With Open Enrollment underway at CoverME.gov, Maine residents have an opportunity to find a new health insurance plan. Thousands of Mainers will enroll in a high deductible plan, which can seem like a financially savvy choice for a healthy person. However, a plan with an affordable premium does not guarantee access to affordable or convenient health care. Insured patients could wait weeks to see a doctor in their network and still pay out-of-pocket expenses, some unexpected, for urgent care or ER visits.
To meet this need in a simple, affordable way, more doctors are starting their own practices using a Direct Primary Care model. In Maine, these independent doctors, often referred to as DPCs, charge an average monthly rate of $75 for unlimited calls, 30 to 60-minute appointments, flexible hours and a consistent level of communication and care that has been shown to improve health outcomes. There’s no waiting for treatments to be approved, no meeting a deductible and no confusing, surprising charges. If you hold an insurance policy, it would still cover emergencies, prescriptions, and labs or imaging needs, although many DPCs offer deep discounts on some of these services.
Dr. Lisa Lucas owns her direct primary care practice Fulcrum Family Health in Freeport, where she also lives with her husband and three kids.
“Direct Primary Care is wonderful for patients, but it’s also wonderful for physicians too,” Lucas said, explaining how she came to open her practice in 2018.
For the ten years that she helped care for her mother, who lived with multiple sclerosis and breast cancer, Lucas was working in inpatient and outpatient settings, balancing her family’s needs with long hours and an unpredictable schedule. She recalled speaking often with her mom about being unable to build a relationship with overbooked doctors and how doctors themselves felt restricted by their roles in larger settings. Before her mother died, she promised she would make a change.
“My mom was physically limited,” said Lucas. “It was exceptionally difficult for her to travel to an office, but she was told she needed in-person visits for every concern.” In her own practice, Lucas has the flexibility to offer phone, text, email, telehealth, in office visits and the occasional house call. That helps her bring her whole self to work. “There’s a lot of burnout and stress in this job,” she continued. “And when we are happy, we are much more emotionally available for our patients.”
Many Maine DPCs are listed on TaroHealth.com/Maine, a service that helps patients find their closest DPC practice and set up an initial, free consultation. Some of the doctors even have straightforward pricing and service lists right on their websites, remarkable transparency in today’s medical business.
Dr. Oren Gersten owns Portland Direct Primary Care which is in South Portland’s Knightville neighborhood. Like Lucas, he expressed a feeling of freedom in running his own practice. By cutting out traditional insurance claims processes, administrative employees and large office space, practices like theirs can keep overhead and monthly rates low while providing quality preventive care.
The DPC business model allowed Gersten to find balance and fulfill the vision he had as a medical student of being “that person you go to when you need help,” treating both his patients and himself in a holistic way. As more patients and doctors discover the DPC model, both Gersten and Lucas hope that there will be a cultural shift in how we prioritize and price health care services.
“It’s weird to think of being an entrepreneur because we’re doctors first. We’re not trying to invent something,” Gersten explained. “But a lot of the system is business led care, and we see the consequences of it. Physicians can be leaders too and DPCs are bringing the good things about primary care to the forefront.”
To find and join your nearest Direct Primary Care practice in Maine, visit TaroHealth.com/Maine.
Comments are not available on this story.
Send questions/comments to the editors.
