December 15, 2015 02:00 pm | Chris Crawford, AAFP
Flanagan began his journey to becoming a DPC champion through traditional channels. He went to medical school at the University of Nebraska Medical Center College of Medicine in Omaha; did his residency at the Family Medicine Residency Program at St. Mary’s Medical Center in Grand Junction, Colo.; and in 2004, went to work for a startup private multispecialty group practice in the Frederick/Firestone, Colo., area (a bedroom community of Boulder) for a number of years. His small medical group introduced the first physicians to the town.
As if opening a new clinic wasn’t stressful enough, Flanagan was deployed the same year to Iraq, where he provided care to soldiers throughout 2005 as part of the Army National Guard. When he shipped out, the news was splashed across the front page of the local newspaper with the headline “Doctor Goes to War.”
After returning and deciding he wanted to own his own medical center someday, Flanagan went to work for Centura Health, the largest provider of health care in Colorado, for a few years, eventually transitioning back to the Frederick/Firestone area in 2009, when he opened the first of three North Vista Medical Center locations.
It was around this time, Flanagan said, that he noticed some of his fee-for-service patients were struggling in the current health care system, and he began investigating an alternative care delivery model.
“I had patients saying — for one reason or another, be it copays or ‘I just got fired from my job — I can’t come see you,’ or ‘It’s too expensive to come see you,’ or ‘My company just signed up with Kaiser and you aren’t a Kaiser doc, so I can’t come see you,'” he said.
What Flanagan said he eventually discovered was that the bar is set so low for traditional primary care practice in America, it’s pretty easy to step over it and find a better way to answer patients’ needs.
“You can’t get in to see your doc, you have to wait in the lobby for way too long and sometimes you don’t even see your doc — you see another doc or a mid-level,” he said. “Then when you go in, your doc spends three to five minutes with you. Or you get kicked out to the urgent care and you have a $50 copay. What other industry would be satisfied with this?”Flanagan was already well-versed in the frustrations of trying to run a fee-for-service practice, including high overhead and the slow process of getting insurers to pay.
“Imagine your plumber showing up and you say to him, ‘I know it’s $100, but I’m going to pay you $70, and I am going to give you that money in a month or two from now,”‘ he said. “Your plumber would say, ‘Are you crazy!?'”
According to Flanagan, working in a fee-for-service setting comes with the “noise” of prior authorizations, insurance paperwork and coding that, collectively, create major barriers to delivering great patient care.
“I truly feel it’s important to protect the patient-physician relationship, and we should try to do as much (as possible) in this country to push away the noise that gets in the way of this relationship,” he said. “That’s why it was crystal clear for us as a startup to say, ‘Here’s what we’re going to do; is it going to work? I sure hope so, because we’re banking on this, and it’s got to be better than where we’re at.'”
So to bypass these barriers, Flanagan decided to offer his patients and employer groups the option to pay for their health care directly for less than a monthly phone bill. And like that, in 2011, Nextera Healthcare was born.
Nextera Healthcare Today
Currently, Nextera Healthcare boasts 18 health care professionals (physicians, nurse practitioners and physician assistants), including those in its affiliated practices, plus roughly 40 support staff.
Nextera offers month-to-month DPC contracts, so if individuals, families or employees decide to pursue other health care options, they can leave without penalty. But so far, most clients have stayed with Nextera long-term, supplementing that care with a major medical, high-deductible plan for big-ticket health care needs.
“You are going to pay less than the cost of a latté every day to have connectivity to your doctor, so in case the ‘stuff’ does hit the fan or you want to talk about your sleep problems, your weight problems or your challenges with high blood pressure, you have a primary care provider who is there for you,” Flanagan said.
Connectivity is a big selling point for DPC and Nextera, and Flanagan gives each of his patients his cell phone number and encourages them to contact him with any health questions. He said he typically gets a text or a call from a patient at least once a day.