You're on the short list to run this clinic as Director. Before the next conversation, here's the whole picture — in one guided path.
This started from something personal — I experienced homelessness without a safety net or continuity of care, and I kept watching the same pattern repeat. RootBound is my answer to it. What you're about to see is the whole machine, and the part I'm hoping you'll come hold.
Kal Elliott, DNP, ARNP, FNP-BC Founder & Medical Director
Welcome. You're on the short list to lead RootBound as Clinic Director.Before our next conversation, take ten minutes to see the whole picture.RootBound began from something personal — and a pattern its founder kept watching repeat.Patients discharged into instability, with no one holding the thread afterward.This is the organization built to interrupt that — and the role we're hoping you'll hold.
00 · Why RootBound exists
"Patients discharged into instability, care plans that didn't match real life, and harm that happened outside any institution's responsibility."
Across trauma, psychiatry, and community medicine, the same gap kept showing up — the space between a discharge and a real life. RootBound exists to close it — complementary to the safety net, never duplicative — reaching the hours and ZIP codes existing clinics can't cover at scale. Everything that follows is one expression of that single idea.
The problem comes first, because everything else answers it.People are discharged into instability. Care plans don't match real life.And harm happens in the gap — outside any one institution's responsibility.RootBound is built to close that gap: complementary to the safety net, never duplicative.It reaches the hours and the ZIP codes the system can't cover at scale.
01 · The organization
A direct-care clinic, built on full practice authority
RootBound opened as a Direct Primary Care practice under RCW 48.150 — telehealth-first, after-hours staffed by clinicians, priced on a sliding scale, open to patients regardless of insurance, income, or ZIP code. It's nurse-led because Washington grants ARNPs full independent practice authority.
RootBound opened as a Direct Primary Care practice under Washington's DPC statute.Telehealth-first, after-hours staffed by clinicians, priced on a real sliding scale.Patients are taken regardless of insurance, income, or ZIP code.It runs nurse-led — Washington grants nurse practitioners full independent practice authority.A hundred and fifty ZIP codes, six service lines, three entities, a clinician on the line around the clock.All of it on one shared technology stack.
02 · The role
What you'd own
Four standing responsibilities. The ninety-day plan is simply how you pick them up, one layer at a time.
01
Run the programs
All six programs on one clinical backbone — from the revenue engine to the post-discharge pathway.
02
Build the network
Hospitals, public health, FQHCs, Critical Access Hospitals, and state agencies.
03
Guard the structure
Keep the three legal entities and their regulatory root barriers clean.
04
Drive the funding
Carry the HRSA, USDA, and CMS rural-transformation grant pipeline.
So — what would you actually own? Four things.Run the programs. All six, on one shared clinical backbone.Build the network — hospitals, public health, rural hospitals, state agencies.Guard the structure: keep three legal entities and their regulatory root barriers clean.And drive the funding — the federal grant pipeline that underwrites the mission.The ninety-day plan is just how you pick these up, one layer at a time.
03 · The portfolio
Six programs, one backbone
Each program is one expression of the mission — a revenue engine, a hospital pathway, a public-health partnership, a membership stack, a rural program, and the follow-up SOP that holds it together.
A · Revenue
RootBound Glow
The aesthetics line that funds the mission — and routes a primary-care touchpoint with every visit.
B · Transitions
TLC
The 30-day hospital-to-home pathway for high-risk discharges, paced by condition.
C · Public health
STI Partnership
A proposed §318 partnership with Public Health–Seattle & King County.
D · Membership
The Continuum
Tiered DPC plus financing and catastrophic-coverage navigation.
E · Access
Taproot
Statewide rural reach — cellular RPM, mobile clinic, food-as-medicine.
F · Backbone
Follow-Up Ops
The SOP spine — escalation pathways and a named owner for every episode.
There are six programs — and they all run on one backbone.Glow, the aesthetics line, is the revenue engine that funds everything else.TLC is the thirty-day hospital-to-home pathway for high-risk discharges.There's a public-health STI partnership, and a six-tier membership stack.Taproot carries care into Washington's care deserts.And underneath all of it: the follow-up SOP — a named owner for every open episode.
04 · How it pays for itself
A model that's diversified and viable
The aesthetics line cross-subsidizes sliding-scale primary care and the rural mission — a deliberately recession-resilient mix. The membership stack breaks even near 210 paying members, ramping toward ~430 over 24 months.
$2.8–3.4M
projected Year 1 revenue
$4.5–5.2M
projected Year 2 revenue
8–12 mo
to operating break-even
58–68%
blended gross margin
Now — how does it pay for itself? Deliberately, and from more than one direction.The aesthetics margin cross-subsidizes sliding-scale primary care and the rural mission.It's a recession-resilient mix by design.The membership stack breaks even around two hundred and ten paying members.Year one revenue runs near three million; year two, toward five.Operating break-even lands inside the first year, at a healthy blended margin.
05 · The structure
Three entities, three root barriers
A clinical PLLC, a licensed insurance advisory, and a 501(c)(3) foundation each do one job — and the root barriers between them are what open funding doors without risking the DPC license. 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 — DPC statute Direct fee covers only primary care
Coverage Advisors, LLC
A Washington insurance producer holding all ACA, indemnity, and accident-product solicitation.
Root barrier 2 — Producer separation Keeps the PLLC clean of Title 48
The Root Foundation
A 501(c)(3) — receives rural grants, owns the mobile unit, sponsors $0 memberships, runs produce-Rx.
Root barrier 3 — AKS / Stark hygiene Flat fees, no volume bonuses
The structure is three entities — and three root barriers between them.A clinical practice, a licensed insurance advisory, and a nonprofit foundation.Each does exactly one job. The root barriers keep each one legally clean.That's what lets RootBound open funding doors without risking the DPC license.Keeping those root barriers clean is one of the Director's standing duties.
06 · Your first 90 days
How you'd step into it
Three movements, deliberately paced — earn the chart before you change it.
Days 1–30
Land & learn
Get access, shadow, read the canon, change nothing. Earn the chart and the trust.
Days 31–60
Take the controls
Own the follow-up backbone and the operating cadence. The clinic runs to your rhythm.
Days 61–90
Build & extend
First hospital MOU, the public-health conversation, the first grant filings, one rural pilot live.
So how would you step into it? In three movements, deliberately paced.Days one to thirty: land and learn. Get access, shadow, read everything — change nothing.You earn the chart before you touch it.Days thirty-one to sixty: take the controls — the follow-up backbone and the operating cadence.Days sixty-one to ninety: build and extend.A first hospital agreement, the public-health conversation, the first grants, one rural pilot live.
07 · How you're measured
By Day 90, every program has a named owner and the cadence runs without the founder. By 6–12 months: welcome visits inside 14 days, one hospital MOU live, one grant ≥ $25K awarded, a rural pilot county on RPM. But one metric sits above the rest.
Zero episodes that went quiet. No one fell through — and the data proves it.
And how would you be measured? By a clear scorecard — and one metric above it.By day ninety, every program has a named owner, and the cadence runs without the founder.By the end of the year: timely welcome visits, a hospital agreement, a grant, a live rural pilot.But one number matters more than all of them.Zero episodes that went quiet. No one fell through — and the data proves it.
The through-line
Every program is the same promise, scaled: no one falls through.
That's the walkthrough. The Director is the person who holds the programs together, keeps the entities clean, and turns relationships into reach. Explore anything in depth — then let's talk.
That's the walkthrough.Every program is the same promise, scaled: no one falls through.The Director holds the programs together and turns relationships into reach.Explore any of it in depth from here — the overview, the programs, the handbook, the first ninety days.And when you're ready, the next step is simple: a conversation. We'd love to have it with you.
