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Case Study

How Colorado’s Largest DPC Network Leveraged Technology to Break Through with Employers

nextera-hero-image

109

Independent physician affiliates

70+

Near-site & on-site clinics

24%

Net growth in memberships

$100k

Recovered by HintOS™ dunning processes

$913

Annual savings per member vs PPO plan

Introduction

Blazing the trail for a better way of care through DPC

Headquartered in Boulder County, CO, Nextera Healthcare was founded in 2009 by Dr. Clint Flanagan and his wife, Deirdre Flanagan, as the state’s first direct primary care (DPC) membership program.

As the practice’s direct-to-consumer offering gained traction in the community, the Flanagans took their healthcare model directly to employers—starting with local small businesses and eventually expanding to serve larger self-insured companies. In 2014, they started the Nextera Healthcare Community—an affiliate network of independent clinics—to care for remote employee-sponsored members.

As their plans for expansion came into focus, so did Nextera Healthcare’s need for an enterprise-grade administrative platform that could meet the demands of their increasingly complex and sophisticated business.

I realized that we could save employers a significant amount of money by offering advanced primary care, which often results in decreased high-dollar downstream claims.”

Dr. Clint Flanagan, Founder & CEO

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Challenges

When Nextera Healthcare began offering memberships over a decade ago, their objective was to take excellent care of people for a flat affordable monthly fee—no copays, no surprise bills, and no limits on office visits or care. However, they hadn’t yet figured out all the logistics required to turn their vision into reality.

Over the years, the operational challenges emerged on several fronts.

  1. Relationship management was the first and most foundational challenge. Dr. Flanagan’s team needed a scalable way to keep track of the thousands of financial and clinical relationships they were creating between members, physicians, affiliated clinics, and employers—including more than 70 uniquely priced employer plans—so that members would receive the right services, employers would get billed the right amount, and Nextera Healthcare and its affiliates would get paid accurately and on time.
  2. Another challenge was leveraging data to show self-funded employers the transformative impact that direct primary care can have on employee health and healthcare costs. Dr. Flanagan and team needed a way to extract their membership data and pair it with utilization and clinical data.
  3. Keeping things easy for HR departments was another hurdle. The less disruptive Nextera Healthcare could be to existing HR processes and workflows—including working through TPAs and benefits advisors—the easier it would be to break through with larger employers.
  4. More recently, dealing with employee census files from TPAs had grown into a time-consuming and error-prone administrative burden for Nextera Healthcare as they brought on bigger employer groups. They needed a reliable, easy way to keep eligibility status and member information current across their entire network.

How HintOS™ Helps

Since 2015, Nextera Healthcare has used HintOS to connect every aspect of their DPC operation, and the platform has helped the Flanagans and their leadership team bake operational best practices and consistency into their organization at scale.

The Eligibility AutoSync™ feature of HintOS was a game-changer for how Nextera Healthcare keeps up with changes to employer-sponsored member eligibility. The configurable rules engine automatically syncs employee census files from TPAs and HRIS systems so that Dr. Flanagan’s team and affiliated providers always have up-to-date eligibility and patient information. Today, 74% of Nextera Healthcare members run through Eligibility AutoSync. In fact, HintOS automatically processes over 10,000 daily changes to eligibility and personal information across all HintOS Enterprise customers—freeing teams to focus on other tasks that add value and create world-class patient experiences.

Collections is one area where HintOS has had a direct impact on Nextera Healthcare’s revenue. In the last year alone, the platform’s advanced collections and dunning processes have recovered over $25,000 in failed payments..

HintOS also allows Nextera Healthcare to pre-schedule plan changes—for example when a member ages into another membership tier—so that members are always on the right plan and the practice doesn’t let revenue slip through the cracks.

The unrivaled flexibility and pliability of HintOS gives Dr. Flanagan’s team the freedom to bring more innovative and cost-effective healthcare solutions directly to employers. Using advanced plan administration tools in HintOS, Director of Employers & Affiliates Katie Harmon can set up an unlimited number of unique plans and pricing schemes to fit the terms of virtually any employer or affiliate agreement. For example, some employer plans include additional free services, while others require a deductible to be met before labs are covered. HintOS keeps everything structured and organized so that members enroll in the right plans, receive the right services, and pay the right amount every time. And Hint’s free affiliate portal ensures that every affiliate—whether they run on HintOS or not—always sees updated and accurate member information.

HintOS is powerful and manages a lot of complexity, but it is still simple to use.”

Deirdre Flanagan, VP Operations

To support direct-to-employer sales and retention, Nextera Healthcare pairs financial data from HintOS with clinical and utilization data to quantify the impact that their unique brand of direct primary care has on healthcare costs. One employer saw annual savings of $913 per member compared to their existing PPO Choice plan. In another example, a Colorado school district saved over $1.4 million after rolling out the new membership benefit. Moreover, school district employees who participated in the plan enjoyed an average out-of-pocket savings of $1,000 annually and a 50% reduction in overall healthcare costs. By setting up on-site and near-site clinics for schools, Nextera Healthcare drove a significant reduction in expensive and oftentimes avoidable downstream claims—including 72% fewer hospital claims, a 62% reduction in surgical care, and a 74% decrease in ER claims.

Harmon described the “peace of mind” of knowing that their employers can make self-service updates to employee rosters through the Nextera Healthcare Employer Portal powered by HintOS. Harmon’s team even receives real-time notifications whenever members come on or off employer plans. HintOS also manages Nextera Healthcare’s invoicing, employer payments, membership payments, and the flow of funds to affiliates, all automatically based on rules the team defines for each affiliate and employer.

As the world has changed and cyber attacks on US healthcare organizations have become more frequent and costly—averaging $8.6M per incident in 2020 according to IBM—HintOS has helped Nextera Healthcare more easily meet stringent HIPAA, SOC 2, and ISO27K patient privacy and data security standards.

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Results

Today, Nextera Healthcare runs one of the largest and fastest-growing Direct Primary Care networks in the US with thousands of members across more than 70 owned and affiliated locations in Colorado, the Midwest, and the East Coast.

Despite the challenges presented by the COVID-19 pandemic, Nextera Healthcare has thrived—seeing a 24% increase in membership during 2020-2021—with much of their growth coming from self-funded employer groups. And with the enterprise-grade flexibility of HintOS, Nextera Healthcare can accommodate an ever-growing network of affiliates and employer groups while continuing to serve individual members and families in their community.

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Nextera Healthcare Community locations

Hint has provided the kind of cost-effective infrastructure we need to take DPC to more employers and ultimately to more people across the country.”

Dr. Clint Flanagan, Founder & CEO

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