How It Works

Big Tree Solutions is a virtual clinic (telemedicine) that helps provide access to treatment for a reasonable cost. We bundle the cost of the doctor’s office visit, other care provided by our clinic, labs (done at your local Quest branch) and medications from our dispensary (with free shipping). We establish a doctor-patient relationship and provide appropriate medical examination via video chat (we will send a link which transports the patient into a virtual exam room). If we are unable to care for the disease process that a patient is dealing with via video, the patient is not charged.

The patient fills out a form on this website and then they are contacted via email to set up their first visit. They will be asked to fill out a series of forms on their medical history here. If medically appropriate, the patient can be prescribed medications. If patients decide to get their medications through this platform, we will put a credit card on file and bill it for their medication and other services monthly. We do not prescribe any controlled substances through this platform. Medications are shipped free to the patient’s home. Follow up is done via video or text messaging as medically appropriate.

We do not bill insurance for any of these services. This is not health insurance. We will explain in detail what services are covered by your monthly payment. Big Tree can at any time explain why your care no longer satisfies the criteria for one of our pathways and direct a patient to receive care elsewhere.

Big Tree Medical Home is a direct primary care clinic that works with individuals and health plans to find solutions for health care in an attempt to create a low cost, high-quality health care experience for individual patients. Under Missouri law, physicians are able to purchase medications from a pharmaceutical wholesaler and resell them to patients. Because we do not have contractual relationships with insurance companies, we are free to sell them at a fraction of the cost that is typically paid at a pharmacy.

FAQs

Birth Control

Can I blame you if I get pregnant or get an STD? I thought these pills were perfect.

No. Oral contraceptive pills are not perfect at preventing pregnancy, they do not protect at all from sexually transmitted diseases and they can cause side effects. They are also used by millions of women to help regulate their cycles, decrease the chance of getting pregnant and to treat other conditions such as acne.

Do I have to get a Pap smear and pelvic exam to get birth control prescribed?

No. This is no longer recommended as it acted as a barrier to women obtaining medication. We certainly recommend Pap smears as directed by various medical and governmental organizations.

Diabetes

Why are glucose test meters not included in the level 1 and level 2 plans?

Most experts agree that patients on only oral medications do not need to test their blood sugar at home.

What about medicines like Jardiance that claim to improve my heart health too? Why don’t you use those medications in your programs?

Medicines like Jardiance are excellent medications, and though expensive, are the right medicine for some. All newer medicines for diabetes are required to be tested to see if they improve heart health. Older medicines were often not tested. Thus all newer, and thus still expensive, medications for diabetes can make a claim to improve heart health, whereas older, generic medications cannot make such a claim.

What if I want to do other medications?

Our regular program, Big Tree Medical Home, has the ability to prescribe other medications. This program was designed to optimally integrate both state-of-the-art medical care and sensitivity to price. Other, newer medications have a role in the care of diabetes, especially if price is not an important consideration. For those patients for who price is keeping them from getting care, we believe this program is optimal.

ED

Who cannot utilize our program?

Persons with Aortic Stenosis, a heart attack or stroke in the past or patients with congestive heart failure or take nitrates for chest pain. Patients with end-stage kidney disease or liver disease or untreated high blood pressure are also unable to join.

General

How does this work for a business?

Big Tree Virtual Medical Home makes an excellent employee benefit.  We like to work inside an insurance plan of some kind, but work with many employers who use Big Tree as the sole employee benefit.  Though Big Tree cannot provide many aspects of the health care system, we typically believe that we can provide about 80% of the care a person will need in a given year.  Not bad for $44/month.  And as you could imagine, insurance plans that include Big Tree are way less expensive than ones that don’t.  We can certainly help you set up a plan that is significantly less expensive than regular insurance.  For more information, email Jen@bigtreemedicalhome.com

What if my health condition requires a physical exam?

Fortunately, few medical conditions require an in person exam.  But some do.  Some coughs need to be evaluated with a lung exam.  Some rashes need to be touched.  Like any Telehealth medical provider, we may recommend that you seek local care.

Is talking to your team as good as going to the Mayo Clinic or some other fancy health system?

Yes and no. In the end, everyone treats diabetes and depression with the same few medications. From a diagnostics perspective, I wish everyone could get care from the top internists at Mayo. Unfortunately, that is not possible. Countries must either ration health care by price or by making you stand in line (Uwe Reinhardt, if I remember right). Our country rations by price. The more you pay, the better your care, and, there are no cheaper options. We are just trying to leverage mobile technology, mid-level providers and generic medications to help lower the cost of care. If you are a multi-millionaire, then head up to Mayo and buy your medications at Walgreens. Or we can prescribe you the same exact medication for a much cheaper price. An insurance broker compares this to buying Busch beer at a Cardinals game or at a gas station across the street from the stadium. Same beer. Different price.

Are the medicines and supplies from foreign countries?

We use the same FDA approved suppliers as any use pharmacy would use. Though it is legal for individual patients to buy up to 90 days of medicine from out of the country (like you can do at pharmacychecker.com), it is not legal for us to purchase medications that are not approved by the FDA. This is all legit.

Who are your doctors and nurses?

Adam Wheeler M.D. is the attending physician, who designs the programs and oversees several assistant physicians. Helena Galstian M.D., Megan Ellis R.N., and Noe Rusaya help patients apply the care pathways. Though this is a new idea, our team has coordinated care for thousands of people in many complex and diverse environments.

What if, after talking to the doctor and nurse, I don’t want to follow one of the care pathways? What if they don’t think they are appropriate for me?

There is no charge.

How long do I have to commit to the program?

We mail you a month of medication at a time. You can cancel any time.