The Next Big Thing

Published on: December 26th, 2012

Don Poncelow cannot fathom life during the past two years without Dr. T. There were all the appointments during his wife’s fatal battle with cancer, there was care for his own medical needs, including the time he was hit by a car while riding his bike, and there was support for his depression after Elaine died. There were countless hugs, cups of tea and numerous talks.

“I don’t know what I would have done,” Poncelow says, tears streaming down his cheeks. “We didn’t even have to think about insurance or co-pays—except with the specialists. The doctor was always here. The night Elaine died, Dr. Tusek was leaving on a trip the next day, but that night he came and spent 45 minutes with us. It was incredible.”

Poncelow lives down the road from North Vista Medical Center, and he stopped by this December morning because a cold was getting the best of him. He didn’t have an appointment, and he didn’t have to wait to see David Tusek, who owns North Vista Medical Center along with Clint Flanagan. Poncelow didn’t have to show his insurance card, and he didn’t have to worry about a co-pay. In fact, he doesn’t have insurance. He pays $99 a month for unrestricted visits to see Tusek, Flanagan and their team in their Firestone and Longmont offices.

Poncelow is the beneficiary of Nextera Healthcare, North Vista’s direct primary care program. Under Nextera, patients pay a monthly payment, much like a membership fee, and in return they receive unrestricted visits, 24-hour care and digital communication with their physicians. Nextera covers the basics at North Vista along with discounted prices for extra work, such as X-rays, lab work, MRIs, testing and more.

Paired with a high deductible, a traditional insurance plan for emergencies, direct primary care is a revolutionary boon for Americans in 26 states. That now includes Colorado. Tusek and Flanagan spent the last three years developing Nextera, and they launched it last September, making it the Centennial State’s first direct primary care provider. Their number of Nextera clients has been growing rapidly ever since. They estimate one-third of their business at North Vista Medical Center uses Nextera.

“People can see us in three different ways: They can see us using Cigna or Humana or any of the typical, conventional ways people receive health care; they can pay cash; or if you don’t like either of those, they can use Nextera Healthcare,” Tusek said. “While we believe that the old model is profoundly outdated and inefficient and it needs an overhaul from the ground up, it’s still the way it’s done. We provide care for those with health insurance, but we’ve created an alternative.”

Working in emergency rooms, hospitals and clinics, Tusek and Flanagan have witnessed how complicated, confusing and disheartening the healthcare system has become. It’s problematic for both patients and doctors, who are pushed to see as many patients as possible in a short amount of time. They say it’s created a disconnect between physicians and their patients.

“Our job as our patients’ physician is to be their quarterback and their guide and to give them peace of mind,” Flanagan said. “There is an old saying, from Sir William Osler, that goes: Good doctors know their patients’ diseases, but great doctors know their patients.

“That’s our job, but there are so many barriers for doctors to know their patients,” he continued. “In the case of Nextera, we remove those barriers.”

It’s an old-fashioned idea: A doctor-patient relationship, in which a patient can come in to see his or her doctor anytime. It doesn’t become a question of co-pays or insurance coding or time or money.

“When it comes to the fire, flood, tornado healthcare problems out there, it is understandable that there is a lot of paperwork. There is double checking and triple checking,” Tusek said. “But for a pap smear or a physical, for the flu or strep throat, depression, insomnia, high blood pressure, you don’t need 26 steps in the billing process. And that’s what you have. It takes 26 steps for me to generate a claim with Cigna or Humana and to go through all the different players in that massive cog—26 steps to get the money from point A to point B.”

When the doctor is always available and seeing him or her is affordable, it leads to proactive healthcare, Tusek said, as opposed to just reactive medicine. They have clients who are designated uninsurable; others can’t afford health insurance. Some had traditional health insurance coverage but opted for a combination of Nextera paired with a high-deductible insurance plan. And like Apple and Facebook, which have direct primary care providers on their campuses, local businesses have also started seeing direct primary care as an option for their employees.

Tusek and Flanagan call Nextera their crusade, and they hope to see it revolutionize healthcare in Colorado. For them, it brings soul back into medicine. It’s no longer a political hot-button or a fiscal nightmare. It’s not about billing departments of insurance companies and it’s not about being a cog in the system. It’s about affordability, transparency and their patients.

“We have had front row seats to all the problems in our healthcare industry, and we looked around to see who was trying to fix those problems and saw politicians and economists and insurance company executives and hospital administrators,” Tusek said. “We found a lack of meaningful ideas. There are ideas, lots of ideas, there is no lack of ideas. But none of them make a difference.”

Many of those ideas, he says, continue to expand the “Wizard of Oz-like screen for healthcare costs.”

“We said, ‘Let’s tear down the screen.’ You should know how much that MRI costs or how much amoxicillin costs before you go to the pharmacy and see that it’s a $300 medicine,” Tusek said. “Let’s be very transparent about the cost. Let’s figure out the way to provide the maximum amount of value to service with the greatest amount of access and convenience.”

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