Direct Primary Care Doctor
Dr. Clint Flanagan is the founder and CEO of Nextera Healthcare and North Vista Medical Center. Nextera Healthcare is Colorado’s first Direct Primary Care (DPC) program, established in 2009. Nextera Healthcare members are assessed an affordable monthly membership fee for unlimited office visits and virtual consultations with physicians at North Vista Medical Center and affiliate medical practices. Nextera Healthcare was selected by FierceHealthcare out of hundreds of healthcare companies across the world as one of the 2019 Fierce 15 companies and has been designated as one of the most promising healthcare companies in the industry. Nextera Healthcare has established a community of over 100 clinics throughout Colorado, Maryland, Michigan, Nebraska, Iowa, Florida, Virginia, Wyoming, and the Washington DC area. North Vista Medical Center, voted Best Business by the Longmont Times-Call Reader’s Choice Awards, is a primary care hybrid practice with 6 locations in northern Colorado.
Board-certified in Family Medicine, a diplomat of the American Board of Family Medicine, and an actively practicing physician, Dr. Flanagan has been a fixture in Colorado healthcare for over 20 years. Dr. Flanagan has been named one of the top Value-Based Care Thinkers in 2022, was named to the Top 20 Who’s Who in Direct Primary Care in the US, and was invited in 2019 to be a founding committee member of the Direct Primary Care Mastermind Initiative focusing on serving employers.
Dr. Flanagan graduated from the University of Nebraska Medical Center and completed his residency at St. Mary’s Family Medicine Program in Grand Junction, CO. In addition to working as a Family Medicine physician, he has fifteen years of experience as an emergency physician working in many underserved communities throughout Colorado and as far away as Iraq where he served as an officer in the Army Medical Corps.
An accomplished healthcare visionary, Dr. Flanagan regularly contributes to policy discussions at the state and federal level to ensure physicians and healthcare providers have ample opportunity to deliver high-quality, affordable, and accessible care to families and businesses. He has testified on behalf of DPC and has been directly involved in DPC legislation that passed unanimously in Colorado and Nebraska. He sits on the Steering Committee of the National Direct Primary Care Coalition and during their June 2014 Washington DC conference, he was invited to discuss DPC at the White House. He has also been invited to present his insights on the emergence and implementation of DPC to a wide range of groups, including medical students, residents, and professional associations. His free time is spent enjoying his family and outdoor fitness pursuits in the Colorado Rockies.
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Here's a glimpse of what you'll learn:
Dr. Clint Flanagan's journey from traditional fee-for-service medicine to direct primary care (DPC) and the founding of Nextera HealthCare.
The benefits and advantages of DPC, include improved patient-physician relationships, more comprehensive care, and affordable pricing.
The legislative efforts and challenges involved in establishing DPC programs in Colorado and Nebraska.
The impact of DPC on employer benefit plans and the potential for DPC to provide accessible healthcare for everyday Americans.
Dr. Flanagan's unique experiences as a DPC physician, his involvement in policy discussions, and his recognition as a top thinker in value-based care and DPC.
In this episode...
Dr. Clint Flanagan of Nextera Healthcare shares his journey and experiences in the direct primary care (DPC) field. Dr. Flanagan discusses the benefits of DPC, such as affordable and accessible healthcare for patients. He emphasizes the importance of building lasting relationships between patients and doctors and how DPC can provide comprehensive care. Dr. Flanagan also talks about Nextera Healthcare's expansion, their goal to provide the right care at the right cost, and their knowledge of employer benefit plans. He shares his passion for helping people and his commitment to providing excellent care. Dr. Flanagan also discusses the legislation surrounding DPC in Colorado and Nebraska and the need for better access to primary care for underserved populations. The episode concludes with a discussion on the history of Nextera Healthcare and their success in attracting early adopters to their model.
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6 DEGREES FIRESIDE CHAT—STRATEGIZING PARTNERSHIPS WITH MEDICAL PROVIDERS—THE SUPPLY SIDE OF HEALTHCARE—DR. FLANAGAN DISCUSSES THE IMPORTANCE OF DIRECT PRIMARY CARE
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Transcript*
Direct primary care is an innovative, alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and, in return, builds a lasting relationship with their doctor and has their doctor available at the time. their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model.
I'm your host, Marielle Concepcion, family physician, DPC owner, and former Fee for Service doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care. Direct. Primary care.
Hi, I'm Dr. Clint Flanagan in the Boulder, Colorado area and DPC to me, it means so many things, but if I were just to boil it down, I think it's important for people to know that direct primary care is a model of care. That's arguably the best model of primary care in this country and that it was started by physicians.
That had worked in a fee for service system and said, gosh, we need to do better not only for our patients, but also for positions. So they can remain independent and perhaps own their clinics that they'd like to while many things can be said about. I just think it's really important to know that physicians created this model because we needed to do better than the existing model. I'm Clint Flanagan. I'm a family medicine physician in Colorado. And this is my story.
Dr. Clint Flanagan is the founder and CEO of NextEra Healthcare and North Vista Medical Center. NextEra Healthcare is Colorado's first direct primary care program, established in 2009. NextEra Healthcare members are assessed an affordable monthly membership fee for unlimited office visits and virtual consultations with physicians at North Vista Medical Center and affiliate medical practices.
Next Era Healthcare was selected by Fierce Healthcare out of hundreds of healthcare companies across the world as one of the 2019 Fierce 15 companies and has been designated as one of the most promising healthcare companies in the industry. Next Era Healthcare has established a community of over 100 clinics throughout Colorado, Maryland, Michigan, Nebraska, Iowa, Florida, and New York.
Florida, Virginia, Wyoming, and the Washington, D. C. area. North Vista Medical Center, voted Best Business by the Longmont Times Call Readers Choice Awards, is a primary care hybrid practice with six locations in northern Colorado. Board certified in family medicine, a diplomat of the American Board of Family Medicine, and actively practicing physician, Dr. Flanagan has been a fixture in Colorado healthcare for over 20 years. Dr. Flanagan has been named one of the top value based care thinkers in 2022, was named to the top 20 of who's who in the direct primary care in the U. S. And was invited in 2019 to be a founding committee member of the Direct Primary Care Mastermind Initiative, focusing on serving employers.
Dr. Flanagan graduated from the University of Nebraska Medical Center and completed his residency at St. Mary's Family Medicine Program in Grand Junction, Colorado. In addition to working as a family medicine physician, he has 15 years of experience as an emergency physician. Working in many underserved communities throughout Colorado and as far away as Iraq, where he served as an officer in the Army Medical Corps, an accomplished healthcare visionary, Dr. Flanagan regularly contributes to policy discussions at the state and federal level to ensure physicians and healthcare providers have ample opportunity to deliver high quality, affordable and accessible care to families and businesses. He has testified on behalf of DPC and has been directly involved in DPC legislation that passed unanimously in Colorado and Nebraska.
He sits on the steering committee of the National Direct Primary Care Coalition and during their June 2014 Washington, D. C. conference, he was invited to discuss DPC at the White House. He has also been invited to present his insights on the emergence and implementation of DPC to a wide range of groups, including medical students, residents, and professional associations.
His free time was spent enjoying his family and outdoor pursuits in the Colorado Rockies.
Welcome to the podcast, Dr. Flanagan. Hey, Mariel, nice to see you.
This is such a treat because, you know, we've been on stage in the past couple of years and we've done all these formal things, but it's so nice to just have a relaxing conversation with you. You're back home, I'm back home, and we're really, you know, bringing to the forefront your story.
And I am so, you know, I'm always such a fan of, of hearing, you know, the history of NYX Fair. I totally, You know, I have a little bit of a background hearing your story in little bits because we've been on stage together for the past couple of years talking about DPC. But I also, you know, love, and people probably don't know this, that you were born and raised in Nebraska.
Like, I always love pointing that out because people from Nebraska are my people. And you went to medical school with Dr. John Jacobson, who was formerly on the podcast. He is practicing in Kearney, Nebraska. Dr. Julie Tice, who's another medical school classmate of yours, was my former attending in Superior, Nebraska.
So again, welcome, welcome, welcome to the podcast.
Thank you so much and very much looking forward to this. Yes, you're right. I was born in Nebraska. I grew up there as a kid. Did my undergrad there as well as a bit of, uh, HIV research and some grad school that went on to med school there. And yeah, I met Dr. John and Julie, uh, and yeah, lots of good things come out of Nebraska.
Awesome. I, uh, I'll make sure that Dr. Amber Beckenhauer, uh, replays that also. So she'll love it. So let's get back to your, you know, your roots in choosing family medicine. When you went to medical school, Did you decide early on that you wanted to be a family medicine physician or was that, did that come later in the third and fourth years of medical school?
Yeah, so I had experiences as a kid, including surgery on my knee when I was a ninth grader, I believe, in Nebraska, and so kind of had a, a patient experience there. And then throughout my childhood years had just really good. I'm your care experiences with physicians in the small town that I grew up in and I would say that's where kind of things, let's say, started.
I didn't have any positions in my family. Although I had some friends that had a parent that was a physician. And then early on, I think it was in high school. I got in something called the explorers club and the explorers club allowed us to kind of, let's see. Pick something we were interested in and explore.
And in that case, uh, at the, uh, local hospital in Fremont, Nebraska, as a high school kid, got to learn more about medicine and hospitals. And through that really further solidified my interest in medicine. And so I would say as, as I went into med school, I wasn't a hundred percent sure what kind of doctor I wanted to be.
I just know for sure. I knew for sure. I want to be a physician. And, uh, explored a number of things ranging from emergency medicine to rheumatology, and it was kind of probably through the earlier clinical years, especially I did a rural rotation. So, as a, as a younger med student, you're able to spend some time in the rural community and and boy, I sure enjoyed everything that primary care clinicians could do it. I don't know that there would ever be a boring day.
That was kind of my idea that I had as a, as a doctor in training and, and, and as time moved forward and now, you know, reflecting back on 20 some years as being a family medicine physician, there, there's never a boring day or there's never monotony.
I love it. And totally, you know, those experiences of being in a rural location when you're in medical school, it's, it's incredible.
I remember my husband was told by the medical student who had rotated in Superior. Before he went out there that he needed to get new shoes because if he was going to follow Dr. Tim Blake and Dr. Julie Tice, he needed to walk fast. And so I think it's so special that you were able to see what a true family physician can do when they're given, you know, a community that loves having.
A doctor that knows them definitely gets a little dicey there, you know, over time with when we throw fee for service in the mix, but I love that that was what you experienced going into becoming a doctor and the doctor you are today. So let me ask you when you graduated residency, was it then that you moved to Colorado or how did you make your way out to Colorado?
Yeah, so, uh, like a lot of Nebraskans or Midwesterners, we coming to Colorado as a, as a youngster on vacations. And so doing all kinds of things from, uh, going to the Royal Gorge to seven falls to hiking and Rocky Mountain National Park. I think when I was 15 I climbed Longs Peak and, and so, uh, as a, a flatliner from Nebraska coming out to this utopia of Colorado, it sure had an impression on me as a kid.
And continue to come out here, uh, skiing and camping and those kinds of things. So, when it came time to pick a residency program, my wife and I, who's her name's Deirdre, who's also from Nebraska. We just, we kind of said, gosh, do we want to stay in the Midwest here? Where do we want to go? So I did in my last year of med school.
I did some rotations. I spent some time in Austin, Texas. Spent some time in Greensboro, North Carolina, spent some time in Kansas City, and then also spent about a month at the St. Mary's family practice residency program in Grand Junction. And again, all fun places and great programs, but my number one choice was Colorado and that's how I landed here.
I love it. And when you were deciding that, you know, Colorado is going to be where you guys were going to set, settle down and create roots for your family, were there aspects of family medicine that you loved, especially the reason I asked this is because, you know, given all of those different experiences and having so much exposure to, again, family medicine.
And I compare it to programs that are opposed family medicine programs, where there's very different pathology that people can see in a opposed family medicine program versus an unopposed family medicine program. Yeah, for me, I believe I went to the National Residence Symposium that they put on Kansas City and that might not be the exact name, but in short, there are a lot of residency programs there in figuring out.
Gosh, where would I potentially like to go? And what type of rescue program would I like to be involved in? That was another huge draw for me to Saint Mary's because Saint Mary's is a community based residency program. So there are no other residents and I think around at the time. That I went there around 90 percent of the residents that leave that program go into small towns.
And for me, that was super appealing and with that came up, let's say a level of training that would prepare you for about anything. Right? Including the rest of the program is pretty high. A lot of training in the hospital and the ICU as well as a lot of OB training and there was definitely a point in my career where I thought I was going to be doing OB.
So I was getting lots of deliveries as a resident. So, yeah, for us, as we made that decision, not only was the location very important, but it was important for us to be in a community based residency program and have essentially the year of our mentors and colleagues that were training us and we were the only residents in town.
Right? So it kind of makes a difference versus if you have other types of residency programs in your
training. And I definitely put a shout out to those people who are, you know, applying to residency programs or thinking about, you know, should I do an opposed or an unopposed? It's definitely something to think about because, you know, we've heard from other physicians who have trained in rural programs.
An example is Dr. Phil Hellman out of Michigan at Paradox Health DPC. There is really truly, in my opinion, and I know a lot of people share this opinion, there is a true difference between When you are the only residents in the hospital and when you are one of many specialties in the hospital. So, definitely just want to put a shout out there.
Now, when it comes to your time in the Army Medical Corps, how did that fit into your residency and your position as a fee for service private physician in Colorado?
Yeah, so I got into the Army when I was in med school back in Nebraska. And I come from a family where my almost all the. Men and some of the women family members, both at my parent level, as well as grandparents and then beyond cousins, et cetera, and spent time in 1 of the services, whether it was the Navy or the Air Force or the army.
And as I was in med school and kind of looking at my debt, I wanted to be a bit more proactive. So I was looking at options, all kinds of options from rural repayment programs. Uh, to the military and a friend of mine was in the Army National Guard while he was in med school. He was an MD PhD program. And so that's where I got to exploring it.
Uh, and I really thought that, you know, it would provide me a pretty tremendous opportunity to not only serve our country, but also to to be in a place where I could get some training that I might not otherwise get in the civilian world. And then it was also, let's say, conducive to being a student. So that was maybe my second year or so of med school.
So I still had a lot of training left and they had a program that required an eight year commitment. And so what happened is in typical National Guard fashion is, you know, you spend a weekend in my case, I'd go to Lincoln and then you do a week or 2 of, let's say, 80 or annual training and just work that into the med school schedule.
And then, as I moved out to Colorado, I transferred units and went to a pretty cool medical unit Montrose, Colorado, where we did some fun things like, you know, airplane crash rescue. So I was with a medical unit that gave us some training that, you know, you typically wouldn't get in a civilian world. Or Lincoln.
So, you know, that's, that's pretty amazing. Now, how did that work for you? Because for those people, like Dr. Jenna Silikoski, who've been on and they were in the army and then, then they bought their DPC. I don't actually remember when Jenna went into the military, but for you, when you were in the army national corps during medical school, and then also during residency, how did that work with your training program?
Did you have to take off? Certain amount, a certain amount of time and then extend your residency so that you could do your service while a resident.
Yeah, so at least at the time, fortunately, I would say both on the training front with regards to med school and residency as well as the military front.
There were flexibilities, right? And scheduling where you could make it work at least back when I was moving through. So, with the Army National Guard, uh, you know, I'd leave, uh, Omaha and, and then, uh, go to Lincoln an hour away and, and, and do some training with, uh, the medical group I was part of. And with that, they kind of, in general, put you in with a medical group versus, let's say, the infantry, right?
Because they want to put your, put your skill set to use. And then that would happen once a month where I'd go down for that weekend training and then as you fast forward into, let's say, 80, I was able to work it out with my electives where I believe it was pretty involved in wilderness medicine. So, I did a wilderness medicine on Jackson hole, Wyoming, and I want to say, I was the 3rd or 4th year met student at the time.
So. That worked out pretty well, because you're on a medical student budget, and yet you can go do this wilderness medicine course in Jackson Hole, Wyoming, and mix in some nature with a little bit of training with really cool guys that know a ton about wilderness medicine and emergency medicine. And that was part of the annual training experience with the military.
Right so that, let's say, accounted for me. Hitting certain criteria, and then, as you fast forward into residency, same kind of thing. In fact, my last year of residency. I worked it out where I did a, uh, my annual training in Oahu at Schofield Barracks. And so as one of my electives in residency, I, and my wife Deirdre at the time, and my, we had a daughter at the time, went to Hawaii.
And I did my elective while I was essentially getting paid as a resident, and then also got paid because I was, uh, fulfilling. The requirements of the Army National Guard, and I'll never forget my, my mentor at residency, his name was Dr. Sherman Straw. Sherman was like, Flanagan, what are you doing again?
Like, you're going to Hawaii for a month rotation in medical care and you're getting paid for that? I'm like, it's my electives, right? Like, you could do electives as your third year. So that worked out super well. So when I said, you know, it kind of afforded me opportunities that I might not otherwise have, would have had.
That that was 1 of them and a great training at Schofield Barracks and got to see a bit of Tripler and do some things in Oahu that I would have never probably had done just through my regular residency program. Right? And then with that, there was also loan repayment that started kicking in when I was a resident, which was very helpful.
That's awesome. And, you know, again, just talking to those people who have not yet finished residency, it's definitely something to look into because there's lots of opportunities to craft your electives the way you want to. So I think that's awesome that you crafted your residency elective so that you could be in such a place.
I think that's super awesome that you were able to get paid like you did for, for being in that experience. But also, you know, for, for those people who are wanting to do things like. Go to conferences or pick up certifications, you know, do phlebotomy skills, whatever, like, think about, you know, in residency, you really have a lot more time, I feel, than in your own practice, whether you're in fee for service or you're opening a DPC to do more exploring.
And it's also typically cheaper if you do things as a medical student and as a resident versus when you're a new grad. So definitely things to think about for those listeners who are out there, you know, who haven't yet graduated residency. So, with that, now you went from all of this experience to working in fee for service and you were with a multi specialty group for quite some time.
So tell us about that experience because, you know, for, for someone who has this broad range of exposure, you know, wanting to stay in Colorado, get that, but how did you pick that particular clinic to work in and how did that change over time?
Yeah, so, you know, while you're a resident, like, in your 2nd year, usually, sometimes your 3rd year, you're saying, gosh, what do I want to do after residency?
So, we were in that lane and we knew in general that we want to stay in Colorado. Uh, we were on the Western slope and Grand Junction loved it, loved living there, but all of our family in general was back in Nebraska. So we want to move a little bit closer. So we started looking really from Colorado Springs all the way north up through Denver into the Walmart, Boulder area, and then up to Fort Collins.
So, I did some rotations, including my 3rd year, I spent, I think, about a month in Fort Collins. With a family medicine group called associates and family medicine. Great group. Uh, and there was a Nebraska doc, Dr never be that had worked there. So, kind of falling back on Nebraska ties and spend a month.
They're working. And then we explored the front range. Colorado knew that that's kind of where we wanted to land. And then through another colleague who I think I had connected with, I was serving on the Colorado family physicians board as a resident. They were working with a group in Longmont, Colorado.
That was about a 50 doctor multi specialty group. So, through some conversations there, I found out that they were hiring and actually building a brand new office in a small town. And so that was super appealing, uh, that I could move into a new office that was in a small town and that small town here in Colorado had never had a primary care clinic.
So this was think of it like a satellite office of the mothership and essentially, uh, I had the opportunity to be hired along with another, uh, couple of docs, including a pediatrician and we would be that small town's 1st clinic. And then I would come on essentially as a physician and the compensation benefits package was was nice and and moving into a group that was all owned by doctors and having the ability to have a partnership track where I can eventually become a partner for a couple of years or so.
And. So that seemed to me very appealing, plus kind of had the safety net of just from a compensation work perspective of having a lot of doctors around me for support. There were a lot of offers at the time, but for me, I want to be in a physician owned group. And so that opportunity came up and went forward with it.
And, you know, it, it still continues to be a very attractive option for people. You know, I was just talking to third year residents from my former residency who were, you know, they didn't know about DPC at the time. But one of them. I think went to a practice where she was buying in to be a partner in the Bay Area.
And then when I was in residency, a class above me or two classes above me in the class below me, they went into practices that were physician owned, um, where you could be a partner. And, you know, I, I definitely would say that that is still a thing. Like as, as we talk about fee for service and when we talk about, you know, corporations owning a physician clinics and, you know, Contracting physicians as employees, there definitely are options still where there are physician on clinics.
So it's definitely something to look into, especially if you're considering, like, maybe DPC in the future, but right now fee for service, it's definitely still a thing. So, when you talk about it being physician owned, and when you talk about, you know, really embodying this full scope, small town family doctor in your area and being the go to clinic for your population, your community.
How did it change over time to make you start thinking about there's got to be a different way to do medicine.
Great question. So coming out of residency and super excited about, you know, moving to a new town. My wife and I had built a new house and we had, we're building our family with my new daughter, Kira.
And just, you know, you're, you're kind of a greenhorn resident and moving away from working a hundred hours a week or 120 hours a week back in the day, they didn't have parameters on 80 hour work weeks with us and just really ready to, to, to be a physician in that setting. Residents typically graduate like in June timeframe ish.
And so I got a call to duty letter from the army. I want to say maybe in July, August. Right after residency to go to Iraq in October of the year that I graduated from residency. And so you can imagine, you know, we're moving to a new town meeting new people. Our clinic technically wasn't finished yet. So we're on a small clinic, right?
Downtown this small town. Um, myself, pediatrician, some staff, and that was about, let's call it August. And and then in October, I went to Iraq and and so I had, let's say, a couple of months of experience. But this was a clinic where there were no patients because we were brand new. And so, you know, we, the pediatrician, Wade and I.
Would joke, you know, we could go have, like, an hour or 2 lunch and then work out for 2 hours. And it was so much fun. Meanwhile, why we're stopped salaried and obviously we want to build a clinic. And by the time I left, I was seeing, you know, 30 patients per day, but it was just a lot of fun as a small town, new physicians getting to know everybody.
We got to lunch with the mayor and then we'd go out and connect with the people that own the golf course. And then. Connect with the local banker and connect with townspeople. And it was just, uh, it was kind of like, let's see what you might envision if you're moving to a small town where there never, never was a clinic.
So, a lot of this, let's say, a small town romance or whatever you want to call it. Right? Where. You know, just excited to start seeing people taking care of the community. And this is the kind of thing where, like, we're literally on the front page of the paper. The paper was called the farmer in the minor.
The editor was actually my patient in that same paper. I remember there was a picture of me and my daughter Kira in the headline was doctor goes to war. Like, so, so really, you know, got to embrace this community, live there and came back from Iraq, um, in 2005, and then start practicing and, and just really excited about taking care of people in that community.
And then, you know, very quickly, you, you start to learn, or at least I did about just a bit of the business of medicine and this weird billing and coding stuff. That you have to do, and you just do it. And at least that's what I did. And I'll never forget, like, my favorite person was a gal that worked in the coding office for the multi specialty group.
So I learned so much from her because I, that's the way the business is handled. And so when you're seeing 5 or 10 patients today, that's 1 thing. But when you start to see 25 to 35 patients today, you know, you really have to become. Quite experienced it at the billing and coding piece. Otherwise, it can really occupy a huge chunk of your day.
And usually, most of us just want to take care of people. So, learned a lot about that piece and then with that very quickly found that gosh, there's got to be some different options when it comes to. Providing care for people. So that's what kind of led us down a pathway of, you know, how do we better do this?
Yeah. How do we do it better? For sure. And that's, you know, like you, you said, you know, and we're, we're alluding to the, the journey that you've taken through Nextera Healthcare. But it's so interesting that when, when we talk about numbers, right? Like we hear these numbers, like 30 to 40 patients a day and you have how many people on your panel and then people very frequently in DPC talk about like, you know, how many do you see a day?
Like, what percentage of patients do you see on your panel per day? And even if we look at like 1%, it's like, okay, 1 percent in a DPC practice versus 1 percent in a fee for service practice that is like pumping out people, you know, visits like 35 to 40 a day. It's like. That's how you get 3, 500 to 4, 000 people is like if you have that many people and you're seeing 1 percent of that population, you know, just just I put those numbers out there just so people can see the stark difference between 1 percent of 4, 000 versus 1 percent of 600 is a very different number of patients that you see per day.
And so, you know, when it's something that I was thinking about. Like, if you can't get during an interview at a fee for service place, like, how many people do you have on your panel? Because, like, for example, I know physicians who they can't get that information from their corporation, but if you ask a person, like, how many people do you see a day?
And you can do the math backwards, like, if you see assuming 1%. This is how many people they approximately have on their panel. It's another way to interview a place if you're looking in a fee for service position before doing DPC. You know, there's, there's all these things that I learned as a DPC physician that I, you know, Oh, I could have asked something about like, for example, how many physicians have stayed in this area over the past seven years?
How many family practice physicians have stayed in this area of the past seven years? There's, there's things that I, I look at now that I'm like, you know, I wish I would have asked those questions before, but you know, hindsight is 2020. So with that, though, I wanted to ask about your salary because. When you started and you're on salary, even though you're coding, because that was very much how my journey was, it was like, you show up, you do your codes, however, you're still getting this magic salary, so it doesn't actually matter what you code at the end of the day.
Did you transition from salary to RVU production at a certain point? Yeah, and sorry if I confused you there, but we had our base salary and it was productivity on top of that. So, yes, that's why I wanted to become a master of coding because that's how it was paid. Gotcha. Yeah. And so we had, uh, as a multi specialty group to, we also had some ancillary services.
So we had an ambulatory surgery center. That's essentially all the partners share profit in. We had an imaging center MRCT scan mammography that we share profit in. And so, so you're, you know, a multi specialty group with a CFO and, and those were lanes that primary care clinicians could, could share.
Those lanes would impact our compensation is the short. So, so yes, you know, that's why I definitely became very familiar with well, what's the payment between a 99213 and 99214. And, you know, understanding the details of your. 10 to 15 to 20 different insurance contracts, like all this stuff that you don't really get much insight into when you're in a med student or a resident, you come out into it and you're like, wow, who designed this, who designed this because it's getting in the way of my patient care, it's getting in the way of my family time.
Well, like you said in one interview, how you were tired of. You, you became tired of looking in the ear of the insurance person who was then looking at your patient with no actual care for what, you know, their health was, they just saw codes. So, you know, it's, it's something that the people who are listening to this podcast are very familiar with, sadly, but, you know, we are all changing the culture in America, so love it.
Now, when it came to you, You know, working in this model of base salary fee for service production, you know, being a part, you know, working towards partnership, getting a cut of the, the profits that were made at the imaging center, et cetera. How did you decide not only there need, there should be a different way, there has to be a different way, but how did you decide to transition into the direct primary care space?
Yeah, so, uh, there were a couple of chapters there, uh, and one of those is, uh, I was part of that group that really, when I started with them, I really thought that was going to be the job for the rest of my life and about 2 to 3 years in just started getting concerned about the way administration was handling things.
And the short story on that is within a period of about 2 years, 20 of the 50 partners left that group and left. And some of them were neurologists. Some were orthopedists and Lily walked across the street to a certain extent in town had a non compete wrote a 100 and some 1000 dollar check and start practicing as a orthopedist or start practicing as a neurologist in my case.
I, the street was a little longer because I went 15. 1 miles away. which was my non compete and literally put up a clinic 15. 1 miles away. And so kind of have that experience. And at that time I joined, uh, Colorado's largest healthcare system, Santora Health, and helped them establish a clinic in the North Metro area.
So that chapter it's important to bring up because again, this is me coming out as a resident thinking I was going to have my forever job. In a brand new clinic in a small town, and I didn't leave that job because I was dissatisfied with compensation. I had a really good compensation benefits package. I left it mainly because I was concerned about the way administration was handling things.
And I wasn't the only doctor. And so. During that time, I continued to do emergency medicine. So, back in the day, us residents would moonlight in the, in, uh, small town ERs. And so I started doing that as a, gosh, I think a 2nd year resident into my 3rd year and then continued on doing, uh, working in emergency rooms in small towns here in Colorado.
And that was kind of giving me this other lens. Right of the, um, let's say, at a high level, the dysfunctional healthcare ecosystem. So, in the and, you know, have the patients coming through or non emergencies. So, having that experience, and then the experience is a primary care clinician and then as well working for largest provider of health care in our state for a couple of years.
It just really kind of got me to thinking of, gosh, can we do care a different way? We're going to do the care that we want to do with a different model of business because the existing model, I'd had enough experience in it that I'm like, I can't do this for the next 20 to 30 to 40 years of my life. I just, I can't, there's gotta be a better way.
So I had kind of enough experience that led me down to a lane of, I gotta do something different. And then bring us to your fateful year of 2009 when you, I believe that was when you met Dr. Garrison Bliss. So tell us about that meeting and like, you know, as I think about all of the people learning about DPC and starting DPC and they're like, Tell me about this.
Tell me, how did you choose it? Like, I wonder what that conversation was like, because DPC didn't have a Facebook group back then. Like DPC didn't have laws back then, you know? So, so tell me what was that conversation like and how did it really codify your path forward into like, great, I have, you know, this experience with fee for service.
I have this experience with, you know, being a pioneer bit in bringing care to communities. And then deciding to use that knowledge and go into DPC.
Yeah. So I'm so thankful that I met Garrison. Uh, so thankful. So back in 2009, I had started North Vista Medical Centers. So I had left Centura Healthcare amicably and had the opportunity to open up my own medical center.
So I opened up North Vista Medical Centers, which was a fee for service practice, and then, uh, simultaneously was thinking about doing. Primary care with a different business model. And so in the early days there, we just called it monthly membership medicine because we did not know what DPC was. There really wasn't much of it at all in the country in 2009 outside of maybe garrison and maybe a few others and moved forward with our monthly membership medicine model.
So we had our name. We had logos and marketing material and mainly who we were advertising to our own patients and saying, hey, listen, we're going to do this monthly membership medicine. It's 99 a month, unlimited care, connect with us at any time, meet you in the office after hours, et cetera. We'll take care of you.
And there's no copay or bill, just pay that, you know, proverbial gym fee. So we were down that pathway. And at the time I was a member of the American Academy of Private Physicians. So AAPP is no longer around, but in the AAPP was a lot of docs that were independent docs. And a number of them were concierge medicine docs.
And so, so very much involved in that, and the AAPP was having a conference in Denver, and I want to say this is probably 2011. 2011 ish. Okay. So it wasn't in the beginning for us. 2009 was 2011 and Garrison was going to that. And essentially we were like, Hey, how about we buy a dinner? So I'll never forget it.
We went to the Kevin Taylor restaurant in Denver. They had a little area down below. That was kind of the, the, the, the, let's call it like a wine cellar is what it looks like. And we had, I don't know, a 2 or 3 hour dinner and a couple of bottles of wine and just, you know, it was so good to, to let's say, uh, find a friend, um, that, uh, was calling what he was doing direct primary care.
And, of course, we'd done some research prior to all that. So, uh, realized that he had, I think at the time, maybe it had had, um, interestingly, Jeff Bezos, uh, and Michael Dell, like Dell computers, and maybe a few others help him out financially. And so we figured, gosh, those are really smart guys. Helping Garrison out and they're calling the thing direct primary care and it's very similar to what we are doing.
We should now start calling ourselves DPC is a little bit of the story. It's a longer story, but that's a little bit of the story. And. I can't tell you how good it was to meet him and then to also, not too long after that, David Chase started writing about direct primary care in Forbes magazine. And then David was kind of the emcee at the first DPC summit, which was put on by the family medicine education consortium in St. Louis, uh, when Larry Bauer was running things. So Dave Chase was writing about this. So there were kind of a number of really pivotal, important pieces for us. To, to your point, it helped solidify what, you know, uh, some cowboys in Colorado were doing, uh, and, and maybe it wasn't so crazy, right? Well, tell us about then, you know, when you're talking with Garrison, when you're seeing Dave Chase talk and write about DPC, and you already have this membership model, you know, under your belt.
That you had, you know, like you said, marketed to your own patients. How did you then re market the direct primary care, that title specifically, to your patients, whether they were on membership or whether they were still fee for service?
Yeah, so you can imagine a lot of this is happening within the smaller community that we essentially kind of been in and known for years.
Right? So, we had all the way back to the very beginning, right? So residency had been going to chamber of commerce meetings. I had been talking to small business owners, so very much involved in the community and and part of that remember was around the time of the passage of the affordable care act. And while we had hoped that the Affordable Care Act, which essentially had really good intentions in the beginning, but maybe kind of fizzled out in the 4th quarter with regards to insurance companies and their involvement in it.
We had hoped that that kind of had been, let's say, a solution for primary care, but really what it was, was more and more people having like, high deductible health plans and not really getting, let's say, better if Or more primary care. That's my short synopsis on that. But, uh, so part of it was like, hey, listen, we understand you have this high deductible and you need to follow up with me with regards to your diabetes and your high blood pressure.
And I know you're going to be out of pocket for those visits. So 1 option is you can join next era pay monthly fee. And then kind of over time, we'd say, you know, this is called direct primary care. It's a model care created by physicians that solve problems. The existing fee for service insurance model.
And you pay a monthly fee. And again, we were setting numbers back then. It was 99. Like, we didn't have a lot of books to read or places to go. Uh, we just, so back in the day, it was like, let's just keep it under a hundred bucks. Um, and part of that was, you know, if you can afford a cell phone bill, which most people had, few people had cell phones back then, not, not like it is now, but, uh, you can afford what we're doing.
If you can afford your cable bill or your Quest bill or, or your Comcast, right? So that was kind of the idea in, through those relationships in time, we, Just realized a lot of people, small businesses didn't have any kind of health benefit for their employees. So that's where the light bulb went on for us.
So, hey, maybe we should help start taking care of them. And so we say, hey, it's 99 and you, the employer that owns your company, you can decide how much of that you want to play and then pull the rest out. Maybe you can even pull the rest of their paycheck pre tax. So that's how the, let's say the wheels started turning when it came to, we have an opportunity here to take care of employers in our town.
And most of these were small businesses with less than 50 employees.
That's awesome. And that's what I was going to ask, you know, in terms of the people who were joining on to your practice and to this new model of healthcare in the area with the ACA passing, like how did, or who was joining your practice?
And so, because I know like now Nexstar Healthcare is very much predominantly. Serving people who are getting care through their employers. And so, you know, it's, it's very interesting even back then how, you know, small businesses like you're talking about were really understanding before having, you know, the pandemic show people like really what is wrong with American health care.
They were very open to, hey, like, this totally makes financial sense and it makes medical sense for our employees. So I just love that, you know, they were early adopters. Now, when it came to, I just want to take a segue here into Nextera, because I don't actually know the history behind Nextera Healthcare and how did you come up with the name?
So there are a number of chapters, I'll give you a few of them, but one is our original name is Revolutionary Healthcare. That was, I think at the time I was listening to Muse, a band that I I liked back in the day and still like a lot today and they had a song called uprising and things were a bit of a revolution and that's what we were doing.
Right? Like, that's where we were at. We had this charge and and this was a change. Some of it was to restore the way things should be in primary care. Others was to disrupt and innovate. So, very early on, we also figured out. I can't recall. I think it was through our attorney that a gentleman by the name of Steve case, who.
Owned aol. com dating me a bit here. I had a company called revolution health. So that's where we're like, okay, maybe we shouldn't go up against that from a trademark perspective. So, that's where we hired a marketing company and the boulder area as well as a few other marketing companies to try to come up with a name.
And at the end of the day, it was my wife Deirdre. Who came up with next era and so for those of you that don't know it's it's next era because we weren't happy with the existing era of fee for service medicine. So we wanted to create the next era of healthcare. So that's how next era healthcare came to be.
Love it. And I will say like people, you know, who are hearing the Muse reference and stuff like they also don't know about the DJing. So please do put a little bit here about the DJing before we go on.
So a buddy of mine, Scott and I, uh, back, it started in high school where we started DJing proms and homecomings.
And, and that morphed into a little bit of college where we do house parties. And again, date myself here, like DJing did not used to be show up with your laptop and Spotify. So we literally would. Burn tapes with a Sony dual cassette recorders and make tapes and we had literally albums. So our setup included, you know, the Sony dual cassette and including, uh, we play albums and a lot of times, you know, it'd be a 2 to 3 hour cassette taping.
So we'd have to put a lot of time into that. And you have to think about the crowd and, and the different types of music and the genre you want to play. And then we have our light show, and it was all kinds of fun stuff in high school. And then around, gosh, 1988 or 89, the Sony 5 changer CD player came out, revolutionized what we were doing.
And so, uh, yeah, that was a whole fun chapter, you know, that, like many of us, you know, very into music. And for us, that actually has relationship to our company and how we named it Revolutionary Healthcare as we fast forward.
I love it. So, you know, kudos to Deidre for coming up with NextEra. I love that, you know, it's very, it's very forward thinking.
It's still revolutionary when it comes to, you know, how NextEra as a, as a company was set up, how did Deidre continue to be in the fold? And I asked that just because especially like. Working with family members, like clearly there's lots of examples in DPC, people who are doing it, like Dr. Emily Scott and Dr. James Gore, who we, we both saw down in San Diego a couple of weeks ago. There, Dr. Amy Austic, Dr. Brian Austic, you know, there's another example, but how did you guys decide that both of you would be coming into the fold? And how did you set up roles in Nextera Healthcare with both of you? Yeah, so obviously, as a spouse, you know, conversations happen and in this case, she, she has a background and expertise in business and marketing and, you know, you're bootstrapping things and wanting to make things work out.
So, a lot of conversations right about, hey, how can we do better a lot of back and forth? And so, fortunately, I kind of had. This great sounding board, let's say, you know, obviously there, let's say, at a high level or so, there's a little bit of crazy and it was always good to come back to her have a little bit of grounding and say, what do you think?
And to have those conversations because we were really pioneering a new way of care here in Colorado and she was very, very instrumental in that moving forward as as we were down a pathway. We needed help. Right in, didn't quite go to chase bank and say, give me a half a million dollars and hire a bunch of people, right?
You're bootstrapping things and, and fortunately was able to be in a circumstance for, you know, my wife had a ton of expertise in business and marketing and could help. So that was a super helpful and I'm forever grateful for that. Uh, as we moved forward and our company started kept growing and growing and growing that, you know, there it is in a role where she's the VP of operations.
So, she, for years has ran all kinds of things from HR detail to payroll to hiring, firing, uh, et cetera, et cetera, and really helps on the strategy front and helps on the marketing front granted. We, we have other people that help us. Handle the detail, but she helps with regards to the strategy on a number of those pieces and it was that way years ago and it's, it's still that way, you know, fast forward to today.
It's so cool because again, especially with the both of you really, you know, from the ground up embodying what it means to be, uh, providing healthcare at Nextera Healthcare specifically, it's very cool to not have to, you know, onboard someone and teach them the principles or teach them the values. Like.
You guys created them, so love it. Now, when it comes to, you know, your opening statement, and you talked about how direct primary care really allows physicians to, to do the doctoring that they went to medical school to do, you have affiliates for next door healthcare. So tell us about how did growth go from providing care in your community to providing options for people to become affiliates?
And still, you know, practice under their own DPC flag as an XTERRA healthcare affiliate. And how does that work in terms of getting patients? Because it's, it's not just in Colorado.
Yeah, so I think it's important to remember. So we started off with one clinic. This is back at a time when there was no DPC in Colorado.
And maybe there's just a little bit across the country. And as we started having members sign up, or patients, right? We like to call them members. Uh, we were very much retail oriented. That was, let's say, the majority of our membership high. And as we continue to really have people join the gym. I mean, again, you can have a good idea, but then you have to have the strategy and the execution on that front.
We're like, gosh, maybe we are kind of onto something and it was kind of 1 piece after another, uh, you know, meeting Garrison, Dave chase writing about things just. Things moving in the right direction. The American Academy of Family Physicians bringing about five or six of us into this like think tank where we had a moderator for a week long weekend because they wanted to really understand us and see how we're different than concierge medicine.
Like these pieces, you can start to see this evolution. And then, you know, our first employer group signed up small company and this gentleman didn't have anything for his employees. And then, you know, now he can offer this awesome benefit that actually puts him in the marketplace as an employer. Puts him in a more strategic position because now he can tell his HVAC technicians that, hey, listen, you can see these guys and you want for your primary care issues.
Granted, they're not insurance. They're not going to, you know, help you with an ICU stay, but they're going to be your doctor. And so that was pretty cool for that owner to be able to pay for that. And then for those employees to have this really nice direct primary care benefit. And again, we had to explain this to them, right?
They had no clue what DPC was. We just say, hey, you're going to get your position and, and literally text me back in the day. We didn't have spruce. We didn't have elation. We didn't literally, it's like, here's my cell phone number. And so through that, uh, we got to get traction with, uh, let's say, uh, bigger employers and opportunities there.
And our very 1st affiliates weren't DPC doctors because there were no DPC doctors are very 1st next era affiliates were physicians that I knew and guys like down in the Colorado Springs that I just great docs that I knew and trusted and I said, hey, would you be part of this? And literally it was a, it was like a handshake.
At a Colorado Academy of Pham Physicians annual meeting in Cheyenne Mountain Resort in Colorado Springs, right? It was like, would you come on board and and and we'll pay you per member per month as they come on to you. Uh, but for us to, let's say, put up a brand new clinic in Colorado Springs when we're an hour and a half north of there for only a few members, like, financially, that would be very, very risky for us.
So, you know, we're again, we're, we're bootstrapping it, so we're, we're not going to put. 200, 000, 300, 000 into a brand new clinic down in Colorado Springs. That being said, there are good doctors that were already at down there that owned their own clinics. So, for us, that was part of the, let's say the filter, like, it wasn't us going to a large healthcare system saying, could you be part of what we're creating?
It was us going to our friends that own their own clinics. So kind of this goes all the way back to, like, Nebraska, like, like, it's really important to have physician ownership and or physician leadership in medicine. And back in the day, years ago, a lot of physicians own their clinics. It's just thrilling to me to know that we're starting to see in 1 case, more of that courtesy of DBC on the flip.
Less of that because big systems are acquiring primary care clinicians. So, you know, interesting to see, let's say that chess game and all of us know what the better way is.
Amen. Amen to that. Now, when you started going beyond the, the handshakes with these friends who were, you know, people that you trusted, you definitely expanded and, you know, for example, to the state of Nebraska.
And so, tell us a little bit about how Strata Health came into the fold and how it became something that if you're a state employee in the state of Nebraska, you could tap into DPC. Yeah,
so as a Nebraskan, even though I've lived in Colorado for 20 some years, it bothered me that Colorado had, I'm sorry, Nebraska had no DPC.
And so Senator Murphy, who I think previously was the CEO of children's hospital. Senator review just a phenomenal gem and. He had called me and said, hey, listen, I understand you're doing this thing. I'm a senator in Nebraska, and we'd really like to pass legislation here to make Nebraska even more friendly to direct primary care.
So I said, yes. And went back and he held a symposium for senators in Nebraska as well as businessmen. And in fact, I think the luncheon was at Blue Cross Blue Shield, which is unbelievably hilarious. I think hilarious thinking back on it. And so we passed or I'm sorry, we knew that there was going to be some legislation that was likely going to pass.
And my old essentially attending in medical school, Dr. Joel Besmer, who runs a tremendously successful concierge practice called Members MD in Omaha, uh, Joel and I kept connecting and mainly we were connecting through Concierge Medicine Today's forums. They'd have these conferences down in Atlanta and Joe would speak on the concierge side and then I would speak on the DPC side.
So, so let's say through the evolution of that and knowing that Nebraska was going to be, let's say more open for DPC. We said, let's think about solving for that. And it was a lot of fun because about once a month, I'd fly back to Nebraska and essentially I would pitch the next era idea to employer groups and Joel was taking care of the C suite of these employers because they were part of his concierge practice.
And so that was a lot of fun, and that's essentially part of how Strata was born. Let's replicate what has been working in Colorado with Next Era Healthcare here in Omaha. And fast forward to today, uh, or to your point, um, through that process. Well, first off, the legislation passed unanimously, okay?
Democrats and Republicans. Passed unanimously, number one, and Governor Ricketts at the time, from the Ricketts family, signed that into law. Uh, we were pretty excited about that, and through that came an opportunity to take care of the state employees. So that's a little bit of background on how the legislation passed, how state employees are able to get DPC, and then how STRATA was
created.
It's such a powerful example of how DPC can really be made accessible to everyday Americans, right? It's like, you're a state worker, I mean, like, I grew up in Sacramento. Everyone's a state where everyone's parents are state workers where I'm like, this is so sad, but it's like, I didn't know actually what our parents did.
They just worked for the state. Right. And so it's like, it's so awesome that, you know, everyday Americans could access direct primary care and not just like you said, you know, just those C suite people who Joel was taking care of previously. So when we talk about law and where law can help, you know, DPC be protected in certain areas.
Where, you know, this, this interview is coming on the heels of Jake East talking about the three bills that are on Capitol Hill as of this recording, it would be amazing if things magically passed by then by, by the time it airs. But, you know, there are three bills, which is incredible, you know, compared to bills about family medicine or primary care in general.
These are DPC focused bills, looking back on laws and DPC, tell us a little bit about Colorado and how Colorado came to have a DPC law, because like there's other places in the states that do not have DPC laws, like Jay pointed out in his interview.
Yeah, so we in Colorado started around 2009, you know, with the idea, I think we were finally seeing patients around 2010, 2011 that were next to our members.
And we moved forward with taking care of employer groups and, you know, fast forward to, let's say 2016, understanding there are like, some changes happening at the federal level. We said, maybe we should put a law on the books here in Colorado, even though we've been doing business for years and and part of what gave us the ability to, let's say, do that business and be pretty reassured is very, very early on.
We met with the division of insurance here in Colorado and I'll never forget it because. We said, hey, you know what we're doing is primary care and she's like, you guys aren't going at risk. You're not an insurance company. Go do what you want to do. Like, I'll never forget that. So we're like, let's go.
Let's get members on board. Let's keep growing our business. And we don't have to worry about the division of insurance coming after us thinking that we're somehow insurance. I mean, we're charging 99 bucks a month. We don't have millions sit in the bank. We're not taking risk. So, that's how we, uh, and part of that was, like, get membership, right?
And then have friends in lots of places in case the bogeyman come out of the bushes at you. So, that was part of our strategy. And then, as we started into, like, 2016, 2017, and then seeing some other states pass legislation, we said, gosh, maybe it is time here in Colorado. And, you know, there are times where the DOI head can change, and there's times where the governor can change, right?
So, we, uh, with the Colorado Academy of Family Physicians, so CFAP was, uh, tremendously helpful and supportive here, and, uh, we put some legislation through. There were those of us in Colorado that were DPC ers, so we testified at the committee levels that, uh, then passed unanimously, it went to, uh, the House and Senate, and passed unanimously out of both the House and Senate, And then, in that case, Governor Hickenlooper, uh, signed it into law and actually had a DPC signing day, which was unbelievable.
Right? So, all of us, Dr. Lisa Davidson, myself, Dr. Bender, Dr. Mike Keller went to the Capitol and I'll never forget it because I also brought my 3 kids. And governor Hickenlooper gave my kids a pen, essentially, that he had signed that bill into law with. So I think it's just testimony to the power of direct primary care that here you have a Republican governor in Nebraska, and it passes unanimously.
Let's say, in a more conservative state, then you have Colorado with a Democratic governor, and it passes unanimously and signed into law, like, essentially what these laws said was. We're not insurance, so therefore the division of insurance is not to regulate what we do. We already know that the law of the land, the Affordable Care Act says that DPC plus a qualified health plan meets the requirements of the ACA.
So we already have that federal law and now you see, I think, gosh, over 30 some states that have these state laws. And then, of course, we have some states that are laggards, uh, that are still trying to sift things out. They're just laggards. And one of them I'm going to call out is Alaska. It's far past time that Alaska needs to get this done so the citizens of Alaska can have access to DPC, which they should have had that years ago.
And, uh, there, there have been some hurdles in the way, but yeah, exciting to see the stuff that's coming out as a veteran. Gosh, I would love for vets to be able to have access to direct primary care in a way that's different than what it is right now, which right now they, they do have access. They pay out of their own pocket.
I'd much rather be that our government step up to the plate and pay the average. 80 or 90 that it cost to join a DPC practice in this country for vets. Like, you want to really want to change care? Don't spend billions more on vet centers, spend billions on direct, actually millions, doesn't need to be billions on direct primary care, and you're going to see a change in this country.
It's amazing, you know, what bootstrapping with the right people and the right intentions can do. So love it. And when it comes to, you know, the three bills that are on the Hill again, as of this recording, you know, nothing, none of those have passed officially yet, but they're making it through committees.
And one of those bills that had a pastor committee. Successfully in June was the Medicaid Primary Care Improvement Act. So again, another example of how bipartisan Kim Schreier from Washington and Dan Crenshaw from Texas are the people behind this particular bill. When it comes to Medicaid in particular, I want to ask this because Colorado, you know, versus other states, it is more restrictive when it comes to DPC and Medicaid patients.
So what do you see as a potential for the Medicaid Primary Care Improvement Act? Helping Medicaid beneficiaries access DPC in Colorado.
Yeah, so a lot of thoughts there. Let's see if I can distill down to a few. Yes, you're correct that Colorado, I believe, is one of only two states in the country, Colorado and Kentucky, where a Medicaid recipient cannot pay a DPC doctor.
So that blows our mind, right? And they should be able to. So you got to fix things to make that a possibility. Medicaid recipients all across the country are being underserved. Just like hardworking blue collar Americans that have high deductible plans are being underserved just like people with fancy Cadillac PPO plans are being underserved.
Right? So there's lots of people that are underserved. And I mean, very specifically people that just don't have really good access. It's not convenient. They don't have a relationship. They don't have trust in their primary care physician. So that's a lot of Americans. So, as we think about Medicaid, Medicaid is a tremendous opportunity, and we would love for there to be a lane where a Medicaid recipient could see a DPC physician and have that paid for by essentially the taxpayer, right?
There's 2 people that pay for health care in this country. 1 is employers and the other is the taxpayer, right? It's not insurance companies. It's not the government. Uh, that's the tax dollar, right? So, so, at the end of the day, how are they, how is the government spending our tax dollars? And gosh, it would be tremendous.
I would love to have a clinic that serves Medicaid. I'd open that up in a heartbeat. And I'll tell you years and years ago, the leader of the house here in Colorado, he actually had come to us and say, I'd love to run a pilot where there's a next era clinic, right next to an F. Q. H. C. And I said, we'd love to do that.
Right? But, you know, this stuff takes a lot of time when it comes to the government and the processes and the movement of that. But I sure hope in my life. Thank you. That will, we'll see that because, because a lot of Medicaid recipients are being underserved.
Well, there's a lot of us, including myself who agree with that.
I definitely, if you have not listened to Jake Keese's episode, definitely take a listen to that because hopefully, you know, we will see really big changes when it comes to legal Capitol Hill supporting DPC through law. So that would be awesome to see more of that. So now when it comes to you being a national speaker, when it comes to direct primary care, You speak to patients, you speak to employers, you speak to, you know, people who are business owners, you speak to people who are just in the business of health care.
So I want to ask what questions do you continue to get about direct primary care, whether to be to clarify what is DPC still or whether it be, you know, about the future of DPC in health care. Yeah.
So, you know, part of that is kind of like, why should I do DPC? Right? Like people, whether that person is a, you know, a patient or whether they're a business owner or a CFO, like, why, why should I do direct primary care?
And, and part of what we come back to them with is, you know, are you as an individual or as an employer, are you happy with your health care? And are you happy with the amount of money you're spending? And that's a couple of questions we've been asking for years. And hardly ever do we get yes and yes, no matter what crowd we're in front of.
You know, can you text your doctor right now and have your doctor respond? No matter what crowd we're in front of, like, hardly ever do we get a yes to those types of things. Right? So that's where we start to get at. Well, okay, let's start to think about how we perhaps can improve your care, the access, the convenience of it, the connectivity.
Let's talk about moving beyond just seeing your doctor once a year for an annual checkup. That is so old school. You know, it is just if you want to move the dial on your health and wellness, and you want to get to optimal health, you don't go to the gym once a year, like, you go to the gym, hopefully a lot.
So who better to help you down that pathway than your primary care clinician? The problem is hardly any Slice of America can get that right now through traditional fee for service primary care. And about half of Americans have high deductible health plans, so they're only seeing their doctor once a year.
And I haven't met a DPC doctor out there, or even a primary care doctor in general, that doesn't want to help people with their health and wellness, right? That doesn't want to talk to them about their lifestyle, about their sleep, and their nutrition, and their exercise, and their emotional health, right?
Like that's a, that's bread and butter primary care. And fortunately, in direct primary care, we have the time for that. Patients have access to us. We don't have the cost barrier because there is no cost. When you come see us, you can see us face to face. You can see us virtually. And so we're changing the relationship that patients have with their primary care clinician, which truthfully right now is pretty low.
Right? It's kind of, if you look at what a scale of 1 to 100, or you look at a net promoter score, these different rating systems, like, a lot of people just don't have a relationship with the physician and the healthcare team that can take care of 90 plus percent of their needs. So that's what, you know, we offer a DPC and that's what truthfully many of us went to med school for back in the day, as we did all this training and went to residency, because we really want to take care of people and when you don't have access to the doctor and healthcare team that can take care of 90 plus percent of your needs in a very formal manner.
Now, you're actually putting yourself in a position where that's a great risk, whether you're a patient, or whether you're a CFO and so the challenge isn't, you know. When am I going to do DPC for my, me or my family or my company? The challenge is if you're not doing it, if you're not doing it right. And so it's been years in this arena and there's nothing better out there, right?
Sure. There's full risk plans with Medicare Advantage, but that is a lane right now that who knows if that's going to be around in a few years because of what's going down. And it goes back to the beginning of direct primary care where a lot of pioneers were in the existing system and said, hey, we can do better.
We're at that place. Now. We're far beyond proof of concept, but we're getting ready to participate in the 2nd Millman report that will come out that will sure further show the ROI and value of and just realize, I guess, you know, as you think about gosh, should I do or not? What kind of value we're currently getting?
And unfortunately, most Americans are spending a lot of money. Thank you. Most employers are larger employers are spending 13, 600 dollars per employee on average for a benefit plan. And yet their employees don't have really good access to care. It's not convenient. It's not accessible yet. That cost of that premium for the employer went up 6.
5 percent from last year this year. So, you know, I don't know if I, I don't think I answered your question directly or in short manner. But, you know, people aren't happy with their care and they aren't happy with what they're spending who is arguably the best person in the world to help you with that. Dr. Mariel, you know, or Dr. Josh down in Kansas, or Dr. Lansing can last advance in Kansas or Dr. Amber and Blair, Nebraska. Right? Like. All these physicians, Dr. Matt Hayden out in, uh, D. C., Dr. Eric Kroll down in Florida, like, the list goes on, like, all these docs are out there, and we're in 50 states, and have been now for years, and it's time you go find yourself a DPC doc.
And I love, you know, I set you up there because I love how you answered that, especially because, you know, the majority of people are getting care through Nextdoor Healthcare or getting Nextdoor Healthcare through their employer. I love that, you know, that's the type of stuff that you can say to a person who's joining as a member or their family is joining, or you can say to someone who is.
The employer or someone who is the, the person building the plan for the employer, because what you're saying there is so high level as to the impact that DPC can truly have. And like you referenced, you know, the Milliman study. Definitely. If you've not checked out the Milliman study, check that out.
There's lots of data in that study that can be used no matter if you're rural or urban or whatever to prove that DPC is not just all, you know, words and non corporate. You know, fancy websites like we actually do make a difference in the pockets of people who are choosing DPC and we definitely make an impact positively in their health care.
Even before DPC, we knew that primary care significantly impacts a person's morbidity and mortality impacts your morbidity, your mortality and your spend. Right and you're here time and time again, a lot of DPC docs talk about, hey, we're not only here to help you with your health. Not just be sick care doctors, like, we want to help you get to optimal health.
Number 1, but number 2, we're here to be a good steward of your pocketbook. And when it comes to writing orders, whether that's for an X ray, whether that's for a CT scan, whether that's for an elective knee surgery, whether that's an order to go see a behavioral health specialist, et cetera, not only are we going to help you down that pathway and provide the right care at the right time.
Hopefully the right place, right for the right cost. Like, these are just things that are, uh, bread and butter every day, direct primary care. And it's not that we couldn't do those in fee for service medicine. We were trying. We were just in a model where the volume was so tremendous and the business of it was so messy that, that it was really hard to do all that we can do in full scope primary care.
Uh, you look at DPC, you can do full scope primary care. And you can provide, you know, a half hour to an hour to 90 minutes. Of time with a patient and really start to get into detail and then write an order for, uh, Crestor and they get it mailed to their home. And we bypass to traditional PBM because it's more efficient and more effective and affordable to get it mailed to their home through an entity like.
DRX Health, or we maybe even have the Crestor in our office, right? Like, all these things that primary care docs do. We have the time to do it. We're super passionate about it. And you're right that with Nextero, as you look across our organization, again, we started with 1 clinic, now we're over 40 clinics in Colorado, we're over 100 clinics in 14 states.
We're soon to expand even more so into the Pacific Northwest. With a number of clinics in the common thread here is these are all DPC physicians that own their own clinics, except for, like, maybe 1 or 2. and those were like, legacy fee for service docs and long month that are part of our direct primary care network here serving a school district as we think about employers.
We've grown from taking care of companies of 5 or 10 to taking care of companies of thousands to taking care of the school district where my 3 kids have gone to school, which is 55 schools and 6000 or I think cover lives or so to fortune 500 companies. So, we have a Fortune 500 companies that have employees in multiple states that provide Nextera and they pay 100 percent of the Nextera benefit for their employee, just like some of the smaller companies do.
So, whether you're a craft beer company, or whether you're a, you know, a satellite company with rocket scientists or a municipality, like, DPC can really a provide a tremendous primary care benefit for your employees. But B, it can actually set you apart in the marketplace compared to other employers because you're offering such an awesome benefit for your employees.
And this will not, you know, break the bank. On average, it's 70 to 80 per member per month, right? Like this is not your typical 1, 000 Cigna policy here in Colorado per month, right? So, so, uh, yeah, it's fun to see where it's going and we're not done yet.
I love it. Um, and you know, it's, it's so important to hear that because in our culture, post pandemic.
We had the great resignation and then people are starting to go back to work. But especially if you're standing out there with like, and we offer healthcare, that's amazing. You know, especially if you're a smaller business where people don't expect that they're going to find healthcare benefits at, you know, a brewing company or, you know, at a, you know, hardware shop, a mom and pop store.
So it's, it's incredible. Now, let me ask you this because. With you, you know, sharing like where the next era footprint is, I want to ask about, you know, there's lots of opportunities that people with lots of money specifically like VC companies are coming at, you know, buying out health care, for example, Amazon bought out one medical.
When it comes to, you know, you talking about how each of these DPCs are independent, they're just affiliates, they're getting the benefits of having an employees nationwide, you still, you know, continue to like, like you're in your office right now and you just saw patients right before this interview.
What is it that drives you to continue choosing to be a family medicine physician in DPC versus like, Hey, I built this thing. I'm going to sell it off. And what words would you say in closing for other people who are thinking about if I grew my DPC to have multiple clinics, what are some things I should think about to.
Continue being the doctor that I, you know, went to medical school to be.
Yeah, I think maybe there's one question in there. Let me know if I get this wrong, but, you know, we're having a lot of fun. I would say we're, we're just, we're having as much fun today as we did back in, let's say, 2009, 2010. I would say at a high level, like, there's less risk now, right?
Comparatively, we've really figured out a way that works for the patient, which is the most important, right? A way that works for the physician and health care team. You don't want to design and forget about the health care team and physician. It's a way that works for employers in a way that's works for communities.
And it's so cool to see a lot of fun things happening that I wish would have happened a decade ago. Some of these fun things are everything that's happening with health Rosetta, everything that's happening with Nelson Griswold and next gen benefits. And his Ascend conferences, the things that are happening with David and Emma and you power symposium, the things that are happening at the FAP level and the support of the DPC summit, what health is doing, uh, it's just.
None of this stuff happens without a team of awesome, cool people, hopefully trying to roll in the right direction. And we wish that a lot of these things would have been around 10 years ago, where we'd have benefits advisors calling us saying we want next era in our plan. We're not going to do it any other way.
Like, I love Nick. So, and what they're doing a decent. Right, like, fronting these benefit plans with and if you think about it, statistically, there are 150Million Americans. That get their health benefit through their employer 150, 000, 000 or so next era is solving and wants to continue to solve for that.
It takes a huge village to try and make that happen. Right? And so part of this is, as we're going forward, we want partners to help us with that mission. Of the right care at the right time, the right place for the right cost and the ability to expand. And part of that is we want to have more next era branded clinics.
These are clinics that we own and run and we employ the physicians and healthcare teams and we'll continue to have more affiliates. The cool thing with what we've created, we're now the nation's largest position owned and led a direct primary care community. And what I love about it is, you know, your experience with where you live as a doc and the network that you have is different than what Dr. Hayden has in DC and it's different than what Dr. Amber has in Blair and it's different than what Dr. Eric Kroll has in Tampa and with what he has going on there, right? Like, very organic and we know the right orthopedic hand specialist. And we know who has a good behavioral health therapy company, and we know the right physical therapy group to send to, but then taking that a step further at Nextera, like, we're super familiar with the plan design that the employer has.
So, when I talk about advanced direct primary care, I'm talking about these kind of pieces where we are very familiar and maybe we even help design the self funded benefit plan with a innovative benefits advisors. We've helped design that. And we know the fine details of it. So that part there is what it's care navigation and premier care.
Clinicians are typically pretty good at care navigation, but traditional fee for service. Doctors don't know a thing about the plan. Typically of the patient they're seeing. They don't even know what they're necessarily getting paid through a United contract. So in advanced direct primary care, we are very familiar with the employee benefit plan.
We go to open enrollment meetings. We stand there and talk to the employees and we meeting, uh, administrators from our team as well as doctors and saying, hey, we're not a vendor for your company. We're the physicians taking care of your company. So, kind of a long answer to what you're, you're, you're getting out of here, Mariel, but we want to continue to provide really, really good care to employer groups and communities we serve.
We are definitely open to retail members that just want to join. And we need more people to come and jump in the ship with us. And whether those are business people or whether those are doctors. And if I could just give a self plug right now, like, I need more physicians right now to come on board. And, and we'd love to offer you an awesome job here in Colorado.
So that is something that back in the day, when I came out of residency, I didn't have that opportunity, right? I could join a big system. I can maybe open up my own practice, which is risky, or I could join a multi specialty group. Well, now you can join DPCs, and there are DPC docs all over the country that are hiring.
Not every doc is cut out to run their own business. And maybe that's only 10 percent of us. Right? Uh, so it's okay to not have to run the whole business and we've got an awesome team here. And boy, I'd love for at least 1 or 2 male physicians to pick up the phone and give me a call. I just hired 2 female positions.
So, we need another mail or 2 to help join us. Uh, and I think maybe 1 of the last parts that comes up on your question is. Yes, I, I, I have a panel of DPC patients that I see and that's some of the most fun part for me is I just love taking care of people and being involved as a clinician day in day out better helps me remain focused on the business side with that.
Thank you so much. Dr Flanagan for joining us today.
Oh, such a pleasure very all and so appreciate everything that you're doing, not only in the community you serve, but for all of us across the country with my DPC story dot com.
Next week, look forward to hearing from Dr. Philip Olshausen, formerly of Rogue Direct Primary Care in Medford, Oregon. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about DPC. Leave a five star review on Apple Podcasts and on Spotify now as well, as it helps others to find all these DPC stories.
Lastly, be sure to follow us on social media. If you're wanting to continue learning more about DPC... In the meantime, check out dpcnews.com. Until next week, this is Marielle Conception.
*Transcript generated by AI so please forgive errors.
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