As part of our look into how primary care and health systems are adapting during the COVID-19 pandemic, we had the great privilege to sit down (virtually of course!) and talk with Dr. Clint Flanagan, Healthcare Pioneer, CEO, and Founder of Nextera Healthcare. Dr. Flanagan is an influential leader and pioneer of Direct Primary Care (DPC), a model delivering superior value and improved health to individual patients and employers alike. We got the chance to hear from Dr. Flanagan regarding how Nextera and their patients were in a perfect position to thrive in a virtual care world, how they utilize telehealth tools, and the attributes of the DPC Model that strengthen patient-provider relationships in ways that deliver superior health outcomes. Check out more of Dr. Flanagan’s insights in the full interview below.
C3LX: Dr. Flanagan, thank you for your time today speaking with us. To open up, we wanted to understand your perspective on how the current COVID-19 crisis is impacting primary care practices?
Dr. Flanagan: COVID-19 has exposed significant inefficiencies and barriers for patients in traditional insurance primary care settings. Many of physicians were already aware of these challenges. This is such an unprecedented time and it has created tremendous hardships for patients as well as physicians in the insurance based primary care system. In many of these primary care practices it’s hard to get in to see a physician (for example for same day urgent care concerns), now it’s even harder. In fact, some practices have closed. The insurance model is built on face-to-face, in office interactions and these office visits generate revenue for the primary care practice. Primary care practices are seeing 50-75% decreases in office visits and this negatively impacts monthly revenue. Many practices are furloughing staff, decreasing physician office time by 20-50% and considering closing their doors.
C3LX: We agree. The other aspect we’re seeing is even if practices are compensated for telemedicine services, it’s still very transactional and often it is not with their trusted physician. For patients with an underlying chronic condition, not communicating with a physician or practice that knows them opens up more risks of that patient not managing their chronic disease. The system doesn’t seem like its built to handle this quite yet. How are you all doing on the Direct Primary Care side? You seem to be much more equipped to be the solution at a time like this.
Dr. Flanagan: Yes, we have been doing virtual medicine for years and have platforms that support virtual care, so for our patients it’s really not much of a loss of continuity or a tremendous change for them. Our offices are still open, but we have moved more towards virtual visits for routine/chronic/wellness checkups. We also have a COVID-19 medical response team that fields all incoming calls and that team triages to determine next best steps—which could include a virtual visit with the patient’s physician (at no cost to the patient). If a doctor’s day (pre COVID-19) was maybe 70-80% face to face, and 20-30% virtual, that’s now flipped. Now that doctor’s day is 70-80% virtual. I myself am having virtual only clinic days. In primary care we’ve known for years that 50-70% of primary care visits can be done virtually prior to COVID-19, and now the light is being shed on that even more so! Virtual care is built into the Direct Primary Care model (at no extra cost for the patient). This is not the case with fee-for-service/insurance based primary care.
C3LX: With Nextera already actively using Telehealth with your patients, what in your mind has worked well and what’s still needed in these technologies during COVID-19 and beyond?
Dr. Flanagan: Many DPCs (and the telehealth companies they work with) are ahead of the curve, and without Nexetra Healthcare asking, Spruce (the telemedicine platform we use) put in a COVID-19 screener template for our patients. If one of our members has a COVID-19 concern, they call the office, the COVID-19 medical team has them fill out the screener on the app and this goes directly to the doctor the member is attached to. The doctor can then take a look at details on the screener and follow up via phone, video and/or text—all on a HIPAA secure platform. Plus, our patients (members) are getting to connect with their physician vs “a physician/provider” they don’t know. The good platforms have been very agile and that is tremendously helpful in this rapidly changing environment.
C3LX: That makes a lot of sense. In one of our recent LinkedIn posts, we shared a 2015 Harvard Business Review article that demonstrated the importance of strong patient-provider relationships in achieving improved health outcomes. What are some examples of the power of these relationships that you see with your patients and Nextera’s patients?
Dr. Flanagan: I’m very familiar with that article. The short on that is, it’s one thing to connect with a doctor, versus your doctor. The telehealth platforms out there today are a doctor, and you are often times connecting with him or her once, one touch. No continuity of care. Contrast that with DPC/ Nextera Healthcare. We want many touches and sometimes the touch is an email, sometimes it’s a call, sometimes it’s face-to-face. Usually care starts with your first “Welcome to Nextera” visit, where we spend time getting to know you. This sets the foundation for follow-up visits/ “touches” and we are often connecting with our patients 4-5x/year and part of what makes this easier for patients is there is no co-pay or bill for touches. Contrast that with traditional fee for service/insurance system where patients see their doctor approximately one or two times a year. With the DPC model, we want patients to connect with their doctor at least 5 or 6 times a year and this helps establish a relationship and trust. Our physicians/medical teams have the time to spend 30-60 minutes with patients during visits (vs the average 10-minute insurance visit) really getting to know their patients and this helps with medical decision making. If a physician/provider is only spending one or two visits with a patient per year, it’s hard to have a robust relationship—plus that fee-for service physician typically has a patient panel of over 2,000 patients. The DPC model helps foster stronger patient/physician relationships and DPC patient panels are often much less (i.e. 500-1000 patients). Finally, patients are more likely to follow the guidance from a physician that have a strong relationship with and trust. DPC is built for this.