Lessons in Greatness: One DPC Doctor’s Journey To Success

By Michael Tetreault, Editor

Designing Our Practice, Nextera Healthcare in Firestone, CO

clint flanagan mdAccording to North Vista Medical Center and Nextera Healthcare Co-Founders Drs. Clint Flanagan and David Tusek, “The DPC model was very attractive to us because, under this approach, we could sustain the value of the patient/provider relationship and create more accessible care for our patients. We wanted to restore the ‘art’ of healthcare delivery and not focus just on the science of it. We are credited with being one of the first to market in Colorado with a DPC program via Nextera Healthcare.

An in-depth analysis of our financials revealed we needed to continue operating under the fee-for-service model for their insured patients, and then introduce the DPC option alongside. We did not want to undermine our existing patient relationships by declining traditional insurance, but we also wanted a tangible option for patients who were uninsured or under-insured and forced to seek alternatives due to rising healthcare costs.”

Determining the right price point for the monthly DPC membership, and what services would be included in said membership were both of vital importance. At first we considered charging a monthly fee accompanied by a very low fee per office visit. However, we both agreed the dual fee structure would create complexities and we were trying to simplify the delivery of primary care. Thus, we set a $99 per month individual price, $139 per month for couples, $179 per month for a four-person family, and $39 per month per child for additional dependents.

We were fortunate to be uniquely qualified to handle a broad range of healthcare issues due to our extensive training in both family and emergency medicine. Thus, the services covered by our monthly membership fee were equally wide-ranging:

  • Routine pediatric care
  • Adult medicine and wellness
  • Gynecological care, including Pap tests
  • Care and treatment for chronic conditions, such as high blood pressure and diabetes
  • Dermatological services, including treatment and/or removal of precancerous and certain cancerous lesions, cryotherapy and removal of warts, skin tags, age spots and cysts, and acne treatment
  • Acute care for non-life threatening emergencies and medical problems
  • Wound repair, including stitches or surgical glue
  • Fracture care, including casts and splints for broken bones not requiring surgery
  • Trigger-point and cortisone joint injections
  • Annual physicals
  • End-of-life care
  • Customized weight management
  • Treatment of depression, anxiety and mood disorders
  • ADD and ADHD evaluation and management
  • Smoking cessation and alcohol abuse management

Our fee also included some critical relationship-building elements that would set us apart, such as (1) unrestricted visits with providers at our three North Vista Medical Center locations; (2) extended office hours, including Saturdays; and (3) remote or virtual access to providers via email or phone.

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Due to the additional benefits provided to our Nextera Healthcare members, we created a staff education program on how to handle traditional fee-for-service patients and DPC members concurrently based on their health issues. Because DPC members were promised round-the-clock access, more urgent patient issues meant DPC members took priority over fee-for-service patients. Also, if DPC members needed urgent care after regular office hours, the on-call provider would meet them at a North Vista Medical Center facility for care. Fee-for-service patients might visit a 24-hour urgent care facility, in contrast. Staff understanding of the flow of their system was critical to fulfilling our promise to our Nextera Healthcare patients.

We also had to acknowledge that, while our services were extensive, certain activities couldn’t be performed at North Vista Medical Center. We’ve always believed in being a patient’s ‘healthcare quarterback,’ so we negotiated highly competitive rates for lab and imaging services within our market. We determined the services most crucial to our patients, educated ourselves about available resources in our community, and created a list of options with full cost transparency. A sampling of rates follows:

  • CBC                $5
  • CMP                $5
  • HgbA1C         $11
  • Lipid panel      $5
  • Uric acid         $5
  • Vitamin D       $28
  • Ferritin             $8
  • TSH                 $8
  • Cardio CRP    $16

The cost savings we achieved for our patients was tremendous, thanks to our long-standing community and business relationships. For example, the combined costs of the above tests would be $630 for a self-pay patient, yet our rates meant all tests combined would cost a Nextera Healthcare member just $91 out-of-pocket.

We negotiated similar discounts for imaging services, as follows:

  • MRI non-contrast       $450
  • MRI with contrast      $650
  • Athrogram                   $650
  • CT without contrast    $300
  • CT with contrast         $400
  • CT with both               $450
  • Ultrasound                  $190
  • Ultrasound – vascular  $250
  • Ultrasound – pelvic     $250
  • Ultrasound – breast     $100
  • Upper GI                     $130
  • Barium swallow          $90
  • X-ray – 2 to 3 views    $60
  • X-ray – 4-plus views   $90

Ongoing analysis also helped us understand what staffing we would require to accommodate our DPC membership. We used the following rationale to determine provider staffing levels:

The average family medicine physician has a panel of approximately 3,000 patients under the fee-for-service model. However, a DPC provider can generate similar revenue with a patient base of approximately 1,000 members, which reduces patient volume and increases the amount of time spent with each patient, a cornerstone of the DPC value proposition. Our DPC model allows us to split shifts. Ideally, four providers work out of one location, with two providers working on weekday mornings, two on weekday afternoons, and two on Saturdays. Under our model, DPC providers work a 30-hour week, far less than the typical fee-for-service primary care provider who works a 50 to 60-hour week.

About Dr. Clint Flanagan and Dr. David Tusek
Nextera Healthcare
8308 Colorado Blvd, Suite 200
Firestone, CO 80504
Office: 303-501-2600


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