Narrator

Welcome to TEDMED Conversations, where medicine, science, and the human experience meet the ideas shaping our future.

In this episode, we're diving into a question many families and clinicians are asking.

What if pediatric care were designed around relationships, not volume?

Your host is Teresa Santoro, a health care leader and strategist with deep experience in care delivery models that put people first. As CEO of RVNA, Teresa has spent her career reimagining how care can be more humane, more sustainable, and more closely aligned with the needs of both patients and providers.

She's joined by Doctor Lauren Hughes, a pediatrician and the founder of Bloom Pediatrics, a direct primary care practice built on a simple but radical premise. Fewer patients, more time, and care that extends beyond the exam room.

By stepping outside traditional insurance based models, Doctor Hughes is experimenting with a new way of delivering pediatric care, one that emphasizes access, trust, and long term health.

Together, Teresa and Doctor Hughes explore the promise and trade offs of direct primary care for pediatrics from how it changes the doctor family relationship to what it reveals about the pressures facing clinicians today to the bigger question of how we might redesign care systems to better serve children and the people who care for them. This is a conversation about innovation, courage, and what it really means to put kids and caregivers at the center of health care. This is TEDMED Conversations.

Theresa Santoro

Hello, Doctor Hughes, and welcome to TEDMED Conversations.

Dr. Lauren Hughes

Thank you so much for having me.

Theresa Santoro

Absolutely. So, Doctor Hughes, before we get into the nuts and bolts of direct primary care, I'd love to start with your story.

What was the spark for you? What made you think this is the kind of pediatric practice I wanna build? And ultimately, what led you to create Bloom Pediatrics?

Dr. Lauren Hughes

So it actually kind of started back in childhood. So my dad is a small town family medicine doctor. He owned his practice. It was a traditional practice, but it was a traditional practice, what it was in like the eighties and nineties, and people would pay him in like tomatoes and corn and things like that. And, you know, a lot of farmers and a lot of things.

So I remember I helped him put in stitches for the first time when I was, like, six, and it was on my kitchen table. I kind of grew up with that was my idea of what medicine was, where you just took care of people, and that was that was it. You know, we'd be out at dinner and people would come up and they're like, hey, doc. You know, I got this I got this limp, and he's like, yeah.

Call the office. We'll I'll get you in Monday morning. Like that sort of a thing.

Get to college, get to med school, and finally got to residency.

And when I was in residency, was my first time truly practicing in what the the health care system is now, and there was one very specific incident that happened in residency that I was like, I can't I can't practice this way. I had this one patient that was very well known to me. She was a recurrent she had asthma. They struggled with access to care, affordability of medication, and so she came in frequently for exacerbations.

And I saw her before lunch. I gave her a treatment. I said, hey. Run downstairs.

Get something to eat. Get, like, an hour or something. Come back up and so we can make sure the medication worked, that you're good to go. I wanna make sure that you're safe before I send you home.

And when she came back up, saw her again, she was good, was able to send her home.

I got in trouble for that because you can't bill twice in the same day.

For a patient. The exact words said to me was you will never keep the lights on if you practice medicine this way.

And I sat with it, and I was like, but but I didn't I didn't do anything wrong. I I, like, I I struggled so much with how am I in the wrong here.

And I couldn't fathom that that would be how I practice the rest of my life of either send her home and fingers crossed that she does okay or sent her to the ER where her mom is now going to miss an entire evening of work or they're not gonna be able to be seen or be exposed to who knows what, be stuck with this bill. And so I remember thinking, like, I've gotta figure out what I can do.

And I was doing my night rotation later on and was scrolling through Facebook, and a local physician talked about her practice. And so I started googling her practice, and she does direct primary care, and I started reading about it, and I was like, this is this. This is it. This is how I can, you know, with what my childhood expectation of what health care was, and now what I am seeing, what health care is now, and they are not the same.

Direct primary care was the way that I could practice medicine old school without the constraints and the issues and the moral failures that I felt in the current system. So I crossed my fingers, told my husband. I said, hey. You know how I've never made money?

I'm gonna continue not doing that, and we're gonna also take out a loan.

And the day after I graduated residency with four month old twins and a brand new three year old, started Bloom Pediatrics.

Theresa Santoro

Wow. What a great story. I just love how it began so organically and with the example you used with your dad of what a beautiful, beautiful story.

You know, many listeners have heard the term direct primary care or DPC but may not fully understand what it truly means in practice.

Could you walk us through what DPC is and just as importantly, what it's not? You know, I wonder if some people are thinking, you know, how does this differ from traditional concierge medicine? You know, what is it and what isn't it?

Dr. Lauren Hughes

The phrase that we use in DPC is if you've seen one DPC practice, you've seen one DPC practice, and they are all incredibly different. And my favorite part is that I get to make it exactly what I want and however I want it to be. It's not concierge. It is it feels similar in terms of the contact and the accessibility you have to your doctor. Concierge is typically where they charge a fee for the access, but then they also bill your insurance.

And direct primary care is we have nothing to do with insurance at all.

It also is much more affordable than I think most people realize. It's usually seventy to a hundred dollars a month, and most people are, like, assuming it's in the realm of a thousand. And so it's much more affordable than people than people realize.

And then compared to, like, a traditional practice where you have to pay a copay or whatever, we we don't do any of that.

So in my practice, how it works is our patients pay a monthly fee, and they have access to us at all times. They can text us, call us, send us pictures. Right before this, I was getting a picture of, hey. This rash popped up.

Do I need to be worried? What can I give? Was able to answer it in just a couple minutes. And so you're able to just handle things very quickly.

Patients can have as many visits in a month as they want, and it doesn't cost them anything additional.

Theresa Santoro

You know, that's really innovative and is impressive that you have, you know, carved out this niche. I think one theme that comes up when speaking with clinicians who have pursued independent or innovative care models is the gap between medical training and the realities of running a practice. We know that physicians spend years, right, mastering diagnosis and treatment yet receive minimal formal training on operations and how to run the business, finances, revenue models. And you know these are the very skills that can determine, right, how much autonomy they have in shaping their patient care.

So for me, in my practice, nonprofit, home health, you know, community health, one of the challenges and the joys of running a mission driven organization is balancing that financial sustainability with the desire to provide care that truly meets the community need. You know in our case it's often unreimbursed care or free vaccines or wraparound services. I imagine you must face very similar opportunities and challenges at Bloom. How has running the business audio practice allowed you to provide those kind of services?

And and why do you think it's important that physicians need to learn it?

Dr. Lauren Hughes

Whenever you work for a company, you need to know how it works at every step. And that's why I really enjoyed, like, starting my practice because I know everything from how to get the toilet seat fixed all the way up to how to get the the billing correct. Right? And so I think it's important to know how where you work, how things work.

And with the business side of it, we get no training. None. I have no idea how to start a business. I had no idea how to do any of this, but we are taught how to seek out resources and find help.

And that was something that I was able to utilize and talk to other people and create a network and be able to understand how to start a business. How can I balance having a financially successful business with doing philanthropic things? And that's, again, part of, like, I get to do whatever I want. So, you know, whenever the shutdown happened, I stopped billing anyone that was affected. I do a free vaccine clinic in the fall for flu, COVID, and RSV for anyone that can drive to our office. I spend the entire weekend doing giving those vaccines as well as the weeks preparing for it. One of my partners does free physicals and lead screening and immunizations at Head Start, which is the local government assisted funding for preschools.

And so we are able to do whatever it is that we feel drawn to do. And so whenever we have a patient that has a need, if, you know, they lose a job, if if something goes on, they just talk to us and we are like, okay. Yeah. Until you're back on your feet, we'll figure it out.

I get the autonomy to do that. Whereas if I was in a traditional practice and someone lost their insurance, k. Bye. Good luck.

You know?

Theresa Santoro

Yeah. That kinda leads me to my second question. You know, I just love how creative you've been. You've sort of looked out of the lines of, you know, this is what reimbursement, this is what the insurance covers, and this is all we can do.

With that in mind, how do you think the lack of business and operational training in medical education affects sort of mainstream. Again, you've been very creative in how you've, you know, looked very holistically and comprehensively at people's needs. But mainstream, you know, you you just sort of you don't go out of those lines. The lack of that education, how has that affected the general population or physicians at large?

Dr. Lauren Hughes

So I think whenever you're in a traditional practice, you do have a lot of support, is necessary with the amount of patients that you see. Right? But what you don't see then is like, okay. Well, this patient, I I referred over to this clinic for PT, but they don't they no longer take their insurance or this referral specialist is no longer taking that insurance or this medication is they can text me and say, the one you sent in my PBM no longer calls tier one.

And so now they it's a ninety dollar copay for my medication. And there is so much whenever they leave your office that in a traditional practice, you don't know. You don't realize that these medications patients aren't filling them because they can't afford them because their pharmacy plan changed. And whenever you are the only one providing that care, I know all of it.

And so my patients are able to tell me, hey. This inhaler is no longer covered. We have to figure out what inhaler we can get you. And there's so much of that business side of it.

I also get contacted for every prior auth. And so I am very aware of the struggles that go with those prior auths because I am the one handling it from the first denial. So I think it gives me a very good perspective.

In a traditional practice, I wouldn't have that because I have the support staff, which it does kind of give you a bit of a tunnel vision of like, no. I prescribe the medication and the patient gets it, but I also understand that you can't do all of the things in a practice that sees forty patients a day.

Yeah. I I think that's well described, the tunnel vision. I I mean, that is sort of the standard. Right? If if you can't think creatively and and look to meet the needs. Do have that tunnel vision, you're absolutely right. You know, I'm just wondering, as you began to understand the business side of practice through all of this hands on experience, and it sounds like you're extremely hands on, you know, on the back end of running the business, Was there anything that surprised you the most that you can see coming?

So the thing that surprised me most was how inexpensive things are without insurance. Wow. I was mind blown at the cost of labs, at the cost of imaging, at the cost of medication without insurance. In Kansas, as a physician, you can both prescribe and dispense medication, and so we keep, like, amoxicillin on hand, and a hundred ml bottle from the wholesaler is two dollars.

A CBC is two dollars. A lead screen is twelve dollars. A vitamin D level is thirteen dollars. A chest x-ray with the read is thirty dollars.

It really frustrated and infuriated me to realize that these bills that we are getting for labs and images and stuff whenever we utilize insurance because if you have a contract with an insurance company, you are obligated to bill them and how much cheaper it is without them. And it it just was so frustrating for me to, like, to fully comprehend how expensive insurance has made primary care. Now insurance for the serious stuff, the hospitalizations, the ER visits, like, yes, that's when it's necessary. But in the outpatient setting, getting, like, a vitamin D and a thyroid panel is less than twenty dollars for my patient.

That's okay.

But if I built their insurance, it would be hundreds. And in addition, like, if I get you know, if we get an MRI on a patient, it's two hundred and fifty to four hundred dollars. And without insurance, there is no prior authorization hurdle to overcome, and so it doesn't delay care. We get care done faster. Whenever I first got our contracts for our imaging and labs, I just my jaw was on the floor for many days.

Theresa Santoro

Wow. It sounds that is incredibly eye opening. Thinking about, any listener who might be across the country who would like to model something similar that you're doing in Kansas City, what skills or knowledge areas do you think are essential for any clinician listening now who would like to create a more flexible mission driven care model that you have done?

Dr. Lauren Hughes

You have to be willing to run a business. It's not for everyone because not every doctor wants to be a business owner, and you have to want to be a business owner. You have to want to deal with taxes and the the all the paperwork and the filings that go along with it.

But if you have that drive, you have to be, you know, which I feel like a lot of physicians are very self motivated, and so you have to have that because you don't have anyone telling you what to do or when to do it. You have to just decide it needs done. So you have to have that, and then you have to be willing to, I think, which I would hope most physicians are, but like you need to be able to really listen to your patients and know that you are going to be spending a lot more time with your patients. And so you have to have that desire to like really dive in deep with patients and their histories. And then outside of that, you just gotta be a pretty good clinician.

If you want to start one what I thought was that was, like, one of the first pediatrics one of the first pediatricians in Kansas City to have a direct primary care practice, but I I was a niche because I do breastfeeding medicine. I'm in also an IBCLC. And so having that as an additional thing, you know, that there's doctors that do, like, specialize in allergy or something. So you find, like, your your niche and you can really something that you really enjoy, and then that can help set you apart. And it really, like, for me, helped keep my passion going, which I love being a pediatrician. I love being I love doing lactation work.

And so it helps keep it sustainable.

Theresa Santoro

Right. Right. It's difficult to be siloed, right, today in health care without some kind of integration or or partnership. Have there been any partners, community partners or vendors or resources that have helped you along the way?

Dr. Lauren Hughes

Direct primary care doctors. Other direct primary care doctors. The direct primary care community across the country is phenomenal.

I mean, they sent, hey. Here's a checklist of how to actually start your practice in Kansas of, like, here's how you here's the link to file your LLC. Here's the link to submit it to the Secretary of State. Here's the link to do all of this stuff.

I am also incredibly lucky to be in Kansas City, which is kind of a very centralized hub for direct primary care. We have several. And they had done a lot of the work with, like, these labs and imaging negotiation prices. It's called the Midwest Direct Primary Care Alliance in Nebraska, Kansas, Missouri, and it's all of us.

There's dozens of us now.

And when we have a group like that, then we are able to have, like, a little bit more power for getting these discounts. They also host these meetings where they have things like the most recent one was an orthopedic group that is starting to do a cash pay option for, like, walk in fracture clinics and things like that, which, you know, kids always break their arm at at a busy part of the day in an ER, you know. And so, like, they have walk in fracture clinics, and so they really help with a lot of that and then a ton of, like, calling them up and they're like, hey. I'm out of, you know, urine cups.

Do you have any oh, yeah. Yeah. Yeah. Swing on by and grab some. So there's so much camaraderie in the direct primary care community that we have just been it has been a godsend.

I have no staff. I was completely solo till I hired my second doctor in twenty twenty twenty four, and it has been great.

Theresa Santoro

Wow. That's amazing. I mean, you really have been an incredible role model. I see a book. I see a white paper. I certainly see something, in in the future because I can only imagine the trajectory of growth you've had in patients as the word's gotten out as the your outcomes, the benefit, you know, for families, not only the individual patient, but the impact you're making. I I can only imagine you must see a a growth trajectory.

Dr. Lauren Hughes

Oh, yeah. Because I started right out of residency. Right? So I wasn't known at all in the community.

No one knew who I was. I had no one wanted to refer to me. No one knew what really direct primary care was or what pediatrics was. So I was out every single day, boots on the ground, like, networking with people, telling people about what my practice was until it eventually, you know, you hit this bottleneck where enough people tell their friends because that's how most people find a pediatrician as well.

You know, my friend's cousin uses this and and then it eventually hit this. And then it really has and it's done much better than I I would have ever guessed it would be. It's grown to something I'd never imagined that it would be. And I think people just really value having that close, close relationship with your doctor that where, you know, they come in and I'm like, oh, yeah.

How's the new house? Like, oh, are you you know, what's the new job like? And we we know them so personally that it creates this extra level of trust and care that I just I don't think can be matched in a traditional system.

Theresa Santoro

Right. I couldn't agree more. It it sounds incredible. In this data driven world we're in, have you begun to collect that data and really able to demonstrate improvements in growth and development, education for families?

Dr. Lauren Hughes

Oh, I haven't.

But that I mean, I would imagine that, like, if I could compare ER visits, you know, something like that Hospitalizations or illness.

I would imagine ours is extremely, extremely low. You know, many reasons of one, our patients know when when to go to the ER. And so it's not a they aren't going there not bashing any parents, but, like, just for a fever or something like that. They they call us.

Or, like, they know, oh, hey. We're starting to get this croup cough. Can we go ahead and do some steroids before it gets bad at two o'clock in the morning? Because that's always when it's bad. And so we're able to prevent a lot of that complication from happening because we are being able to be proactive and we're telling them what to watch for, when to intervene, and what to intervene with, that I imagine our hospitalization and ER rates are incredibly low.

Theresa Santoro

I'll bet they are. You know, in my world, in home hospice community health, a tremendous benchmark is enabling the patient to remain at home for adults, remain at home, higher quality of life, preventing them from evolving door in and out of the emergency room, technology in the home, We're managing, maintaining people living a higher quality of life at home. Right? Managing these conditions. I can only imagine what your data is trending at because it's a better quality of life, more educated families. And you're right. It's earlier intervention versus waiting for the symptoms to show up, and then you have no choice but to seek acute care.

Dr. Lauren Hughes

Right. And I also would be interested in, like, seeing parents' time off work, days of school missed. What that measurement would be because I imagine our parents are are taking a lot fewer days off calling in sick a lot less, and our kids are probably in school at better rates. There's a lot of the question of, like, why would I pay for this and insurance? And it's like, well, if you look at the overall of one ER visit is six months of of care, or, you know, the amount of time that you're not taking off of work is also a a massive factor.

Theresa Santoro

Right. Absolutely.

You know, it feels like, you know, you just identified at least six data points and it makes a compelling argument of the value.

So looking beyond today, we know healthcare is constantly evolving, full of headwinds, tailwinds, whether it's policy shifts, staffing pressures, innovations in care delivery. When you think about Bloom Pediatrics five or ten years from now, how do you envision shaping your practice to meet the challenges? What what's your vision for this kind of care and experience you want your patients to have?

Dr. Lauren Hughes

I've been struggling with this because physically, my office is at capacity. Like, there's four of us in seventeen hundred square feet. We are running out of space. We can't add anyone else.

But the need is not slowing down. And so my next thought is, like, how can we how can I either coach other people to open one? How can I open additional blooms? How can we shift this to allow for more people to get this level of care? And so that is, I think, starting now with podcasts like this where we start teaching people about that there is an alternative way to practice and that this is something that is doable and it is something that is scary, but it is very doable for other people to do. And then it maybe will be a bloom somewhere else in Kansas, maybe a bloom in another state. That is TBD.

Theresa Santoro

That's wonderful. So aspirational. I think probably the sky's the limit of where you can take your practice because it certainly is an innovative model. And congratulations to you, truly.

Dr. Lauren Hughes

Thank you.

Theresa Santoro

So thank you Doctor Hughes for sharing your insight and your vision. It's inspiring to hear how you're shaping pediatrics care in Kansas City and beyond and I'm sure that listeners have gained valuable perspective on the possibilities of direct primary care. So thank you very much for your time today. I've learned a lot.

Dr. Lauren Hughes

Thank you so much. Thank you, Teresa. I had a good time. Thank you.

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