Everything about the role, in one place

Why RootBound exists

RootBound began from something personal. The founder experienced homelessness without a safety net or continuity of care, then watched the same pattern repeat across trauma, psychiatry, and community medicine: patients discharged into instability, care plans that didn't match real life, and harm that fell outside any one 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 the ZIP codes existing clinics can't reach at scale. Every program in this briefing is one expression of that single idea: no one falls through.

What the clinic is

RootBound opened November 18, 2025 as a Direct Primary Care (DPC) practice under Washington's DPC statute (RCW 48.150): 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. Patients are accepted regardless of insurance, income, or ZIP code, and the after-hours line runs 24/7, answered by a clinician — not a queue.

It is nurse-led by design. Washington grants ARNPs full independent practice authority (RCW 18.79.250) — to diagnose, treat, and prescribe without physician supervision — and has been a Full Practice Authority state since the 1980s. The founder pairs the doctorate (DNP/ARNP) with an MBA, a Lean Six Sigma Black Belt, and a PMP: a clinician who is also an operator.

The whole clinic runs on one operating stack: Healthie (EHR), Radix (telehealth), 100Plus (cellular remote monitoring), and Cherry (patient financing), with QuickBooks behind the financials.

The six service lines

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

• Primary care — continuity DPC, the medical home everything routes back to.
• Behavioral health — integrated mental health and psychiatry, including Spravato.
• Sexual & reproductive — STI screening and treatment, Expedited Partner Therapy, contraception, doxy-PEP.
• Gender-affirming care — affirming primary and hormone care.
• HIV / HCV — prevention, testing, and linkage to care; PrEP and PEP.
• Substance use — MAT / MOUD and recovery support, woven into primary care.

What you'd own

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

• Run the programs — operational ownership of all six on a shared clinical backbone, from the Glow revenue engine to the 30-day post-discharge pathway.
• Build the network — relationships with hospitals, Public Health–Seattle & King County, FQHCs, Critical Access Hospitals, and state agencies.
• Guard the structure — keep the three legal entities and their root barriers clean: the DPC statute, insurance licensure, and Anti-Kickback / Stark hygiene.
• Drive the funding — carry the grant pipeline (HRSA, USDA, CMS Rural Health Transformation) that underwrites the mission-driven and rural lines.

You report to the founder, who hands you operations to free his clinical and strategic focus. You decide daily operations, episode ownership, Glow protocol governance, and vendor management within budget. You decide together on partnerships, grant applications, pricing, and hiring. The founder holds clinical authority, mission and brand, governance, and capital structure.

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 aesthetics line that cross-subsidizes sliding-scale care — HydraFacial ($149–$269), SkinPen, Daxxify, Keravive, and Ourself retail, each under ARNP supervision and Washington scope rules. The entry HydraFacial runs ~77% gross margin; aesthetics earns $500–800K in Year 1, and every aesthetic visit also routes a primary-care touchpoint. It is the cash engine, not a standalone med-spa.

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 (COPD ≤24h, heart failure ≤48h). RootBound owns the episode to a clean handoff at Day 30. It targets a 20–50% reduction in 30-day readmissions, protecting a partner's HRRP revenue (up to 3% of Medicare payments), and bills through TCM/CCM/RPM. The flagship pilot is Swedish Edmonds.

C · The 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. It would operate as a §318 sub-recipient with 340B drug access, with FQHC Look-Alike pursued as a parallel route, measured on the metrics PHSKC already tracks.

D · The Continuum — the membership stack

Six tiers pairing continuity DPC with patient financing and three catastrophic-coverage paths: Rooted-Sponsored ($0, Foundation-underwritten), Rooted rural ($75→$25), Bronze ($145), Silver ($245, the conversion target), Gold ($325), and a Rural Overlay (+$30). Every Silver and Gold member completes an RBCA Coverage Review within 30 days — a tracked obligation, not a courtesy.

E · Taproot — statewide rural reach

Cellular-first remote monitoring (no Wi-Fi needed; ~$115/patient/month net at scale), telehealth-first access, 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 backbone

The SOP spine beneath everything: four parallel tracks, three-attempts-then-escalate, red-flag routing, and a single named owner who holds each episode to closure. The rule that never bends — three documented attempts, then escalate; nothing closes without a chart note.

How it pays for itself

The mix is diversified and recession-resilient by design — aesthetics is the cash engine that cross-subsidizes the mission lines. The membership stack breaks even near ~210 paying members, ramping toward ~430 over 24 months, with modeled peak cash burn around $150K.

Rural remote monitoring more than pays its own way — roughly $140–170 per patient per month under 2026 CPT reimbursement. Pre-launch investment runs $250–400K, with aesthetic equipment ($175–275K) reaching break-even in 6–12 months at moderate utilization.

Three entities, three root barriers

Three legal entities each do exactly one job, and the barriers between them are what open funding doors without putting the DPC license at risk. Keeping them clean is a standing duty of the Director.

• RootBound Health, PLLC — the clinical core; all six service lines; employs every clinician; bills Medicare RPM/CCM/TCM. Root barrier 1 — the DPC statute: the direct fee covers only primary care, and staff never solicit insurance.
• RootBound Coverage Advisors, LLC (RBCA) — the Washington insurance producer holding all ACA, indemnity, and accident solicitation. Root barrier 2 — producer separation: keeps the PLLC clean of Title 48; all coverage talk deflects here.
• The Root Foundation, 501(c)(3) — receives rural grants, owns the mobile unit, sponsors $0 memberships, runs Produce Rx. Root barrier 3 — Anti-Kickback / Stark hygiene: flat fees only, no volume-based payments; money moves only on a written, fair-market-value agreement.

How you step into it

Three movements, deliberately paced. Nobody expects you to drive on day one — they expect you to listen first, earn the chart, and then never let an episode fall through.

Days 1–30 · Land & learn

Provision every system, read the canon, shadow all six service lines, meet the team one-to-one, map the open episodes, trace the three entities — and change nothing. Draft a 30-day observations memo. Gate: you can name every program owner, log into every system, and recite the escalation rule from memory.

Days 31–60 · Take the controls

Own the Follow-Up SOP and become the escalation point; chair the weekly ops review and own the monthly board pack; become a named episode owner; tighten Glow governance and ship one process fix. Gate: the cadence runs on your calendar, and no open episode is missing a named owner.

Days 61–90 · Build & extend

Sign the first hospital case-manager MOU, advance the PHSKC §318 conversation toward a draft MOU, stand up the Foundation and file the first RCORP-Planning application, and pilot the Rooted rural tier on telehealth + RPM in one Eastern WA county.

By Day 90, every program has a named owner, the cadence runs without the founder, and no episode falls through — measured, not assumed.

The operating rhythm & the measure

The clinic runs on a fixed cadence, and the dashboard is the single source of truth. You chair the operational beats — daily red-flag triage, the weekly ops review, the monthly board pack — while the founder, counsel, and board hold the quarterly and annual governance beats with you.

By 6–12 months, "good" looks like: 100% of open episodes with a named owner, welcome visits inside 14 days (≥80–85%), at least one hospital TLC MOU live, at least one grant ≥$25K awarded, and a rural pilot county live on remote monitoring. The metric above all the others: zero episodes that went quiet — no one fell through, and the data proves it.

What new directors don't see coming

Beyond the operating core, the role carries the clinic's clinical-safety, compliance, and business obligations. In brief, you also own or steward:

• Clinical quality & safety — a continuous QI program, adverse-event reporting with root-cause review, written crisis pathways (911/988), mandatory reporting, and controlled-substance / MOUD governance (DEA, PDMP, Spravato REMS).
• Compliance & licensure — HIPAA privacy and security with signed BAAs, telehealth licensure and consent, credential tracking, professional-liability coverage, and a controlled contract repository.
• Operations & continuity — the revenue cycle for the billed lines, patient intake, grievances, inventory and cold chain, EHR-downtime and disaster recovery, and cybersecurity.
• People & growth — staff management and coverage, patient acquisition, capacity and panel modeling, and the annual calendar of grant, board, license, and insurance deadlines.

When you're ready

The whole role comes down to one promise, scaled: no one falls through. The Clinic Director holds the programs together, keeps the entities clean, and turns relationships into reach. When you're ready, the next step is simple — a conversation.