How Next Level Urgent Care started from a $ 1K ER visit

Dr. Juliet Breeze was watching her four kids splash in the pool in their southwest Houston home, when she saw her son pop up from underwater and start screaming, clutching his ear.

Breeze, a primary care doctor, recalls thinking, “Oh, gosh, he blew his ear drum.”

It was Saturday and the pediatrician’s office was closed, so she took him to a freestanding emergency room in a strip mall. She figured it couldn’t be that expensive. Then, a few weeks, she was billed about $ 1,000 for a five-minute visit that would have cost $ 60 at her pediatrician’s office.

“I felt like there was something wrong happening. I realized patients like me, a mom of four, need to access medical care for non-life threatening things after work hours, ”Breeze said. “But there wasn’t a good, trusted place for me to receive that care.”

That experience inspired Breeze to create such a place and launch a network of urgent care centers – where a visit can cost as little as an insurance copay – and explore ways to deliver affordable health care. Since 2013, her company, Next Level Urgent Care, has grown from nine locations to 23, with plans to nearly double that number to 42 by the end of year.

Next Level also has expanded into primary care, and last year, launched a new service, called Next Level Prime, in which employers pay a flat rate for membership and their employees can receive primary care services without charge at any Next Level Urgent Care.

More than 30 businesses, employing from 10 to 2,500 people have enrolled in Next Level Prime, generally paying about $ 60 per employee per month. In the first year, member businesses saved an estimated 50 to 75 percent on basic medical services, such as doctor visits, lab work and other non-emergency care, according to Next Level.

With just one year of data, it’s hard to say whether Breeze has hit upon a new model that could increase access to health care while lowering costs. Breeze is now in discussions with Vivian Ho, a health economist at Rice University, about a study to determine whether Next Level Prime’s approach has staying power and how much it might save employers in health care costs.

“It’s really promising,” Ho said. “It’s especially promising for the companies they’re trying to pitch to – the ones that have middle class workers who are price sensitive, but want good health care.”

Breeze, 53, didn’t anticipate she’d find herself on the business side of health care. She moved to Houston in 1991 to attend Baylor College of Medicine and worked as a family practice doctor for 4½ years. But when the office manager for her husband’s orthopedic practice abruptly quit, she stepped in and received a crash course in the business of health care.

In 2006, while managing her husband’s practice, she began pursuing her own ventures. She teamed up with two former Accenture employees to develop a rehabilitation hospital, surgery center and medical office building.

She has since sold those properties, but it gave her the experience and credibility to start her own company – and raise $ 5 million to launch Next Level Urgent Care.

At first, the new business was a challenge. With her husband’s orthopedics practice, she could rely on referrals from other doctors. But patients typically use urgent care centers when they can’t get to their doctors. They don’t make appointments and they don’t come back for follow-up visits.

That meant making it count when patients came in – short wait times, quality care, affordable costs and follow-up calls to check on how patients were doing.

“It is really important for us to make an impression that people would remember us,” Breeze said, “and want to come back.”

Change and opportunity

The pandemic brought plenty of patients – Breeze recalled lines around the block during the Delta surge in summer 2020 – as well as big changes and new opportunities. Then, Breeze said, she and Next Level, got a lucky break.

Breeze was serving on a charity board with Dr. Atul Varadhachary, the managing partner at Fannin Innovation Studios, a life sciences incubator in River Oaks. During a call with board members, he mentioned he was working on a saliva antibody test for COVID-19 and needed COVID patients.

Next Level had no shortage of COVID patients, and Breeze offered to help. Varadhachary suggested clinical trials.

Urgent care centers aren’t typical venues for clinical trials. Clinical trials require a great deal of documentation, including informed consent from patients, and that can take extra time, conflicting with the urgent care model of trying to treat patients as efficiently as possible. But Varadhachary became impressed with Breeze and her staff di lei.

“I was struck with their responsiveness and engagement with us,” Varadhachary said. “That showed me they were a team worth taking a chance on.”

Next Level completed the trial for the antibody test and then did another one for Fannin Innovations Studios, this time for a drug to protect people from infection if they came in close contact with COVID patients. Both the test and the drug are still going through the approval process.

Breeze recognized a chance to develop a source of revenues for the clinic – drug companies pay fees to providers that host trials – and help her patients. She and her team of lei began writing to pharmaceutical companies Regeneron and Eli Lilly about holding trials at Next Level clinics for their monoclonal antibody treatments for COVID-19, citing the clinics’ previous experiences. Regeneron agreed. Eli Lilly soon followed.

Both treatments were eventually approved by the Food and Drug Administration. Next Level is now conducting other clinical trials, including one for an Alzheimer’s drug developed by Eli Lilly.

“It’s great for our patients. When there was nothing available to people for COVID, we had opportunities for people to not only advance science, but also possibly receive lifesaving medications, ”Breeze said. “And luck of the draw, both Regeneron and Eli Lilly monoclonal antibodies worked.”

The pandemic also brought changes beyond health care, contributing to labor shortages as the stimulus-fueled economy rebounded with the lifting of public-health restrictions. Breeze saw another opportunity.

Cutthroat competition

In January of 2021, Breeze and her company launched Next Level Prime, using the membership model in which employers pay a flat rate to provide free primary care services to employees. She marketed the program not only as a way to lower health care costs, but also as a valuable benefit that could help companies attract and keep workers in the cutthroat hiring environment.

“So many companies are dealing with labor shortages, and there’s a lot of competition in the labor market,” Breeze said. “Offering employees free, basic health care may make the difference between retaining an employee or not.”

Ho, the Rice health care economist, said Next Level’s membership model could bring significant cost savings for employers. Under the fee-for-service model that dominates health care, providers get paid each time they do a procedure or run a test, providing incentives to do more of both regardless of their need or efficacy. Paying a flat fee eliminates that incentive, said Ho.

“If they perform multiple tests that have no shown benefit, they’ll lose money,” Ho said. “In contrast, fee-for-service providers make more money if they run more tests and do more procedures.”

When health care services are more accessible and people use them, they are less likely to suffer costly illnesses down the line. But there is a flip side to the flat-fee models – the incentive to hold down costs could lead providers to cut corners on testing, procedures and care. That makes it imperative for Breeze to track patient outcomes and customer satisfaction, Ho said.

More employers have shown interest in Next Level Prime membership, but some have operations outside of Houston, where nearly all the clinics are located. They told Breeze they would sign on if she could serve employees in other cities.

Next Level now has 14 urgent care centers under construction in San Antonio and Austin, plus six more in construction in Houston.

Woman with purpose

This ambitious expansion came as no surprise to Dr. Robbyn Traylor, Next Level’s the chief medical officer, who recalled Next Level’s inaugural year when Breeze opened nine clinics in nine

“She is a woman that moves with a purpose,” Traylor said.

Today, Breeze said, her purpose is to make her clinics’ services as accessible as possible.

“I’m trying to take the complexity out of medicine,” Breeze said. “I think that the biggest problem with health care is that it’s very fragmented. Everybody’s trying to help patients, but they all are in these silos. I hope I can bring things together a little more. “

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