Nick Soman, Decent: You started out as an Army doctor and also worked at Thrive supporting naturopathic care. What first appealed to you about the DPC model?
Mark Tomasulo, One Medical: In all fairness, when I started PeakMed, people really didn’t know what DPC was. I described it like people being sold a pizza but they have never experienced what pizza was. Something like, “I’m going to take some bread, cover it with tomato sauce and some cheese then bake it and you’re going to pay me for it.” The people who must have heard that for the first time a thousand years ago probably thought you were crazy. However, once they tasted pizza, they wanted more and more and were happy to pay for it. DPC, in my mind, is so similar to something so simple that it just tastes good once you experience it and you’re more than happy to pay for it. So back to the question...I loved the idea of practicing medicine the way we were trained and taking control of an industry that, in my opinion, was undervalued as a primary care physician. I liked the idea of controlling my own destiny and at the same time shaping an industry that was just starting to crawl called DPC. DPC, in my opinion, was the most purist way of practicing medicine and it took me back to a time when physicians were regarded as a pillar of the community. Not just as physicians, but as teachers, counselors, businessmen, and someone that could be trusted with your most intimate secrets. With that said, I took the approach that I wanted every primary care provider to experience this utopia and set out on a mission to change an industry which put me on the business side of DPC and building a scalable solution so more people could experience this utopia.
Nick Soman, Decent: You've been lobbying recently for the Primary Care Enhancement Act (H.R.3029) and the Medicaid Primary Care Improvement Act (H.R.3836). What should people know about these bills?
Mark Tomasulo, One Medical: These two bills are incredibly important for driving scale within the DPC space. H.R. 3029 ultimately solves the tax code issue revolving around the first dollar coverage when you have a HDHP paired with an HSA that the employer contributes to which puts exposure on the employee for violating the tax code. Most jumbo employers do not want to expose their employees to this IRS issue, so they choose not to put DPC arrangements in place without significant workarounds. Some statistics show over 50% of all current health plans are in an HDHP arrangement with an HSA so correcting the IRS language would unlock millions of employees to participate with a HDHP and HSA arrangement when paying for DPC. H.R. 3836 ultimately would allow a Medicaid arrangement to pay for DPC services, unlocking millions of Americans to elect into a DPC arrangement as well. This would be a game changer for both the provider, patient, and state setting up a unique win-win-win scenario for all parties involved.
Nick Soman, Decent: You founded PeakMed, ran it for nine years, and then sold it to One Medical two years ago. What are the best and worst things about your job?
Mark Tomasulo, One Medical: The best things about my current role is being able to influence one of the largest companies in the world, Amazon, who is the parent company of One Medical, regarding the direction, strategy, and opportunity within DPC. My goal when I started PeakMed was to change an industry and I think I am in a position to at least influence what impact DPC can have on the industry of healthcare and that is incredibly exciting. The worst thing about my job is adapting to a slower more methodical way of scaling and growing. Large organizations have such complexities to them that making change is sometimes challenging and long thought through. However, one thing that Amazon has proven throughout the decades is that they know how to scale. So, I am learning a new way of thinking and I am incredibly excited about the end result once that comes to fruition.
Nick Soman, Decent: You've also worked as the National Medical Director at NFP, one of the nation's largest benefits brokerages. What misconceptions about brokers would you like to clear up?
Mark Tomasulo, One Medical: There seems to be a school of thought sometimes within the DPC community that brokers are just in the middle and can be bypassed or removed from the relationship between the employer and DPC practice. This may be true in small employers where brokers don’t exist, but once you have a broker involved in building a plan for the employer, you have to shift the idea that they can be bypassed. In reality, they actually need to become your best friend and confidant in what you’re selling. The broker/employer relationship is typically very coveted by the employer and you will not get the opportunity to sell to the employer if you don’t have the support of the broker. Broker/consultants are critical to the success of DPC at scale and are pivotal partners in the process. My experience is to take the time to educate brokers on the value of DPC, learn to speak their language so you’re an asset to them, empower them with data and ROI calculations so they can speak intelligently to the employer about your value to the plan. Together you empower each other to grow both the business of DPC as well as the book of business for the broker. This is when your practice will start to accelerate and achieve the goals you dreamed of when you started the practice.
Nick Soman, Decent: Who else in healthcare inspires you, and why?
Mark Tomasulo, One Medical: In all fairness, I don’t think I can put a finger on anyone in the healthcare space that inspires me on a personal or professional level. Cynical as that may sound, the things that inspire me are other professionals that have shaped industries like Elon Musk or Richard Branson have. They didn’t start an industry from the ground up but rather found ways to improve an industry and make it work better for everyone involved. They helped shape the future of industries that already existed in ways that were only imagined in their heads and brought to fruition through having a clear strategy, building a team with the same mission and vision in mind, hard work, sleepless nights, fear of bankruptcy lol, and a tenacity for not accepting no or it can’t be done mentality. I think healthcare needs people like that and in my opinion, that’s when you will see healthcare change for the better as a nation and hopefully DPC is the beacon of light leading the way.
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