Direct primary care
Fits today
Flat-fee memberships billed on your own merchant account, no claims, a portal on the patient's phone and a check-in before every visit. This is the practice that runs on it now.
Excelsior Framework · a physician-owned MSO
Your whole practice, on a platform you own.
Records, visits, memberships, billing, messages, mail, the website and a private AI, on hardware in your own office. Built inside a direct primary care practice.
1 clinicExcelsior Medicine in Reston runs on it every day.
0 requestsThis page loads nothing from anyone else's server.
0% shareNo revenue share, no per-patient fee. What renting costs →
Why we built it
Practice software should answer to the physician who uses it. So a physician built this one.
Every screen started as something Dr. Alluri needed in the middle of a visit. His training shaped the software, and the software stayed inside the practice.
The platform
Twelve things a practice runs on, sharing one record
Every piece works on its own. Together they write to one chart, one ledger and one calendar, on your hardware. Each has its own page.
Health recordChart, medications, results, prevention plan
Scheduling and check-inBooking and a pre-visit check-in
TelehealthVideo visits on your own server
MessagesPatient messaging, filed to the chart
AIScribe, chart review, summaries, on your GPU
Patient portalThe whole practice, on a phone
MembershipsFlat fees on your own accounts
BillingA ledger of every charge
MailCovered mailboxes and a private mail server
WebsiteThe practice site, built to be found
Documents and wearablesRead on premise, paired by an opaque id
Business officeCRM, calendar, documents, per business
An example
One patient's week, in six of them. Tap a tab to hold it.
Excelsior EHRSearch patients, codes, pages… ⌘KClinical workspaceRADr. AlluriFAMILY MEDICINE · MD
Nora Whitfield 0000421 draft note×
NW
Nora Whitfield member
MRN 000042 · 46y · DOB 1980-03-14 · Reston, VA
⚠ Allergies: PenicillinHypertension
MessageBillingScheduleCheck-in · review needed
OverviewStoryEncountersPrevisitVitalsLabsMedicationsOrdersDocuments
BP, home average128/78↓
A1c5.6%
Colon screeningdue2027
Active problems 2
- Hypertensioncontrolled
- Seasonal allergiesprn
Medications reconciled
- Lisinopril 10 mgdaily · still taking
- Cetirizine 10 mgas needed
Since last visit
- 14 home readingsavg 128/78
- Check-inwaiting
- 1 documentfiled · on premise
History rev 14
- Noteunsigned draft
- Patient summarydraft
EXCELSIOR · WORKSPACE · MSOlive · just readT0 · mesh + SSOMedicine PLLC◧ agent
Excelsior Medicine · CRM · Contacts
Lead InboxPipelineContactsCallsCommsAccounts
Nora WhitfieldXR-01J8 · member since Aug 2026
Plan$250/moactive
Renews1 Octcard on file
Panel412no per-member fee
| touch | when | where |
|---|---|---|
| Site form · inquiry | 14 Aug | excelsiormedicine.com |
| Enrolled · adult membership | 15 Aug | self-service |
| Portal account created | 15 Aug | practice edge |
EXCELSIOR · WORKSPACE · MSOlive · just readT0 · mesh + SSOMedicine PLLC◧ agent
Excelsior Medicine · Payments · Overview
OverviewBy businessMoney inRecurringPayouts & feesMoney outReceipts & statements
Ledger · SeptemberExcelsior Medicine · your merchant account
Collected$103,000412 renewals
Processing fees$3,110to the processor
Platform fee$0always
| date | entry | amount |
|---|---|---|
| 1 Sep | Membership · Nora Whitfield | 250.00 |
| 1 Sep | Card processing fee | −7.55 |
| 1 Sep | Revenue share | 0.00 |
Excelsior MedicinePATIENT PORTALvoice on
Get ready for your visit
A few questions from your Excelsior assistant so your care team walks in already knowing your story. Talk or type; tap an answer when one fits.
Excelsior is getting you readywe're on: blood pressure · 1 answered
voice onsave and leavestart overExcelsior asks · 2 of 3
Since your last visit, has your home blood pressure been higher, lower, or about the same?
One-tap answers
HigherLowerAbout the same
Or type your answer in your own words…
SendSkip this oneI'm done
Monday evening: the check-in asks about blood pressure in one tap. The answers wait for the clinician, not for a model.
Excelsior MedicinePATIENT PORTALvoice on
Messages
Messages with your care team
Not monitored for emergencies. If something is urgent, call 911.
My home readings this week averaged 128/78. Should I keep the same dose?you · 08:12
Yes, that is right where we want it. Keep the dose and we will look again at your visit on the 9th.Dr. Alluri · 08:40
Thank you. See you Wednesday.you · 08:41
Write to your care team…Send
Earlier that week: a question about a dose, answered by the clinician, filed to the chart.
Excelsior EHRSearch patients, codes, pages… ⌘KClinical workspaceRADr. AlluriFAMILY MEDICINE · MD
Nora Whitfield 0000421 draft note×
NW
Nora Whitfield member
MRN 000042 · 46y · DOB 1980-03-14 · Reston, VA
⚠ Allergies: PenicillinHypertension
MessageBillingScheduleCheck-in · review needed
OverviewStoryEncountersPrevisitVitalsLabsMedicationsOrdersDocuments
Note writer unsigned draft
S:Home BP averaging 128/78, no dizziness, no chest pain reported.
O:BP 126/80 · HR 68 · weight 82.1 kg
A:Hypertension, controlled on current dose.
P:Continue lisinopril 10 mg · recheck labs in 6 months.
Sign noteOpen Copilot
Proposals accepted3of 6
Edited0
Left the building0bytes
Messages · threaded to the chart, no vendor inboxmade-up patient
A visit, start to finish
The platform fits the visit, because the visit shaped it
The software reads and drafts. The clinician decides. Nothing is signed, sent or filed by a machine.
Before the visit
The patient checks in, the chart gets ready
A clinician-written check-in gathers the history and screens for alarm symptoms first.
check-in3 of 3 answeredalarm screennone reportedmedsstill taking · 2since last14 BP readings
During the visit
Video on your server, listening on your hardware
Video runs on your own server. Listening, when the clinician turns it on, never leaves the building.
videoprivate · no third partylisteningon · on premisepatient sees"listening"transcriptclinician only
After the visit
A draft note waits for a signature
The assistant proposes; the clinician accepts, edits or discards, line by line.
proposals7accepted6edited1notesigned · rev 14
For the patient
A plain-language summary, published on purpose
Everyday words, sent to the portal only when the clinician publishes it.
summarydraft → publishedto-dos2 · on the phonenext visitbookeddata locationyour building
Prepared for what comes next
Take back control of your data, your costs and your license
Today, records leave the building by default, and per-seat, per-patient and metered-AI fees grow with the practice. We built it the other way around.
Data containment
Your records sit on hardware you own, inside a network that dials outward only. Anything leaving is allowed by name, or it does not leave.
encrypted offsite backup, keys with you
rented · 400 patients$2,960/mo
ours · AI included$395/mo
rented · 1,200 patients$3,680/mo
ours$395/mo
seven vendors at their list prices · ours measured, plus what we pay
Subscriptions and API meters
Rent scales with patients, seats and tokens. Ownership does not. The AI runs on your own GPU for about the cost of a light bulb.
the full table is on Own or rent
yours
the recordsthe practice's
the hardwarethe practice's
the patient relationshipthe practice's
the code that runs itopen, with the practice
the management companyclinician-owned
Your license, your business
Most practices were sold and rented back through a management company someone else owns. Ours is the clinician-owned version. If you ever leave, you take everything.
no revenue share, no term sheet
Read the fine print of a rented platform
from a widely used direct-care platform's published terms · sources on the Research page
Rented
$500 a month to export your own data, and only on the two top tiers
30 days to retrieve your records after you leave, then they are gone
30 days' notice and the price can change; your remedy is to leave
"As is": no uptime promise anywhere in the terms
AI on the higher tier, then per clinician, then per 50 members
Owned
$0 to export: the chart's storage format is the export format
Forever: the records are on your disk, with their history
No subscription to raise; hardware bought once or already yours
Uptime is published on our Telemetry page, from our own monitoring
AI on every build, on your GPU, no tier and no meter
Why practices choose it
Built for direct care, from inside a direct care practice
Four reasons physicians call, in the order they bring them up.
Every screen came from a visit.
Dr. Alluri trained in family medicine, then built the record he wanted to chart in, the check-in he wanted patients to fill, and the assistant he wanted to review, one visit at a time.
Walk through a visit →Your data stays in your building.
The chart, the video, the messages, the model that drafts the note: all of it runs on machines the practice owns. Backups are encrypted before they leave, and the keys stay with you.
How containment works →No per-patient rent on your own work.
A fuller panel should not mean a bigger software bill. No subscription, no revenue share, no per-seat AI tier.
See the numbers →The proof is a working practice, not a slide deck.
Excelsior Medicine, a direct primary care practice in Reston, Virginia, runs on this stack every day.
Try the example portal →Who it is for
Built for every kind of clinician-owned practice
Direct care first, because that is what our clinic is. Physician, nurse practitioner or physician assistant led, solo or a group. Every practice type, and how well it fits →
Direct primary careFlat-fee memberships, no claims. The model fits exactly; it is what runs today.fits today
Concierge and membershipRetainers, packages and hybrid revenue on your own merchant account.fits today
Family and internal medicineThe record, the check-in and the visit were built inside a family practice.fits today
Nurse practitioner and PA ledNothing here assumes an MD. The clinician who holds the license owns the stack.fits today
Functional, integrative, longevityLong visits, prevention plans, wearables and documents read on premise.fits today
Virtual clinicsVideo on your own server, a portal on the patient's phone, no app to install.fits today
Behavioral health and therapyPrivate video, secure messaging and a record that never leaves the building.fits today
Insurance-billing practicesNeeds a claims lane we have not built. We say so before you ask.not yet
Beyond medicine, the same discipline fits law, accounting and design practices that would rather own their systems.
Questions physicians ask
Straight answers
Answered the way we would answer them on the phone.
Is Excelsior Framework an EHR?
Yes, and more. A self-hosted record at the center, and around it the memberships, billing, scheduling, video, messaging, mail, website, portal and AI a practice needs. We do not sell a subscription. We build it on your hardware and run it with you.
Is AI included?
Yes, on every build, on your own GPU. No AI tier, no per-note bill. A person approves anything that matters.
Can I take my data if I leave?
Yes, all of it, in the format the system keeps it in, with its full history. No export fee.
Is it HIPAA compliant?
No software is a HIPAA certificate. We build the controls, keep the evidence and hand you the documentation: encryption, access control, audit trail, signed business associate agreements, and a network that only lets traffic out by name. The obligations stay yours, and you will know exactly what they are.
Does it run a real clinic?
Yes. Excelsior Medicine, a direct primary care practice in Reston, Virginia, runs on it every day.
Get in touch
Tell us what you're working with
A sentence or two is plenty. We read everything and reply ourselves.
This lands in our own CRM, on our own hardware. No form service, no pixels.
Prefer email? excelsior@excelsiorframework.com
Excelsior Framework / Information / Who it is for
Who it is for
Every kind of clinician-owned practice, and how well it fits
Direct care first, because that is what our clinic is. Nothing in the stack assumes an MD: the clinician who holds the license owns the systems, whether that is a physician, a nurse practitioner or a physician assistant, solo or a group.
Concierge and membership
Fits today
Retainers, packages and hybrid revenue. The membership and ledger systems do not care what you call the plan.
Family and internal medicine
Fits today
The record, the check-in and the visit journey were built inside a family medicine practice, one visit at a time.
Nurse practitioner and PA led
Fits today
Every screen says clinician, not doctor. Sign-in, the chart, the note and the summary work the same for whoever holds the license.
Pediatrics
Fits, with care
The portal's calendar, to-dos and messaging fit a family; a guardian account is on our list and not built yet.
Functional, integrative, longevity
Fits today
Long visits, prevention plans with due dates, wearables paired by an opaque id, documents read on premise.
Virtual clinics
Fits today
Video on your own server, joined from a web portal with no app to install and a second-factor sign-in.
Behavioral health and therapy
Fits today
Private video, secure messaging threaded to the record, and a chart that never leaves the building.
Urgent care and walk-in
Fits, with care
Scheduling and the record work; point-of-sale for a walk-in visit is simple billing, but insurance claims are not built.
Insurance-billing practices
Not yet
Direct care skips claims by design. A fee-for-service practice needs a claims lane we have not built yet.
Groups and networks
Fits, with care
Records are kept per business, so a second site or a venture never shares a list with the first. Employer-sponsored plans are on the list.
Beyond medicine
Fits today
Law, accounting and design practices that would rather own their systems get the same discipline: records with history, calendar, documents, mail and a private assistant.
"Fits today" means a running service in our clinic does the job. "Fits, with care" means the pieces exist and a practice of that kind would be the first to run them. "Not yet" means a lane we have not built.
We are one clinician-owned practice and one consultancy. We do not claim every vertical. A running clinic is the proof, and we would rather tell you where the gaps are than have you find them.
Questions about any of this?
We answer them ourselves, on the phone or by email.