FREQUENTLY ASKED QUESTIONS

Questions worth asking
Straightforward answers

Good questions deserve real answers. If something isn't covered here, the discovery call is the right place to ask it.

THE PRACTICE

  • Your primary care doctor is working within a system built for sick-care — managing disease once it appears, in 15-minute appointments, against a panel of thousands of patients. That model has real value for acute illness. It is poorly designed for what you actually need: early detection of cardiovascular, metabolic, neurologic and cancer risk, a clear picture of where your biology stands right now, and a personalized strategy for the next 20 to 40 years.

    The difference isn't just the tests we run. It's the standard we're working toward. Primary care asks "Are you sick?" This practice asks "Are you optimized?" — and uses the data to answer that question precisely.

  • No. This practice does not cover primary care services — acute illness, routine prescriptions, urgent care. I recommend maintaining a relationship with a primary care provider for those needs. What this practice covers is a different layer entirely: advanced diagnostics, proactive risk reduction, performance optimization, and the ongoing clinical strategy that standard care doesn't have the time or tools to provide.

  • An executive physical is designed to confirm you're unlikely to have a cardiac event in the next 12 months. It's a snapshot. Useful — but limited.

    This practice is built around a 20 to 40-year time horizon. We're not checking whether you're stable. We're building an architecture: establishing your biological baseline across cardiovascular, metabolic, cognitive, and structural systems, identifying where risk is accumulating years before standard markers would flag it, and running a continuous feedback loop using repeat testing and wearables to stay ahead of it.

    The relationship is also different. An executive physical is a transaction. This is an ongoing clinical partnership — with direct physician access, continuous data monitoring, and a protocol that evolves as your life, stress, and biology change.

  • This is a fair question and I'll answer it directly. The interventions we focus on — VO2 max improvement, ApoB reduction, insulin resistance reversal, sleep architecture optimization, muscle mass preservation — are among the most robustly studied areas in medicine. These aren't fringe ideas. They are supported by decades of peer-reviewed research and increasingly adopted by leading academic medical centers.

    What is newer is the integration of these interventions into a coherent, proactive clinical strategy rather than treating each in isolation. That is the practice of longevity medicine — and the evidence base for it strengthens every year.

  • Dr. Rich Stagliano has been practicing medicine for over 25 years, including almost a decade as an emergency room physician — a foundation that instilled rapid pattern recognition, decisiveness under pressure, and a systems-level view of human physiology.

    Most recently, he served as Medical Director at Biograph in San Mateo, CA (2022–2025), one of the country's leading longevity and precision health clinics. He founded this practice — formerly Live Fit Medicine — in San Francisco in 2008, and is now based in Bend, Oregon.

    He holds his MD from Drexel University School of Medicine (1999) and completed his Emergency Medicine Residency in Philadelphia in 2002. He is fully licensed in California, Colorado, Florida, New York, Oregon, and Washington.

THE PROGRAMS

  • There are two entry points, built for different levels of readiness and needs.

    The Longevity Baseline Assessment ($5,000) is a comprehensive, one-time diagnostic evaluation — labs, DEXA, VO2 max, genetics, cognitive function, sleep, and hearing — followed by a dedicated results review with Dr. Rich. You leave with a precise picture of where your health stands and a roadmap for what to do about it. No ongoing commitment required. Read more about the Assessment here.

    The Longevity Membership ($15,000/year) is a 12-month physician partnership that goes beyond assessment to execution. Where the Assessment tells you what's wrong, the Membership is how you fix it — with repeat testing at six months to measure what's actually changed, unlimited follow-up appointments, direct physician access and coaching. Read more about the Membership here.

  • Both programs begin with a similar comprehensive baseline. A mobile phlebotomist draws your labs at your home or office — over 100 biomarkers covering lipid metabolism (including ApoB and Lp(a)), inflammatory markers, metabolic function, hormones, organ health, immune function, and more. Beyond labs:

    • VO2 max testing — one of the strongest predictors of all-cause mortality, and rarely measured in standard care. Establishes your cardiorespiratory baseline and informs personalized training zones.

    • DEXA scan — the gold standard for body composition, providing a precise breakdown of lean muscle mass, bone density, and visceral adipose tissue that BMI and scale weight cannot capture.

    • Genetic testing (Invitae/Labcorp) — clinically validated analysis of hereditary risk across cardiovascular disease, certain cancers, metabolic disorders, and neurodegenerative conditions including Alzheimer's.

    • Cognitive function testing (BrainCheck) — a validated digital assessment of memory, attention, processing speed, and executive function, establishing your personal baseline rather than a population average.

    • Sleep assessment — the Assessment includes a single-night at-home study; the Membership includes a 30-night FDA-cleared study reviewed by a board-certified Sleep Medicine physician.

    • Hearing assessment (Shoebox) — a clinically validated at-home evaluation; untreated hearing loss is independently linked to accelerated cognitive aging and elevated dementia risk.

    • Continuous Glucose Monitoring (Levels): Only for Membership Patients.

    All prior records are reviewed and integrated from day one.

    The Membership includes repeat testing at 6 months.

  • Based on your risk profile and initial findings, I may recommend additional testing. These tests are not included in the price of your program, but I frequently have access to professional pricing and pass those savings directly to you. These may include:

    • Coronary Artery Calcium (CAC) Score — quantifies calcified plaque in the coronary arteries to detect subclinical atherosclerosis

    • Coronary CT Angiography enhanced by Cleerly AI — goes beyond CAC to detect non-calcified and soft plaque, distinguishing stable from vulnerable plaque with AI-enhanced precision

    • Whole Body MRI via Prenuvo — screens for hundreds of conditions including early-stage cancers, vascular abnormalities, and organ-level changes, without radiation exposure

    • Galleri multi-cancer early detection test by GRAIL — a single blood draw that screens for more than 50 cancer types using cell-free DNA analysis

    • Microbiome analysis and other emerging diagnostics — as clinically appropriate based on your individual profile

  • No. Targeted supplementation is one tool among many — and a relatively minor one. The foundation of this practice is hard data: VO2 max, advanced blood chemistry, sleep architecture, body composition, and functional performance metrics. Supplements are only recommended when there is a specific clinical rationale tied to your biomarkers, correctly dosed, and aligned with your health goals. I actively eliminate what isn't working for you — what I call "supplement noise."

  • Yes, where clinically appropriate and evidence-supported. This can include lipid-lowering therapy based on ApoB and Lp(a) levels, metabolic interventions, and other targeted pharmacological strategies. Every recommendation is grounded in your specific data — not population averages or standard guidelines that may not apply to your individual risk profile.

    Please note: Prescription medication is only available in the Membership.

GETTING STARTED

  • No. The majority of care — consultations, data review, protocol adjustments, direct messaging — takes place remotely via video and phone. For diagnostics that require in-person testing (VO2 max, DEXA, and any advanced cardiac imaging), I coordinate with facilities local to you. Lab draws are conducted by a mobile phlebotomist who comes to your home or office. The goal is to minimize friction at every step.

  • I am fully licensed in California, Colorado, Florida, Oregon, New York and Washington, and I serve patients remotely via telehealth across all six states. For patients in the Bend, Oregon area, additional in-person coordination is available.

  • Schedule a free 20-minute discovery call. No pitch, no commitment — just a direct conversation about where you are and whether my practice is a good right fit. Click here to schedule.

  • Yes. Many patients come in managing something — elevated cardiovascular risk, early metabolic changes, a strong family history, or findings that were identified and left under addressed in conventional care. My role is to bring rigorous, data-driven attention to the whole picture, accounting for what's already present, and build a strategy that addresses it. The work is always individualized.

  • No — and that's an intentional design choice. Insurance-based medicine requires volume to be sustainable, which means shorter appointments, narrower testing panels, and care organized around reimbursable codes rather than your actual health goals. Operating outside that system is what makes a genuinely different standard of medicine possible.

    However, some expenses — including lab work, certain imaging, and physician consultations — may be eligible for reimbursement through a Health Savings Account (HSA) or Flexible Spending Account (FSA). I recommend confirming eligibility with your plan administrator.

  • You can contact my team with questions via the form found here.

Still Have Questions?

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20 minutes, no commitment, no pitch.

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