Missional medicine: making primary care primary
By Mark Blocher, Christian Healthcare Centers · Aug 26, 2021
Timely, affordable access to good primary care helps patients, enables doctors to know them better
Part 2 of 2
In part 1 of this series, I made the claim that modern medicine suffers from mission drift, that it has strayed from its core mission of caring for the sick. Patient care has taken a backseat to other objectives, especially the seemingly insatiable drive for revenue capture. Too much of modern medicine is designed around the payment, not the patient.
I also argued that the U.S. health care system has become increasingly secular, even hostile, toward the long-held Judeo-Christian values that have been the moral foundation of Western medicine. This drift guts the soul of health care—that is, compassionate, merciful caring for the sick.
Consequently, the time has come to create a distinctively Christian health care system that restores the soul of health care. Christian doctors need an onramp to practice medicine as a medical ministry, where they can freely live out the Gospel in ways that benefit their patients. There also needs to be a safe harbor for patients to be cared for by doctors who will be unapologetic advocates for them. This month, I broadly describe how the vision of “missional medicine” works at the primary care level, and how a Christian health care system can be a blessing to members of health care sharing ministries.
There is no well-functioning health care system in the world not built on the foundation of exceptional primary care. Unfortunately, primary care does not work well in the American health care system. Modern primary care forces doctors to push patients through appointments quickly by ordering lots of tests and referrals to more specialists. No system can ever have enough specialists, surgical centers, or world-class technologies to compensate for not having a solid primary care model as its foundation.
Christian Healthcare Centers (CHC) was created to be a model that makes primary care primary. Primary care doctors provide upwards of 80 to 90 percent of the medical services the average person receives each year. They are like the conductor of an orchestra who blends the contributions of other musicians to make beautiful music. Likewise, the primary care doctor is essential to coordinating a continuity of care that benefits patients. Just as a good orchestral conductor needs to know each musician and her capabilities, a good primary care doctor must know her patients well; not just their medical history, but what is important to them and their family.
No one disputes the claim that timely, affordable access to good primary care benefits patients and reduces overall health care expense. The goal of a missional health care system is to keep people at their best, not just see them at their worst. Truly missional medicine strives to care for the whole person, not merely treat symptoms, because missional physicians see patients as beings created in God’s image, not merely a collection of biological parts and organ systems. Although many secular medical professionals speak of being “holistic” and caring for “whole” persons, modern health care as a system falls short because it does not subscribe to a Biblical view of personhood.
There is no well-functioning health care system in the world not built on the foundation of exceptional primary care. Unfortunately, primary care does not work well in the American health care system.
CHC’s mission is to provide exceptional medical services to the Body of Christ and the local community, guided by Biblical values. We work to keep God’s people healthy so they can minister to one another and to the world. As a witness to the world, CHC also provides its services to non-Christians, where doctors have an opportunity to speak Biblical truth into the lives of lost individuals in ways they could not if they worked in a secular medical office.
To facilitate this vision of missional medicine, we strive to make primary care affordable, convenient, and personal. This means broad use of telemedicine; timely access to necessary in-person appointments; same-day or next-day sick visits; 24/7 availability of our doctors by phone, text, or email; onsite X-ray, labs, medication dispensary, ultrasound, and Biblical counseling; and helping patients with referral appointments for specialty services—all for the cost of a monthly cell phone bill, with no co-pays or deductibles. It is like having a doctor in the family. This basic model is common to practices called direct primary care, although many DPCs do not include the Christian focus.
Since opening in 2017, our patient population has consistently grown each month, drawn from every conceivable demographic. Patients from 32 Michigan counties use CHC as their medical home. Our patient census includes many households that also belong to health care sharing ministries such as Samaritan. It surprises us how many of these patients have not been seen by a doctor for years before they joined us. Many of their children had not been to a doctor since they were born. They typically avoid seeing a doctor until they are sick. As a result, many simply use urgent care centers or hospital emergency rooms for their health care, both of which are expensive.
Missional medicine aims to not only reduce the inconvenience and expense of accessing timely medical care when it is needed but also helps people avoid a need for it by encouraging routine wellness checks and making preventive screenings a priority. Patient history is vital to making correct diagnoses, and the only way a doctor can know a patient well is to spend time with them. That is why CHC provides 30-, 60-, and 90-minute appointment times and why our patients are able to contact their doctor via phone, text, or email without having to churn through a phone tree.
Accessible, personalized care is an essential component of missional medicine.
Since many of CHC’s staff belong to SMI, helping the Samaritan family “bear burdens” by protecting our own health and that of our fellow SMI members is important, keeping the SMI family from sharing more medical expenses for conditions that could be avoided. In 2020, Christian Healthcare Centers saved patients over $1 million that they would otherwise have spent out-of-pocket.
From the beginning of the medical care journey to the end and at all levels in between, health care that is based in Biblical values and acknowledges God’s sovereignty brings healing of body and soul.
For example, the most common reasons people go to an emergency department are abdominal pain, acute respiratory symptoms associated with severe colds or flu, and minor lacerations requiring sutures. Treating these in the ED is extremely expensive. CHC handles these cases easily in the office, using our own X-ray, ultrasound, and medical staff.
What do those services cost CHC members? They are included in the membership fee. Having the right equipment and qualified personnel to use it enhances timely access to care and controls the cost.
With primary care as its foundation, a Christian health care system also utilizes specialists to care for medical needs that exceed the scope of primary care.
For example, in 2019 CHC added obstetrics and gynecology services and is in the process of building a new facility where half the space will be devoted to medical specialties to provide many in-office procedures and outpatient surgeries within a Christian environment. This facility will provide primary care on one side of the building and procedures such as colonoscopies on the other. Bundled pricing not only provides faster access to quality specialty care for patients, but it also benefits sharing ministries by reducing shareable expenses.
In keeping with CHC’s life-affirming mission, CHC’s OB/GYN Dr. Shannon Madison not only provides personalized women’s health services for CHC patients, but, through the organization’s Healthy Tomorrows Maternity Program, provides maternity care for abortion-vulnerable women referred by pregnancy care centers. Dr. Madison is able to perform a number of procedures in the office, thereby improving timely access and reducing cost.
Dr. Ted VanderKooi, who, with his family belongs to Samaritan, is one example of the missional physician working in the mainstream of health care.
As a general surgeon, Dr. VanderKooi provides low-cost, bundled fees for many procedures and surgeries that would otherwise cost patients or their sharing community many thousands more. As a committed Christian with 25 years of experience, he has tried to be missional in his work but found it increasingly difficult to do so within the “big box” health care system where he worked. A model like CHC provides a platform for him to serve patients better, to be more professionally fulfilled, and to enjoy a better work-home balance. He is representative of a growing cadre of Christian physicians who are determined to restore the soul of health care by practicing missional medicine.
From the beginning of the medical care journey to the end and at all levels in between, health care that is based on Biblical values and acknowledges God’s sovereignty brings healing of body and soul.
Mark Blocher and his wife, Julie, are Samaritan Ministries members. He is a bioethicist and co-founder and CEO of Christian Healthcare Centers based in Grand Rapids, Michigan.