A bad sprain, stomach bug or deep cut needs immediate medical care, which likely means a trip to the emergency room.
Then comes the mental math, weighing the cost vs. the benefit: Do I really need to get this seen? Would I be OK if I don’t? Can I afford it if I do go to the ER?
Dr. Dee Bonney is intimately familiar with those questions. The longtime emergency room physician has seen it play out in his professional life, as well as with his own health. Getting that care should not require such internal debates.
"Something had to change. It’s always been this mystery — what am I going to have to pay? What’s the surprise? Then you get the bill, and it’s a shock," said Bonney, founder of Alpha Omega Elevation Health & Wellness.
In an effort to expand its offerings and address what they see as the shortcoming of the health care system, Alpha Omega Elevation has adapted a new approach to physical health. Known as direct primary care, the program works as a health care membership plan that provides care for maladies such as broken bones, cuts, illnesses and wellness visits, all for a fixed monthly price.
The addition of direct primary care adds a new dimension to Alpha Omega Elevation’s existing addiction treatment services, and provides another option to what Bonney sees as an increasingly broken health insurance system in the United States.
"We’re aiming at working people who want to not have huge, common expenses for health care. I think people get sick, and they feel really bad, and feel like they should be seen. But they don’t want to spend several hundred dollars or thousands of dollars for a virus," he said. "If you have a viral illness, you can at least come here and I can explain that, and you didn’t spend anything out of pocket when you saw me."
The transformation of Alpha Omega Elevation’s Greenwood offices has been ongoing for months. To provide the kind of primary care they envision, Bonney and his team had to reimagine their work space.
New treatment rooms outfitted with examination tables were constructed, while carpet was removed and replaced with hard floors for a more sterile environment. Equipment such as a subterfuge to handle blood draws, an electrocardiogram to monitor heart function, splints, IV bags and other items had to be purchased.
A large group meeting room, which had been used for counseling in their addiction treatment, has been segmented and turned into two smaller spaces to see patients.
The work was exhausting and exhilarating at the same time for Bonney and his wife, Megan Bonney, a registered nurse. They established Alpha Omega Elevations in early 2019 in an effort to address the deepening opioid epidemic in central Indiana.
Their approaches takes two directions. Clients are prescribed medications to help relieve symptoms of withdrawal, to medically treat the way addiction has changed their brain chemistry. At the same time, Alpha Omega Elevations uses Christian counseling and group therapy to heal the spiritual void.
That same method will be the pathway forward for this new venture.
"Our whole foundation is on faith. When someone comes in for an ankle sprain, it might not be the time to talk about faith. But when that same person comes in because they had a loss or an injury in their life, we can kind of go into the more spiritual things and have discussions," Bonney said. "There aren’t a lot of doctor’s offices that have a biblical pastor and counselor on staff."
The renovations are the results of months of research and debate, as Alpha Omega Elevation leadership considered the move to direct primary care.
Direct primary care has found increased usage in the past decade. The model consists of charging patients a recurring — typically monthly — membership fee to cover primary care-related services. Patients are not charged per visit out of pocket, unless additional care such as imaging is needed.
About 1,200 direct primary care practitioners operate in 48 states, according to the Direct Primary Care Coalition. In Indiana, the coalition lists three locations offering the model.
Research into the care model has shown it to be beneficial to both physicians and patients, according to the American Association of Family Physicians.
"For family physicians, this revenue model can stabilize practice finances, allowing the physician and office staff to focus on the needs of the patient and improving their health outcomes rather than coding and billing," according to the association’s policy paper on direct primary care. "Patients, in turn, benefit from having a DPC practice because the contract fee covers the cost of many primary care services furnished in the DPC practice. This effectively removes any additional financial barriers the patient may encounter in accessing routine care, primary care, including preventative, wellness, and chronic care services."
For Alpha Omega Elevation, the motivation to move to a direct primary care model stemmed from the Bonneys’ own desire to do more with the clinic.
The couple had decided that Bonney was going to scale back his time working as a physician in the emergency department at Franciscan Health Indianapolis, only taking on two shifts a month. The goal was to focus on expanding the care provided at Alpha Omega Elevation.
"We had this addiction office, and we knew it couldn’t grow more until I had the time and energy to water it," Bonney said.
That left a question — how to do more with Alpha Omega Elevation? Bonney pondered their options, and his mind went to a fellow doctor and friend who had started offering direct primary care in Tennessee.
They discussed the model, and last year, Dee and Megan Bonney drove to his practice to observe how it operated. They returned feeling energized that they could bring a similar concept to Johnson County.
"In the current climate of health care, it’s such a good option for people," Bonney said. "Everyone seems to either have no insurance, or if they do have insurance, they have a high deductible plan."
With their direct primary care plan, patients pay $69 per month for the base membership, and $25 per dependent. In doing so, they are entitled to a number of primary and urgent care needs that cost nothing out-of-pocket. People can schedule office visits, get treated for broken bones, sprains, injuries requiring sutures or receive intravenous fluids.
"With that monthly membership fee, you can create a line item in your budget and say, OK, if something comes up, we may have to pay a little more money for the pharmacy or something else, but we pretty much know what we’re going to pay," Bonney said.
If people need x-rays or ultrasounds, Alpha Omega Elevation has partnered with Meridian Radiology to provide the imaging. All members have access to Bonney’s cell phone if they have questions or need to call at odd times. Bonney also helps point patients to more comprehensive treatment if needed, saving them time.
"Even if we’re not fixing the problem, being the person who helps them navigate that health care maze has value," he said. "Having trained in emergency medicine and practiced it for the past 20 years, I kind of know what can help people stay out of the ER. Obviously, that’s not going to be for everything. But having a doctor who can navigate that can help."
The $69 monthly fee may sound steep, particularly if a patient doesn’t need care in a particular month, Bonney said. But he compared it to paying for other types of insurance.
"You don’t really get upset if you pay car insurance and you don’t get into an accident. You don’t get upset when you send in your life insurance check and you didn’t die," he said. "It’s that kind of mentality. It’s really assurance."
Alpha Omega Elevation will offer direct primary care at both its Greenwood location as well as a second office they opened recently on the northside of Indianapolis. The offering will supplement their existing addiction treatment, which remains a cornerstone of the clinic’s mission.
"We haven’t lost our focus on that. I think as people learn what we do, it’ll allow even more people to understand we do addiction as well," Bonney said. "Now, you don’t have to admit you have a problem to engage in our services."
