Membership plans reshape primary care

LONGMONT — The connection between John Adams, a patient of Nextera Healthcare, and his doctor goes one step beyond the typical doctor-patient relationship: He texts his primary-care doctor when he has health questions.

Adams, a 65-year-old maintenance worker in Frederick, discussed the perks of his membership with Nextera when he arrived recently for an appointment with Dr. David Tusek. Town employees have memberships with Nextera as part of their health plans.

“One of the best things about Nextera is the access,” Adams said.

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Founded by Tusek and Dr. Clint Flanagan in 2009, Frederick-based Nextera employs 30 people and has clinics in Boulder and Longmont. The company has 10 affiliate private-practice, primary-care physician groups from Fort Collins to Colorado Springs that provide services through Nextera. The provider offers monthly memberships for care outside of insurance, unlike most primary-care clinics that bill on a fee-for-service basis through insurers.

Nextera also offers fee-for-service care, but the provider centers its business model on getting patients to purchase memberships, especially through its target demographic, small and mid-sized employers along the Front Range. The model is geared toward people with high-deductible plans with the idea that patients’ needs mostly can be addressed through primary care. Some employers pay the entire membership for their employees, while others have their employees contribute.

Nextera charges $99 per adult each month and $79 for each additional adult. It also charges a one-time $29 registration fee. Children cost $49 apiece for up to four; additional children are free. Nexterra saw more than 9,000 patients last year, 1,000 of whom have memberships. It expects to double memberships in the next six months.

The company is part of a growing national movement of so-called direct primary-care providers who offer monthly memberships to patients. Denver-based DaVita HealthCare Partners Inc. (NYSE: DVA) and Seattle-based Qliance Medical Management Inc. offer similar direct primary-care programs.

Primary-care doctors consist of general practitioners, family physicians, pediatricians, general internists and geriatricians. Of the more than 624,000 physicians in the United States who spend most of their time caring for patients, slightly less than one-third are specialists in primary care, according to the U.S. Department of Health and Human Services. More than half of the 956 million visits to office-based physicians in 2008 were to primary-care doctors.

Nextera began with five private-practice physician groups, and has doubled that number as physicians contend with pressure to join hospitals because of financial concerns, including expensive overhead and billing. Primary-care doctors also can do less paperwork for insurance reimbursement under the membership model.

“They’re struggling because they’re competing against large network hospitals,” Nextera Healthcare CEO Julie Krommenhoek said. “We’re really pioneering the way to get back to full-time private practice.”

People who need treatment from a physician specialist do so through their insurance plans through a referral from Nextera. The provider’s physicians also sit down with their patients and explain treatment given by specialists.

Nextera has communicated its message nationally, with Flanagan and Tusek going to Washington, D.C., last summer to meet with White House staffers on direct primary-care initiatives.

“It was an enlightening conversation in which we had the rare chance to share with those at the top of health-care reform the many innovative steps we’re taking to dovetail direct primary care with existing health-insurance policies,” Tusek said.

Flanagan said primary-care providers can address most of a patient’s needs, helping lower health-care costs system-wide. Patients who have primary-care doctors can save about a third in medical costs instead of seeing expensive specialists.

“I look at that as an opportunity,” he said.

Steve Lynn can be reached at 970-232-3147, 303-630-1968 or slynn@bizwestmedia.com. Follow him on Twitter at @SteveLynnBW.