Reviews & News

Tested, safe and effective COVID-19 vaccines will help us get back in control of our lives and back to the people and places we love.

Scientists had a head start. The vaccines were built upon decades of work to develop vaccines for similar viruses.

Tested, safe and effective. More than 70,000 people volunteered in clinical trials for two vaccines (Pfizer and Moderna) to see if they are safe and work to prevent COVID-19 illness. Volunteers included Black/African Americans, Hispanics/Latinx, Asians and others. To date, the vaccines are 95% effective in preventing COVID-19 with no serious safety concerns noted in the clinical trials. The U.S. Food and Drug Administration (FDA) makes sure the vaccines are safe and can prevent people from getting COVID-19. Like all drugs, vaccine safety continues to be monitored after they are in use.

You cannot get COVID-19 from the vaccine. You may have temporary reactions like a sore arm, headache or feeling tired and achy for a day or two after receiving the vaccine.

Supplies are very limited. Right now, very few vaccine doses are available.

Take your shot at no cost. The COVID-19 vaccine is available for free, whether or not you have insurance.

Click here for helpful FAQs regarding the vaccine.

Click here for updates from the Buncombe County Health Department’s vaccination distribution.

Written by Dr. Rachel Hines

Source: Asheville Citizen-Times, Sunday 18 October 2020

I appreciated Ms. Wicker’s article “Mission Health: What Has Changed Under HCA and Why.” As a local family physician, we hear stories of heroic and timely care as well as staff overwhelm, high cost, and poor access. Unfortunately, the closing of primary care offices in Biltmore Park and Candler was not surprising.

Hospitals are where our sickest kin go (with the exception of some on Labor and Delivery). In contrast, strong primary care prevents people from getting sick or at least prevents existing medical conditions from progressing to the point of needing hospitalization. When primary care is undermined, especially in safety net clinics, people will get sicker and end up utilizing specialty, urgent, and emergent care more often. With any for-profit hospital corporation at the helm, this ultimately boosts the bottom line at the expense of individuals’ health, not to mention the rising costs of care. This is not unique to for-profit health systems but it is a more exaggerated one. Primary care has been steadily consolidating under systems – like Novant, Vidant, UNC, Duke, and Atrium to name a few just in our state. There are many reasons for this including federal legislation spanning multiple presidencies.

None of this has to be a given. It is not a given that so many people must get sick enough to go to the hospital. Many acute illnesses can be prevented by a combination of counseling, medicine, lifestyle, and, ironically, avoiding the hospital itself – medical errors in hospitals are consistently a leading cause of death in the US. It is also not a given that doctors must be disincentivized to accept Medicaid and Medicare insurance, as Ms. Wicker alludes to in the article. It is not a given that the practice of primary care must be reduced to writing prescriptions or referrals in a 10 minute visit. It will take advocacy, innovation, and legislation to put us on a new path.

The story of my own practice, Lantern Health (formerly Avenu Health) was nearly another cautionary tale. Founded by Mission in 2017 as the system’s “Innovation Clinic,” its goal was to transform and strengthen the practice of primary care. Our care delivery was ultimately modeled as full-scope Direct Primary Care (DPC). In short, a financial model based on a monthly fee instead of fee-for-service translates into simplicity, transparent pricing, access to physicians through the full range of virtual and asynchronous options (texting, phone, video), and more time with providers, nurses, and health coaches. These are measures that routinely prevent chronic conditions, prevent worsening illness, prevent the need for hospital care, and save money. Mission recognized the need to re-center its own primary care services in a flailing system and was trying to do something about it.

HCA had an opportunity to continue this effort but chose not to. In February of 2020, Avenu Health was divested from HCA. Thankfully, my physician partner purchased our practice and as Lantern Health, we have continued to grow and deliver high-value primary care alongside several other local DPC practices. Now, in a fit of irony, we see that HCA touts a $25 million innovation grant aimed at investing “in local companies working to improve the quality, cost or efficiency of healthcare in the region.” This while they have removed quality incentives and focused entirely on volume (i.e. profit) as the priority for providers in HCA practices. As a citizen of the community, I want our local hospitals to exist and thrive for unpreventable emergencies and specialized treatments. I am unconvinced, however, that a for-profit hospital-based system can choose the right priorities – even when it was handed to them by their predecessor. I hope HCA proves me wrong but I’m not holding my breath.

Instead, I will go into work today, spend an hour with new patients, offer health coaching or mindfulness therapy, discuss nutrition goals, recommend supplements or medicines, and dig into the root causes of problems. People will call or text us – during or after hours instead of going to the ER or missing work. Innovation is happening. Primary care is available in Asheville. It just cannot and should not look the same as it has in recent memory.

And if you are getting primary care as it’s meant to be – keeping you as far from the hospital as possible – the office will not have HCA’s name on the door.

Dr. Rachel Hines is a Family Medicine physician who lives and practices in Asheville, NC. Her practice, Lantern Health, is a direct primary care practice that serves individuals of all ages, families, and small businesses in Asheville.

Dr. Rachel Hines was recently interviewed on The Podcast by KevinMD! Check it out here.

“I struggle for words to describe life in the season of COVID-19. Depending on the day, I need at least a few adjectives: ‘peculiar,’ ‘fine, all things considered,’ ‘terrifying.’ ‘Joyous’ and ‘anxious’ certainly make odd bedfellows in my brain.

As a mother and physician living this new reality, I’ve been extra thankful for Irene, who taught me the power of ‘and.’ Irene is a clinical psychologist who was tasked with helping my family medicine residency classmates and me build skills for self-care and counseling. She taught me to replace ‘but’ with ‘and’ in conversation. This subtle verbal acknowledgement can reconcile what would typically be perceived as conflicting emotions or realities–like mental yoga. The shift has served me well in my medical career and in personal relationships. Imagine how different it feels to hear someone say, ‘You’re doing the best you can, but you can do better’ versus ‘You’re doing the best you can, and you can do better.'” —Dr. Rachel Hines

The large-scale meat industry has been hard-hit by COVID; a recent CDC report highlights several reasons, including conditions that force workers to be in close proximity to each other and create difficulty in adhering to protective gear or sanitation recommendations. There have been high-profile outbreaks in our own state in five counties. I used to work at Chatham Hospital in Siler City, where an outbreak at Mountaire Farms poultry plant has filled beds with COVID patients.

Grocery stores across the country are now limiting how much meat people can buy in the context of lower stock. As a family physician who treats many nutrition- related chronic illnesses, I see this an opportunity to encourage all Americans to reduce their meat intake. Just as reduced air pollution during the pandemic has benefited human health and the environment, so could shifting to more plant-based eating.

Eating foods that come from plants instead of animals has innumerable health benefits, some of the most notable being reductions in risk factors for cardiovascular disease and cancer. According to a 2019 study by the American Heart association, “Plant-based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and allcause mortality in a general US adult population.”

Plant-based eating is not necessarily synonymous with vegan, which means eating only plants. Vegan diets have been mainstreamed and popularized by documentaries like The Game Changers and Forks over Knives but the truth is that you don’t have to give up meat altogether to experience benefits. Many societies touted as “Blue Zones” – where people regularly live to be 100 – do eat meat, though in much lower amounts than we’re accustomed to in the United States. Sardinia, Italy, is a great example of this, where about 5% of their diet is from meat, poultry, and seafood.

Our collective culture overemphasizes animal sources of protein while in fact, you can make balanced and delicious meals without using any products that come from animals.

Eating plant-based protein like beans, nuts, whole grains, and potatoes in place of poultry, pork, and beef will shrink the factory farming industry that is ripe for outbreaks like COVID.

Free resources abound, like Pinterest and plant-based eating blogs. In Asheville, we are lucky to have many local restaurants (including those that currently offer takeout) offering creative and delicious plant-based meals; I love Luella’s tempeh barbeque and Blue Dream Curry is our go-to lunch spot at work. I approach primary care through the lens of lifestyle medicine, which empowers each of us to consider the ways in which health starts at home. In response to grocery stores carrying less meat, I would challenge our community as follows: Let’s embrace this!

Buy meat, eggs, and dairy to have sparingly throughout the week from our farmer’s markets or other local sources. Embrace your personal soul foods, whatever they may be, and allow them to bring you joy. For most of the week, stick to the simple and delicious world of plant-based nutrition to improve your health.

Dr. Rachel Hines is a Family Medicine physician who lives and practices in Asheville. Her practice, Lantern Health, is a direct primary care practice that serves individuals, families, and small businesses in Asheville. She is a member of the Western Carolina Medical Society’s Lifestyle Medicine Advancement Group.

Read more from our very own Dr. Rachel Hines, quoted below!

The novel coronavirus (COVD-19) outbreak has created unprecedented challenges for physicians and patients across the health care system. Office-based doctors are scrambling to provide access to their patients through telemedicine and virtual visits while navigating a new terrain of billing codes and payment rules for these services. Others are tightening their belts as they contemplate how they will be able to meet payroll and keep their doors open with a sharp downturn in office-based appointments.

One group of doctors that seems to be riding out the storm better than most are direct primary care physicians. Direct primary care (DPC) is a practice model that allows more flexibility than traditional fee-for-service practices because physicians work directly for patients and eliminate third-party payers like Medicare, Medicaid, and insurance companies. Most DPC practices are set up as memberships, with patients paying a monthly fee to their doctor (averaging $77 per month) for all primary care health care services.

Telemedicine and virtual visits

Unlike most primary care practices in the fee-for-service realm, many DPC practices are already set up to provide virtual office visits through telephone and video consults, as well as providing access by email and text message. Since patients pay for services through a monthly membership, there is no need for DPC doctors to worry about how to code and bill for these non-office visit services.

Thi N. Vo, DO, MBA, who works with First Primary Care in Houston, TX notes that that she and her and her physician partners were able to implement changes to protect their staff and patients from the risk of coronavirus very early on. “We went to virtual only, cut down to minimal staff, and began alternating days,” says Vo. Because the office already had applications in place to serve patients virtually as a part of the direct care model, Vo says the transition was “impeccably smooth and caused negligible interruptions to our daily work flow.”

Although new mandates from the Centers for Medicare and Medicaid Services are now allowing payment for telemedicine services, doctors who wish to bill Medicare must follow a slew of rules, such as the requirement that the visit consist of both audio and video components. Since DPC doctors don’t rely on Medicare billing, they have greater flexibility in providing care by a simple phone call when appropriate. However, many practices are already set up to provide web-based video consults, which are often embedded into their electronic health systems.

“While the major medical systems in my city struggled to make the necessary bureaucratic changes to start telemedicine and bill for it, I was able to continue to care for my patients seamlessly without interruption with telemedicine,” says Rebecca Berens, MD, a direct care physician with Vida Family Medicine in Houston. “I even opened up my services to non-members when I learned that patients were being turned away from other primary care offices and urgent cares due to an inability to provide telemedicine.”

With the increased anxiety surrounding the coronavirus and self-isolation, some DPC practices are also helping patients by incorporating virtual psychology services. At Gulf Coast DPC in Fort Myers, Florida, psychologist Victoria Frehe-Torres, PhD provides counseling to adults and children at the discounted rate of just $60 per session for practice members.

Email and texting

While the Department of Health and Human Services is currently exempting HIPAA privacy rules for communicating with patients, opening up the possibility of using “everyday communications technologies such as FaceTime or Skype,” DPC doctors have long offered patients the opportunity to opt-out of burdensome “secure” messaging portals and systems, allowing them to communicate directly with their physician via text and email.

“We have the ability to personally communicate with our patients to help them through this difficult and scary time,” says Jaclyn Nadler MD with Coastal Med DPC in Englewood, FL, whose weekly updates have been well-received by her patients. “I have received so many positive replies—‘thanks for being there for us,’ ‘your communications give me comfort,’ ‘I know where to go for accurate information,’ and ‘I’m so glad to have a doctor who personally responds to my questions and fears.’”

Molly Rutherford, MD with Blue Grass Family Wellness in Crestwood, KY notes that she has been able to continue to care for her patients fighting addiction. “Patients in treatment for addiction are especially grateful to have a telemedicine option, as most outpatient treatment centers are highly regulated and slow to adapt during these uncertain times. Stress is a huge trigger for relapse, and patients feel comforted knowing they can easily reach me.”

Many DPC physicians are not only sending regular communications via email but are also keeping up a visible social media presence to keep patients and the community informed. Paul Thomas MD with Plum Health believes that DPC doctors are well-poised to become thought leaders on addressing the pandemic. “As primary care physicians, we are uniquely equipped with not only the knowledge to educate our patients about the coronavirus, but we also have the tools to spread excellent information at our fingertips.” The Detroit-area physician notes that his social media posts have been shared widely and have even led to media appearances and increased the growth of his practice.

Office safety

While many hospital-based physicians are reporting concerns over being forced to work without proper personal protective equipment, DPC doctors have the flexibility to adapt their practices to protect themselves and their patients. Garrick Baskerville, MD, the owner of METSI Care, a DPC practice in Austin, Texas, says that one of the advantages to owning his own DPC practice is that he can set the rules for his clinic “I’m able to wear the proper PPE that was sourced from my community to ensure that my patients are protected.”

Many DPC physicians agree that the practice model is better able to keep them safe than a traditional fee-for-service practice. Jeanette Williams, MD, a DPC physician in Calistoga, CA says that “while many of my friends, family, and colleagues are worried about me as a ‘front-liner,’ the truth is that my system of practice with virtual communication and built-in care keeps everyone safer.”

Deborah Sutcliffe, MD, a primary care DPC physician in Red Bluff, CA, shifted most of her patients to telemedicine due to California’s shelter-in-place order. For the few patients that have required an in-office assessment, she feels that DPC has allowed her to provide a safer environment. “I keep my office clean myself. I escort patients right into my exam room so that they don’t have to risk exposure to others in a waiting room. And when they need medication treatment, I am usually able to provide them with what they need right from my dispensary so that they don’t have to take a separate trip to the pharmacy.”

Financial flexibility

Many office-based physicians are worried about how they are going to pay their overhead with the downturn in office visits. This includes paying staff members, and the worry that new legislation will require them to pay for up to 12 weeks of sick leave for anyone who becomes ill from coronavirus or has to be home with children affected by school closures. Since DPC practices typically have lower overhead and employ fewer staff members, many feel more financially prepared.

“Knowing that my practice is financially secure is something that would not have been possible four years ago,” says Deborah Sutcliffe, MD. “I would have been torn between my own financial security and putting patients at risk by requiring an office visit so that I could bill for services and pay my employees and myself. Now I can assure my medical assistant that she will be paid regardless of how many hours we keep the office physically open.”

However, some newer DPC practices are struggling as they try to grow their practice during the pandemic. Tete Tonwe, MD, who recently opened Divergent Direct Primary Care in Lewes, DE notes that she hasn’t been able to recruit patients as easily as she had hoped. “People are so scared, and some are broke.” However, DPC has afforded some good news. “The amazing thing is that I posted a fundraiser on my personal Facebook page. In this way, I’ve been able to provide telemedicine at no cost for those who can’t afford it.”

Satisfied patients

With increasing concern over the economic implications over the coronavirus, are patients canceling their memberships out of financial fears? Most DPC doctors I talked to said no. Rachel Hines, MD, MPH with Lantern Health in Asheville, NC, says that her patients see her practice as an affordable safety net. “Our patients represent some of the hardest hit industries due to social distancing measures—hospitality, food, and beverage service; retail, non-medical factories, and arts.”

Linnea Meyer, MD, owner of Wellscape Direct MD in Boston, MA, has not had any membership cancellations. “Many have expressed how grateful they are to be members of a practice that already had everything in place for virtual visits. Many have said how reassured they have been to be able to reach me easily and get a quick response.”

At my practice, I’ve been overwhelmed by the response I’ve received from patients from my weekly newsletter updates informing them of guidelines and recommendations in real-time. Patients truly value the comfort and reassurance that their personal physician can provide for them, especially in these uncertain times.

A return to practice autonomy

While the DPC model provides an abundance of benefits, the most important is this: DPC allows returns autonomy to practicing physicians. Ellen McKnight, MD, a rheumatologist with a direct care practice in Pensacola, FL, says, “DPC doctors who had rejected the ‘system’ and taken control of their practices have been perfectly poised to respond. The takeaway is that physicians everywhere must once again be in complete control of how our knowledge and skill will be used. For that to happen, we must reclaim our autonomy.”

In moving to a DPC model, doctors reject not only payment from third parties, but also refuse to participate in burnout-provoking mandates. In DPC, there is no “pay for performance” or mandatory patient satisfaction surveys. If patients are happy with their doctor, they continue to pay the membership. If not, the patient is free to leave.

Without insurance credentialing, there is no need to participate in expensive and burdensome maintenance of certification programs. With an in-house dispensary of low-cost, generic medications, there is little need to fill out prior authorization forms.

If a doctor wants to change an office policy, there are no forms to fill out, no permissions to seek, no case to be made. DPC offers a return to autonomy that doctors—and patients—desperately need. As Rachel Hines, MD, MPH says, “I hate that it has taken a pandemic to reveal that what our healthcare system needs is a strong, accessible, and nimble primary care base—DPC in a nutshell.”

Rebekah Bernard MD is a direct primary care physician in Fort Myers, FL and the author of How to Be a Rock Star Doctor and Physician Wellness: The Rock Star Doctor’s Guide.

Source: https://www.medicaleconomics.com/news/direct-care-practices-perfectly-positioned-help-patients-during-coronavirus-outbreak March 30, 2020

Via Mission Health Blog

A human relationship – a connection – is the core of primary care and a key ingredient to health and wellness. That connection can look different for all of us. A new venture, Avenu Health, right here in Asheville is an alternative to the traditional primary care setting.

Avenu Health is what’s called a “direct primary care” practice for people up to age 64 that uses a membership-based model. You receive comprehensive care including personalized prevention, nutrition and exercise counseling, chronic disease management and care for those occasional sick days.

Ben Aiken, MD, is the medical director and family doctor at Avenu Health. He joined us in our latest podcast episode of My Healthy Life to help us understand how this new model of healthcare works – helping you imagine how this model could fit into your lifestyle.

The practice, located in downtown Asheville, is staffed by a team of primary care providers and a health coach, and operates on a membership model, which means insurance is not required. Members access the services by paying a monthly fee that gets them 24/7 access to the provider – that might mean in-person visits, phone calls, text or email messages, or even virtual visits. If you already have insurance, Avenu Health would be an additional service that you’d pay via a monthly membership for added convenience and access to 24/7 care.

Dr. Aiken is passionate about how Avenu Health personalizes a person’s healthcare experience. “We ultimately want to transform how people experience healthcare,” he explains. “We want that to be a seamless, frictionless, really positive experience where there really aren’t any disincentives to engage.”

Avenu Health focuses on a person’s lifestyle as part of their overall health. They believe in caring for the whole person – so that you not only get well when you’re sick, but also stay well when you’re not. Through their relational approach, they provide primary care as it was meant to be: grounded in a relationship between people. They are passionate about personalizing care and are focused on delivering an authentic, hassle-free experience to help individuals achieve your optimal health.

Via WLOS

ASHEVILLE, N.C. (WLOS) — A new health service in downtown Asheville hopes to make treating patients easier and less costly.

Avenu Health’s approach to primary care is similar to signing up to a health club. Members receive 24/7 access to unlimited telehealth visits and nearly unlimited in-person visits. Its ribbon cutting was Monday.

“Primary care is the foundation of making sure that individuals are staying well and making sure their wellness is where it needs to be. By doing the membership basis, we are able to lower the overall costs of what it is to deliver primary care, and we can do it in a more effective way,” Avenu Health president Jonathan Bailey said.

Services include personalized prevention, nutrition and exercise counseling, chronic disease management and care for those occasional sick days. The practice does not accept insurance because clients join through a monthly membership program.

Learn more at hello@lanterndpc.com