In 2011, he forged out on his own and founded ReforMedicine. From its humble beginnings, ReforMedicine now operates clinics in Eau Claire, Menomonie, Lake Hallie, and Hudson. (A fifth location, Cardinal Healthy, is an on-site clinic for Chippewa Falls school district employees and their families.)

In addition to Dr. Usher, ReforMedicine now has a team of four physicians, three nurse practitioners, a physician assistant, and dozens of other staff. More importantly, ReforMedicine has thousands of satisfied patients and scores of employers who rely on them to help bend the soaring health care cost curve downward.

The secret — which isn’t so secret — is simple: ReforMedicine doesn’t accept third-party insurance. Instead, Dr. Usher and his team offer direct pay medical care, which generates savings for patients and employers.

Primary care has different goals from other kinds of medicine, Dr. Usher explains: “We’re trying to keep people healthy and out of the hospital, so they don’t need as much expensive specialized care.” He compares primary care to preventive maintenance on a vehicle, such as getting an oil change or replacing tires.

And yet, he adds, the way primary care is typically financed is the same way that other kinds of more specialized care are financed: through insurance.

“Americans finance primary care with insurance the same way you finance sick care,” he says, “which makes no more sense to me than trying to charge your auto insurance company for your brake job and your tires and your windshield wipers.” This model creates an enormous amount of administrative overhead, which in turn drives up insurance premiums and medical costs.

“It’s a win-win-win. ... Patients love it, employers love it, and frankly we love it.”

ReforMedicine breaks free from this model. As a direct-pay clinic, pricing is clear and upfront, with no confusing and costly back-and-forth between providers and insurance companies.

Patients need no referral, so they can call and set up appointments, often for the same day. And because they’re not rushing as many patients as possible through the system to boost insurance reimbursements, ReforMedicine’s providers are able to offer longer — and sometimes more frequent — appointments than insurance-based providers. This leads to more personalized care.

“We know as providers that we’re not bankrupting the patient to have them come back once a week for four weeks and follow up with us,” Dr. Usher said. “Sometimes people need that for various reasons, because you’re adjusting a lot of medications or because you just are worried about them.”

Dr. Usher said he finds this kind of medical practice far more fulfilling than the more impersonal insurance-driven model. “What I like is knowing that patients trust me to hear what they are truly saying even if they don’t use words,” he explains. “I like to educate them in ways that work for them. I like seeing the light bulb come on, their eyes light up when they finally go, ‘Oh I get it.’ ”

ReforMedicine also partners directly with employers to keep their workers healthy. Employers contract directly with ReforMedicine to provide wellness physicals, care for chronic conditions, treatment for non-emergency illnesses, and more — including a medical weight-loss program. With ReforMDirect, an employer sponsored membership model, employers can realize 20-40% savings on their health plan spend and see health improvements in their employees.

Dr. Usher believes obesity is an epidemic because of Americans’ carbohydrate-loaded diets. Addressing it — through a combination of improved nutrition, medication, behavior changes, and movement — improves individuals’ health, saves money on medical costs, and even impacts those around them for the better.

“It changes the whole culture of the workplace,” he says of ReforMedicine’s services for employers, “because people suddenly are getting healthier. All of a sudden, there’s a buzz about it.”