Dr. Clint Flanagan has been a physician in Colorado for 25 years. He is one of the earliest adopters of Direct Primary Care in the United States, a co-founder of Nextera Healthcare (now Kerix Health), and a member of the Direct Primary Care Coalition steering committee. In conversation with Mehul Agarwal, Founder of HealthCompiler, Dr. Flanagan traced the full arc of his journey, from a small-town clinic in Nebraska to the front lines of a national movement.
Roots in Small-Town Medicine
The interest in medicine started in junior high, when a knee injury from hurdling led to surgery. The orthopedic surgeon who fixed his knee and got him back to sports left a lasting impression. But it was primary care that shaped his path.
Growing up in Fremont, Nebraska, his family went to a local clinic where the doctors did everything. They handled stitches, sick visits, hospital admissions, and delivered babies. They were pillars of the town. That same clinic still takes care of his mother today.
"Those clinicians were just connected, caring," he says. "They were willing to do about anything we needed. It was a really good interaction, very impressionable on me as a youngster."
He joined an Explorers program at the local hospital in high school, gaining early exposure to clinicians, surgeons, and the business side of medicine. In college at Wesleyan, he majored in biology on the premed track and volunteered in the ER at Bryan Hospital in Lincoln. After college, he spent time in an NIH-funded HIV research lab, publishing papers and working with a postdoc. He enjoyed science, but realized he preferred working with people more than mice.
Medical school confirmed what the small-town experiences had planted. During his third and fourth years, he rotated through residency programs in Colorado, Texas, and North Carolina, and chose family medicine. He trained at St. Mary's Hospital in Colorado, an unopposed community-based residency where family medicine residents got broad clinical experience. Over 90% of graduates went into private practice in small towns, often as the only clinic for miles.
In his second year of residency, he began moonlighting in the emergency room in Delta, Colorado, and continued doing ER work until 2017.
The Pathway to Nextera
After residency, Dr. Flanagan moved to Boulder County and joined a 50-physician multi-specialty group that had been around for decades. He helped open a satellite office in Firestone, Colorado. It felt like a dream job: a brand-new clinic in a small town, part of a physician-owned group. But he also got his education in billing and coding, productivity-based compensation, and the business realities of fee-for-service medicine.
Administrative challenges led about 20 of the 50 physicians to leave. Dr. Flanagan was one of them. He moved into emergency medicine and eventually joined Centura Health, at the time the largest healthcare provider in Colorado. Good people, he says, but a very slow-moving ship. He helped them open a new clinic in the Denver metro area before deciding to own his own practice.
Each chapter was formative. He had been a partner in a physician-owned group, an employee of a large health system, and an owner of a fee-for-service primary care practice. Simultaneously, he was working in emergency rooms and seeing firsthand the barriers patients faced getting care, and the costs when they could not.
"The evolution of billing and coding has polarized the patient-physician relationship," he says. "The clinician is in this place where they're thinking, as they're looking at the patient, what can I do that's billable. That's a morally complex arena to be in. I haven't met a doctor that doesn't want to just be in the lane of how can I best help you."
Monthly Membership Medicine
Around 2009, Dr. Flanagan and his team began offering something they simply called monthly membership medicine. They did not know the term Direct Primary Care existed. The idea was straightforward: patients pay a fixed affordable monthly fee and receive unlimited primary care in return.
They launched it underneath their existing fee-for-service practice. Many of their patients had high-deductible health plans that only covered one preventive visit a year. Everything else, every diabetes follow-up, every blood pressure check, came out of pocket until the deductible was met. Patients were avoiding care because they were worried about the bill.
"Rather than not get care at all because you're worried about what the doctor bill will be, just pay a fixed fee and have peace of mind," he says. "You can come in and see your doctor whenever you want. You can call your doctor, text your doctor."
People signed up. The noise of billing and coding disappeared. Revenue became fixed and predictable, a stark contrast to the variable revenue and accounts receivable cycles of fee-for-service medicine. And with the time freed up, the team could focus on what they had always wanted to do: be health coaches for their patients, working on sleep, nutrition, exercise, and emotional health.
"There's not a code for healthy," he says. "You can't code for that. You have to code for disease state."
Then the employers appeared. Some of their individual members owned small businesses, plumbers, HVAC companies, with 10 or so employees. When asked what they offered their workers for healthcare, the answer was the same: they could not afford traditional insurance. But they could afford $99 a month.
That was the light bulb. About 160 million Americans receive their healthcare benefits through employers. The practice started taking care of employer groups, and a new chapter began.
Dinner with Garrison Bliss
Before any of this had a name, Dr. Flanagan was a member of the American Academy of Private Physicians, an organization populated mostly by concierge doctors. They happened to hold a conference in Denver. Before attending, Dr. Flanagan had connected virtually with Dr. Garrison Bliss, who had founded Qliance in the Pacific Northwest and was calling what they did Direct Primary Care.
They met at the conference and went to dinner. Over a bottle of wine, they compared notes. The business models were strikingly similar. Dr. Bliss had early angel investors that Dr. Flanagan recalls may have included Michael Dell and possibly Jeff Bezos and Drew Carey.
"I remember really being impressed with Garrison," Dr. Flanagan says. "Number one as a human. Number two as a physician. Number three, the business model."
The timing mattered. Dr. Flanagan and his team had been putting their eggs into the membership medicine basket, believing in their core that it was best for patients and physicians. But belief and profitability have a long stretch between them. Finding a like-minded pioneer validated the path.
From that point on, they started calling themselves Direct Primary Care. The relationship with Dr. Bliss continued for years. Dr. Flanagan was invited onto the steering committee of the Direct Primary Care Coalition, a position he still holds. He spoke on a panel at the first-ever DPC conference in St. Louis alongside Dr. Rushika Fernandopulle, who founded Iora Health and later sold it to One Medical for roughly $2.1 billion.
"In the early days, just having connectivity with these other pioneers and thought leaders that were doing what I really felt was the right thing for patients and physicians and communities," he says. "Boy, we sure banded together."
The Legislative Fight
A significant chapter of Dr. Flanagan's work has been in policy. As part of the Direct Primary Care Coalition, he has spent years in Washington educating senators and members of Congress alongside a small band that included Dr. Bliss, Dr. Fernandopulle, and healthcare lobbyist Jay Keese.
One of the longest-running battles was over HSA eligibility. The coalition had sent a letter to the IRS more than a decade ago asking them to update the HSA language, which had been written before DPC existed. The IRS told them to go pass a bill. That took years, spanning multiple administrations. Through what Dr. Flanagan calls herculean efforts, they got it into HR1, the reconciliation bill. As of this year, Americans with HSA accounts can officially use those dollars to pay for DPC memberships.
"Granted, before that, thousands of Americans were already using their HSA funds to pay for DPC," he says. "The private market is usually ahead of the government. But it really helped having that legislation passed."
The coalition has also been deeply involved at the state level. Nearly 40 states have passed legislation establishing that DPC is not insurance and therefore not subject to regulation by the division of insurance. Dr. Flanagan personally helped pass those laws in both Colorado and Nebraska, testifying in both states. Colorado's law passed unanimously under Governor Hickenlooper, a Democrat. Nebraska's passed unanimously under Governor Ricketts, a Republican.
"This is not a Democratic issue. It's not a Republican issue," he says. "We've got people from both sides that all agree DPC is really important."
The next frontier is Medicare and Medicaid. The coalition has held numerous consultative meetings with CMMI, the Center for Medicare and Medicaid Innovation, advocating for a voucher-based model that would allow Medicare recipients to choose a DPC physician. At the state level, Dr. Flanagan has been involved in efforts to make DPC an option for Medicaid recipients, many of whom face long wait times and end up in the ER by default.
The Role of Data
Dr. Flanagan is direct about one of DPC's biggest challenges: proving its value in a language that employers and CFOs understand.
The DPC physician provides enormous value day-to-day, from managing chronic conditions to catching cancer early to navigating patients through specialty care. But historically, the only language available to quantify that value has been utilization codes and billing data, a system where 30 to 40% of the data entered through CPT and ICD codes is wrong.
"Most of these EMR platforms have been legacy practice management things that are just set up for billing and coding," he says. "There's a huge opportunity for EMR platforms to evolve and capture the value of that physician-patient interaction with as few keystrokes as possible."
He recounts a physician at One Medical who requires 32 keystrokes to enter a medication renewal. "Thirty-two keystrokes. Utter technological failure," he says. "And this is Amazon."
On the employer side, Kerix Health delivers quarterly business reviews showing engagement, avoided urgent care and ER visits, and cost comparisons between direct-pay and traditional PPO lanes. Working with a direct-pay bundled services partner, they showed one Colorado school district $1.2 million in savings by routing employees to direct-pay surgery partners instead of through the PPO network. They also identified $1.7 million in specialty drug overspend through the PBM lane that could be addressed with alternative pharmacy partners.
"It's amazing how many super savvy employers that are spending millions don't know their per-employee-per-year cost because their brokers hid it from them," he says.
Advice for Those Considering DPC
For physicians thinking about DPC, Dr. Flanagan encourages immersion in the community first. Attend the DPC Summit and Hint Summit. Reach out to DPC physicians nearby. Join the DPC Docs Facebook group. Consider becoming a member of the Direct Primary Care Coalition and getting involved with the Free Market Medical Association and Health Rosetta.
But he is also candid about a decision many physicians do not think about early enough: do you want to own the business, or do you want to be employed by one?
"Sometimes even though the steak tastes good, it's hard to run a restaurant and sell that steak," he says. "Probably less than 10% of people want to own their business and have the chops to do that. And that's totally okay."
Kerix Health alone has hired around 15 physicians in the last year. The number of DPC practices looking for employed physicians is growing across the country. Whether someone chooses ownership or employment, Dr. Flanagan believes the model itself is what matters.
"Once you know about DPC, it's going to be really hard to work for a big health system," he says. "Because once you know, it's like, boy, I'd sure like to be in that model where I can spend time with patients, where the business model is aligned, and I can grow as a physician and be a leader in the community I serve."
What gives Dr. Flanagan confidence in the future of DPC is the community itself. Throughout his journey, from those early conversations with Garrison Bliss to lobbying in Washington to opening new clinics across multiple states, he has found the DPC world to be unusually generous with its time, knowledge, and support. The playbooks have been written. The history and experience are there for anyone willing to reach out.
"One beautiful thing about our DPC community is you'll just find a lot of people in it that are happy to tell their story and happy to help you," he says. "There are so many partners out there now that really want to support direct primary care. It's a great time to be in this space."