A West Des Moines physician who is beginning his third year operating a direct primary care practice has now launched a 24-hour urgent care/extended care clinic as an additional service for his members, but the clinic will also provide a much-needed off-hours community resource to the public.

More than 500 Central Iowa patients are currently enrolled as members of Exemplar Care, a direct primary care practice established by Dr. Jon Van Der Veer in January 2019. The steady revenue stream from the flat fee member rates paid by his patients have made it possible for him to launch the 24/7 urgent care clinic. It’s located in an expanded facility he’s moved into at 7300 Westown Parkway, Suite 330. The urgent care clinic officially opened on Feb. 15.

Van Der Veer determined that the need for an urgent care clinic that could remain open 24/7 existed after discussions with a number of Central Iowa business leaders. Other urgent care clinics in Greater Des Moines only remain open until early evening hours. Exemplar Care’s H-shaped medical building has separate wings for primary care, urgent care and extended care patients.

“We’re hiring between seven and nine clinicians — all fairly tenured and experienced clinicians,” he said. “We think that having a skilled workforce is first and foremost in importance.” The physicians are investors in the practice as a professional licensed limited liability company and use a management services organization to handle financial and management aspects of the business.

The middle part of the H-shaped building that connects the two ends is the primary care wing, where Van Der Veer has brought on a physician assistant to help handle the increase in patients.

“As we continue to grow, we have [doctors] in our urgent care clinics who would like to transition to the primary care piece,” he said. “It’s really easy to plug in somebody on the urgent care side — so we’ve basically got our stable fully loaded.” Leading Urgent Care at Exemplar Care as medical director is Dr. Katie Kuehner, who previously was an emergency physician at Boone County Hospital.

The key to making the business financially sound is having the foundation of the fixed revenue stream from the established primary care members, with additional fee for service revenue from the urgent care the icing on the cake.

“So the urgent care and extended care areas are there to serve members, first and foremost,” Van Der Veer said. Those members’ fees pay for their urgent care visits, so there is no added fee paid when they use the urgent care. Nonmembers can also access the urgent care and extended care facilities by paying a fee-for-service rate.

“For our urgent care we’ll have 100% transparent pricing for the visit fee, for imaging, for routine blood work, for urine samples for drug screens. We basically found out the price points for everyone else in the community and we are lower than them for cash-pay rates. We are putting everyone on notice that prices can and should be transparent.”

The third wing of the building will be used for extended care — intended for patients who may need several hours of observation or an additional round of treatments before they can be safely released to go home. Patients can receive extended care for up to 23 hours, after which they would either need to be discharged or transferred to a hospital.

“Direct primary care is still the core of who we are,” Van Der Veer said. “So if you are an employer group and let’s say you have 200 people, and 100 of them want to enroll in this, they will have the same direct primary care benefits — the texting, the Facetime calls using HIPAA-compliant videoconferencing.”

Exemplar Care’s largest employer group currently is the convenience store company QuikTrip Corp. The Tulsa, Okla.-based company’s self-funded medical plan still offers a health insurance option, “but they largely let me do all the primary care pieces for anyone who selects that plan that has [the direct primary care option]. Although individual patients who have come through the door by word of mouth make up the majority of his patients, Exemplar has begun attracting some small employer groups as well.

Insider: Read a Business Record article about how Exemplar Care got started and how it works.