Healthcare Rebel Alliance: Q&A with Clint Flanagan, founder of Nextera

Health insurance 101
Healthcare industry
Direct Primary Care
Healthcare Rebel Alliance

Dr. Clint Flanagan is an experienced CEO, founder, and physician, recognized as a pioneer in Direct Primary Care (DPC). He established a nationwide physician community offering advanced DPC to employers. Skilled in healthcare consulting, family and emergency medicine, and public speaking, Dr. Flanagan contributes to state and federal policy discussions, advocating for accessible and affordable care. He has influenced DPC legislation and serves on the Steering Committee of the National Direct Primary Care Coalition. In his free time, he enjoys family and outdoor activities in the Colorado Rockies.

Nick Soman, Decent: Why did you decide to work in healthcare? And why do this?

Clint Flanagan: You know, I can't summarize that in 30 seconds. The short answer is, we felt what we were doing was right. When you think about the doctor-patient relationship and all the things getting in the way, we felt we had a really good story. That belief helped us move forward despite challenges. We had the idea and vision, and then had to figure out the strategy and execution.

Nick Soman, Decent: You are one of the original inventors of DPC. How did you invent or adopt the model in the first place? And you and I have had many conversations over the years and so this part is for the public. I really want them to hear you know every part of that story, even if I've heard it before.

Clint Flanagan: We weren't the first to go down this pathway. I think of people like Dr. Garrison Bliss out in Seattle. He was one of the pioneers in the Pacific Northwest and, along with Jay Keese, coined the term "direct primary care." When we started in 2008-2009, we knew we couldn't continue with fee-for-service medicine for the rest of our careers. We looked around and surveyed the landscape. While we saw some other models out there, we didn't see one that served the community.

So we decided to keep it simple: charge a monthly fee under $100 and provide unlimited primary care. This was back in 2009. We called it "monthly membership medicine." It wasn't anything fancy—just monthly membership medicine. You pay us monthly, and we provide unlimited care. We used the term "gym membership" so people would have some familiarity and understanding because this was brand new in 2009.

A little after we started thinking about things, there was a conference put on by the American Academy of Private Physicians. Many of those physicians were concierge doctors. Dr. Bliss was coming to that conference, and we had been crossing virtual pathways that existed in 2009. He came to that conference, and we chatted. I'll never forget, we took him out to the Kevin Taylor restaurant in Denver and had a great two- or three-hour-long dinner with a bottle or two of wine. He was calling himself direct primary care. At the time, he had some angel investors through Jeff Bezos and Michael Dell. We thought, if those smart guys invested in Dr. Bliss, maybe we should start calling ourselves direct primary care too.

The model was built on three tenets: one, we don't bill insurance for any primary care; two, we provide unlimited visits; and three, we cover our patients 24/7, not just Monday through Friday, 8am - 5pm. We’re not adversarial towards coverage—we think everyone should have coverage for catastrophic needs. But using an insurance plan to pay for primary care is like using your fire insurance for your home to mow your lawn—it’s just weird.

Very early on, we liked small businesses and started taking care of employer groups. Many of them had zero benefits for their employees, but almost all those owners could afford $99 a month. That's when the wheels started turning about getting into the employer space and trying to solve for that.

Nick Soman, Decent: How did you come up with the $99 price point, and why is it still under $100?

Clint Flanagan: Honestly, it was more like finger to the wind and throwing spaghetti at the wall. We thought people could afford less than $100 a month. We set it at $99 for the first employee or individual, less for the spouse/partner, and less for the child. That model worked, and we haven’t changed the spouse or kid prices for five or six years.

This model works on volume; we need about 600-800 members per doctor. We also started taking care of employer groups, which could afford $99 a month per employee.

Nick Soman, Decent: You are still charging less than $100. That’s a big choice.

Clint Flanagan: Yes, and we haven't increased it like others have. We think it’s important that primary care be physician-led and physician-owned. That way, a lot of the right things happen. Unfortunately, in 2024, the right people aren't always at the table, and Americans are underserved. Can you text or call your doctor right now? Can you get a same-day appointment? Typically, the answer is no, yet people pay $2,500 a month for a PPO plan.

Nick Soman, Decent: I like to use a music analogy for healthcare. The PPO model is like Spotify, with all the choices. But most people want Pandora, a trusted service that makes good recommendations. What they want is guidance and a doctor in their corner.

Clint Flanagan: I hear you. Imagine paying your monthly fee for Spotify and not being able to log on. Every time you listen, it’s Rick Astley’s "Never Gonna Give You Up." Or you get charged $5 three months later for listening to Taylor Swift when you wanted the Teskey Brothers. That’s how messed up our healthcare system is.

Nick Soman, Decent: Most people want what you’re offering. They want compassionate patient care. Let’s talk about the future of DPC. What does a successful, thriving DPC movement look like in 10 years?

Clint Flanagan: The growth in DPC is tremendous, especially in the employer space. We’ll see more DPC physicians owning their practices and joining groups like ours. More employers will provide a DPC benefit to their employees, whether a company has 10 plumbers or 10,000 engineers.

We’re seeing more movement towards self-funded plans and innovative benefits advisors. Direct primary care has to be the living room of the healthcare home. It can't be DPC light, with just virtual care. The doctor-patient relationship is crucial. We started with one clinic in Boulder County, now we have around 115 in 18 states. We’re improving and replicating what works, always keeping the doctor-patient relationship sacred.

Nick Soman, Decent: What are the best and worst things about your job as Clint Flanagan, founder of Nextera?

Clint Flanagan: The best things, I think about yesterday. I still see patients and have about 700 Nextera members that I take care of. I've been doctoring for over 20 years, and Nextera started about 15 years ago. Many DPC docs see these things every day, but a lot of America isn't quite aware.

Yesterday, I saw a 47-year-old male that I've been taking care of for years. He's an engineer with a scrotal mass. He trusts me, and he was worried he had testicular cancer. Within about 10 seconds, I told him it wasn't that and that we needed to get an ultrasound. We then talked about his knee pain and fatigue. His main concern was the scrotal mass, and I got him in for an ultrasound within a day or two.

Another patient was a woman whose 30-something-year-old son was hit by a driver walking home from work and passed away. Imagine that as a parent—losing your 30-year-old child. We put the computer aside and talked for 45 minutes.

A third patient, a longtime patient of mine, recently retired from a Fortune 500 company. He had belly discomfort, and we quickly discovered he had pancreatic adenocarcinoma that metastasized to his liver. He had no risk factors, was healthy, and we talked for 45 minutes about his condition.

These conversations don't happen with virtual DPC when there's no long-term relationship. All those patients have been with me for years. When they're in the scariest time of their lives, they don't want to talk on the phone to someone in a different state. They want to sit down and talk with their primary care physician.

All those cases required steps afterwards. We call it care navigation. Our medical assistants and nurses handle all the care navigation for next steps in these circumstances. We understand the benefit plan the employer has and where these people need to go for ultrasounds, hematologists, oncologists, liver biopsies, etc. For most Americans, no matter how much they pay for their PPO plan, care navigation is a cluster. It takes months to get a liver biopsy or a follow-up MRI. We make these things happen quickly.

You got me down a pathway there, Nick, talking about the best and worst. That’s an example of what we do every day. To have the ability to do that without the administrative burden of seeing 30 patients a day and then spending a third of the day on the computer is unbelievably liberating. I don’t have worst days in DPC because I have the perspective of a fee-for-service primary care doctor. My most challenging days in DPC pale in comparison to my best days in fee-for-service primary care because things are aligned.

Nick Soman, Decent: What do you wish every single employer specifically in the world understood deeply about DPC? What do they need to know that they don't know?

Clint Flanagan: A few things come to mind. If you're not doing direct primary care (DPC) as an employer in 2024, you are spending way too much money for your premium and doing a disservice to your employees. If your broker, HR person, or CFO has baked in fee-for-service insurance-based primary care, you're not serving your employees well. As an employer, if you want to set yourself apart and be aware of your most valuable asset—your employees—you need to consider what you're spending on your health benefit.

You can't just turf it to HR. As the CFO, especially in this day and age with the Consolidated Appropriations Act (CAA) and fiduciary responsibility, you need to be thinking about this. If you don't have the expertise, bring in people who do.

Every employer in America should think about how they can integrate direct primary care into their benefit plan, whether they have 10 employees or 10,000. There are those of us who can help solve that. If your broker isn't providing that answer, you need to consider a few things: Is my broker serving the interests of my company as they should be? How is my broker being compensated, and are they transparent about it? If they aren't talking about direct primary care, why not?

Ten years ago, it was understandable because there were only a few of us. Now, while we aren't all over the country, like Starbucks didn't get all over the country in a few years, it takes time. We're now at a place where we can solve for direct primary care in just about any zip code, and that's exciting.

Outside of payroll, the biggest cost is what employers are paying on premiums. Let's stop calling it health insurance—it's not health. It's a premium, and it's questionable whether it's even insurance anymore because 30 to 40 percent of Americans have a huge deductible, and most don't have a thousand bucks in their savings account. Insurance should be there when the stuff hits the fan, and you shouldn't have to cough up a $10,000 nugget.

That's not how my state farm auto insurance works. When I totaled my BMW because a drunk driver hit me, I didn't have to spend 10 grand to get a new vehicle. Words are important, and people talk about health benefits, health care, and health insurance. What we do at Nextera is health. We sit down and talk about sleep, nutrition, exercise, and emotional health. We engage and want to be proactive and preventative. When you find doctors and health teams that do this, it's one of the best investments you can make for the dollar you're spending.

Nick Soman, Decent: That was great. Every time we talk, I get excited to support you and build with you.

Clint Flanagan: Good to chat. Appreciate the time and look forward to the next time we can connect. Take care.

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