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The portfolio
Six programs on one operational backbone
Each program is one expression of the mission — all sharing the same clinical chart and follow-up SOP. Pick one to dive into the detail.
Each program is one expression of the mission — all sharing the same clinical chart and follow-up SOP. Pick one to dive into the detail.
The aesthetic service line is the cash-pay margin that underwrites sliding-scale primary care and the rural mission. Five modalities, each performed under ARNP supervision and Washington scope-of-practice rules.
Protocol governance, device certification, RN decision algorithms, and margin discipline — every appointment also routes a primary-care touchpoint.
Aesthetics runs $500–800K in Year 1, $1.0–1.5M in Year 2, at a 55–70% gross margin — the cash engine that cross-subsidizes sliding-scale primary care and the rural mission.
Aesthetic equipment is a $175–275K pre-launch investment with a 6–12 month equipment break-even at moderate utilization. Chair and device utilization is the number to protect.
Every aesthetic visit also routes a primary-care touchpoint — Glow is a front door to the medical home, not a standalone med-spa.
Every modality runs under ARNP supervision and Washington scope rules. You own protocol governance, device certification, and the RN decision algorithms behind each service.
Patient financing rides on Cherry, which renders its own Reg Z / TILA disclosures — staff never paraphrase terms, and no financed visit closes without a signed receipt and chart note.
A Licensed Esthetician is pulled in around Month 6–12, gated to aesthetic-volume demand — payroll tracks demand, never leads it.
High-risk discharges are flagged by the hospital case manager from Day −2, scored for risk, and handed off with first-contact timing set by condition — because different conditions fail at different speeds. RootBound owns the episode to a clean handoff at Day 30.
| Condition (DRG family) | First contact | RPM kit | In-person |
|---|---|---|---|
| COPD / AECOPD | ≤ 24 hr | Pulse ox ± BP | 7–10 d |
| Heart failure | ≤ 48 hr | BP + weight | 7–10 d |
| Acute MI / angina | ≤ 48 hr | BP + HR | ≤ 7 d |
| Major surgery / CABG | ≤ 48–72 hr | Wound + mobility | 7–10 d |
| Sepsis / pneumonia | ≤ 72 hr | BP + pulse ox | ≤ 7 d |
A High or Critical risk score (11–20) pulls first contact to ≤ 24 hr — it overrides the condition window upward, never down.
Runs on hospital case-manager referral agreements — the Director's relationship to build and keep warm.
Targets a 20–50% reduction in 30-day readmissions in the enrolled cohort, protecting 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), expanding to broader Providence Swedish and EvergreenHealth. Structured transitional care cuts 30-day readmissions (OR 0.78); 7-day follow-up roughly halves readmission risk (HR 0.52).
TCM, CCM, and RPM (CPT 99453+) carry the revenue — $480–720K in Year 1 at a 65–75% margin. The 90-day pilot delays the line, but TCM/RPM billing during the pilot partially offsets it.
A 20–50% readmission cut protects the partner's HRRP revenue — up to 3% of applicable Medicare payments. That's the business case you carry into every case-manager conversation.
It runs on case-manager referral MOUs — the first signed by Day 90, two-plus live by month 12. MIH (community-paramedic) integration extends the in-home reach.
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 the hours and south-King ZIP codes the existing clinic can't reach at scale. Complementary, not duplicative; measured on the same metrics PHSKC already tracks.
STI screening & treatment, Expedited Partner Therapy, doxy-PEP counseling & prescription, HIV/HCV testing & linkage — under ARNP scope and CLIA-waived protocols.
Operate as a §318 sub-recipient with 340B drug access per HRSA guidance; FQHC Look-Alike pursued as a parallel route. WA DOH looped in as pass-through.
Coordinate with PHSKC Disease Intervention Specialists; report testing volume, positivity yield, treatment completion, and time-to-treatment quarterly.
Testing volume, positivity yield, treatment completion, and time-to-treatment — coordinated with PHSKC Disease Intervention Specialists.
STI screening & treatment, Expedited Partner Therapy (treating a partner without a separate visit), doxy-PEP, and HIV/HCV testing & linkage — all under ARNP scope and CLIA-waived protocols.
A six-tier membership that pairs continuity primary care with patient financing and three patient-selected catastrophic-coverage paths — turning ability-to-pay variance into a feature. Grant-funded and urban-margin tiers cross-subsidize the sponsored ones.
| Tier | Price / mo | For | Includes |
|---|---|---|---|
| Rooted-Sponsored | $0 | Below 138% FPL, lapsed / awaiting Medicaid | Full Rooted services, Foundation-underwritten |
| Rooted (rural) | $75 → $25 | Rural members, agricultural workers, homebound | Telehealth-first DPC, cellular RPM, mobile clinic |
| Bronze | $145 | Cost-sensitive entry | DPC only |
| Silver | $245 | Most members — the conversion target | DPC + pre-enrolled financing + brokered coverage intro |
| Gold | $325 | A complete healthcare home | DPC + after-hours + concierge enrollment + quarterly review |
| Rural Overlay | +$30 | Any tier in a qualifying rural ZIP | Adds RPM, mobile-clinic access, doubled telehealth |
Every Silver and Gold member must complete an RBCA Coverage Review within 30 days of enrollment — a tracked follow-up obligation, not a courtesy.
The membership line breaks even near ~210 paying members, ramping toward ~430 over 24 months, with modeled peak cash burn around $150K. Primary care runs $600–800K in Year 1 at a 55–65% margin.
Silver ($245) is the tier most members should land on. Tier mix and the Silver conversion rate are standing board-pack KPIs you own.
Patient financing rides on Cherry; catastrophic coverage is brokered by RBCA. Sponsored tiers are underwritten by the Foundation and the urban-margin tiers.
The DPC fee covers only primary care — never insurance. All coverage talk deflects to RBCA, verbatim; the 30-day Coverage Review is the tracked handoff that keeps Root barrier 1 clean while still serving the member.
Washington has the patients but not the points of care. Nineteen rural counties carry federal HPSA shortage designations, much of the state sits beyond a 60-minute drive to primary care, and the Medicaid unwinding is pushing 400–470k Washingtonians off coverage. Taproot is how RootBound reaches them — not by building a clinic in every town, but by rooting one nurse-led practice in Seattle and extending care outward across the whole state.
RootBound is planted at its North Seattle home. Phase 1 reach — telehealth and cellular RPM — spreads outward to every rural corner of Washington; Phase 2 adds a monthly mobile-clinic circuit to the sites the roots already touch.
No home Wi-Fi required — embedded-LTE blood-pressure cuffs, scales, and pulse-ox ship to the door and stream straight into Healthie. ≈ $115/patient/mo net margin at scale.
Radix is the front door — async messaging plus scheduled video, Spanish-language from day one in Eastern WA. Every touch charted in one record.
A monthly circuit — Skagit Valley, the Olympic Peninsula, the Cascade foothills, and Eastern WA partner sites — for the hands-on care telehealth can't reach.
Produce Rx via the 1115 HRSN waiver — $50/week for 8 weeks of produce from Washington farms, prescribed like medication.
The rural build is grant-underwritten: USDA Community Facilities (up to 75% of a ~$285–425K mobile unit), HRSA RCORP-Planning then RCORP-Impact ($750K/yr × 4 = $3M), and a CMS Rural Health Transformation pass-through via the WA Health Care Authority. The Root Foundation owns the rural assets, so grant dollars never touch the DPC license.
Cellular RPM reimburses ~$140–170 per patient per month under 2026 CPT — about $115 net at scale — so rural monitoring more than pays its own way. Telehealth + RPM launch first; the mobile clinic and Produce Rx follow only once their grants land.
Launch on telehealth + RPM alone; 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 agricultural communities — built to survive even if telehealth flexibilities sunset.
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.
TLC transitions — condition-paced first contact, RPM, in-person within the window.
Lab results, STI treatment, EPT, and time-to-treatment follow-through.
Threshold breaches and chronic-care check-ins routed off the RPM dashboard.
Welcome visits, coverage reviews, and lapsed-member re-engagement.
Three documented contact attempts, then escalate — never let an episode go quiet. The owner's name is on it until it closes.
100% of open episodes carry a named owner, at 6 and 12 months. You also watch overdue follow-ups and welcome visits inside 14 days (≥80% → ≥85%).
Every attempt and closure is charted in Healthie with a complete audit log. RPM threshold breaches route in off the 100Plus dashboard the same way a red flag does.
You are the escalation point. The coordinator routes by severity; after three attempts or any critical flag, it reaches you — decide, act, document.
Zero episodes that went quiet. No one fell through — proven in the data, not assumed.