Dr. Randy Baggesen stumps for fostering wellness, not just treating illness.
Dr. Randy Baggesen
Dr. Randy Baggesen is no Marcus Welby. If you’re looking for mild-mannered and cautiously measured medical advice, you may want to look elsewhere. If you’re looking for fatherly indulgence and a reassuring pat on the knee over those extra 50 pounds you’ve been carrying, he’s not your man. Baggesen is what you’d get if you rolled up the evangelical zeal of your CrossFit instructor (he’s a devotee) with the self-assured salesmanship of an investment banker (he used to be one), threw in a medical degree (VCU School of Medicine) and then said the hell with the way doctoring is usually done in this country.
The 55-year-old primary-care physician and medical director of n1Executive Health Group in Richmond is a man ready to offer his unvarnished opinion, whether it’s about American health care in general or about the health care choices being made by the patient sitting in front of him. He is also one of a growing number of physicians nationwide who have opted out of the standard third-party payer, insurance-based medical practice to embrace an entirely different model, popularly known as concierge, retainer-based, or membership medicine (although Baggesen prefers the term “direct-care medicine”). It offers to patients, in return for a payment of a set monthly or annual fee, far greater access to their physician and much more personalized care. Just as important, it offers physicians a way to escape the crushing patient loads, grueling pace and ever-escalating amounts of paperwork associated with a typical fee-for-service practice.
It isn’t just this high-volume, rapid-turnover model that Baggesen rejects, however, but the focus, he argues, that drives it: fixing problems rather than preventing them, treating illness instead of fostering wellness.
Why do you prefer the term “direct-care” rather than “concierge” medicine?
Direct care is paying the physician directly for services, without the intermediary of insurance. We offer the same kind of access that people associate with concierge medicine, but we are an advanced adult-preventive-health care clinic. We still use insurance if our patients need to go get a mammogram or a colonoscopy; if you need to go to the emergency room, if you need a surgery, then insurance is there to cover a catastrophic or unanticipated loss. But if you are my patient, I want to talk directly to you, so we have taken the insurance company out of the middle.
What’s wrong with the way healthcare is practiced in the U.S.?
Our American health care model is broken not only for patients but also for providers. Everyone thinks the U.S. has the best health care system in the world, but what we have is a very good, very fractured sick care system. American medicine is not worried about root causes of illness; American medicine is “are you sick, how can we cure you.” To develop relationships with patients, to really keep them healthy and away from the risks of disease, takes a great deal of time to accomplish, and that is literally almost impossible in the hurried encounter that we have turned medicine into.
What makes your practice different?
Our practice is about health enhancement, prevention of disease, avoidance of disease. We are looking at the root causes of chronic illness and the risk factors for disease, and we try to effect a different outcome. Early detection and intervention are key.
How do your patients experience that difference?
We provide all the sick care, referrals, patient advocacy and other services that other primary care physicians offer. But what we do that is different is, every year, we put all of our patients through a comprehensive physical, which lasts about four hours. It includes a full review of the patient’s medical history. We do tests, including exercise stress tolerance, EKG, vision and hearing screening, glucose tolerance, body composition, and carotid artery measurements to assess for vascular disease. Then we spend an hour to 90 minutes going over everything. We discuss results and we put together a personalized prevention and health-planning document.
What about the criticism that this model of care is only for the well-to-do?
We say you have two assets: You have your financial assets, but you have an entire other asset class, which is your wellness, and we are wellness-asset managers. The same way your financial manager would put together an asset management plan, we put together an optimal wellness plan.
Why would someone who is young and healthy consider private-physician care?
People tell me, “I would never do this—there is nothing wrong with me.” Nobody knows if they are well. We find things in young healthy people all the time, things that in 20 years might have an outcome not only on their life expectancy but on the vitality of their life as they live it. So we look for risk factors and we focus on maintaining wellness. In a world where people will spend eight dollars on a cup of coffee, people should be willing to be invested in their wellness.