About James Pinckney II, M.D.
Dr. James Pinckney II, M.D.,believes that integrity and hard work are critical to building customer loyalty. A visionary, he founded Diamond Physicians in 2012, a membership medicine practice that focuses on the patient-physician relationship. This healthcare niche has gained momentum in response to sprawling waste and frustrations with healthcare delivery systems and is now known as Direct Primary Care. Diamond bypasses cumbersome and inefficient “middlemen” to deliver personalized, high-quality medical care directly to their valued clients. Diamond has expanded into five companies and Dr. James incorporated Diamond Health in 2018 to solidify his vision of transforming healthcare delivery in America. Diamond Health is the parent company of Diamond Physicians, Transcend Onsite Care, Diamond Franchising, DrLink a HIPAA complaint telemedicine app, and Diamond Health MSO consulting firm.
About Diamond Physicians
At Diamond Physicians, we believe that all individuals should have access to high-quality and personalized healthcare. But when one steps into a traditional waiting room or hospital setting, the opposite is usually found: long waiting lines, limited face-to-face time with a physician, referral hassles and limited availability. Our patients are exposed to a completely different experience at Diamond. Traditional insurance doctors see about 3,000 patients—our doctors see no more than 600 patients. This limit allows us to provide high quality, personalized health care. The patient experience is extremely important to us. Visit diamondphysicians.com.
Medical Travel & Digital Health News (MTDHN): Please tell us about your practice and what you are focused on in today’s world.
Dr. James Pinckney (DRJ): I started the practice in 2012, then called Membership Medicine. We wanted to create a completely different health care delivery model that was more reminiscent of the relationship between the doctor and the patient back in the 1950s, when doctors did house calls and you paid cash. It was a simple relationship.
The third-party payer system complicated and convoluted every aspect of the model. Now insurance companies are in the way: they tell doctors what tests we can order and how much we’re going to be reimbursed and they tell the patients where they can go, who’s in network, who’s out of network, how much their co-pay is and how much their deductible is.
It really has complicated something that is very simple and just like other industries. Doctors provide a service and it should be paid directly by the consumer. Insurance should be used for catastrophic issues only, which is what insurance is designed for.
Insurance is a risk mitigation tool, whether it is home, car, dental or health insurance. You are not supposed to use it every day. It defeats the purpose of insurance.
So, if you go back to your core principles of insurance, you can actually create a high deductible, low premium plan that is utilized in case of disaster, ER visits, hospitalization, surgeries, cancer treatments–things that cost thousands of dollars.
When you use your health insurance for everything, the cost is dramatically inflated, and that is what we have been trying to get society to understand about healthcare and health insurance.
People think just because they have good insurance, they have great access to care, but this is not true. There is no correlation between insurance and access.
MTDHN: Would you say that your practice is what is also known as “concierge medicine?”
DRJ: We are technically direct primary care, which is a direct relationship with your doctor.
People pay a monthly or annual membership fee for all their primary care services –unlimited visits, no copays, 24-hour access to the doctor, unlimited urgent care.
We do cash pay discounts on labs and imaging, so you get tremendous value for your membership fee. I like the term membership medicine because it explains exactly what it is, although direct primary care is the vernacular used today.
In contrast,concierge medicine charges an annual retainer, but they also charge insurance. So the retainer gives you access to the doctor but you still are charged a copay. It follows the traditional insurance model, but you also gain access to your doctor’s cell phone number and 24/7 access.
I love that concierge provides better access to care for patients, but it does not solve the underlying issue of using insurance for primary care. Insurance utilized for primary care is extremely inefficient.
Direct primary care delivers tremendous value and it’s all included in the membership, whether the patient needs IV fluids for a stomach bug or nausea medication — it’s included.
Whatever we can do within our four walls is included, such as annual labs, CBC, CMP, A1C, TSH, lipid panel and a PAP smear. And patients can call us whenever they want to reach the doctor.
We have a HIPAA-secure app called DrLink that’s also included in the membership, so patients can video chat with us or text — they don’t have to be seen inperson if they don’t want to.
In fact, 70-75% of our visits are telemedicine through our app which we call Virtual Diamond Care. You can still use evidence-based medicine and do all the things that normal doctors do in person for a lot of issues in primary care.
When COVID-19 hit, we were wonderfully prepared to transition to telemedicine because we were doing it already and our clients are used to a monthly membership model. We were not as hard hit as other primary care practices across the country.
MTDHN: How many doctors are in your practice?
DRJ: We have two locations in Dallas and one is a franchise. We have 31 locations in our affiliate, Diamond Direct Care network across the country.
We don’t own the practices in our Diamond Direct Care network, but these are also direct primary care doctors that share a like-minded vision. When we locked down an employer contract that has employees all over the country, we send them to our affiliate offices.
MTDHN: Who are some of your clients?
DRJ: We have law firms, CPA firms, construction firms, a company that does benefits, real estate and other associations and a large sports association. Our clientele ranges from high cash flow oil and gas companies to very low-margin cleaning companies.
MTDHN: What happens when the patient must go to the hospital?
DRJ: They should have some sort of catastrophic insurance plan, whether it be a high deductible, low premium plan or a cost share/medi-share plan or indemnity plan. That’s up to the client to determine their level of risk.
Some of our clients don’t have any insurance, but the vast majority of our clients do have some sort of catastrophic coverage.
MTDHN: So, the insurer or plan would direct them to a hospital?
You have to figure out who’s in network, who’s out of network, or if you have an indemnity plan that covers you on a cash basis and how many hospital days you use to determine coverage.
MTDHN: Does your doctor help patients to select the hospital?
DRJ: We have affiliations with every hospital within the metroplex, so we don’t have privileges, but wherever our members want to go, we actually call the ER or the hospitalist on call and either get them directly admitted, so they aren’t just a number. We talk to the charge nurse and ER doctor and alert them of the situation.
To give you an example, I had a client who had right lower quadrant abdominal pain for a few days and was keeping in touch with me. He didn’t really think anything of it, but finally I said, look, this is getting bad. You are about to go out of town, so let’s get some labs and a CT scan. Sure enough, he had a ruptured appendicitis that had walled off in his right lower quadrant.
He’d had excruciating pain that had gone away because the section of infection had been walled off, but it was still very serious. The CT confirmed appendicitis. Instead of sending him to the ER, I called the hospital and told them the situation, and got the surgeon on the phone and scheduled emergency surgery for the patient without him having to go to the ER.
I went to the hospital to let him know I was there if he needed anything. He was already intubated, and they were about to start the surgery after just 60 minutes from the time I called them and told them what was going on. It was incredible.
MTDHN: You ought to be commended for that level of care. What happens when a patient must see a specialist, either through telemedicine or direct?
DRJ: We have a Diamond Specialist Network and three specialists in every specialty – dermatology, endocrinology, pulmonology, cardiology and so on. They have agreed to see our clients within 48 to 72 hours.
MTDHN: How much does it cost to have this membership?
DRJ: We have four levels, but the ones I want to focus on are our basic offerings.
- The first one is Diamond Physicians. For employers, it is $165 per month per employee—about what you’d spend for a cup of coffee a day. These physicians have no more than 600 patients.
- Our middle tier Diamond Direct Care is $95 per employee per month, and the difference is that Diamond Direct Care physicians have a higher patient panel—from 600 to 1,000 patients. Your typical insurance model has three to 4,000 patients. With Diamond Direct Care, the patient volume is still 75% fewer patients than in a traditional model.
- DrLink is the telemedicine piece that we call Virtual Diamond Care and a huge benefit for companies because we are on a lockdown with the pandemic. You get the same doctor every time you call, unlike the big telemedicine companies where you get a different doctor every time you call. We provide greater personalized care and continuity of care. While it’s 10x the cost of traditional telemedicine, it’s 100x the value.
MTDHN: Have your patients ever left the country to have surgery?
DRJ: Yes, we have international clients who are citizens of other countries but have homes here. For instance, my Mexican clients will have surgery in Mexico because its cash pay, and the experience is much better than here in the U.S., from what they’ve told me.
Medical tourism is a big thing for some of my clients and I can understand why. They pay in cash, stay at a beautiful resort in Mexico, get surgery from a top surgeon, and the cost is about 90% less than their copay in the United States.
MTDHN: How did these international patients get to you?
DRJ: From our Diamond Luxury Healthcare brand.
Most people would associate that level with concierge care, but we still do not charge insurance. It is still technically direct primary care–just more expensive.
Through this brand, we have been able to take care of celebrities, professional athletes and politicians. These is how our international clients heard about us and joined our practice.
MTDHN: How many lives do you cover just in the Dallas area?
DRJ: About 3,000 members in Dallas-Fort Worth and many more on the national level.
MTDHN: What is the future of primary care medicine with all these dire reports?
DRJ: I think direct care is the future, with the changes in insurance, the COVID-19 pandemic and erasing state borders. I’m licensed in Texas and California but can now see patients anywhere in the country—which is how it should be.
We all take the same national boards so being licensed in each state makes no sense. I foresee membership medicine and care going toward a subscription basis. Look at Netflix, Microsoft Office and buying razors. It’s all membership based.
I also think the relationship between you and your doctor is going to be more intimate with membership medicine, decreasing anxiety about care. Spending significant time with your doctor simply doesn’t happen anymore in primary care. But that will change.
MTDHN: Are there parts of the country where you see growth for Diamond Physicians?
DRJ: With the national associations we are working with, we plan on being in all 50 states in the next 1 to 2 years. It’s going to be a bright spot in a very dark time for the U.S. and the world with the COVID-19 pandemic.
It will revolutionize primary care in America. After we come out of the darkness of this COVID-19 tunnel, we’ll see the inefficiencies of our healthcare system and know that it has to be changed. Direct primary care will help facilitate change and inject efficiency into our healthcare delivery system.
MTDHN: Would you characterize your practice as a corporation?
DRJ: We have a corporate entity called Diamond Health, and several subsidiaries of Diamond Health. We help practices transition to direct primary care, and sell franchises, which has interested many physicians. We provide all the tools and insight on how to run and operate the practice and business structure to allow physicians to come in and actually see the patients.
Our vision is to not push margins but help as many people as possible and deliver the best possible care across this country.