My Commitment to Outcomes-Based Payment

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How much is your health worth?

Is being able to ride your bike without pain worth more or less than buying another new bike you can’t ride? Is losing five pounds of fat and feeling better in your body worth more or less than a new couch? Is reducing your risk of accelerated biological aging/premature death, heart disease, diabetes and cancer worth more or less than a new car [1]?

Health is a multiplier

Health is worth more than anything else because without it, you can’t enjoy much else, and with it everything else is more enjoyable. So what stops you from investing more in your health? For many people the answer is that they lack the certainty that a given dollar spent on health will actually improve their health. They have bought treadmills that they didn’t use and have paid for treatments that didn’t help.

Outcomes-Based Payment: You only pay if we succeed.

This is where outcome-based payment comes in. You setup an initial appointment with me and we meet over skype, facetime or google hangouts. I conduct an evaluation, and based on my findings we work together to set a specific goal to be accomplish by a specific date. We agree on the effort you will have to put into doing homework to reach that goal and the number of sessions you will need with me. You purchase and schedule your sessions. If you attend your sessions and complete the agreed upon homework and you still don’t meet our goal then I take full responsibility and refund your sessions.

Health Care Accountability and the Free Market

As a solo practitioner operating in the free market with clients paying me directly,  the success of my business has always hinged on my success as a clinician. My commitment to outcomes based payment is a formalization of my investment in my clients results. This reflects a greater trend in healthcare as third party payer models in health care such as Medicare have moved to outcomes-based payment to control costs albeit without the one on one relationship provided by my model.

An Example: Hiking Pain Free

You have had pain in your right knee off and on for years, Recently it has been getting worse and is especially problematic while hiking. You booked tickets to hike the Inca trail with your partner and a group of close friends next spring and are seriously doubting your ability to go because of your knee. If you rest the knee your pain may reside but you will be too out of shape to do the hike and the knee pain will probably back again when you start hiking as it has in the past. You book a telehealth session with me and I conduct a thorough and meticulous evaluation. We set a 60-day goal hiking on Mount Diablo in Walnut Creek CA, covering 6 miles with 4>,000 feet of elevation using trekking poles and a <5lb pack to replicate the Huayllabamba to Pacamayo section of the trail.

Based on the evaluation I determine that you will need to complete 15min of daily stretching with and three weekly strength training sessions of one hour duration, two of which will be with me. Your purchase a program of 16 sessions valid for 60 days, and schedule your sessions. In our face-to-face sessions I teach you the specific exercises you need and ensure your technique is correct. I help you keep track of your program by sharing it in a secure google spreadsheet that I update and progress after each session. I provide specific guidelines for progressing your hiking, swimming and biking and answer your emails in one business day. We work through setbacks and keep moving forward, reaching our 6 mile hiking goal and setting new goals to further improve your health and get more out of life!

Frequently Asked Questions About My Outcomes-Based Payment Commitment

What Kinds of Goals Can We Set?

The combination of my license as a physical therapist and certifications in strength & conditioning and fitness allow me to help with a wide range of health goals. The goals we set will always be relevant, specific, objectively measurable and have a set deadline. Think of these goals as the minimum level of success at which you will feel working with me was worth the time and money. I will measure progress throughout our sessions and aim to exceed our goals. Here are a few examples:

  • Body Composition: Reduce body fat from 40 lbs to 36 lbs measured by DEXA in 30 days.
  • Pain: Left Achilles tendon pain during 30 min run at 6 mph <2/10 in 90 days.
  • Strength: Complete 5 consecutive dead-hang pull-ups in overhand grip, hands shoulder width apart, chin above bar at top and elbows fully extended at bottom in 60 days.

Goals related to pain are considered physical therapy and subject to the licensure of your location during our session. Currently I only have licenses to practice in MA and CA but will be able to see physical therapy clients in many more states when the licensure compact goes into effect in 2018.

My certification as a nutritionist does not allow me to treat medical diagnoses. I cannot prescribe a diet to cure obesity, diabetes etc but I can offer you science-based nutritional advice even if you have a medical diagnosis.

My personal training license is nationwide, allowing me to work on goals of stength, endurance, speed, power, and mobility even for people with medical diagnoses such as osteoarthritis, chronic low back pain, etc.

If you reside outside the US, check with your local jurisdiction to see if there are any limitations on your ability to work with me.

What if you want to get healthier but don’t have a specific goal in mind?

Many of my clients simply want to maintain or improve their health without any specific goal in mind, and this is perfectly fine. These clients typically acknowledge the value I provide by being there to guide them along the path of optimal health. Without a specific goal to measure, sessions are not refundable on the basis of progress.

What if you just want a single session?

If you simply want an evaluation, a second opinion, my expert advice on a health related issue or a follow up session that is not goal based you are free to purchase a stand-alone session. These sessions are priced 10% higher and are not refundable.



1. 2012 Booth F. Lack of Exercise is a Major Cause of Chronic Disease. Comprehensive Physiology

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