizona who have staged strikes or high-profile protests in recent weeks to draw attention to what teachers unions see as a growing crisis in the profession.

In Colorado the need is especially stark – and apparently at odds with a state economy that ranks among the nation’s best. The average teacher salary – $46,155 in 2016 -ranks 46th among states and Washington, D.C., according to the latest figures from the National Education Association.

By another metric, Colorado’s dead last. The Education Law Center, an advocacy group, said this year that Colorado’s teacher salaries are the worst in the nation “when compared to professionals with similar education levels.”

Teachers rallied in and outside the building Monday, holding signs and chanting slogans including “You left me no choice. I have to use my teacher voice.” They drew honks from passing cars before heading inside, where their cheers and songs resonated throughout the Golden Dome, drawing lawmakers out of their respective chambers to investigate the noise.

Washington, D.C., native Callie Gonyea, who is in her second year teaching at Ellis Elementary School in Denver, said she was surprised to learn that Colorado spending was so far below the national average given the number of people moving to the state and the millions of dollars raised in taxes on legalized marijuana.

“There’s no reason we should be down there,” said the second-grade teacher, who walked outside the Capitol holding a sign that said “We(e’)d like the weed money, man.”

Gonyea said she would like to see more funding to pay for mental health treatment at her school, which has one full-time psychologist. She said her class alone has three students who would benefit from daily check-ins with the therapist.

While recent teacher protests have come in firmly red states, Colorado has a Democratic governor and a Legislature split between Democrats and Republicans, but it has some of the strictest spending limits in the country thanks to a constitutional amendment passed by voters in 1992, and all tax hikes require voter approval.

Education advocates have filed statewide ballot measures this year to raise revenue for schools, but past attempts have repeatedly been rejected by voters.

It’s not clear if Colorado’s activism could be a sign of protests spreading to more Democratic-leaning states. There are two blue states are in the bottom half of per pupil spending with Colorado — California at 35 and Oregon at 36.

Monday’s demonstration was organized by the state’s largest teachers union, the Colorado Education Association, which estimated the morning crowd at 400. Englewood Schools Superintendent Wendy Rubin said that over 70 percent of the district’s faculty was expected to be absent so classes were cancelled Monday.

School funding has been at the forefront of the state’s spending fights for years, but organizers said this year’s lobbying day drew additional interest in light of recent demonstrations across the country.

Democratic lawmakers cheered the protests on Monday, stopping to pose for selfies with the teachers. But Republicans questioned the timing of the demonstrations in a year that lawmakers are expected to increase K-12 funding by the largest amount in recent memory.

“As a lifelong educator — I was in education for 40 years — I can see what the concerns are, but quite frankly this year they’re totally unfounded,” said state Rep. Jim Wilson, R-Salida. “I find it kind of ironic that we have the stirring up of the CEA troops and bringing them to the Capitol today when we’re considering a school finance bill this year which has the biggest increase since 2008.”

Colorado currently underfunds its schools by $822 million annually, pinching rural areas in particular, where school districts face teacher shortages. Lawmakers in next year’s budget plan to “buy down” the annual amount owed to schools by $150 million, and boost per-pupil spending by 6 percent. It’s unclear if the additional funding will result in lasting raises in the poorest districts, where superintendents complain of losing teachers to places like Walmart.

A sweeping pension reform effort moving through the Legislature could require districts and teachers alike to contribute more to the Public Employees’ Retirement Association, which faces an unfunded debt of at least $32 billion. And a property-tax limiting provision of the state constitution is expected to trigger cuts to local school funding in 2019.

Colorado recently ranked 40th in spending per student according to 2013 figures from the National Center for Education Statistics compiled by the Colorado School Finance Project.

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