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Ashewell Medical Group

An interview with owner Dr. Carly Brown

WCMS’ Health Innovations series highlights WNC physicians, practices and programs that are on the cutting edge of healthcare transformation, both big and small. WCMS supports local physician members who are change agents by recognizing them and sharing among other WCMS members and the general community information about these local innovations. If you know of such a physician or practice, please contact Miriam Schwarz.

Ashewell Medical Group is a Direct Primary Care (DPC) model. According to owner Dr. Carly Brown, the practice brings very high quality primary care to Asheville at affordable prices for those with or without insurance. The practice offers a full package of care

including a pharmacy, wholesale meds, labs, and imaging. The practice assigns 500 patients per physician. This allows patients to have a personal relationship with their physician, including 24 hour access to them. “Our services are very highly personalized. Patients get luxury care at an affordable price,” says Dr. Brown.

Dr. Brown opened Ashewell because she found that patients were growing dissatisfied with the level of care they were receiving in fee- for -service practices. Patients experienced reduced visit times, high wait times, polypharmacy, and depersonalized care. Ashewell patient visits typically range between 30-60 minutes, versus the usual 15 minutes or less found at many practices. The first visit for new patients is 60 minutes. The schedule is set based on patient need. The practice is also able to see patients on the same day. Patients are able to call on weekends and use text and email in order to communicate with Ashewell physicians.

Dr. Brown says that she’s learned some key lessons along the way. First, in order to develop a practice like this, physicians have to have confidence in their abilities. Dr. Brown recommends that physicians “find in yourself that person who was able to be so successful academically. You can accomplish these goals if you have the confidence and drive to do so.” She goes on to say, “You don’t need third parties or practice managers to run a practice. Take back your practice. It’s not as overwhelming as you think.” Second, having your own pharmacy is invaluable because otherwise drug prices are higher due to mark ups. Dr. Brown notes, “When you provide the medications at cost to your patients, you bring a value to your practice which is above and beyond clinical practice.”

The impact of her practice has been profound for Dr. Brown.She says, “I now have extremely renewed faith in the
physician-patient relationship.” She explains that patients see her as a health care leader, a partner who cares for them, and a physician who is truly invested in their health. Patients are thus more motivated to change their lives in order to get better. Dr. Brown finds that her patients want to improve their quality of life because the investment of time and resources Ashewell makes in them sparks in them confidence to keep trying. Dr. Brown says, “They have renewed hope. They have access to things they didn’t have before.”

Additionally, health outcomes are better. Ashewell sees reduced metrics in blood pressure, HgA1C’s, body weight, and rates of depression/anxiety. The practice offers treatment using non- narcotic modalities for depression and pain. Having a pharmacy on site means that patients have access to a better selection of medications. Management of pharmaceuticals is done very carefully in order to meet people’s goals. For example, for mental health, Dr. Brown sees the patient every 4 weeks vs. every 3 months. Since the visits are free and unlimited, patients can be seen frequently and medications can be adjusted in a more timely way.

Dr. Brown sees herself as bringing a solution to the table that works for her and the patients. The rise of DPC reflects the increased frustration with the health care system on the part of physicians and patients. But it also reflects hope that medicine can continue to be something that is available to everyone and that brings wellness to all.

Dr. Brown’s primary influencers and mentors include her father, who was an entrepreneur and pushed her to be a leader in her field. Another influencer is Dr. Josh Umbehr, a physician who created an EMR specifically for direct primary care. She says that the DPC community is a “movement of doctors advocating for doctors.” DPC gives doctors the opportunity to take on leadership and run healthcare themselves. Dr. Brown also praised her husband (who’s also a physician) for supporting her 100% and having faith in her abilities.

At DPC’s very core, the patient’s perception is that the physician truly cares about them. Dr. Brown says, “You can’t put a metric on it, but when a patient thinks the doctor cares about them, there’s a level of anxiety that goes away. DPC humanizes medicine.” Dr. Brown says, “Often I’ll go home and feel like luckiest doctor alive. This is a perfect way to practice for primary care doctors who want to know their patients deeply. I sleep well at night because my family of patients are tucked in. When you remove the third party payer, a huge weight is lifted off your

shoulders because only you are responsible for the health care with no middle person interjecting or taking advantage of your patient. You take on the responsibility but it feels more natural because it’s all yours.”

Dr. Brown’s advice to others interested in implementing DPC is that physicians must make a real commitment to the model. Owning a business is not a good fit for those who just want to clock in and clock out. Become knowledgeable about all of the facets you need to manage before opening the doors. Dr. Brown advises, “Be prepared for criticism and naysayers; you have to have passion to charge ahead despite all that. If you have that, you’ll be fine.”

DPC allows physicians to focus on the lifestyle medicine aspect of the practice—diet, nutrition, weight management, prevention—and restores the physician’s ability to deliver those services. In a regular practice, there simply is not enough time and reimbursement to practice lifestyle medicine. Dr. Brown concludes, “Doctors can make a difference in our communities if we decide that we want to. If you are passionate about this type of practice but don’t know the way to get started, just find someone who does know the way and call them up