Can Spending More on Healthcare Now Actually Save You Thousands Later? My interview with Dr. Alex Watson of Admire Medical

Ralph Estep Jr.
00:00:00

Are you tired of watching your medical bills pile up? Does your current approach to healthcare feel like it's draining your bank account?

Well, what if I told you there's someone who's actually helping patients save thousands while actually improving their health? Today I've got an absolutely Incredible interview with Dr. Alex Watson.

He's from Admire Medical, and he is revolutionizing healthcare through preventive medicine. He's going to share how one of his patients eliminated insulin dependency and and transform their health completely.

So stay tuned as we tackle the burning question, can spending more on health care now actually save you thousands later?

Podcast Announcer
00:00:39

In a world where crushing debt keeps you trapped, where living paycheck to paycheck has become your new normal, and where the dream of retirement seems impossibly out of reach, there's hope. Join financial evangelist Ralph Estep Jr. A man who's walked through the fire of financial failure and emerged stronger on the other side.

Welcome to Ask Ralph, the show where real world experience meets biblical truth. To break the bondage of financial despair.

Get ready to take control of your money, break free from the financial stress and align your resources with God's purpose for your life. This is Ask Ralph with Ralph Estep Jr.

Ralph Estep Jr.
00:01:18

Well, welcome to the show. I have got a powerful episode for you today that is going to transform how you think about healthcare spending.

Today you're going to discover how preventive health care can become one of your smartest financial investments, and that's demonstrated through real success stories. On my interview with Alex, Watson and I talk all about his practice.

The second thing we're going to learn today is why being a good steward of both your money and your health aligns perfectly with Christian principles.

And then I'm going to give you some practical strategies to leverage tools like HSAs and preventive care programs to potentially save you thousands in future medical costs while improving your quality of life. Now, if you missed yesterday's show, it was all about protecting yourself from income tax identity theft.

And I packed it with some crucial information which could save you from becoming a victim of tax fraud. And I gave you some real things you can do right away if you've already experienced that.

Before we get to the interview, I want to read a question that I got from Susan right here in Delaware. And this was a heartbreaking message. She said this. Dear Ralph, I'm writing to you as I look at another stack of medical bills on my kitchen table.

I'm only 47, but I'm already drowning in health care costs. Between my diabetes medication, blood pressure pills, and regular doctor's visits.

I'm spending over $500 a month, money that should be going towards my retirement or helping my kids with college. Last night I had to tell my daughter we couldn't afford her soccer camp this summer because of my medical expenses. It breaks my heart.

I recently heard about preventive healthcare programs, but they seem expensive up front. We're talking several hundred dollars a month for membership based care.

With my current bills already stretching me thin, I am scared to take on another expense. But I'm also terrified of what my health issues might cost me in the future if I don't get them under control.

Just last month I had to use my credit card to pay for my medications and because my emergency fund is depleted, Ralph, I feel stuck in this vicious cycle. I want to be a good steward of both my money and my house, but right now I feel like I'm failing at both.

How do I know if investing in preventive care is worth it financially? I need to make a change, but I'm paralyzed by fear of making the wrong choice.

Please help me understand if spending more on health care now could actually save me money in the long run. Well, Susan, thank you for your question. And I hear what you're saying. Those monthly medical expenses are draining your emergency funds.

They're draining your retirement and they're cutting into your children's education and you're forced to use credit cards for basic medical needs. And you're making these heartbreaking choices between medical expenses and children's activities. And I hear what you're saying.

You got this fear of taking on additional expenses for preventive care. I also hear what you're saying. You feel like you're failing as a steward of both your finances and your health.

You're paralyzed with fear of making the wrong decisions.

And Susan, you're experiencing guilt over impact on your family's quality of life and struggling with balancing immediate needs versus long term financial security. But here's the truth, Susan. In this interview I have today, I am going to give you some hope. I'm going to give you some concrete answers.

Now if you're just like Susan and you've got a financial question, today's question is sort of a health and finance question.

One of the best things you can do is start your search for information by going to askralph.com if you go to askralph.com that's the page for my show, you'll see a search icon.

Just type in that Search what you're looking for because I've got almost 700 shows, we've got a bunch of blog posts out there and all that sort of thing. So start you, you are looking for information there and you might just find that I've already done an episode on it.

Now, Susan, I want to share something deeply personal with you before we get into this interview, because what you said really hits close to home for me. It's something I feel deeply personal because at 52, I look in the mirror and sometimes I barely even recognize it.

Like many of you, I've spent decades focused on building my business, growing wealth and all that kind of stuff, but at the same time neglecting the temple that God gave me. Yes, I skipped regular workouts to save money. I wanted to go and get my work done. I worked 80 hours a week.

I ignored exercise, I had ignored proper nutrition. And when I think about it, I was prioritizing business growth over personal well being.

You know, at the time I rationalized and saying, well, you know, these poor health choices, well, they're necessary sacrifices. Well, I learned very quickly. My wake up call was being diagnosed with type 2 diabetes.

And I've got high blood pressure, I require multiple medications a day. I'm shooting myself with insulin, I'm taking once a week injectables. And I realized I wasn't being a good steward of my health or finances.

And listen, this has had an emotional toll on me because I feel shame just like you, Susan. I feel shame about not taking better care of myself.

I have this guilt over potentially shortening my lifespan, which would impact my wife and my children. Now my children are older, but still. And I'm getting frustrated just like you are, Susan, with these monthly medical expenses.

And the biggest thing is I have this fear of these future health complications because I'm going to say something provocative here. I look around, I don't see a lot of fat old people. I know that might sound mean, but look around, it's the truth.

And I guess about three months ago, I met Dr. Alex Watson and I started to understand and learn more about preventive approaches to health care.

And I'm under understanding connection between physical and financial health. Hey, Dr. Alex actually came to my house and he helped me go through a workout.

And I discovered the importance of self care even in my professional success. And now I'm gonna tell you right now, this is what I took away from Susan and you can do the same. And this is a great interview. We talk about this.

I am now committed to regular preventive care. I'm invested in my health as part of my spiritual Stewardship. And I'm learning to balance business success with. With personal well being.

Because here's the truth, Mom. If your health's no good, you'll never get to that business success and big picture thing.

I'm finding peace in prioritizing both my health and my wealth. And this reminds me of a powerful verse from First Corinthians, chapter 6, verses 19 and 20. And I thought this was perfect.

Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own. You were bought at a price, therefore honor God with your bodies.

I don't know about you, but that is a very strong and pointed statement. Well, now let me share with you what I'm grateful for today.

Because today I'm grateful for the wisdom God provides in helping us understand that taking care of our health isn't just about physical well being. It's about being good stewards of the bodies he's given us. And that's exactly what Alex and I talked about. So let's get right to the interview.

Well, Alex, thank you for joining us on the show today. It's a pleasure to have you.

Dr. Alex Watson
00:08:41

Thank you for having me.

Ralph Estep Jr.
00:08:42

So we're going to cut right to it. We talked about it in the beginning. I talked about why this is so important.

And basically what I'm saying to my listeners today is that physical health is an important part of financial health.

And I'm going to launch right into the first question I have for you, and that is what inspired you to create this medical practice focused on this preventative and what you call prehabilitation care?

Dr. Alex Watson
00:09:07

Yeah.

So to give you that, that piece of the story, I expand it a little bit just because it was an iterative process and evolution in terms of just kind of where my interest and passion lied.

And then as we built the practice, everyone that got involved here, of course, you know, their interests and passions and populations that they wanted to help the most kind of drove some of this change here.

So when I was in residency, I studied physical medicine, rehabilitation, which is helping folks rehab after brain injuries, strokes, spinal cord injuries, burns. And at that time, I already kind of knew that there was going to be more to my training besides PM&R. I thralled about the field.

I found it very, very rewarding just helping people get back to where they were functionally and physically and mental health and everything like that.

But after a while, it's pretty obvious that there were a number of kind of chronic diseases that led to Most of the diagnoses I was seeing and a lot of that related to metabolic health. So these. As early as my first year of residency, I started giving continuing education credits in obesity medicine.

Knowing that was going to be either another certification.

I wanted at the end to be able to demonstrate our kind of gravitas in that area or at least just for my own knowledge so I could practice better as I was going through residency and could bring that to my rotations and everything. So I started doing the CME credits and knew, yes, I'm going to, I'm going to incorporate this into my practice in the future.

It seems like a great kind of mesh or, you know, melody between subject matter areas and would create kind of a unique proposition for us as a practice just because there aren't many physicians with that dual training. And as I got to the point of graduation, I was ready to actually just start the practice right out of residency.

And that's not always typical, usually in a kind of financially makes sense. I had a little bit of stability first before launching the private practice just because the transition can be kind of rocky at times.

But at that point I was just, you know, I was a career changer before going to medicine. I really wanted to get started and everything.

So I got a job down here in Delaware, found a great inpatient rehabilitation job that gave me the stability but the flexibility to be able to build this practice, see patients followed after discharge from rehab and then while doing that, build up that prehab components of getting folks ready for the surgeries that may get them into rehab and then I get to see them afterwards again. So better continuity and care.

After doing that for long enough, realized that it couldn't build the practice well enough while also working a full time job elsewhere.

So spoke with the administration there and decided that it was best if I focus more on admire medical for the short period of time and kind of see where that takes to the future. So at that point we were still kind of straddling a few areas, Prehab being a big part of that. Just because that was my interest.

That was where, you know, I found that we probably affect the greatest amount of change just in building confidence for individuals who wanted to get surgeries, needed knee replacement, hip replacement, whatever, and just didn't have the physical help to, you know, go through surgery safely.

Ralph Estep Jr.
00:12:16

So that's what you're really talking about with prehab, just to cut you off a little bit real quickly. So define what prehab looks like. I mean, I imagine that rehab is after a surgery, but Prehab, talk to us a little bit about that.

Dr. Alex Watson
00:12:29

Yeah, so prehab is specifically a defined period of time before the elective or planned procedure, intervention, something like that. And the idea being that most of us aren't in our best health day to day.

So what can we do that's gonna most quickly and substantially improve our baseline health going into a surgery or cancer therapy or pregnancy?

This way your outcomes are better, you get back to regular, you know, everyday life faster, lower risk of readmissions and infections and all these sorts of things.

And, you know, it sounds kind of just like an intuitive practice, like, shouldn't everyone kind of be doing more or less prehab, whether it's defined or not?

But really what it comes down to is a unique set of skills in terms of how we can lower the barriers to do the things that we all know we should be doing.

So a lot of cases, the reason why PM&R goes into prehab is because our training gives us pay, management expertise, functional assessments and adaptive equipment, things that we can do to circumvent any sort of physical limitations that we have.

So if you are having chronic pain due to a pinched nerve in the back, and so you're also weak in one leg and you have a foot drop and you're struggling with a BMI, is 45 out of control, diabetes, high blood pressure, all that stuff, and you have ideally eight weeks to get ready for surgery. Where did you start? That's kind of where this prehab and obesity medicine background comes in.

There is to say, all right, well, you know, if you prioritize the, the physical function aspect, first, control that pain, which usually involves improving sleep, well, then if your sleep is better and the pain's better, your blood sugar isn't better, your blood pressure will come down, you can do more activities. So then your pain and you sleep get better again.

And then with the obesity medicine training, all right, well, how can we, you know, what sort of swaps can we make to medication that might feed two birds with one scone? How can we make the biggest chain, the fewest moves that will also be the least jarring to our systems?

On the negative end, I was the positive jarring, of course. So that's a pretty obvious consolidating all those different areas of perspective into one quick plan with a defined end at that plan.

So, you know, you have to hit these goals by 8 weeks or 6 weeks or how it just wants for this.

Ralph Estep Jr.
00:14:42

And to be honest with you, before I met you, and I'll be the first one to admit I'm a patient of your practice now. Before I met you, I had never heard of Prehab. Like, I don't hear many doctors talking about prehab.

I imagine that's been a challenge for you because how many people know that's even a thing? I mean, my expectation is I go to the doctor because my knees have been bothering me. And the doctor says, ralph, guess what?

You're the lucky candidate for knee replacement surgery. And I'm just assuming on the way out the door, I'm scheduling the surgery.

Maybe I'm scheduling blood work ahead of time, maybe an EKG to make sure my heart's not going to give out.

But I have never experienced a doctor saying to me, well, Ralph, one of the things you could do to improve your overall, you know, situation with the surgery is go to Prehab. So I'm assuming that's been an obstacle for you.

Dr. Alex Watson
00:15:28

It has been. And actually, I knew I was onto something during residency because my mom was living with us.

We had our son during when I was in residency, so we needed the help there. Of course. It's just nice to have family.

And she was getting a hip replacement, and I went to one of her appointments with her, and on the wall of the exam room, there was a sign that said, if your BMI is over, it was already for that office, expect that your surgeon will refer you to a B.C. medical specialist for weight loss before surgery. So, anecdotally, that's obviously true. You're going to have that recommendation regardless.

But the fact that it's happening enough times that people are either hesitant enough or just don't know it's an option or requirement in this case tells me that there is both the benefit and the potential for, you know, a good population here. And the education piece is necessary.

So on the flip side, there are kind of pockets of places where Prehab is either well known or goes by another name or a cousin of it kind of thing.

So, you know, in Christiana and a lot of major health systems, there is an idea of a Center for Surgical Optimization or things along those same lines that's very similar to it. But often the recommendations are going to be much more standardized, much less about kind of the finer moves and medication changes. So the.

The example I usually give here is if you're on something, you know, diabetes medication that potentially it's insulin, so something like a glipizide that may, in the short term control blood sugar, and long term, essentially puts you at risk for all the same insulin side effects as insulin.

Well, of Course, we have the newer GLP1 medications or SGLT2s or all these other medications that should be on most people's radar and aren't on everyone's medication list for one reason or another.

But if there's a way you can make it safer to take one of those medications, if that was the reason why you weren't on it already, then that can be swapped in and phase out some of the other ones. And when it comes to prehab, that's relevant because those other medications can acutely control blood sugar, improve wound healing.

SGLT2s and GLP1s can improve wound healing for those reasons, just because you have much more stable blood sugars and you have less of the ups and the downs and everything.

They also protect small blood vessels, which are really important when you're healing a wound, especially in the leg or some kind of less profuse tissue. So those little changes that you can make there are going to make the bigger impact than a standardized.

Here's a worksheet with a, you know, couple of basic exercises, you know, cut out sugar and add protein. That's most of the standardized recommendations before surgery.

So what a dedicated prehab program does is it factors in individual patient limitations and builds a plan around that. So I'll make one more story to that one, is that, yeah, a lot of major systems will have prehab programs for organ transplant or cancer therapies.

That's kind of where this has been around for a while.

And when it comes to organ transplant, there are so many chronic diseases that go along with end stage organ failure and situation particularly we saw a lot of lung transplant patients preoperatively over at upmc. In those cases, you have a lot of restrictions just because of the advanced copd.

By itself, you can't lift a lot of weight in your arms because it's gonna put pressure on the heart. You have to monitor your oxygen while you're exercising. I'm speaking fast. I just kind of show the laundry list of things you gotta watch out for.

And that leaves the patient with, okay, so what can I actually even do then? And so building a plan around that where you can build the most muscle but you can't lift a lot of weight. How do you do that?

Well, there's options like blood flow restriction training or optimizing other things that might be worsening muscle mass loss and kind of reversing some of that momentum in the wrong direction is half the battle.

Ralph Estep Jr.
00:19:15

So is an obstacle to that insurance, Alex? Because I'm wondering, doesn't because my experience has been preventative care is tough for insurance companies to cover.

So how do you handle that in your practice and what ways have you found to work around that?

Dr. Alex Watson
00:19:30

Yeah, and I know you know where this explanation is going to be going, of course, with the membership plan. But we started out by being as thorough with our coding as possible.

So, you know, the nature of pre meditation is that you're going to be meeting a lot of the high complexity evaluation and management codes.

And I'm only using jargon here for the couple of healthcare listeners, healthcare employees that might be listening here, in that you have this table when you're doing your coding that shows, all right, what would justify something as mild, moderate or high complexity or low, mild, whatever.

In those cases, the more notes from other providers that you're looking at, the more tests you're interpreting, the more people with whom you're speaking. All those things increase the complexity of care.

When it comes to something preoperatively, that basically inherently is going to be a high complexity situation. Just because again, you have a lot of comorbidities, you're managing many diseases at once. You have this high risk procedure.

Any major surgery really constitutes a high risk procedure. And if you're doing a good job, you're going to be speaking with their surgeon or their oncologist, whomever.

So right there you pretty much meet that high complexity. And what that does is it maximizes reimbursement for whatever you're doing. Even it's just counseling. Just counseling.

But you know, traditionally the highest reimbursed activities are only procedural.

But we don't always need procedures in a lot of these cases, education and really counseling on how to safely exercise and how to safely incorporate big nutritional changes, even if you're on medications that put you at risk for low blood sugar or something like that. Eventually though, we knew that wasn't going to be a long term plan.

So back in July switched to a membership based program where after the initial appointment, where we build out the whole plan.

Hey, if you're working with us, here's what we would do in terms of exercise, nutrition, medication changes, tests, we want to run all those sorts of things.

We give our patients that plan and say, if you'd like, go through this and stay with us and work through this plan, then the next step is picking one of our three membership tiers so they all get you the same level of access in terms of quick appointments, long appointments. Someone from our team always has a cell phone with us. So if there's any major Issues overnight that are urged or immersion.

You can reach us if it's kind of in between there and you just want it on a radar faster. It's a great place to text us that first thing the next day. We can get to 80 to antibiotic order or whatever it might be.

So any membership level gets you that access. And then as you kind of go up, it increases the kind of touch point that you have with our team.

So at the highest tier, that's where I will literally go to the gym with you at least once a month, time provided we can do more than that, and then the other three times for that month, while I'm a physical therapist, I can go with you if you'd like.

Again, this is more for people who have very little time, so they want to make sure they're doing it right and efficiently and don't want to get hurt and concern about their health. That's who that kind of program is for. And kind of the middle two.

There in the middle is what gets you a lot of labs included, medication included or discounted. At least. There are kind of little quirks we're adding here and there.

So right now there's a device that helps you assess what your metabolism is burning on preferentially. So it's gonna be burning more fats for energy, more carbs for energy.

And by, by assessing that relative balance, you can make some nutritional changes for that day that might actually make you feel better and better control blood sugar and things like that.

Ralph Estep Jr.
00:22:53

So for the person listening like me, to me it sounds a lot like a concierge practice. Like that's what we've kind of become. And I've been working with a concierge.

They call it direct care, but a concierge practice, meaning that they don't take traditional insurance. You get a longer appointment time, you have more access to the provider. It's just sort of a I put my arm around you kind of relationship.

And I honestly feel like that's where we're going as a society. And it's kind of a. I hate to say it this way, but you're going to have two levels of care.

You're going to have the care of the people who wait in lines like everybody else. And it's going to sound the wrong way. I'm going to say this ahead of time, it's going to come out the wrong way.

But you're going to have that one level of care and then you're going to have the care for people who want to pay for things on their own and recognize the value. Is that kind of what you're talking about here, Alex, is that I know it's not, quote, concierge care, but is that kind of the approach you're taking?

Dr. Alex Watson
00:23:43

Yeah, I mean, really, I mean, it's concierge care. And the big thing is that we were describing before is direct primary care versus concierge.

And really the difference is DPC is more for primary care practice and in concierge the model is a lot less homogenous. So every practice will do their billing a little different, their membership fees a little different, what's included, what's not.

That's all going to be Condeler's choice there. Whereas DPC is typically much more within a, you know, fewer variations there in how it's delivered.

And what includes is that membership fee that you're talking about for a month, no insurance. Some labs are included, some procedures are included and the access is there.

So the big difference is going to be that in concierge you may or may not be insurance still. We currently do. Our plan is eventually to phase out of that too.

But right now we build insurance just because I'm also occasionally working at the hospital still.

And if I'm credentialed with insurers for that care I deliver, I then have to stay credentialed and work, you know, insurance on any patients that carry those insurance. And the downside there, of course, is then that I have to build their insurance and like the copay and all these things.

So we try and get creative with the ways to minimize the out of pocket expense because you're already paying membership at its own point. But sometimes we can't get around all of that, which is why the plan is to get out of that game entirely.

And not to mention that the inefficiency that insurance system was creating kind of the driving force of allowing the first place.

Ralph Estep Jr.
00:25:15

Why I've taken the approach myself for several years because I remember when I first started in that whole plan was I didn't have a, quote, you know, traditional insurance policy. It was just too expensive. So my wife and I had that catastrophic plan. And the catastrophic plan was great.

If I had a heart attack or a stroke or, you know, something that's major, it was going to cover it. And that's why we decided to take that concierge direct care approach. So who is your ideal customer? And I'm going to share a story here.

You know, I came to Alex through a referral and I said to Alex, I said, listen, I've got this traditional. Mine was even traditional. A DPC might be less traditional, but I just don't feel like all the eyes are being dotted and the T's are being crossed.

I feel like there's more to this puzzle I'm going to share with my listeners. You know, I am a type 2 diabetic. I battle with that. I've got some high blood pressure issues.

And I really approached Alex with, hey, I'm getting older now, I just turned 52 and like, you know, I know my body is not going to be able to handle continuously having these high blood sugar levels. And that's what brought me to you. So what typically brings people to you? What is your ideal?

I want to say customer, patient, whatever the appropriate termist is. What does that look like?

Dr. Alex Watson
00:26:21

Well, it's actually a good way to kind of throw back the first question you asked me and finish that one too.

So, you know, once we got the point of being a Prehab membership based practice, we knew that that's a pretty narrow market and we were already starting to incorporate some wellness care anyway, whether it be testosterone replacement for men, menopause therapies for women after menopause, going through sleep difficulties, all that stuff.

So we kept adding on things that we were managing that, you know, we're comfortable with these things too just because we already come across a lot of during residency or afterwards. Angela did a lot of courses in menopause care.

So we started building out all those different wellness based features which helped the Prehab picture too because you know, if you fix hormonal dysregulation before going into a Prehab program, you're just gonna respond better anyway. So we got that going and just realized we're not just prehab caring, we're kind of preventative and prehab care.

So we kind of morphed into preventative and preparatory care. So preparing for surgeries or cancer therapies, all that stuff.

And when not doing that, using similar principles to live better every day, to be able to do more functionally, to be able to try a new hobby, try and, you know, walk further, try and, you know, take up deadlifting or rock climbing.

So our ideal patient then is going to be somebody who, you know, is in this complex medical scenario, whether it be managing, you know, insulin dependent type 2 diabetes and maybe you have some Hashimoto's thyroid issues, maybe you have high blood pressure, insomnia and low testosterone, or menopause chronic pain. You know, the areas where our unique skill set makes us the best person for you to be, you know, to manage these for you.

So because my training is in obesity medicine and physical medicine, rehabilitation, we don't want to take on patients who only need a couple of our services just because, you know, membership based practices aren't for everybody. It's expensive, out of pocket care. So, you know, you really need to benefit from all the services we're providing to feel that value.

And in those cases, it's somebody who has chronic pain limitations that I can manage with my pain management training and, you know, insomnia for one reason or another, multiple reasons that we can tackle with all that experience that we have there and hormonal issues so we can fix that and see you feeling better.

Okay, now I can take on that new hobby you've been looking for and I can show you how to get started because I was a personal trainer back in college and I really enjoy. That's half the reason why I did the practice.

I spent half my days talking about deadlifting and, you know, push ups and proper form and safety and that stuff.

So someone who has, you know, high goals for themselves but just can break out of that current, you know, circle that they're in of chasing high blood sugar, high blood pressure, fat sleep, that's worse than these things. I can break that and get you to the next level that you want to. Baby, that's kind of the ideal patient.

And if you have a procedure coming up, well, that, that of course improves the motivation in the short term. And so that's another good reason why someone would join us too.

Ralph Estep Jr.
00:29:24

So if you feel like you're not getting anywhere in your current treatment and you're not, and you're not going after taking patients away from their existing providers, that's not your goal. I know that, but what you're saying is, hey, can we take it to the next level? So I will share with you. Alex came to my house.

I brought him down into the dungeon, my friends, I brought him down into the weightlifting area. So Alex is the kind of doctor that will, will show you how to do deadlifts and he'll show you, like, when he left, I was sore.

Dr. Alex Watson
00:29:50

Right?

Ralph Estep Jr.
00:29:50

That's just the truth. But that's the difference, right? Alex is, is you're tailoring it to the specific needs of the patient and they're paying you for that.

I mean, that's why you've got several tiers of service. What kind of, what kind of treatments are you working on?

I know you mentioned hormone replacement for women who are going through menopause and, you know, we know people that they're going through. You talked about testosterone replacement. I know that you deal a lot with weight management.

So if I'm listening to this or I'm watching this show right now and I'm going, well, could Alex help me? Give me a laundry list of those type of things that you deal with every day.

Dr. Alex Watson
00:30:23

Yeah. No.

Our bread and butter these days has been again, testosterone management and the complexity that based on age and other factors here that are what are lowering the hormones in the first place. Menopause therapies. Angela is our nurse practitioner here at Admired. She is, you know, wonderful. And her patients rave about her.

Women who have been having insomnia for three years because they went through menopause years ago and just haven't gotten relief and tried SSRIs and it didn't really help them. She can get them sleeping well. You know, I don't want to oversell it. We'll say weeks to months, but in some cases it's even faster than that.

Obesity medicine is one of my earlier passions here too. So someone struggling with their weight. Well, you know, we have the full gamut of medications right now at our disposal.

We can get them compounded if your insurance wouldn't recover.

We through insurance, part of our membership program, allows us to be able to do all the multiple prior authorizations that insurance requires just to approve a medication for which you're qualified.

Ralph Estep Jr.
00:31:25

These are medications like we hear about Ozempic or Manjaro or I think they're called what S GLPS or something. I. I don't know the name of.

Dr. Alex Watson
00:31:33

Them, but yeah, the OP1 receptor agony, basically just called peptide, you know, but this one niche area, peptide therapy that is more mainstream.

But then for anyone who's, you know, been kind of looking around the intra Huberman space, either TS Space or just general kind of, I want to say not mainstream because they are mainstream, but less conventional medicine takes. Might have heard the term peptide therapy recently too.

It's gotten a lot of, A lot of popularity just because some of the claims for these peptide therapies are, you know, astounding. I feel better than I have in 20 years kind of thing. So we're looking into that right now.

I actually just set up a meeting today with our compounding pharmacists, see which ones they offer, and I put together a blog post and then I'll be doing a little more of a deep dive on each of the kind of main. The higher profile peptide therapies that can kind of Augment what we're doing with conventional medication.

In some cases that's going to be, you know, increasing your sleep quality and your exercise recovery using a medication that helps your body release more growth hormone when you're sleeping. Other ones lower inflammation or can help autoimmunity or help recovery from injury for other, other ways. So we're getting to those therapies too.

More to come on that one.

But our other areas of expertise line pain management, sleep optimization, those we have a unique take on just because, you know, I learned a lot of that both in pain management clinics, but also working with patients and inpatient rehab. So in those cases we've just gotten reps in by iterating all the different standard therapies.

So Neuropaint, who never tries gabapentin, then Lyrica and then Snri or SSRI medication. And then after that it's like that's kind of what you got. Well, it's not what you got.

I mean there's so many different options that a lot of providers, either on the experience with or comfort with, don't get the volume of these situations.

But because of the situations and the training I had, they've gotten very comfortable using some of the lesser known epilepsy medications that can be profoundly effective for intractable nerve pain.

Patients who've had phantom limb pain after a traumatic amputation got them to be able to cancel a nerve ablation that they had planned for the sciatic nerve. Because within this is anecdotal, it is not research based. Within days took this pain that was so debilitating and made it 1 out of 10 happening.

And recently with patient who had a pinched nerve up here, thoracic area that would wake up from sleep throughout the night, so she never had good sleep. Use actually the same medic causing similar medication for that one too that is rarely used for this kind of pain.

That again, just when it works, it works. In these cases we just have built this, you know, toolbox a different medication you can use off label for these purposes.

And after a while you sort of have so many of these that you don't even think about needing opioids. They used to be the, you know, catch all for. Well it didn't respond to Tylenol, didn't respond to Motrin.

The fancy motions of the world didn't respond to all the standard nerve pain medications. I guess you're gonna be on chronic opioids for a while.

We know that worsens pain in the long term, but for a while it's kind of all patients, all providers felt comfort with. Well, we developed a nice list of standard, less standard and kind of over the counter nutraceuticals.

You know, cannabis based therapy for some patients might be, might be reasonable. That's a whole other two hour long conversation. I won't go too deep in the woods with that.

Ralph Estep Jr.
00:35:12

But, but I hear you saying, Alex, and correct me if I'm wrong, and I'm gonna, I'm gonna go down a road, it might be a little bit of, what's the word I'm looking for, A little exciting, right? Or a little bit controversial.

And this is what I hear you saying, is the problem is most doctors, and I'm not throwing doctors under the bus, but I'm going to throw them under the bus, give you about three minutes. That's about how much time you got in an office visit.

And you come in with your list of issues and symptoms and they write you a script so they can get you out the door. And I know it's not their intention.

Like I'm not, I'm not saying that they don't want to practice medicine, but I think what I hear you saying, and I can tell you this from my own personal experience, you can't do it in three minutes, you can't do it in five minutes. So your model is that hour long visit. Your model is the telehealth.

Like you and I had a telehealth meeting the other day for an hour and almost felt like I was taking up too much of your time. But that's the truth, right, Alex, is that you can't solve these chronic conditions by just writing scripts for it.

You can't just sit down with a doctor for three minutes. And I get where the doctors are coming from. I've had clients who are doctors who say, Ralph, listen, I gotta see 20 patients an hour.

And I'd say, well, you're not doing medicine at that point. You're triaging. Does that strike you the same way, Alex? Do you feel the same way about that?

Dr. Alex Watson
00:36:25

A hundred percent. And that's exactly why we did the membership nice and early is I never worked well in those kinds of clinics. My notes were sloppy.

You're just inherently going to make errors in your documentation, hopefully not in your medical practice. And it just wasn't fulfilling.

I was very quickly getting burned out in those kinds of clinics and residency and knew that I was either going to be on the inpatient because you had a better management time sometimes, or I was going to have to do a membership kind of based practice and opted for the latter eventually just because you get the opportunity to provide care that you dreamt about. And that's why I went to med school. It's not even a factor of provider doctor priorities or anything.

It's just the economics of medicine as it is in America right now. When you're on insurance only based system and it becomes a volume. And how can you get the volume?

Well, you have a nurse full of PAs and NPS, which they are great providers in a lot of cases and they extend what you're able to do. But after a while you, and then the whole team of these extenders as some call them, you lose sight of what they're actually doing.

And if you have a whole team and you can't really see how they're doing things, you're not going to be able to give all the patients kind of your unique flavor of care.

So the alternative to that was, well, if you're not paid well to speak with a patient for an hour by insurance, Ben has to come to the patient's pocket. And then it goes back to the question you had or comment a little while ago that it's going to create this two tiered level of care.

It's inherent already is and other countries have that kind of basic social level of care. And then if you can afford it, you have this higher level of access, you want to pay out of pocket or Cadillac plan.

And I confidently say that's the direction we're going about the changes.

Just because you have enough individuals with the, I mean really it isn't terribly expensive in a lot of cases to be in a DPC practice or some of the concierge practices that are on the, you know, more affordable side. Ours of course, kind of middle price point. Not for everybody. For some it might be no big deal, for others it might be a stretch.

But if you're ultimately going to be saving money on other medical bills, medications, because you're going to be able to consolidate them or get them compounded, you're going to defer things from, or stop things from becoming a much more escalated problem by treating it quickly.

Those savings come back to you and it almost, and this is not insurance, but it almost acts like an insurance policy where yeah, some months you may not get the full value of what you paid that month, but the open line of communication, the access to knowledge, just knowing that you have a whole team here that can do those things for you and solve your problems for you when they come up, you know, that ends up being peace of mind and helps you feel well and be well otherwise.

Ralph Estep Jr.
00:39:16

Anyway, you just walked exactly where I wanted you to go because this is a Christian finance podcast. Christian finance show. I talk all the time about how to save money. Now you're talking about paying a monthly fee. Right, I get it. Right.

But let's talk for a few minutes, Alex, about what that really looks like.

Because what you're really doing, and I, and I think you're going to agree with me, is you're saving thousands upon thousands upon thousands of dollars down the road. Now I'll put my own self in. I'm 52. Had I made better decisions at 22 and 32 and 42, I probably wouldn't have the type 2 diabetes.

I probably wouldn't have the high blood pressure. If I had been more focused on that preventive care.

And now I'm spending, you know, a couple hundred dollars to a couple thousand dollars potentially per month on medications, on, you know, different things. So let's talk a little bit about that because really that's what I want the, the viewers and the listeners to hear today is that why is Dr.

Alex on Ralph's show? It's because this ties directly into finance. And I know you know finance too, but it ties directly into it. Let's talk a little bit about that.

Alex, what are your thoughts?

Dr. Alex Watson
00:40:25

Oh, no, I mean, I probably didn't go there, so it's perfect. They said we ended up there.

Anyway, the big piece, I mean, really, it kind of falls into two areas where the cost benefit analysis is in the positive here, either from a corporate side or from an individual side. So, you know, and then they do overlap.

Of course, if you're, well, if you're proactive about your health, if you are sleeping better and not distracted by pain or, you know, hormonal issues, you're more productive, you're going to work more often, you're not sick as much. You're able to, you know, you're less burned down, you're more resilient to whatever else might come up.

You're able to maybe get that promotion or maybe as on the corporate side, you're not having to. You're not having the absenteeism and presenteeism of, of individuals who are.

Aren't able to give it their all because they're understandably dealing with their own personal medical conditions.

So if you have this doctor in your pocket where you can just text or call our office if you need to, again, that peace of mind is huge just for letting you go about your day.

Whereas if you have to find a way to schedule an appointment that's in 15 minutes with your primary care doctor because you suddenly have a severe ear infection or came up with strep promote or something, then all of a sudden half your day at least is gone because of taking the time out to schedule and then to travel, wait, waiting room and all that stuff. So just kind of on the, you know, less abstract perspective, you're going to save that time just in the convenience right there.

But then because of these longer conversations you're having and the better education that we're able to provide in terms of, you know, basic nudges of eat this, not that, take this medication, not that one, all those sorts of things compound into a much better again productivity and wellness and take vacations and enjoy them. You're not spending them as full recuperation time because work doesn't burn you out as badly anymore. All of a sudden.

On the corporate wellness side, we had this program, we work with businesses and can offer discount just because we started that program because of what it could mean in terms of the extra value provide. If we have enough folks in one, you know, area we can schedule kind of checkup visits on site. You don't have to leave at work anymore.

I can go there and see five, six, ten people across the day. Everyone's, you know, way less disturbed by, in their schedule by seeing the doctor. And for us makes it a lot easier too.

Then we get to go one place and have a little site visit for the day and really provide that extra level of care that you can't do if you're working with patients one on one and get an insurance based system and everything. So there are a lot of ways that are obvious and less obvious how taking care of your health can be financially. Really, really good investment.

They're also, I mean the other pieces too fancy event most high deductible plans with hsa. Well if you're not using your HSA dollars for acute care, you get to use it as another tax deferred vehicle and benefit from that side of things too.

So you know, think outside the box. And there are so many ways that this type of program could really help your financial and physical wellness.

Ralph Estep Jr.
00:43:43

I talk about HSAs all the time. It's a triple advantage to them. You know, there's a tax benefit when you put the money away, it grows tax free.

You take the money out of stacks for you just added a fourth one. So now I can use those preventive medicine to help prevent Me from having to spend more down the road.

Dr. Alex Watson
00:43:57

Yeah.

Ralph Estep Jr.
00:44:00

Right. And I think we need to understand there's such a, there's such a huge connection between that health and the finances.

Because like you said, if you're not healthy, you're not going to be as productive, you're not going to get those promotions at work, you're not going to be as keyed in on. If you own your own business, you're going to struggle, maybe you've got those burnouts.

And if you can get into a, we call it a physical fitness routine, if you can, if you get that weight under control, get all this thing, your mental clarity is going to be so much better, you're going to be more profitable.

Dr. Alex Watson
00:44:30

Right.

Ralph Estep Jr.
00:44:30

I mean, it's just the truth. I mean you have to have seen. So tell me about, give me an example of somebody you've really helped.

You know, somebody that you came in and you're like, Ralph, you're never going to believe what I was able to do for this person. Let's, let's do, let's talk about that.

Dr. Alex Watson
00:44:42

I like to tell the story of, let's just call him, let's call him Dave. He actually talks about the whole time. But for him not being here, I don't want to name drop.

Sure, he's earlier patients here and he's thankfully a very outspoken fan of the practice. But he's kind of person who you give him recommendation and he falls into the T kind of thing.

And there are reasons why patients that listen to what I say and I understand that. So like I, this is never gonna be a one sided paternalistic style and say, all right, here's what I would recommend. How do we get there?

Well, well, Dave, he came to me, I met him in the hospital after he'd had a decent stroke, lost movement on one side of his body, got some, you know, muscle spasms. Post stroke depression, super common. Common.

Was affected by a little bit of moot shoot afterwards and had found out that his diabetes that he thought was under decent control. He had an A1C of 13%. So for your listeners. Yeah, exactly. For listeners ideally under 5.7. That makes you not even pre diabetic.

Pre diabetic because 5.7 to 6.5, most above absence, you know, diabetic range. Yeah, a 13. A 1C is off the top of my head. It's walking around with an average glucose like 250 or 300 or something like that.

Ralph Estep Jr.
00:46:03

You're in trouble. You're a ticking time bomb at that point.

Dr. Alex Watson
00:46:06

Exactly. So it was a huge contributor to his stroke in the first place. And the blood pressure effects that go along with that too.

So I worked with him briefly in the hospital. Just saying, all right, like, put a muscle spasm with this medication, get you sleeping better, get you back home.

But he's a hardworking guy, how to get back to work. So I applaud him for that.

And when I first, well, as he was discharged and said, if you work with me, I'm not saying when, I'm saying we will get you off insulin. Because he was now newly on insulin as complicated. Basil Ball is playing. Somebody's taking a long acting, short acting meals. It's burdensome.

And because of that, a lot of patients understandably, just throw their hands up and say, I'll take the A1C. Like, what's that mean? Instead of being more aggressive with the treatment.

Because alternatively too, if you overshoot the mark and drop your blood sugar dangerously low, that's a whole different problem.

Ralph Estep Jr.
00:46:56

Been there, done that, my friend. That is not a fun ride to go on.

Dr. Alex Watson
00:46:59

Exactly. So that's one reason why when, I mean, everyone has the same goal, when possible, get you off the insulin.

In most cases, it's not possible if you don't have the time and really to work with somebody. So for Dave, we ended up, I treated him for, you know, BMI of I think he was about around 35 or 40 when we started.

You know, blood sugar as bad as it was, high blood pressure, muscle spasms, insomnia, sleep issues, history of cancer, and, oh, low testosterone, which you knew about before the stroke too.

But, you know, thankfully, as a very short tangent, we recently have this nice piling of data supporting that going from low to normal testosterone doesn't have all the negative health effects we thought it did back in the day. Instead, it really just augments your response to the helpful things that you're doing.

You know, it makes your exercise that much more effective for building muscle, makes your nutritional changes much more effective for, you know, controlling blood sugar and blood pressure, all that stuff. So we used to be, if you just had a stroke, you know, our prevailing wisdom would have been, we ain't touching that.

That's gonna make you at risk for clots and raise your cholesterol, yada, yada, yada. Now we know that was an option too. So often in our programs we attack that on the earlier side to make the rest of your efforts more effective.

So for days, ended up retesting the testosterone ended up being quite low. And over the course of about a year now. Offense went entirely A1C is under 5.7, I think last checked, no hypoglycemic episodes.

So out of, out of, you know, was there, dropped £80. Something like that. Just feels better, sleeps better, is, you know, he's healthier now than he was before he had a stroke.

Like, that's one of those things that you don't get to say often, but it's because of the diligence, the hard work he put in and my, you know, our style of you're moving in this direction. I'm not going to perm your direction. I'm going to nudge you to keep you on track here.

So all those little nudges added up to really much health of a picture. I mean, he just continues to do well. So the story is right now, do we do this again in six months?

I'll be able to say, hey, he's down to a VMI of yeah, 27. But the next step really is all right, what's phase two? It's going to be building muscle now that we've lost that weight.

And so our work now is kind of coaching how to get more involved with exercise and how to comfortably squat, deadlift or leg press, all the things that are going to build you that reservoir muscle that makes it even easier to control blood sugar.

Ralph Estep Jr.
00:49:43

Alex, we got to wrap things up, but I wanted to give you a couple of minutes now. Yeah, we could go all day because you and I, we become, we become fast friends here. And that's the thing.

I will tell you about Alex if you don't take anything else away from today's interview. Alex cares about his patients. He truly does. And Alex's goal is your overall well being.

It's not just treat this a little cute thing and we'll fix this. Alex looks at things and his teams look at looking at things from a big picture.

So if you want to work with Alex, Alex, what is the best way for folks to get in touch with you and what does that process look like?

Dr. Alex Watson
00:50:16

Yeah, reach out to us many, many ways.

You email me directly alexander@admiremedical.com you can email our patient experience coordinator at the front desk, Kellie K E L L I E@admireomedical.com you can go to admiremedical.com and just see kind of all the resources we have there. There's a little intro video that describes a little more about how we came to be and what our focus is.

There's the insights blog that gives little deep dives into areas that relate to both prehab and preventative care. Our phone number is there too, of course, so you can reach us quickly. You can schedule on the spot on the website as well.

So kind of person like my generation of faith calling people now, now you can just do it all without having to speak to a person and, and get on the books nice and quickly. Those are the best ways.

Ralph Estep Jr.
00:51:04

And I put all of those notes in the show notes.

So when somebody, if you're interested in more and finding out about Alex, you can go to admiremedical.com but I'll also put those things in the show notes. So if you want to go take a look at those, there'll be a link you can click on. Go right to it.

But Alex, listen, I just want to thank you for your time today. And one of the takeaways I have here today is, and I think you're going to agree with me here, there is hope.

There is a path for even somebody like you talked about. This person had a stroke. This person was, Look, I've had a 1C at 11, so I get it, like that's not a healthy place to be.

But what I hear you saying is there is hope.

You just need to find a team of people that are care about you, that are concerned about you, and they're going to work with you to get you to that level that you want to get back to. Because when you get to the other side, it is a fantastic feeling.

Dr. Alex Watson
00:51:49

That's what it is. I mean, the health benefits aren't just to change numbers on a, on a sheet here.

It's to let you get to the point of doing things you never thought possible functionally or, or, you know, being away from home and not worrying about storing your insulin or all that kind of stuff. Things that folks in good health don't even really consider a lot of times as factors here.

The one last thing I want to add too is get our license in many states as well. So we do telehealth. Folks who need telehealth, we can ship medication straight into your house. And we're licensed in, oh, here we are now.

It's New Jersey, Pennsylvania, Maryland, Delaware, Virginia, Texas, Nevada and Arizona. So, and really that's our, that's our goal.

So just help the folks who need it the most and work with the folks who just really, really want to do a deep dive on their health kind of thing.

Ralph Estep Jr.
00:52:39

Well said, Alex. Well, thank you for joining me today. And like I said, I'll put all Alex contact information in the notes.

And as you see my health progress and I'll talk about it on the show. You can say, well, Admire does a good job because Ralph is on the, on the, on the course of getting healthy in 2025. So thanks again, Alex.

I appreciate you joining us today.

Dr. Alex Watson
00:52:57

Well, I appreciate the opportunity to speak about the practice and just, you know, talk about this stuff. I love it.

Ralph Estep Jr.
00:53:01

That was truly a great interview with Dr.

Watson and I want to encourage you, I want to encourage you to reach out to him at Admire Medical if you have any interest in, in any more information. I'm going to put his contact information in the show notes and listen, here's the best part.

He also just published a book and you can get it by going to askralphpodcast.com/admire again, that's askralphpodcast.com admire the name of his book is called Healing in Advance and he discusses how prehabilitation helps improve baseline health. It details its tangible benefits and surgical outcomes, preoperative health and quality of life.

His book is a straightforward explanation that breaks down prehabs core components.

Using friendly conversational language, he talks about spine surgery, cancer treatments and each chapter details terms you should know if you're getting ready to have one of these surgeries and the likely outcome of your treatment and low risk interventions to discuss with your medical team. We each have unique medical journeys and Alex's book breaks that all down.

Now, one of the other things I want to bring to your attention is every day when I record a show, I also write a blog post that's chock full of all kinds of fantastic information. Just like today's show, there's a blog you can go to askralphpodcast.com/blog and I do one of those every day with the show.

So again, that's askralphpodcast.com/blog well, let me end the show with these reflection questions because I've covered a lot today in the interview with Alex was really enlightening. But I want to reflect on some of this. Number one thing, what is your current annual spending on reactive health care versus preventive care?

I think this is one of the things that you really need to focus your mind on. How much are you spending on reactive health care versus preventive care?

And I'm going to challenge you, start thinking about ways to spend more of it on preventive care because it's going to save you on spending on that reactive care in the future. So that's my first reflective question.

Second thing, how might your financial future change if you could prevent or reverse chronic health conditions. I think about it in my own life. I am working really hard right now.

I got one of these Dexcom meters on my arm that tells me every five minutes what my blood sugar is. And it's a way to keep track of what's going on in my body.

And I'm thinking about that future change because I realized there's going to be a financial windfall if I don't have all these medications I have to take, if I don't have to put aside the time for these doctor's visits. So that's the second thing, my second reflection question and the third one, and this one is going to bite. It bit me.

And that is, are you being a good steward of both your financial and your physical health? So those are my reflection questions, you know, how much are you spending on reactive versus preventive care?

How much your future change if you could prevent or reverse those chronic health conditions? And then ask yourself that difficult question. Are you being a good steward of both your financial and your physical health?

So I always like to end the show with some concrete ways that you can make something from today's show. And my three concrete ways are ways to invest in preventive health care while potentially saving you money.

First thing I'm going to ask you to do this. Consider a membership based medical practice that focuses on prevention. I highly recommend Admire Medical.

Like I said, I'm going to put their contact information in the show notes. But think about it. Yes, it's an investment, but it's an investment in the most valuable asset that you have and that is your physical health.

Second thing, I've done many shows on this.

Look at those HSA accounts because one of the benefits of an HSA is, is you could actually use that money to pay for one of these membership based medical practices. So think about that. Use that to your benefit. I'll put a link in the show notes about the HSAs. And number three, and I can't stress this one enough.

You've got to make an investment in regular health screenings and lifestyle modifications before you get these chronic conditions. Because these chronic conditions will destroy your quality of life. Trust me, I'm going through it and I'm in good shape.

Don't misunderstand me, but I see the, the breakdown in my own body because of my inability to honor what God asked me to honor. And that's the temple.

Now tomorrow I'm going to share a game changing episode about a tax mistake that's already silently draining money from many Christian families. Just like yours, and that is selecting the wrong tax filing status because it could be costing you thousands in missed refunds.

So you don't want to miss tomorrow's show. And remember this, my passion is to help you achieve financial success.

I want to see you live out your dreams and I want to see you grow in your faith. And I know together, working together, we can master your finances from a Christian perspective.

So as I always end the show, stay financially savvy out there, work on that health, and may God bless you abundantly.

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