"Primary care without the Gaslighting" with Danielle Lazarowitz, Dr. Jen Rubin & Dr. Kate Eisenberg

Jill Brook: [00:00:00] Hello fellow POTS patients and beautiful people who care about POTS patients. I'm Jill Brook, your hyperadrenergic host, and today I am so pleased to introduce you to a team who is not just wishing primary care was better for complex POTS patients, but they are actually making it better.

Danielle Lazarowitz is the founder and CEO of Chronius Care, and Dr. Jen Rubin and Dr. Kate Eisenberg are physicians with Chronius Care. Their tagline, you're going to love this so much, is primary care without the gas lighting. Danielle, Dr. Rubin, Dr. Eisenberg, thank you so much for being here today.

Dr. Jennifer Rubin: Thank you.

Dr. Kate Eisenberg: Thank you.

Jill Brook: So Danielle, maybe we can start with you. Can you start off by telling us your backstory and why you decided to found a whole new paradigm for primary care?

Danielle Lazarowitz: Sure so my chronic illness journey started about a decade ago when I first started having symptoms of [00:01:00] fatigue and joint pain and I was working a really intense job at the time. And thought that I must have been just a little overworked but I went to my primary care doctor and they did some initial testing on me and luckily I had a primary care doctor who kind of knew to take those symptoms and dig in a little bit deeper. And that put me on the path to my first diagnosis which was an autoimmune disease called Sjogren's, and I lived with that, you know, without major issues for about 7 years. And then about 7 years in, I started having much more severe symptoms, where I was having shortness of breath, I felt like my heart was racing all of the time, I had a hard time exercising and I started having weakness in my extremities, I started having trouble with managing my temperature and being able to, you know, kind of function in my day to day life.

And this kicked off kind of a six month period [00:02:00] for me, you know, really searching for answers of what was going on. So I ended up in and out of the hospital and I got diagnosed initially with another autoimmune disease called Myasthenia gravis, which affects like, how weak your muscles are. But so when I came home from the hospital, I was told to monitor my vitals because I'd had some shortness of breath, and Myasthenia gravis can affect your ability to breathe if it gets really bad.

And what I noticed was that every time I stood up from my bed to do anything, all of a sudden, my vitals, my heart rate, started skyrocketing, and that was really surprising to me because it was never something that was mentioned when I was, you know, in the hospital or in the doctor's office. But looking back, of course, they were never tracking my vitals in the hospital or the doctor's office

when I was standing. It was always while I was seated. Or in the hospital, they would disconnect me from the heart rate monitors every time, you know, I got up to go to the bathroom. No one [00:03:00] was seeing what was going on. And when I raised this to my neurologist,

I said, you know, my heart rate is, like, increasing significantly from, like, 80 beats per minute to 150 beats per minute when I stand up, and I feel really short of breath, and they dismissed it and said, you know, you might just be stressed, or you're likely just dehydrated.

And I knew I wasn't dehydrated because I was drinking a lot of water at the time. So, I kind of felt like I had to do my own research because no one was really taking me seriously. And I saw that when I Googled, you know, heart rate increases when standing, the first thing that popped up was POTS. And so I raised it to my primary care provider and they said, you know, we don't really know how to help you. Talk to a specialist about it.

So they were no help. Then I went to a rheumatologist and they said, we think it's just anxiety, and if you take a Klonopin, it'll solve all of your problems. And I knew that that didn't feel right as well, and I finally pushed to get an appointment with a cardiologist [00:04:00] who was the head of electrophysiology

at Yale, and I said, I think I have POTS, and he did a kind of poor man's sit stand test in the office, and I was like, I think you do too.

But I'm not an expert, we need to get you a tilt table test. And by the way, there's only one in the whole state that you're in, and it's not at Yale, it's at UConn. And it's a long wait to get in because there's just, you know, such little availability. So when I got finally my tilt table test, that's when I got an official diagnosis of hyperadrenergic POTS.

And it was really validating to get that diagnosis after being dismissed by so many doctors of being told, you know, it was all in my head, or just mental health related and now looking back, you know, Sjogren's is actually one of the major causes of POTS. And so my doctors ended up determining that, you know, I had autoimmune dysautonomia, and that's what, what was causing my POTS.[00:05:00]

So now I have a great care team of doctors who understand that connection. It all makes sense looking back. But it was a real challenge to kind of get that diagnosis and then land on the right management, you know, protocol for me because some of my conditions affect what medications I can take.

For example, I can't take beta blockers, which is a common treatment for POTS, because Myasthenia gravis, like, it can make that worse. So it's just interesting on, you know, figuring out the right plan when you have multiple things going on, which I know a lot of POTS patients do. So really building Chronius was saying how negative my experience was of trying to find the diagnosis, how much I felt like I was quarterbacking my own care experience and felt like, why should that have been on me when I was so sick myself to have to take that on?

And really seeing that in an ideal world, a primary care provider would be the one quarterbacking that for me, because I had so many different specialists, and I needed someone to see the big picture, and so that's kind of where the idea of Chronius came [00:06:00] from.

Jill Brook: That's fantastic. And, and then I guess there's this whole big section that I, I don't know if you want to get into it, but like you made it happen. And that's really impressive. I'm sure that there's a lot of patients out there listening right now saying, Oh, yes, I've always wished I could remake primary care, but but you actually did it.

And that's phenomenal.

Danielle Lazarowitz: And I'll say, like, I did it having no, absolutely no experience, and then finding people who did to kind of make it happen, like, the amazing physicians that we have on today. But when I started it, I kind of felt like I had nothing to lose. I was in the lowest point of my life, like I was so sick. I hadn't been able to work.

I was bedridden. I was so ill and I just wanted it to be better. And I thought if it doesn't work, it can't be worse than what I'm dealing with right now. And luckily I found support, you know, from my community to be able to like, build this and then finding the right people to kind of make it happen. I think not a lot of practices are started by patients who don't have health care [00:07:00] background, but there's no one who's gonna fight more for a patient than like someone who's experienced it themselves and knows like what that patient experience can be like.

And that's why a lot of people on our team also have some sort of personal connection to to chronic diseases, whether it's themselves or a family member, and I think that brings a lot of empathy in our team as well.

Jill Brook: Well, that's fantastic. And I do resonate with that. And I guess it's a, it's a song lyric, but freedom is just another word for nothing left to lose. So that is, that is beautiful. I do, I do relate how it is. It's easier to take risks when you're at the lowest point ever, but let's, let's start talking to some of these amazing people that you recruited.

Dr. Jen Rubin, maybe you can tell us a bit about your background and how you came to be affiliated with Chronius.

Dr. Jennifer Rubin: Sure. And thank you again for having us. So my background in training is I'm a med peds physician, which means I'm, I'm boarded in internal medicine and [00:08:00] pediatrics. So, out of residency, I actually started seeing kids and adults, basically from 0 to my oldest patient was well into her 100, not quite 110, but, but big ranges.

And, you know, I, I, I was always interested in kind of the realm of how disease is manifested, walking, you know, people into adolescence and into their 20s and kind of helping them get into that adulthood and advocate for themselves. And I always became kind of curious with with more chronic illnesses.

I was I was more interested in chronic illnesses and kind of helping people manage and I became known as the provider in our practice who would frequently see the patients who, you know, we get transferred in with like 500 pages. And so I kind of just became this person of, like, let's try to figure out how we can help.

And so that range from some chronic illnesses that may affect some of our older population, perhaps more than our younger population, from diabetes and hypertension and heart disease and other things. And then I also had a large subset of people with autoimmune [00:09:00] conditions, which tended to affect some of the younger populations a bit more than some of the older ones.

But again, it doesn't doesn't totally eliminate options. But so many people in their 20s and 30s and 40s. And so, you know, I, I really found it tremendously rewarding being able to help people from the onset of symptoms and whether that was an infection, you know, revealing that there are some other underlying issue that is going on, or kind of, like, open the door to a diagnosis,

helping them kind of evaluate and intervene and kind of get their lives back or figure out how to make their lives better.

That was always kind of my privilege, and I loved being able to to do that. I loved being able to see families kind of grow into, like, like feeling how they can advocate themselves from childhood to adulthood. And so I actually, I was up in Connecticut and was practicing out there for about 12 years in person.

But actually, well, so not all in person, I wound up actually having some family related issues with medical medical, problems, we'll say, and different autoimmune conditions, [00:10:00] and realized that it was, it was fascinating and frustrating at the same time where you would go to a visit with a specialist, kind of tunnel vision again, appropriately

so, because that's what they're specialized in and and I would go and, you know,

be told that there's no awareness of what happens in the six months between, there's also a lot of times no communication that happens back to the primary. And then you check with the primary and it's okay, oh, how did that go? Who did you see? What's the name of the provider? And maybe they'll get a note. Maybe they won't get a note.

And then it's on to the next six month visit. So, I did a bunch of background stuff, was doing some telehealth with the same organization up in Connecticut, but really was, was living this kind of parallel life of trying to advocate, you know, for family members doing, doing a lot of the same stuff.

And then I moved down to Florida, actually, which became an amazing opportunity because that is when I first got my family settled and everything down here and said, okay, I'm ready to get back to work. But I, but I was really loving telehealth. I was loving the convenience that it [00:11:00] provided to patients, especially those with a lot of chronic illnesses where just getting to the doctor's

office can be draining and exhausting and, you know, just, just getting there. And, and a lot of providers don't even, you know, think about that part. It's like, oh, goodness, that patient's running late, now my schedule's... and that's no fault of theirs, but it's, it's a, it's just an amazing opportunity to allow people to be in their homes.

And you get to learn a lot more from people in their home settings, what their environments are like too. So I was looking at that opportunity and I came across Chronius and I read this description and I was like, this is exactly what I want to do this is exactly the type of people I want to be able to help.

And I feel like, you know, it is a gift to be able to do that for people. And you know, we, we wind up serving people with lots of different chronic illnesses. A lot of people are affected by POTS. And so, I was exposed to it in my prior in person care up in Connecticut, but really have now been having the opportunity to really take care of a lot of patients with POTS and other associated [00:12:00] illnesses and conditions and hopefully helping them find ways to feel better and get more control of their lives.

Jill Brook: That's fantastic and I want to talk more about the telehealth angle in a minute, but first, maybe Dr. Kate Eisenberg, can you introduce us to you and how you got affiliated with Chronius?

Dr. Kate Eisenberg: Sure. So I'm a family physician so I also see all ages. I'm in upstate New York, and I also practice in person primary care up here for a number of years after I finished training, but I also have a background in technology and analytics. I have a Ph. D. in epidemiology and a board certification in informatics, so I have a deep interest in improving health systems and care delivery.

So, I come to it from the combination of those interests and from what I was seeing in my practice. [00:13:00] So, I don't think I've been personally impacted by that type of care need in the same way that Jen and Danielle have, but what I saw in my practice was the degree to which I was serving as people's health coach, as their PCP, in order to help them navigate a system that was difficult for them during these vulnerable moments.

And the folks with more complex illness, it became all the more difficult, the more specialists we had involved. And, and with POTS and Dysautonomia, specifically, I had a little bit of experience in person, but those types of conditions that can be managed at least somewhat by a number of specialties, but may not be fully owned by any given specialty, can be particularly difficult to navigate.

So, I did a lot of trying to work with patients to help them understand and set expectations. So they might not be shocked to come upon a situation where a specialist is narrowly focused, [00:14:00] appropriately so in their area, but might not pull back and see the whole picture, you know that's, that's my role.

And I think, you know, I got connected with Chronius around that desire to improve care delivery and was really excited to connect with a team that was really, you know, looking to put something into, to action like that. And that's, it's been really fun to have the, you know, I, I, connected with them before they started seeing patients and started working with them on some of their, you know, educational plans and the approach.

And so it's been really fun to be involved from that point to where we are now to having this primary care where people, you know, arrive at the virtual door kind of exhausted and kind of looking for answers. It's been really fun to support them, you know, even those first visits, people are just so relieved to be able to

you know, say their whole constellation of symptoms and now at this point I think our team, you know, has enough experience that [00:15:00] we know what a lot of those constellations of symptoms look like and a lot of those associated conditions, so those aren't overwhelming to us. They're, they're kind of our, you know, our bread and butter now, and I'm, I'm thinking back to an early case that I had brought to the team to review, like we do, to help support each other, and it was funny, because between the time I'd selected the case and the time that we talked about it, you know, we had all gotten that much more experience that we said, oh, okay, we can, you know, this is our standard case now, so that's, that's been a really fun

kind of group journey to, to become so much more fluent in how we as primary care can advise, coach, and provide real support to, to patients with more complex conditions.

Jill Brook: That's great and it's funny because from what you've said already, I can tell some things that you do differently from a normal primary care [00:16:00] office. For example, my primary care office, you get six minutes, and if you're in the middle of a sentence, it doesn't matter. The doctor walks out, you get your six minutes. And they're always running on time, which is great, but you know, six minutes is six minutes, and so I know you must not do that because you said you can listen to all of the symptoms.

So I'm curious, so what else do, what do you, what do you do differently than a standard? You want to start with maybe what, what it was that you envisioned that would have to be different from what you were used to?

Danielle Lazarowitz: Sure, I can talk about the vision and then maybe Jen and Kate can talk about the execution. But I had a few things in mind. First is I did, I wanted to have longer appointments so that patients didn't feel rushed and that you could actually talk about everything because yes, in those six minutes, there's no way you could even get through like why you're there today and what's going on without the appointment being over.

So all of our new patient visits are an hour long and our follow up visits are typically 30 minutes to 45 [00:17:00] minutes long so that you make sure you really have the time to go through everything and make sure that, you know, all of the issues and how they interact, like you're able to talk through all of that and really share your story.

So that's one piece of it. I think another piece of it is making sure that our doctors have additional training in some of these conditions that we see more commonly, that are maybe less commonly seen in an average PCP practice, that we have folks start with before they start seeing patients. And then obviously, as they have more time with us, as Kate was talking about, you get more and more experience in these conditions where now it's, you know, we see probably one in two of our patients has POTS, for example. So it's very, we're very comfortable with those conditions, which obviously is not the norm for an average PCP practice.

And then it's about everything that happens outside of the appointment, which, you know, a lot of patients talk about it feeling like a full time job being a patient, and it's [00:18:00] because there's so much work that goes into coordinating everything. So we have really robust care coordination and care advocacy support for our patients, where when we make a referral, we don't just say, here, go see a cardiologist, like, have a nice time.

We actually do personalized searches for every patient to find the right cardiologist for their unique needs. And that takes, you know, personal phone calls to a lot of providers, building out a database of specialists that we trust. And then we have board certified patient advocates on our team, which help patients feel like they have a partner to help them navigate the system, deal with billing issues or insurance issues they may have,

or even they'll attend, yeah, even they'll attend virtually specialist visits with them just so they feel like they have that extra support, which I think is is huge.

So I don't know if Jen and Kate want to talk a little bit about what it's like actually executing, like, what might be different of us versus other practices that they've worked [00:19:00] in.

Dr. Jennifer Rubin: So one is, I think time is one of the most beautiful parts about this. I think that, you know, we're all accustomed to filling out intake forms, right? Going to any office, whether it's a primary care or a specialist office, and it's a list your diagnoses, list your medications, your allergies, your histories.

And while those are super informative, I think that every person has a story and I feel like having the opportunity to yes, still go through all those histories, we need to know about your surgical history and your family history. You allow a person to tell a story and understand how things unfold. Also understand how an individual diagnosis doesn't mean that you have every part, every symptom, and it doesn't affect every person in the same way.

So it really, you get to understand how it impacts their lives and then try to build a plan together of how we can make things better. So I think it becomes this balance of

giving a person time and then us being able to ask questions so we can, we can figure out how we can truly help, right?

I mean, we, as physicians, we get trained on objectives, right? We [00:20:00] get trained on what a diagnosis is and the right way of managing it, but so much of medicine is subjective and how it impacts people's care. So I think, I think, you know, it's, it's getting stories. And then, as Danielle was mentioning, just the evolution, what happens afterwards.

So, one is, as physicians, we feel tremendously supported by our teams. We have nurses. We have care coordinators. We have our patient care advocates. We have an awesome team, and everybody has these common goals of trying to help people, hopefully. I think that, you know, we do a lot of record gathering both before visits and then after visits.

And we try to ensure that we get the time to review the records. We find diagnoses sometimes just looking through records that may have been missed along the way and try to communicate back. And we try to stay, it's hard you know, based on locations to know every provider and every specialist, but we do try to put our phone call out there

and say, hey, can we talk to

this provider?

We share a common patient and this is what we're noticing, or this is what we're concerned about them, and we're [00:21:00] trying to help advocate. So, it's really a great opportunity to let people talk. Let people feel heard, let them have ears ears that are attached to brains that have medical knowledge and we have the ability and the resources to, to help them in their, in their medical journey.

So, it takes a bit off of their shoulders and we share the responsibilities and trying to help them.

Jill Brook: That's great, and it sounds like it's just taken as a given that you, you know, you believe your patients, which I think is something that is not a given everywhere.

Dr. Jennifer Rubin: I think a lot of, yeah, as, as Kate was saying, a lot of people just feel, like, relieved to be heard. It's just, it's a, like, wow, actually, like, I was able to, like, you're, you're truly heard, you're truly understood in terms of what you're saying and, and just because you don't have a diagnosis or you did a test and the test result is positive, it doesn't mean that what you're feeling is not a true feeling and it's not a true symptom.

So, it's that [00:22:00] validation piece where a lot of these people have been on medical journeys and have, have run into dead ends or dismissals and, you know, been gaslit which we don't, we don't want for anybody.

Dr. Kate Eisenberg: Yeah, you can almost, you can see folks kind of, you know, you can see them relaxing as that first visit takes place. It's it's a really different kind of conversation, I think, largely because of the time, but also because, you know, as Jen was saying, we can't, we can't help if we don't know the whole story, and if we don't know what's been tried before, and often the concerns folks have are quite subspecialized, or there are certain other conditions that go along with POTS, but you have to get to the right, like, sub subspecialist, and so some of it is helping advise

patients on, you know what, maybe, maybe it's not neurology but neurosurgery actually. And, you know, that might be a different approach that you might not [00:23:00] have thought of. Either way is correct, but this consultation might get you a little farther, a little faster. So some of it is developing our own experience with that type of navigation, and as Danielle was saying, some of it is developing out this network where we know that the folks we're referring to are of a similar mindset where they're open to more complex patients, where they might have more experience with the conditions that we commonly manage, and that can make such a difference in the care experience versus someone coming back from a specialty referral or some other service and saying, you know what, I didn't really get what I wanted out of that

appointment and, you know, everybody, everybody's time and resources are limited. That can get exhausting quickly if you have to go to six different appointments.

Jill Brook: That is so, that is so I can see right [00:24:00] on that sometimes the magic is in finding that right person, and wow, can you burn a lot of money and time and energy in that search. I can see where having professional help from people who kind of know the game. Like, I know a lot of patients who have been patients for a long time say that it took them a while to almost to just learn how the game works in healthcare, because it is kind of a game in some ways.

Like, it took me a long time to learn that, for example, like, there's this element of documenting things that if you don't know that at first, you can waste a lot of time because you didn't document the right things at the right time in the right way. And then, you know, forget it with insurance. And it sounds like you are really helping to coach people either how to do some of those playing the game, or you're just taking care of it for them so that they don't have to know how this whole world works.

Danielle Lazarowitz: Yeah, and I think, like, thinking about POTS, for example, the type of referrals that we make, like we'll refer out very frequently to [00:25:00] cardiologists or neurologists, but you can't refer to just any cardiologist or any neurologist and assume that they're going to have knowledge of POTS or expertise and know how to treat it.

So we make sure that a patient doesn't have that negative experience of us referring them to a cardiologist when we suspect POTS or they have a POTS diagnosis already and that doctor is like, I don't believe in POTS or, you know, this, you're probably just anxious or something, that we don't want them to have that experience.

And it's costly to the system and to the patient to have to like, doctor shop for four different cardiologists until they find one who actually gets it. So it's better all around for us to put in that work up front to make sure they get to the right care sooner. And the other thing now is like we know that it takes time to get in with specialists, especially for these specialists that are like sub specialists as Kate was talking about.

It could be long waits to get in with them. So, you know, our doctors are able to start doing testing or start [00:26:00] doing some treatments right from the beginning while we're, you know, waiting for them to get in, you know, within what they think is appropriate. That could mean that the patients can start to, like, feel better or start to rule, you know, have more data so when they get to the specialist appointment they're bringing like that echo result or that tilt table result or something so that that appointment can be more efficient and effective

Jill Brook: That is huge because I always think there's nothing more frustrating in the world than waiting six months to see that great POTS specialist and then have them send you away to just try more salt and more water. You're like, I could have done that during the six months I was waiting. So that, that is huge.

I think it goes for so many of the the common comorbid conditions that come with POTS. And that must be another thing that you guys end up specializing in, because I think I heard you say that one out of two patients at your practice has POTS, and so you probably are seeing the whole range. I mean, like, [00:27:00] like, we joke about it, right?

Like, it started out that it was the triad, right? It was POTS comes with EDS and Mast Cell Activation Syndrome, and then it grew into, like, the pentad, and they threw in, what was it, autoimmunity and, like, gastroparesis, and then it was the septad, because they threw in, I forget what, and now, now it's kind of just, like, a hot mess of things that can occur, and I can imagine that it's a huge head start to be with a primary care physician

who, first of all, doesn't, like, poo poo the idea that that's possible, and second of all, actually kind of, like, recognizes what some of those things are.

Danielle Lazarowitz: Jen and Kate could probably talk more to this, but I think they'd probably be surprised if they see a new patient that doesn't have either POTS, MCAS, or EDS, at least one of them, or suspect one of them, would be almost surprising in terms of the patients that we see. But, I don't know, Jen and Kate, are you, you seeing like a lot of those kind of comorbidities in the practice?

Dr. Jennifer Rubin: Yeah, definitely. I [00:28:00] mean, we, we, I would say POTS is a very, very, very common diagnosis, perhaps more than even 1 in 2, though, though Danielle definitely knows the numbers better than we do. But it's interesting because some people will have the diagnosis, but it's actually not the primary reason they're seeing us.

And then other people are seeing us for that diagnosis, and that is the primary underlying cause of many of the symptoms they're experiencing. So, it becomes a matter of trying to to try to figure out what it is, right? Is this POTS? And are we, are we dealing with this? And some people, you know, again, have gone through those multiple cardiology visits already and have been dismissed.

And so we do, we try to vet the providers that they are seeing well in advance, so that we know we can get those questions answered. I actually had a conversation today that was somewhat frustrating, but it was, it was, it was important because I spoke with a practice that said, Oh, well, this person who hadn't had a tilt table test, but had a holter monitor done that showed elevated heart rates.

And she said, well, that's just normal. Sinus tachycardia is [00:29:00] normal. And I said, but not for the person who's experiencing symptoms. And it was just this level of frustration that we kind of go to bat for because we want to make sure that our patients are heard. Having, you know, an elevated heart rate, yes, maybe it's not going to be this dangerous heart rhythm that is going to, you know, cause death or cause a tremendous abnormality in your heart wall or land you in the hospital most of the time.

But when you're having a hard time standing up on a daily basis, when you can no longer work because you're having such a level of dizziness and shortness of breath. That, that wait for another 2 to 3 months is a long wait, and it's, it's not fair, especially when patients are coming in to see you for a specific reason, and then being told because somebody else reviews the test that it's not, that it's not an issue.

So, I feel like that is that's something that we encounter a lot, and it's really a matter of trying to identify, diagnose, and, and with the number of patients we have who have [00:30:00] POTS, we've become, as an organization, able to do a little bit more in terms of the treatment, especially because if you look at POTS and the options for medications, there's nothing that's really FDA approved.

It's really just using the medications that are used for other heart rhythm abnormalities or other blood pressure abnormalities or other things, that can then be used off label. So, we've kind of entered that same pool to be able to use medications through education and experience to help, to help people with their symptoms.

Jill Brook: Oh, that's fantastic. So, how do the logistics work? Like, where are you located? Who can work with you? Do they have to be in certain states? What about international patients? Do you take insurance? How, how does the whole thing work?

Danielle Lazarowitz: Yeah, that's a great question. So we launched a year ago in Florida. So right now we are just [00:31:00] delivering care to patients who are physically located in Florida. Our goal for 2025 is to expand to additional states, and long term, the goal is to make care available nationally.

One thing that's really important to us is making sure that our care is accessible and accessible in a few different ways.

So one, we've already talked about telemed and being able to access care from home and how that makes it more accessible. So patients across the state can access versus needing to drive hours to see a provider who gets it. But also from a cost perspective. So I know from my own experience as a patient, a lot of providers in the country who are the select few who understand these conditions often don't take insurance and will charge hundreds or thousands of dollars for an appointment.

And that really makes care out of reach for so many [00:32:00] patients who have these conditions, which I just don't think ethically is right. And so one thing we want to do is make our care accessible and affordable. So we do take insurance right now. We take Cigna and Aetna and we're working to get in network with other plans, commercial plans, as well as Medicare.

And we keep our appointment, our cash pay costs, low for patients who we don't take their insurance right now, and then we charge a small monthly fee, which is 40 a month which covers the both like the additional longer visit costs as well as all of that really amazing care coordination that we do for patients, which when we surveyed patients

that have these conditions and saw that they, some of them spend up to 20 hours a week doing things related to managing their health, that kind of pays for itself in one week in terms of like, what your hourly cost would be of, you know, doing it yourself. And we kind of do that [00:33:00] for you. So, patients who are outside of Florida, right now, they can access our Care Empowerment Platform for free, so that a platform enables you to bring all your medical records into one place.

You can connect all your different patient portals together because it's basically like, think of it as the digital binder. We all have those, like, patient binders. Think of it as a way to make that digital binder. You could also track your symptoms, track your vitals and get patient education.

But also it helps us know where patients are in the country that are interested in us so that we can see, okay, we have a lot of patients, you know, people that signed up that are in New York, so New York might be the next place that we want to go. Right now, we're not planning to deliver care internationally but maybe something will change in the future, but right now we're just focused on the U.

S., and you know, patients can come to our website, which is Chroniushealth. com to sign up, and they can do a free 15 minute call with a member of our team to learn more about if it might [00:34:00] be a good fit for them so that's a little bit of kind of the logistics of how you get connected with us.

Jill Brook: Wow, that's fantastic that you're working so hard to work with insurance and make it accessible because I have, in the last couple of years, you know, basically tried to find my own better, you know, options and holy cow, I, you know, 900 for the first meeting or, and 600 thereafter, or 600 per hour. Those are some of the numbers that I have been finding in order to just even get a shot with a person who I don't know is going to be the right person, but I know that at least they know what POTS and MCAS are.

And and so that's really phenomenal. And I don't actually know that many places where they really understand this stuff and they're trying to make insurance work. So I just want to say, thank you.

Danielle Lazarowitz: Yeah, yeah, I think like the combination of the monthly fee and trying to make it as affordable as we can and we will be launching like a higher [00:35:00] level tier of that next year as well that will be more in line with traditional concierge medicine pricing, but we'll have kind of, you know, 24 7 access to doctors and things like that. But I know my, my specialist that I see for my Sjogren's and POTS is 1, 000 an hour and bills me as if they're a lawyer billing me in 15 minute increments.

And it's a lot and it might, you know, inhibit you from seeking care at all because it's just out of budget. Especially a lot of our patients will have periods where they can't work, for example, because they're so ill. So then it's especially difficult to afford those. And you know, if other very difficult conditions, there's doctors who take insurance, like it should be like that for this too.

Jill Brook: That's fantastic. Wow. Well, we can't wait for you to continue and to grow and to spread further out. I would love to know, so for all those people who are not in Florida, and for, you know, we, we have quite a few practitioners who listen to this too, what do you wish [00:36:00] more primary care physicians understood about this?

Dr. Kate Eisenberg: I think from what I've learned, there's so much we can do in primary care for POTS, and we're certainly seeing that in practice. So, that's what I would say to my primary care colleagues, is there's a number of simple and brief steps that you can take around starting with those educational basics around fluids, electrolytes, and compression, even just that counseling.

That can, that is an appropriate, you know, management step that can take fully care of symptoms for a certain proportion of patients with POTS, but they may not necessarily get that counseling early on in their journey. And then starting with beta blockers and I think between those two steps, you know, that's, that's [00:37:00] providing really great care for, for patients with POTS that you can really manage appropriately from primary care with just a little bit of, of education. And I think the improvements in quality of life and patient education just with some of those simple steps can go a really long way without, without needing, you know, intensive training.

It really can just be some brief self education and, and you can really help folks identify and manage their POTS symptoms better.

Dr. Jennifer Rubin: One other thing I'll just add on top of what Kate said is, I feel like going, like, thinking through med school and training and residency and training, what you don't know, what you weren't taught can be very intimidating, and I do not recall learning much, if anything, about POTS. And so I think that that becomes a natural barrier and a worry from a provider, right?

A provider wants to be able to feel comfortable in what they're treating. They want to know what this means, and [00:38:00] they want to know that that they're not going to miss something, or they're not going to harm a patient, right? First, do no harm, always. I think that there are really useful resources. That could be watching a POTS presentation or watching or reading through a general, even if it's an up to date or whatever type of resource that is that goes through what POTS is.

Because the, the prevalence has been there for, you know, centuries. It's just more a matter of getting rid of the, being the anxiety and get it, get rid of it just being dehydration and understanding what it is so that we can guide in those initial interventions. And it's okay to rely for us as providers to rely on our specialists, but also to, when you send a patient to a specialist, if you say, this is my suspicion, it can help guide, ensure that one, they're seeing the right person, but also help guide what they're looking for, and to kind of have an inkling of what your suspicion is.

It also makes patients feel [00:39:00] heard. And it's okay to tell patients, I don't know for sure, or I'm suspecting this might be the case, but I'm not the expert in it. And so we want to be able to find the right team for you. So I think small blips of information that people are not, providers are not alone and not knowing a lot about this, but it doesn't mean that it's a hard diagnosis to understand.

It can be hard to manage, but that's what, what, what time and experience and specialists are there to help us with.

Danielle Lazarowitz: Two patients, one of Jen's and one of Kate's, who came to us with POTS diagnoses, who were very high utilizers of the ER when they came to see us, like, 20 visits to the ER in the three months before they started with us. And now they're down to like two visits in the last three months that they've been with us.

So like a significant decrease and they weren't crazy interventions that we did that made such a difference. And both of these [00:40:00] doctors have patients that are like this. And interventions that we did were things like setting them up with home health, like IV fluids, instead of them going to the ER every time that they needed that.

Making sure that we got them to the right specialist care to provide that support. And building out plans with them of what to do when they're flaring, so that there's steps that they can take at home without having to go to the ER, but that they feel like they have the knowledge and are empowered to know what to do as their symptoms changed.

And just those changes changes, plus, I think building trust with our patients that they will come to us and say, you know, what should I do, or this other doctor said this, what do you think? That made them feel like they had someone that they could like really talk to and have as like a guide through the whole thing.

But that's such a huge change of like 20 ER visits in three months to two is massive and we've had many [00:41:00] patients like that. But these aren't interventions that are out of reach for most primary care providers to do. So I think that that is exciting and empowering that you can make a big change for these patients with things that, you know, aren't like really wild interventions.

Jill Brook: That's a great point and that's another reason why all the insurances should cover you because I'm sure it saves so much money when you're going from 20 ER visits per quarter to two. I mean, wow, that is just enormous. Well, I'm really excited about what you're doing, and I'm a little bit jealous of all the people in Florida, and so thank you for working on this, and I hope that you have great success.

Do you have any parting words, and can we share your online info or website with people if they want to check you out?

Danielle Lazarowitz: Sure, so our website is [00:42:00] Chroniushealth. com. You know, I think parting words is just saying that it is possible for you to get care where you feel validated and supported on your journey and don't be afraid to push to find care where you feel like you really have that support. And you know, that's what we're trying to create here.

But you know patients have the power to to really like, you know, ask for that and and not settle until they find a care team that really you know, takes them seriously and is there to support them.

Jill Brook: Fantastic. Well, thank you again, good luck, and hey listeners, that's all for today, but we'll be back again next week. Until then, thank you for listening, remember you're not alone, and please join us again soon.