RootBound Health

Clinic Director · Onboarding Reference

The Clinic Director Reference Handbook

Everything the role touches, in one place — the organization, the mandate, the programs, the ninety-day plan, the operating rhythm, the systems, the SOP, the network, and the rules that keep the structure clean. Read it once end-to-end; keep it as your reference after.

RootBound Health, PLLC · North Seattle–Edmonds corridor, Seattle WA
June 2026 · Confidential — internal use · Companion to the Onboarding Deck & Executive Summary

01 The organization

RootBound Health is a direct-care clinic built for the patients the system discharges into instability — telehealth-first, after-hours staffed by clinicians rather than voicemail, and priced on a sliding scale set against King County's real cost of living.

RootBound opened November 18, 2025 as a Direct Primary Care practice under RCW 48.150. Patients are accepted regardless of insurance, income, or ZIP code. It runs six integrated clinical service lines and six programs on one operational backbone, organized under three legal entities — the clinic, a coverage advisory, and a foundation.

Why it exists. The founder experienced homelessness without a safety net or continuity of care, then saw the same pattern repeat across trauma, psychiatry, and community medicine: patients discharged into instability, care plans that didn't match real life, and harm outside any institution's responsibility. RootBound exists to interrupt that pattern — complementary to the safety net, never duplicative — by extending screening, treatment, and follow-through into the hours and ZIP codes existing clinics can't reach at scale.

02 The mandate — what you own

The Clinic Director carries four standing responsibilities. The ninety-day plan is simply how you pick them up one layer at a time.

03 Service lines

Six clinical service lines run under one chart. The connective tissue is the Patient Follow-Up SOP — four parallel tracks, three-attempts-then-escalate, red-flag routing, and a single named owner per episode.

04 The six programs

Each program is one expression of the mission, all sharing the same clinical and follow-up backbone.

A · RootBound Glow — the revenue engine

The cash-pay aesthetic line that underwrites sliding-scale primary care and the rural mission. Five modalities — HydraFacial ($149–$269), SkinPen microneedling, Daxxify (ARNP-only, ~6-month duration), Keravive scalp, and Ourself retail — each performed under ARNP supervision and Washington scope rules. The director's lever is protocol governance, device certification, RN decision algorithms, and margin discipline; every appointment also routes a primary-care touchpoint. Entry HydraFacial Signature runs ~77% gross margin.

B · TLC — the 30-day hospital-to-home pathway

High-risk discharges are flagged by the hospital case manager from Day −2, risk-scored, and handed off with first-contact timing set by condition. RootBound owns the episode to a clean handoff at Day 30. Runs on case-manager referral agreements — a relationship the Director builds and keeps warm. The program targets a 20–50% reduction in 30-day readmissions in the enrolled cohort, which protects a hospital partner's HRRP revenue (up to 3% of applicable Medicare payments). The flagship pilot is Swedish Edmonds (217 beds, ~8,229 annual discharges, 13.1% readmission rate), with expansion planned to broader Providence Swedish and EvergreenHealth. The evidence base is strong — structured transitional care cuts 30-day readmissions (OR 0.78), and 7-day follow-up roughly halves readmission risk (HR 0.52).

TRIS override: a High or Critical risk score (11–20) pulls first contact to ≤ 24 hr — it overrides the condition window upward, never down.

C · PHSKC / STI Partnership

A proposed designated §318 STI-clinic partnership with Public Health–Seattle & King County's HIV/STD Control Program, adding telehealth and after-hours capacity into south-King ZIP codes the existing clinic can't reach at scale. Operates as a §318 sub-recipient with 340B drug access per HRSA guidance; FQHC Look-Alike pursued as a parallel route. Measured on testing volume, positivity yield, treatment completion, and time-to-treatment — reported quarterly, coordinated with PHSKC Disease Intervention Specialists.

D · The Continuum — the membership stack

A six-tier membership pairing continuity primary care with patient financing and three patient-selected catastrophic-coverage paths. Grant-funded and urban-margin tiers cross-subsidize the sponsored ones.

Every Silver and Gold member must complete an RBCA Coverage Review within 30 days of enrollment — this is a tracked follow-up obligation, not a courtesy.

E · Taproot

Statewide rural reach answering HPSA designations, 60-minute care deserts, and a 400–470k Medicaid-disenrollment wave. Four delivery elements: cellular-first RPM (no Wi-Fi; ≈$115/patient/mo net margin at scale), telehealth-first access via Radix, a monthly mobile clinic circuit, and food-as-medicine produce Rx via the 1115 HRSN waiver. Phasing protects the balance sheet — launch on telehealth + RPM; the ~$285–425K mobile unit is Phase 2, contingent on the USDA award. A Spanish-language workflow is required from day one in Eastern WA.

F · Follow-Up Operations

The SOP spine — escalation pathways and episode ownership for everything above. Detailed in §09–10.

05 The first ninety days

Three movements, deliberately paced. Listen first, earn the chart, then never let an episode fall through.

06 The operating rhythm

The clinic runs on a fixed cadence. The dashboard is the single source of truth, updated monthly and reviewed against it. As Director you chair the operational beats; the founder and board hold the strategic ones.

07 Reporting & the dashboard

One dashboard, three audiences. Every number traces to Healthie or QuickBooks — never to a hallway estimate.

KPI dashboard — what you watch

08 Systems & access

The stack you run on — set up in week one.

Week-one access checklist

• Healthie admin role · Radix clinician seat · RPM clinical dashboard
• Cherry merchant portal (read) · QuickBooks reporting view
• Shared drive · board-pack template · the risk register

RPM clinical SOP — know it cold. Thresholds, escalation, and charting are governed by the RPM clinical-review SOP. A reading that breaches threshold routes to you the same way a red flag does — review, act, chart.

09 The Follow-Up SOP

This is the connective tissue under all six service lines. Every episode runs one of four parallel tracks, follows the three-attempts-then-escalate rule, and is held by a single named owner from open to closure.

The rule that never bends: three documented contact attempts, then escalate — never let an episode go quiet. The owner's name is on it until it closes, and nothing closes without a chart note.

10 Escalation & red-flag routing

The path a red flag takes to reach you.

For TLC specifically, a High or Critical risk score pulls first contact to ≤ 24 hours — the risk score overrides the condition window upward, never down. When in doubt, escalate early; the system is built to absorb it.

11 Your people & the network

The inner team

The external network — who to know, sequenced

Sequence is the point: referral partners first (they feed live episodes), then access partners, then capital. Keep a 2:1 pipeline — two prospects in motion for every relationship you're counting on.

12 The three root barriers — what you must never do

The three entities only stay safe if their root barriers stay clean. These are the bright lines — break one and you risk the DPC license, the producer license, or the Foundation's status.

13 Compliance calendar

Trigger to act now: any inter-entity payment without a written agreement, or any unlicensed insurance conversation, fires its mitigation playbook immediately — it does not wait for the quarter.

14 Decision rights

When a call is ambiguous, default to surface early — the cost of an over-shared decision is a five-minute conversation; the cost of an under-shared one can be a wall.

15 What "good" looks like

16 Financial model

The Director owns the clinic to contribution margin. The mix is built to be diversified and recession-resilient — aesthetics is the cash engine that cross-subsidizes the mission lines.

The headline numbers

• Year 1 revenue: $2.8M–$3.4M across all lines; Year 2: $4.5M–$5.2M.
• Break-even: positive operating margin targeted at Month 8–12, depending on ramp speed.
• Pre-launch investment: $250K–$400K; aesthetic equipment $175K–$275K, with 6–12 month equipment break-even at moderate utilization.
• Year 1 operating expenses: ~$750K–$1.16M — the largest lines are provider compensation, medical supplies (COGS), and support staff.

The TLC 90-day pilot delays revenue for that line, but TCM / RPM billing during the pilot partially offsets it — something to model when you forecast cash.

17 Staffing plan

Every hire is gated to a volume trigger, so payroll tracks demand rather than leading it. You watch the trigger metric and pull each role in on time.

18 Glossary