Direct Primary Care with OB: A New Model in Tulsa Healthcare

After spending six years doing family medicine in Alabama, Dr. Jacob Greuel felt called to make a change. He closed his practice, then completed an obstetrics (OB) fellowship, where he delivered over 500 babies in one year. He and his family then relocated to Tulsa so that he could work at In His Image, a Christian Family Medicine residency program affiliated with Ascension St. John. So, for the last nine years, Dr. Greuel has divided his time raising his four boys alongside his wife, Sandy Greuel, while practicing inpatient and outpatient family medicine and obstetrics—all while helping teach the next generation of family physicians.

Sandy, a former ICU nurse, says her husband always wanted to be “that Little House on the Prairie doctor. He loves doing full spectrum family medicine.”

Dr. Greuel says his goal was always “taking A+ care of my patients,” but he was frustrated with the dominant American healthcare model, feeling the constraints of corporate medicine and insurance companies left him with too little time to serve both his patients and his family.

Reimagined Health

But Dr. Greuel says that he has finally found a way to sustainably deliver that personal connection to his patients in the Direct Primary Care (DPC) model. With DPC, patients pay a monthly fee that gives them unlimited access to primary care services. And because Dr. Greuel has also completed an OB fellowship, he is the only DPC doctor in Oklahoma currently providing pregnancy care within this model as well.

Last summer, the couple opened Reimagined Health, a Direct Primary Care office in Tulsa that does “womb to tomb” family medicine. “I am one of the few family doctors in Tulsa who can do c-sections,” Dr. Greuel said. “Hypertension, thyroid—I’m experienced in caring for those conditions outside of pregnancy and inside of pregnancy.”

A More Personal Experience

Continuity of care is also an advantage that Dr. Greuel enjoys. For example, he says that after he delivers their babies, about 80 percent of women use him as their pediatrician. He says that “women want to have shared decision-making. I have time to discuss more things with my patients.”

Dr. Greuel explains, “When I learned about Direct Primary Care, I was excited about being able to practice medicine the way I wanted to practice, to get to know families and care for them in a more personal way. People are not just their medical problems. They have a body, a soul, a spirit, a mind – if I don’t have time or energy or a relationship with a patient, I’m really only scratching the surface of what’s going on with them. DPC allows me to take more time with them.”

DPC vs. Insurance

The Greuels explain that a DPC practice does not take insurance; rather, Reimagined Health patients pay a monthly fee for unlimited access: $90 for adults and $60 for those under age 25, with discounts for siblings. With DPC, they say patients have quicker access to a doctor and more time with their doctor, and the doctor has more time to do research as well.

Additionally, the insurance-based model often requires that patients be seen in the office, and they may be paying more for lab costs, tests, X-rays and MRIs than they would with cash or special discounts that he has arranged with various service providers. Often, Greuel says, DPC doctors can handle patients’ problems by phone, email, or text message, and they can possibly skip unnecessary tests, scans, or treatments just because they can stay in close contact with their doctor. Physicians in this model are also more incentivized by their patients being healthy. He says they can respond more quickly to patients who call in with questions or concerns than they could in the traditional healthcare model.

While there is a perception that DPC is only for wealthy people, Dr. Greuel says that is a misconception. He asserts that the DPC model actually saves people money. “Ninety dollars a month is so much cheaper than insurance,” he says. While he still recommends a high deductible or health share to use for catastrophic or major health problems, he says pairing these with a DPC membership can often be cheaper than typical insurance policies.

The Future of Reimagined Health

The Greuels say they plan to grow the practice and are likely adding a female doctor this summer who will also do prenatal care. Whatever growth is in the future, it will be done slowly and deliberately. “I want it to be sustainable for me and my patients,” says Dr. Greuel.