MARFA — The Marfa Country Clinic, a healthcare provider celebrating its 15th anniversary this month, is now under the management of Bravo Health, the local brand of Hamilton Health Box, a company specializing in hybrid primary care microclinics in rural areas.
The Marfa Country Clinic was founded by Don Culbertson and Valerie Breuvart in 2010. In a letter to the editor in this week’s Big Bend Sentinel Culbertson expounds on the 15th anniversary, thanking past and present clinic staffers and detailing the new collaboration with Bravo Health.
“After a short and much-needed hiatus updating and refreshing our facilities, the Marfa Country Clinic is now collaborating with Hamilton Health Box, known in West Texas as Bravo Health, to return to a higher healthcare delivery capacity and expand our practice by implementing new programs that we believe will improve the quality of healthcare in our area,” Culbertson wrote. “Together the Marfa Country Clinic and Bravo are staffing our clinic Monday through Friday, with a mix of in-person and telemedicine doctors and mid-level providers.”
In a follow up with The Sentinel, Culbertson explained that Bravo Health will essentially act as the clinic’s parent company, taking up scheduling, billing, staffing and more. “We’re providing the car and they’re driving it,” he said.
The company, in collaboration with the Big Bend Regional Hospital District, recently opened a microclinic in Terlingua, and has plans to expand to Presidio soon. Culbertson — who struggled to attract full-time doctors to staff the clinic since he moved to Paris part time after the coronavirus pandemic — said he was introduced to Hamilton Health Box through the hospital district and approached them about taking over Marfa Country Clinic.
“I was able to speak with one of their staff members and propose the idea of our clinic as well, maybe creating something more regional,” Culbertson said.
Culbertson, a physician assistant, will remain an employee of the Marfa Country Clinic, as will current staffers Kaela Donaldson and Kassandra Hernandez. Bravo Health will build off of the success of the existing operation, Culbertson said, but will be able to provide more robust administrative, organizational and staffing services moving forward.
“We wanted to continue the legacy and our reputation and our branding of Marfa Country Clinic. The building is the same. They’ve hired our staff. They hired me. They’re using our facilities. It’s a familiar place,” Culbertson said. “We also wanted to collaborate with them in an effort to lend them our reputation and provide them with momentum to start in the area.”
Chief Development Officer for Hamilton Health Box Chris King said, so far, the Terlingua clinic has stayed busy, and, once the Presidio location comes online, the entity will have a presence across the tri-county area as well as in Pecos.
“What started with an idea down in Terlingua has now blossomed into an operation of four primary care clinics, ultimately, in the coming weeks for the region, under the Bravo Health name,” King said. The term Bravo in the company name comes from the Rio Bravo, he said.
The Houston-based company was founded by Dr. Toby Hamilton, a previous emergency room (ER) doctor originally from El Paso. Its first microclinic was a chicken processing plant in Houston, where an on-site clinician, physician assistant, and doctor helped provide primary care services to the plant’s employees at a small clinic at their work location, helping keep patients out of the ER by diagnosing and managing chronic conditions and prescribing “cheap, generic,” drugs. Physician assistants and doctors also split their time between multiple locations, allowing more companies to extend employee access to primary care — which also saved on healthcare costs for their employers.
In 2022, the company set out to see if the microclinic model it used for companies would work in rural communities in Oklahoma. “We use that same distributed labor model in those rural clinics in Oklahoma to a huge success,” King said. “We thought that rural populations would be standoffish to the telemedicine, but once they experienced it…Our clinics always have the availability to see patients. No appointments are required. You can walk in and get care. The ease of access and the affordability of our clinics make it such that people want to come into the clinic.”
Culbertson said Marfa Country Clinic’s goal is to have that same level of availability for patients. Back when he and the late J.P. Schwartz were staffing the clinic, they “rarely said no” to people, he said, finding a way to fit those with urgent needs in with scheduled appointments. To achieve that goal, the clinic will offer in-person appointments with a doctor of medicine or P.A. up to four days a week, with telehealth options filling in as needed.
Culbertson has been practicing telemedicine since he moved to Paris part time, and the clinic has worked with Texas Tech to provide telemedicine services in the past. But upgrades to telemedicine tools, courtesy of Bravo Health, will enhance operations, he said.
“There’s a big screen TV in almost every exam room, connected to that is a piece that fits in the ear,” Culbertson said. “[Other tools] allow us to have a DERM camera to look at skin. We can look at the throat. We can look in the nose. We can listen to heart sounds and lung sounds. I can listen to that with my noise counseling headphones in Paris, France, and see patients.”
King said Bravo Health hired a regional medical director, James Tarin, M.D., who will help staff the Marfa, Presidio, Terlingua and Pecos clinics, and the company will augment the Marfa Country Clinic staff as needed.
“He was operating a clinic in Pecos as a direct primary care clinician, but we talked to Dr. Tarin and his wife — who is also a physician’s assistant — told him what we were doing and how we really wanted him to be the leader of our organization, Bravo Health, out in that area,” King said. “And he jumped on board. He knows the region as well.”