How Solstice Health Is Transforming Wellness and Direct Primary Care

[00:00:00] It is a catastrophic issue in the American healthcare system. Everybody talks about the charge master in a hospital. I envision the charge master like the Bible sitting on a pedestal with a light hanging over it, but all written in pencil where people just go in and change the price whenever they want to. Do you want to know what CEO and the CFO care about more than anything? It's the very last line. You know, what does it cost? The patient experience begins way back during plan design when the employer folks are putting this design together to then create access to the doctor.

[00:00:29] I would encourage them not to try and control healthcare. I would try and encourage them to control the access to healthcare. If you're trying to structure all these things and you're not talking to the people who are actually caring for the patient, you lose. Just end of story. This is Dr. Tim Murray. I'm the founder and CEO of Solstice Health based out of Milwaukee, Wisconsin.

[00:00:48] Let's talk about your story. What's the patient story or the moment early on that shaped you, how you practice today and how Solstice came about? Sure. So I'm an anesthesiologist by trade. That's sort of my background education. I started out actually in general surgery, realized very quickly that I had ruined my life and decided to switch into anesthesia.

[00:01:14] And there was an interim in between that time where I was doing ER and urgent care. So I had this really interesting background where I was getting sort of the full scope of healthcare in general, anesthesia, surgery and urgent care ER, which is basically where most people are getting their primary care nowadays. But as I was sitting in the operating room in smaller hospitals early in my career, there's always a nurse or someone in the operating room, a circulator who was doing the billing for the case.

[00:01:39] And it was very interesting to me that you would hear the costs of different things. And at one point we were doing an ACL repair. There's a knee immobilizer brace that's associated with that at the end of the case. And it was billed out at $200. So my initial reaction was, well, that's not terrible. I'm sure it only costs $20 to make. They've got some sort of margin that they need to make on that. Subsequently, the hospital lost $3 million in rural subsidies. At some point months down the road, we were doing another ACL and that same exact brace was $800.

[00:02:10] So that really caused me to start digging and you start to look into these things like the charge master. He talks about the charge master in a hospital. And I joke with people telling them that I envision the charge master like the Bible sitting on a pedestal with a light hanging over it, but all written in pencil in a closeted room somewhere in the hospital where people just go in and change the price whenever they want to. And that's actually what you see at any given moment in the hospital system. And then what was the moment when you said like, you know, I got to create solstice?

[00:02:38] And I was about six years into my career. And part of the catalyst for solstice was seeing the level of sick care that we were doing. And the operating room is where hospitals make money. They don't make money really anywhere else. Now they've got medication infusions and all these things with high margins. But earlier it was mostly the operating room. And as we were caring for these people, you would receive them into the operating room. Preoperatively, you'd look at their history and physical exams and you would just see this polypharmacy approach.

[00:03:08] You'd see 14, 15 different medications and really start to look at them. Then they'd come in. And I think one of the things that we were probably most passionate about when we started Solstice Health was wellness. And when I speak of wellness, I speak of true wellness. And the problem with wellness in America these days is that 80% of the population is overweight or obese. It is a massive issue. It's the true pandemic of our time. There's about 4 million people die every single year from obesity.

[00:03:35] And we cried about Solstice because of a million people. This is true and it's ongoing in perpetuity with the obesity pandemic. And so we really wanted to offer something, have a clinical space where we could offer true wellness wellness and really work at getting people down to an ideal weight. And in the meantime, deprescribing medications. Not prescribing, but deprescribing medications because we knew we could do it based on certain physiology that we're aware of. And in the operating room, when we're taking care of these folks, it's very challenging.

[00:04:04] Sometimes they realize it. Sometimes they don't. But when you've got me at the head of the bed, so I'm only responsible for 10 to 15 pounds on the head to move a patient back and forth on a bed. You've got a nurse on either side of the bed that weighs 120 or 130 pound moving a 400 pound patient along with the legs at the foot. And it's just untenable for most people long term.

[00:04:26] And it becomes a burden, I think, not only for the health care clinicians, but also for the patients themselves because bad things happen routinely. And so we really wanted to focus on wellness. And we started doing that. And as we were doing that, we started watching how quickly our ability became to deprescribe medications, the high cholesterol medications, diabetes, high blood pressure medications. Those are sort of the three large catalysts to the rest of probably 90 to 95 percent of the rest of the health care issues that we have in this country.

[00:04:54] Obviously, you mentioned something, deprescribing. That's not every physician I speak with is aligned on that. That's correct. And it's unfortunate. Yeah. So let's talk about a little bit your philosophy, right? So obviously, big things are happening, GLPs and all that stuff is happening. What's where you stand? Is it pro-GLP, let's go, that's the route? Or it's like, let's figure out fundamentals first, then figure it out.

[00:05:22] So I'm probably one of the most ardent GLP-1 haters. I hate them with passion. I think it's an incredibly dirty drug with a dirty mechanism of action. I think when they were first created specifically for diabetic patients, to have a side effect of a medication that allows you to lose weight is a benefit to that subset of the population.

[00:05:44] When you take a side effect and you apply that to the rest of the population who may or may not have the additional comorbidities where the risks start to outweigh the benefits, it is a catastrophic issue in the American health care system. It's a catastrophic issue for the employers that they're giving them to. And I can tell you with certainty, the jury is not out. It's coming out very quickly.

[00:06:09] I just saw a very large study done about the risks of osteoporosis because of the burning of muscle as you're losing fat along with that and bone mass and all these other things. But the jury's not out yet.

[00:06:23] And when you see what I see on the back end in the operating room, it's sort of a robbing Peter to pay Paul when you're the hospital system because you think you're doing a good thing by tackling the obesity issue and having some success with A1Cs and maybe doing a little bit of deprescribing. But I can tell you over here on the other side of it, we're doing more EDDs, endoscopic cameras going down into the stomach to be able to see what's going on.

[00:06:52] Because what's happening with that mechanism of action is you can't stop taking that drug. Okay, that you're not fixing pancreatic dysfunction with that drug. You're not changing behavior with that drug. And so you have to continue down the path of using that drug long term. And when you finally do stop, one of the mechanisms of action is to help sort of paralyze the GI tract or stop the peristaltic activity that we would normally have so that you feel full because you are full. And then you don't want to eat anymore.

[00:07:19] So when they stop taking it, all of a sudden they come in and they say, oh, GI doctor, you know, I've got nausea. You know, I can't swallow the same way. Something's just wrong. And it's like when you were on a GLP-1 for a period of years, it's just like taking anything exogenous. If you start to give thyroid hormone exogenously, it shuts down the beginning of that physiologic process so that you can no longer produce lots of different hormones. And it's the same concept.

[00:07:44] And so when you're increasing healthcare costs on one side while you think that you're decreasing them on the other side, you're doing nothing. And you're really not fixing the true issue of the problem, which is stop eating so much freaking food. Stop eating the garbage American food system and start to go back to, you want to go all the way back, go back to creation. Okay. If you want to talk about, you know, meat and water and vegetables and fruit, those are the things that you should be eating.

[00:08:13] There was no crystal light. There was no sugar additive. That's sort of the food system that you have to envision eating on a daily basis if you want to be consistently healthy. Now, at the same time, people talk about eating a balanced diet. And if you eat a balanced diet, if you have any idea of what the word balance means, that means you cannot lose or gain weight. It's impossible. You ate unbalanced to gain weight and you have to eat the opposite way to lose weight.

[00:08:37] And the only way to truly do that and fix pancreatic dysfunction is what we've been doing at Solstice Health for the last 14 years and working to put people in a nutritional keto, true nutritional ketogenesis, to help burn fat mass, maintain muscle, and lose the weight at the same time so that you can get down to an ideal weight and then begin to eat balance so that going forward, you can't lose or gain for the rest of your life. That's the idea.

[00:09:01] If you don't fix pancreatic dysfunction, you have failed miserably because just to give you some statistics, the average North American in the early 1900s consumed about five pounds of sugar per year. Currently, we consume 150 to 200 pounds of sugar per year. So when you think about the pancreas as an organ and what it does, it spits out insulin, right? It spits out insulin when you need it. Five pounds of sugar per year is no big deal. 150 to 200, when you consistently do that over the course of 30, 40, 50 years, you can't stop it.

[00:09:30] And insulin is a fat storage hormone. It increases cholesterol synthesis and it increases arterial or smooth muscle, all of which is diabetes, high blood pressure, high cholesterol. So if you don't fix that, you fail. Jenny Craig, Weight Watchers, Nutrisystems, all these programs are garbage because they're a hypocaloric approach. And it's job security because when you go back to eating a normal calorie count and you have not fixed pancreatic dysfunction, what happens? You rebound. And when you rebound, you only gain fat mass back. You don't gain that muscle mass back.

[00:10:00] Muscle mass that you're losing every time. And that's why they found that these people have catastrophic coronary events eventually when they yo-yo diet like that because they're burning heart muscle as well. All right. So now let's shift gears. Where do you see employer decisions hurting patients without anyone realizing? There's a lot of different areas. I think that I would say probably fragmentation of their plan design and the way that they structure their benefits is probably the most, probably one of the most significant areas.

[00:10:30] Because when you have brokers, advisors, TPAs, et cetera, et cetera, all creating this plan design and they're not asking the physicians who are actually caring for the patients, you get a lot of fragmentation because everybody wants the new shiny object. Right. There's a new app or there's a new wellness program. There's a new whatever, whatever you want to put on it. And it's none of those things are coordinated on the back end.

[00:11:00] They're just not. There's no way to coordinate all of those different pieces of the puzzle that they try to put together. It looks sexy on paper. Right. And when you talk to the executives, it's like, okay, we put this plan together. It looks amazing. We've got mental health over here in this category and we've got wellness over here and we've got, you know, diabetes management over here. It's like, why do you need any of those things when you could just get good primary care?

[00:11:25] If you had time associated with that primary care, which you get through direct primary care to be able to then pull all those things together and it's no longer fragmented. So I think that's really probably one of the larger issues that we see because I always tell people all the time there's, and I feel bad to some extent, but not really. Like all of the wellness programs that everybody implements, they suck.

[00:11:46] They're totally worthless because you cannot tell me that by stepping on a scale, measuring your hemoglobin A1C and then, you know, quitting smoking a week before you take your cotinine test. All so that you can get a reduction in, you know, or, you know, or some sort of bonus in your payroll. It's ridiculous. That's not wellness. Wellness is, you know, being at an ideal weight, eating organic whole foods, and then participating in some sort of exercise like activity.

[00:12:14] And what would you change if, let's assume that if employers talk to doctors before designing these plans? I would encourage them not to try and control healthcare. I would try and encourage them to control the access to healthcare. There's a big difference. We control healthcare. The doctors control that. We're dealing with the patients, any type of clinician, mid-levels, whoever they may be, are dealing with those patients on a daily basis.

[00:12:41] So allow us to control the healthcare part of it. They just need to figure out how to design the access to be able to get to us. And, you know, we figured out how to do that. We've been doing it now for 14 years at Solstice Health. And so they just need to listen. Stop listening to all the noise around them and the brokers and everybody else around us and bring us in on those conversations because we will tell you how to do it. How in current situation for Solstice, for example, how is it working in your world?

[00:13:11] How are you getting directly? Is it the employers reaching out to you? You are reaching to employers or is it through more from brokers? So it's a hodgepodge. I think now early on there was a lot of just pounding the pavement and just going knocking on doors, cold calling and saying, hey, we've got this product that we think that would be better for you. And sort of the low hanging fruit during those early times was like employers that had on-site clinics because on-site clinics generally don't work, right?

[00:13:38] They have some benefit, but it's very small. Nobody wants their family to come to the workplace to get, you know, an exam done or have their kids running around their workplace. So I just I'm not a believer in on-site clinics. I'm a big believer in near-site clinics and or clinics that are on-site in a completely different setting within a large campus for people to be able to go to. But that's a really large employer. And so we used to reach out.

[00:14:04] Things have shifted, I think, pretty dramatically where there was a broker or two reaching out saying, hey, we've heard about what you're doing because you're with this other employer. Who are you guys and what do you do? And then with the advent of some of these health plans like Self-Fun Health coming into the market, it has changed the game in terms of they are doing that now. They're sort of doing, you know, the pounding of the pavement and cold calling and sort of getting their foot in the door.

[00:14:28] But they understand as a plan that primary care or direct primary care has to be the doorway into the rest of the health care plan. If you don't have that, it's a failure. And they recognize that. And there's, you know, other people out there who are doing it. But as a result of that and going into many more businesses in the last, say, four to five years, there are now so many more brokers who are like, hey, wait, what are you doing? How are you doing that? What's going on? Tell us about what you're doing. Why did you, you know, why did we lose this business and someone else gained it?

[00:14:56] So everybody's just starting to talk, which I think is a good thing. That's the conversation needs to be had. I guess one thing you wish every employer takes home. It would be great if they could recognize the full sale of the influence that they have on the outcomes of their, the health outcomes specifically of their employees. Because the patient experience in the health care setting does not begin in the doctor's office.

[00:15:25] It begins way back during plan design because that is when the employer and or the HR folks are putting this design together to then create access to the doctor. And so they really have to recognize, I mean, that's an extreme level of influence that they have. And if they can leverage that and understand like what we're doing over here not only affects all of our employee base, more than likely the C-suite and the HR people are going to be on that plan as well. So what do you want for your child?

[00:15:55] Do you want to be able to call the doctor who's sort of like your uncle, who you can just call and say, hey, I've got this issue. That's direct primary care. Or do you want to go into the health care system and make that same phone call and say, we'll see you in six weeks. So they have the ability to influence the way that that plan is designed to then achieve better outcomes downstream once the patient enters the doctor's office. Hopefully that makes sense. One word for the gap between employers and doctors.

[00:16:26] Visibility, I would say. I think that the doctors on the clinical side, the doctors, nurses, everybody is seeing the sort of the struggles that the patients face, if that makes sense. And the employers are looking at data. Right. Right. I get so sick of hearing about data and everybody wants to get data and the brokers want to get data. And it's like all the like like on our side, nobody freaking cares. Like we don't care about data at all. Like we care about the outcomes data that a patient will have.

[00:16:56] And you're not going to get good outcomes unless you have time and access and affordability. You know, sort of as the as the tail end of of the important part without that. So yeah. Reminds me of like how. In sales organizations, right. People don't care about how many calls you make. It's how much revenue close. That's the same lines. You care about the outcome. Well, that's what I tell. I try to tell people because they like they'll be like, well, we're with this organization and it's big and the TPA wants X, Y, Z.

[00:17:25] And it's like, do you want to know what the CEO and the CFO care about more than anything? They want to know, you know, what does it cost? What's it going to cost me? You know, it's just that's really truly the only thing that matters. Most underrated thing a doctor brings to the plan design. Reality and experience.

[00:17:48] Again, back to that plan design topic is if you're trying to structure all these things and you're not talking to the people who are actually caring for the patient, you lose. Just end of story. So so we have the experience. We can bring reality to the pieces of the puzzle that you put together. If you're putting pieces of the puzzle together that don't really have a picture on them so that you can know where it's going together, how it all ties together. That's where we come in.

[00:18:17] That's what we bring to the table. So like put us at the table. And my last question. Solstice is listed recently one of the fastest growing organizations in the media outlet. I saw it. Yes. So probably again this year. Yeah, which is a good thing. So tell us a little secret. What are you doing differently? You know what?

[00:18:38] When when we open Solstice Health now for almost 14 years ago, it was never intended for us to sort of hang a shingle and get our, you know, little subset of, you know, direct primary care people of six to 800 people and then shut it off. We really wanted to be able to offer it to the masses. And so as we were working on wellness and infuse the direct primary care, the two of those things together, that started to blossom on its own.

[00:19:07] But what we really wanted to do long term. And again, this is sort of like God author. This is not anything that I could just gin up in my head. I just feel like, you know, God has opened doors and closed doors along the way and we've just followed and listened. But we've sort of wanted to create an ecosystem of services that we could provide. And so along the way, we added IV nutritional therapy, which is sort of a progressive functional medicine type treatment that has led into now being able to do high cost medication infusions downstream.

[00:19:37] We added in hyperbaric medicine a couple of years ago as well, because that's another situation where insurance only covers 15 different conditions. But we know it's internationally recognized to cover about 100 different conditions or at least know that it's good for. So why not offer to the masses? I think most importantly and critically is our ambulatory surgery center that we opened five to six years ago now. There are just a handful. Surgery center of Oklahoma was the main one that we actually used many years ago when we first opened. Keith Smith is a good friend. I sort of consider him the godfather of cash-based surgery.

[00:20:07] But there's only a handful across the country. Now there's about 2,000 to 3,000 direct primary care clinics across the country. Nobody in the country is doing direct primary care and direct surgical care under the same umbrella. So we thought that that would be a really good transition to create a better ecosystem of care where we then had direct primary care, which then often begets some form of specialty care. Obviously, the best surgery is the one not needed. And so that's where you have that early prevention and you can help avoid those things downstream.

[00:20:36] That's the best thing you can do not only for the patient but for the plan design. But having that ambulatory surgery center that's cash-based allowing us to offer surgeries at 70% to 80% less than the hospital system, now we have all of our highest cost drivers under one umbrella. We've got your labs, imaging pharmaceuticals, and surgery expense. And prevention, obviously, is the main key with direct primary care.

[00:20:59] So when you combine all those things together and continue to offer things that I think are value adds to those two foundations, it's a win-win for everyone. There's not much that we don't offer now other than inpatient hospital care because we have access to all these other things throughout our ecosystem. So it's worked well and God has blessed us and we're going to continue to try and push it through.