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Episode 42: The DPC Summit Pre-Conference (2018)–with Bethany Burk and Larry Bauer


  1. DPC Summit Pre-conference
  2. FMEC
  3. HealthTeamWorks


Key among issues facing the Direct Primary Care movement is the ability for employers to find meaningful insurance options that pair up with DPC services.  The 2018 DPC Summit pre-conference deals with just that, making it not only a healthcare conference but in many ways a HR conference. This conference brings together employers interested in reforming their benefits offering to lower cost and improve value and DPC doctors interested in providing high-quality, relationship-based primary care to patients outside of the fee for service environment. By bringing together both stakeholders involved, the conference hopes to catalyze these relationships as part of the transformation that needs to take place to grow DPC. The more that employers can learn about how their healthcare dollars are spent and the more that doctors can learn about the needs of employers, the more they can work together to improve value and lower costs. In the Episode Mr Larry Bauer, Chair of the FMEC, and Ms Bethany Burk, Summit coordinator, talk about the details of the Summit pre-conference and its importance to the conference as a whole and to the DPC movement.

Time Stamped
[02:35] Larry can you tell us about the pre-conference? Where is it? When is it? What does it deal with?
[04:40] Is the format going to be talks, breakout sessions or both?
[06:18] FMEC’s previous experience facilitating HR conference with DPC doctors
[07:11] How will the pre-conference tie into the official DPC Summit?

Larry Bauer, FMEC
Bethany Burk, AAFP


Larry Bauer is the Chair of the Family Medicine Education Consortium. A staunch supporter of Direct Primary Care, he has played an integral role in organizing previous DPC Conferences.


Bethany Burk is a quality specialist with the AAFP and is the current 2018 DPC Summit coordinator, a role in which she has served for the past 5 years.

Related Episodes

Episode 7 (link on its way)

Episode 33

Episode 41

Episode 41: The DPC Summit Healthcare Conference 2018–with Bethany Burk and Dr Kylie Vanaman


  1. The DPC Summit
  2. AAFP


Every year Direct Primary Care doctors from around the country come together at the annual DPC Summit to support DPC doctors—present and future—as well as to grow the DPC movement. It is now in its fifth year of operation and is now likely the fastest growing healthcare conference 2018 has to offer. The 2018 DPC Summit will take place in Indianapolis, IA on Jul 13-15. In this episode, Dr Roussel interviews Bethany Burk, DPC Summit coordinator, and Dr Kylie Vanaman, DPC doctor and DPC Summit steering committee member, about the 2018 summit. In particular they not only discuss the summit logistics but also new focuses on this year’s summit including an increased focus on collaboration with employers and employee benefits consultants. Finally, they also discuss the importance of the summit to the state of the DPC movement, which continues to gain traction.

Key Questions for Discussion

[02:22] To begin, Bethany can you give us a run down of the DPC summit healthcare conference 2018 agenda? Where is it, when is it and who’s invited?

[3:37]  Can you tell us some of the highlights of the healthcare conference?

[04:55] Dr Vannaman, as a steering committee member, what are you trying to focus on in the DPC healthcare conference 2018 that distinguishes it say from 2017 or 2016?

[06:46] I noted in this year’s agenda a focus on DPC as an employee benefit. Can you tell us about some of these talks that deal with the HR side of DPC?

[09:41] Do you see attention to DPC as an employee benefit as a sign of DPC’s growth?

The DPC Summit Healthcare Conference 2018


Bethany Burk is a quality specialist at the American Academy of Family Practice and is the coordinator for the DPC Summit.

Dr Kylie Vanaman is a DPC doctor who has a practice in Kansas City, Missouri and sits on the steering committee of the DPC Summit Healthcare Conference 2018.


Related Episodes

Episode 7 (link on its way)

Episode 33

Episode 42 (link on its way)


Episode 40: The Surgery Center of Oklahoma–with Dr Keith Smith

Episode 40: Bundled payment & The Surgery Center of Oklahoma–with Dr Keith Smith


  1. The Surgery Center of Oklahoma
  2. Time Article on The Surgery Center of OK
  3. Business Insider Article on The Surgery Center of OK
  4. Dr Keith Smith on Fox Business
  5. Dr Keith Smith on CNBC
  6. Dr Keith Smith on ReasonTV
  7. Dr Keith Smith on Capital Account


For most healthcare procedures, the markets have been marked by obscurity and dramatic overpricing. Separate bills from the anesthesiologist, surgeon and hospital combined with extreme price exaggeration often leads to sticker prices for procedures far above fair market value. This leads to increased premium prices and unaffordable procedures for the uninsured. The Surgery Center of Oklahoma is changing all of this by bundling payment to the surgeon, anesthesiologist and facility and kicking out insurance companies. In this episode Dr Keith Smith, co-founder of the Surgery Center of Oklahoma explains how bundling payment and not taking third party reimbursement has allowed them to lower prices for surgeries sometimes by a factor fo 10. As a consequence they’re now forcing other hospital systems to follow suit and be more transparent and fair about their prices. As well, Dr Roussel and Dr Smith also discuss how DPC and the Surgery Center of Oklahoma can collaborate to lower cost and improve value by focusing on transparency and relationships and minimizing third-party involvement in healthcare.

Time Stamped

[02:52] What was your inspiration to start the Surgery Center of Oklahoma?

[05:05] So the Surgery Center of Oklahoma has really been a trend setter in terms of cutting costs. Can you give us some examples of how you’ve been able to save people money on surgical services?

[07:45] How are you able to cut costs for these services?

[10:57] How do patients pay if no insurance is accepted?

[14:50] So this podcast is about DPC, which is somewhat distinct from ambulatory surgery, but I find your work very relevant to DPC. DPC lowers costs by breaking down the barrier of 3rd parties and restores the doctor patient relationship. How can DPC and Surgery Center of OK, or other surgery centers who are interested in adopting a similar model, work together to lower costs and improve quality?

Dr Keith Smith


Dr Keith Smith is an anesthesiologist who co-founded the Surgery Center of Oklahoma after seven years in private practice. He has been featured on Fox Business, ReasonTV, CNBC and many other major media outlets.

Related Episodes

Episode 15

Episode 39: Q&A: How Rural is Too Rural for DPC?


  1. Dr Roussel’s Presentation at the DPC Summit 2017 on DPC in Rural America
  2. DPC: A Consideration for Rural Health
  3. DPC: Improving the Doctor Patient Relationship


As many doctors in rural communities consider closing up shop or selling out to major hospital systems, some are considering a third path: Direct Primary Care (DPC). Yet as a new model, DPC also carries with it uncertainties of sustainability and viability, especially in an unpopulated area. In this episode, Dr Roussel discusses key factors to consider when operating a rural area. In particular he elaborates on the question of what population size is needed to sustain a rural DPC practice.



Time Stamped


[0:56] Last week I received a question from one of our listeners who asked:


  1. “How rural is too rural for DPC?”
  2. “Is there a suggested amount of eligible people in a certain radius [needed to start a DPC practice]?”


[1:07] These are interesting questions and I think ones which many docs in rural areas are asking more and more right now as they either close up shop or sell out to a big hospital system.


To start, just looking at Dr Phil’s mapper, there are many rural DPC practices in small towns throughout the US, not to the point of finding any in rural AK but certainly in rural towns to the likes of:


Kamuela HI, pop 9200

Emerald Falls MN, pop 6k

Garden City, KS pop 26k

Sandpoint ID, pop 7900

Cortez CO, pop 9K

Nashville GA, pop 4600

Ketchum ID, pop 5500


And many more.


[2:00] Now just because a town has a DPC practice isn’t necessarily an indicator of how well the practices are faring in terms of enrollment, but having spoken with many DPC docs who have rural practices, eg Dr Vance Lassey.


And having a rural DPC myself


[2:17] DPC is certainly possible in rural communities, but how rural likely depends on several key factors;



  • [2:27] Proximity to other healthcare providers


      1. If a DPC practice is the only show for 100 miles. It doesn’t matter who or how the payment model is, patients will find a way to pay.
      2. On the other hand if there’s multiple other options for primary care within driving distance, the population may be less willing to go to a DPC


  • [2:48] Position in the community


      1. The rural doc who’s been there forever and is trusted by the community is simply going to have a much easier time than the doc who is starting from scratch
      2. I learned this having been the doc who started from scratch.
      3. Not to say that it can’t be done, just takes longer to grow


  • [3:10] Insurance status of people in the area


      1. If the population is predominantly Medicare/Medicaid it’s going to be harder. Not impossible, just harder, based on what we’ve learned from other DPC practices


  • [3:29] How big a DPC practice needs to be to break even.


    1. Even in the best case scenario, only a fraction of town members who have healthcare needs will sign up.
    2. Certainly possible in a town of 1000 that a DPC doc could make it work if he or she is the only doc in town.
    3. Going to be much harder if there’s another doc who takes insurance in a town of <5,000.


[3:53] The point is that DPC is certainly possible in many remote situations, and certainly with Medicare/Medicaid pilots on the horizon, is only likely to become more likely that rural America has access to a rural DPC, as more docs and patients realize the beauty of going direct.


Related Episodes

Episode 23

Episode 3


Episode 38: Iora Health–with Dr Rushika Fernandopulle


  1. Iora Health
  2. Iora’s collaboration with Humana Medicare Advantage
  3. Iora raises $100M to expand

Iora Health is a company based out of Cambridge, MA that provides DPC services to larger companies. Starting out seven years ago as a DPC practice serving individual pateints, Iora has since moved to focus on employer groups to the likes of Boeing, Dartmouth College, casino workers of Atlantic City, Medicare Advantage patients and many many more. Dr Rashika Fernandopulle is the founder of Iora and now serves as their CEO. In the interview they discuss how Iora got involved in serving employer groups, how going direct has allowed them to improve quality and lower cost for their clients, and howe their collaborations with employer groups can serve as a model for other DPC practices and businesses to form partnerships in the future.


Time Stamped


[2:54] So, to start, can you tell me about the name Iora. Where did it come from?

[3:47] When did Iora start? And how did Iora get involved in employer contracts?

[6:17] What’s the average number of lives covered in a contract? What is the scope of the services in the contract?

[7:39] As mentioned earlier, for many Iora would not pass the litmus test of DPC, but there are many ‘direct’ elements of the care you deliver that differs markedly from the status quo. How does Iora consider itself similar/different to/from DPC?

[9:14] Importance of what Iora is doing to the DPC movement.


Dr Rushika Fernandopulle


Dr Rashika Fernandopulle is a primary care doctor who completed his training at Harvard Medical School (HMS) in Boston, MA. He started Iora as a way to offer high quality, relationship-based primary care free from the constraints of fee-for-service based care. He now serves as the CEO of Iora in addition to being a primary care doctor.


Related Episodes

Episode 35

Episode 36

Episode 37

Episode 37: The DPC Friendly Broker–with Mr George Claassen


  2. Gold Direct Care

Mr George Claassen is one of those exceptional insurance brokers who not only has come to embrace Direct Primary Care (DPC) but also to focus on DPC as the target market of his insurance firm. Self-titled the “DPC Friendly Broker,” Mr Claassen found in DPC a solution to the unsavory options he had available to offer his clients for healthcare coverage. Starting out working with Dr Jeff Gold of Gold Direct Care in Marblehead, MA, Mr Claassen has come to work with many DPC doctors throughout the Northeast. He now focuses on direct primary care patients and doctors, working together with them to find insurance options that can supplement DPC practice membership. In the interview they discuss how he works to pair DPC with wrap-around insurance coverage, what kinds of plans he offers and how DPC doctors can work with other brokers to provide primary care and insurance to pair with DPC membership.



Time Stamped

[2:15] Mr Claassen can you tell us a bit about how you got into being the DPC friendly broker?

[4:51] What types of options do you offer to pair up with DPC membership?

[6:40] What DPC doctors have you worked with?

[9:15] For patients and/or doctors who are looking for a DPC friendly broker in their area, where would you suggest they look?

[12:36] For brokers who want to learn more about DPC, where would you suggest they look?

[13:37] Why the ‘old way’ of offering group plans as a broker doesn’t necessarily serve the needs of the employer.


Mr George Claassen


Mr George Claassen is an insurance agent who lives in Maine. He works with DPC doctors to help them find small to medium sized businesses who are interested in pairing DPC with wrap-around coverage. He can be found at the


Related Episodes

Episode 35

Episode 36

Episode 38

Episode 36: DPC as an Employee Benefit–with Suzy Johnson and Rachel Miner


  1. Employee Benefits Advisors of the Carolinas
  2. Employee Benefit Advisor Magazine
  3. Suzy’s article on why benefits advisors should offer DPC as a benefit

As the Direct Primary Care (DPC) model takes off, many in the employee benefits world are continuing to grapple with Direct Primary Care as an employee benefit. While many brokers struggle to find a place in their offerings for a benefit that (usually) provides no commission, some benefits advisors have fully embraced DPC, recognizing the value it provides to their clients. Suzy Johnson and Rachel Miner are two such brokers who have embraced DPC as an offering to their clients and have worked to adjust their insurance plans to pair with DPC. In the interview, Suzy and Rachel discuss how they learned about DPC, how they’ve come to embrace DPC as a model for their clients and how other brokers who are interested in learning more about DPC can follow suit.

Time Stamped

[2:25] Suzy, to start out, how did EB advisors get involved in working with Direct Primary Care as an employee benefit?

[5:48] How has your experience grown with direct primary care practices?

[8:02] Now Rachel, you have worked with self-funded plans that pair with DPC for some time. Can you tell me about how these plans work and how they pair with DPC?

[13:01] A reference-based self-insurance plan paired with DPC has considerable potential to lower cost for premiums. Why is this?

[16:24] Now, as I’m sure you’re both aware, DPC is very novel and many advisers don’t understand it well enough to know how it fits into the whole picture of health insurance. How would you advise a benefits adviser to learn more?


Suzy Johnson
Rachel Miner


Suzy Johnson is the President of Employee Benefits Advisors in Charlotte, NC. In addition, she serves as a Senior Benefits Specialist and an author for Employee Benefit Advisor magazine.

Rachel Miner is an Employee Benefits Strategist with Employee Benefits Advisors in Charlotte, NC. She has experience facilitating DPC membership as an employee benefit and in crafting wrap-around plans to pair with DPC membership.


Related Episodes

Episode 35

Episode 37

Episode 38

Episode 35: Nextera Health & Digital Globe: A Case Study–with Dr Clint Flanagan


  1. Nextera Healthcare
  2. Digital Globe
  3. White Paper showing results of the Nextera Healthcare/Digital Globe DPC trial

As more and more companies explore the possibility of hiring Direct Primary Care (DPC) practices to care for their employees’ healthcare needs, more will ask how DPC compares to the status quo in terms of cost and quality. Nextera Healthcare and Digital Globe answered this very question. In 2015, Digital Globe, a national security company, hired Nextera Healthcare, DPC practice located in Longmont, CO, to provide DPC services to its members for a 6 month trial period. Digital Globe also provided insurance to pair with DPC membership. At the end of the trial the insurance company analyzed the results of the trial, showing a reduction in overall healthcare costs for employees as well as an improvement in their overall health for members of the DPC practice compared to non-members. The results of this trial were published in a white paper the following year (see above).

In this episode Dr Roussel interviews Dr Clint Flanagan, founder of Nextera Healthcare, about this collaboration. How did it begin? What did the agreement entail? What were the results? And importantly, how can this partnership serve as a model to other DPC practices and companies to collaborate?


Time Stamped

[2:15] So Dr Flanagan, can you tell me about your partnership with Digital Globe. How did it begin?

[3:07] Once your formed the partnership, how did this partnership form in terms of working with human resources to form more formal agreement?

[4:55] How did the clinic reach out to patients to fold them into the flock?

What kind of insurance did patients have?

[5:00] Dr Flanagan describes the pilot study: how it was done with employees who got DPC versus those who didn’t.

[7:10] What kind of insurance did employees have when the trial took place?

[9:03] What kind of quality metrics were used to measure health of employees?

[10:12] What were results of the study in terms of cost?

[11:49] What is the state of your partnership now?

[13:32] What would you suggest to other DPC practices who are looking to work with companies to offer DPC as an employee benefit?


Dr Clint Flanagan


Dr Clint Flanagan is a family doctor from Colorado. He started Nextera Healthcare in 2009 and now serves as the company’s CEO, in addition to being a DPC doctor.


Related Episodes

Episode 36

Episode 37 

Episode 38

Episode 34: Q&A: What is Direct Primary Care?


  1. DPC Defined (Direct Primary Care Frontier)
  2. DPC Detailed Definition (Direct Primary Care Frontier)


As Direct Primary Care (DPC) continues to grow, more and more companies have set up shop with the name ‘DPC.’ While most DPC practices consist of solo doctors who said goodbye to insurance and started charging a monthly fee, larger companies have now joined the space of ‘DPC.’ Companies offering up-front telemedicine with a back-up (fee-for-service) doctor or management groups offering to manage multiple locations and run a clinic via a franchise model are some of the many examples of new models branding themselves as ‘DPC.’ These models are quite different from the solo doc who hung out a shingle and charges a monthly fee. In this Q&A, Dr Roussel discusses the question: What is Direct Primary Care? Is there a strict definition? If so, what is it? If not, how can one tell a ‘true’ DPC practice from a lookalike?


Time Stamped

[1:00] Over the past months as DPC has continued to grow in support and popularity, we’ve witnessed a number of organizations provide clinical care with the name “DPC” that have led many in the DPC community to question what being a DPC practice means?


[1:50] These models are all quite different from the DPC practices like mine and others who run small, independent or maybe 2-3 partner groups. Our practices have more of a homey environment, small-town doc sort of feel to them.


[2:03] While there’s nothing inherently wrong with having a larger group run a DPC practice, if the ‘Direct Primary Care’ as a model gets lost amidst a fray of corporate, government or bureaucratic interests, the entire meaning of the word is lost. This makes it hard for the public to sort out the wheat from the weeds.


[2:30] But where is the line? At what point is corporate or government involvement “too much” for DPC?


[2:36] To answer these, we really need to answer the more fundamental question, what is Direct Primary Care?


[2:42] To start, Dr Phil Eskew on his site DPC Frontier has a post “DPC Defined” in which he posits that for a practice to be a ‘pure DPC” practice, it must:


  1. Charge a periodic fee.
  2. Not bill any third party.
  3. The per visit charge must be less than the monthly charge.


This is certainly a reasonable definition.


[3:05] Some doctors, however, including myself, may find such a definition of DPC to be too rigid to account for the variations in practices out there.


[3:13] What about the ones that take occasional one-time visits? What about the ones that have employer contracts with small businesses? If you examine closely few practices are probably 100% pure according to this definition. Most can agree, however, that some things simply aren’t DPC.


[3:29] A large insurance company contracting with a doctor, for instance, to pay a capitated fee is unlikely to be considered DPC. On the other hand a small employer, say a group of plumbers, who pays the monthly fee for DPC employees, that’s probably not uncommon for DPC practices.


[3:47] Where is the line?


[3:50] My personal feelings about where the line are much like Supreme Court Justice Potter Stewart’s feelings when it comes to hard core pornography: “I know it when I see it…”


[3:57] There are simply some forms of care that simply aren’t DPC by virtue of the adulteration of the doctor patient relationship


[4:04] That’s where I think the core of DPC lies, in the minimization of third party involvement in the doctor patient relationship. What this means in terms of particulars is certainly up for discussion. I would love to hear your thoughts on what is direct primary care.


Nonetheless, this is a discussion we need to have, both amongst DPC doctors, and with the public.


Related Episodes

Episode 1



Episode 33: The Hint Summit–with Zak Holdsworth and Paul Lacey

Episode 33: The Hint Summit–with Mr Paul Lacey & Zak Holdsworth


  1. The Hint Summit
  2. Hint Health
  3. Dr Julie Gunther Speaks Truth About Our Broken Healthcare System


Now in its second year, the Hint Summit is quickly becoming one of the major DPC conferences. In Episode 33, Dr Roussel interviews Zak Holdsworth, CEO of HintHealth, and Paul Lacey, Senior Director of Marketing at Hint Health, about the Hint Summit. In the interview they not only discuss the logistics of the Hint Summit but also its importance to the DPC movement. Unlike other conferences, the Hint Summit is geared towards helping DPC engage the corporate world to the degree necessary to make DPC a cornerstone of the healthcare system.