🔒Healing health care: Movement grows to provide health care through monthly subscription fees

One weekend, a patient reached out to Dr. Erin Oakley at Oakley Pine Family Medicine in Falmouth.The patient had a health concern that, in a traditional setting, likely would have led to an urgent care visit. Things turned out differently when the patient received direct primary care from Oakley. “I was able to evaluate the situation directly, guide next steps and safely manage the issue until follow-up in the office,” says Oakley. “It provided both timely care and reassurance without an unnecessary visit.” Oakley is one of a growing number of direct primary care providers, a health care model that’s gaining ground as health care costs soar and access becomes ever more uncertain. Direct primary care, or DPC, provides direct provider access through a flat membership fee with no deductibles or co-insurance, along with direct access to significant discounts on imaging, labs and medications as part of their membership. Themes include affordability, same-day or next-day appointments and unlimited, unrushed visits.

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In another case, Oakley was able to treat a patient’s laceration directly in the office, which allowed them to avoid an urgent care visit and receive immediate care in a familiar setting. She has also cared for patients with multiple specialists involved who were feeling overwhelmed by fragmented communication.

“Taking the time to coordinate directly with their specialists helped clarify the overall plan and move their care forward more smoothly,” she says. Throughout Maine and the nation, the model is trending up, says Dr. Leigh Ann Higgins, who founded Casco Bay Direct Primary Care in South Portland in late 2023 and leads the New England Direct Primary Care Alliance, a group of approximately 80 physicians. “It has grown exponentially,” Higgins says. “Ten years ago, there were maybe six DPCs in Maine. Now there are over 50. It’s a national trend also.”

Disconnect

Demoralized providers and dissatisfied patients are a big factor driving the numbers. “Many patients today feel a growing disconnect in larger, corporate primary care settings,” says Oakley. “Direct primary care addresses that by putting time, access and relationship back at the center of care, helping restore medicine to its original purpose.” Oakley, a doctor of osteopathic medicine, previously worked in a traditional fee-for-service clinic. Appointments were rushed and connections were limited. That experience led her to direct primary care. The reception has been positive: The practice has grown by about 10 patients per month since opening, primarily through word-of-mouth. “The patients who tend to find my practice are often those who have felt like a number in larger, corporate systems or have grown frustrated by the ‘game of telephone’ between them and their doctor,” Oakley says. “Many feel lost in the complexity of fee-for-service health care. They are looking for a physician who can truly be their teammate, and they place a high value on a strong, direct relationship.”

Forming relationships

Dr. Heidi Larson started a solo practice in Cape Elizabeth in 2020. “I believe that every person has the right to a strong relationship with a primary care physician,” Larson says. “I believe people should be heard and understood as humans, and that our corporate system of health care is not structured around building in the time it takes to develop those relationships.” “Every patient has a story,” says Higgins, “of either feeling overlooked, rushed or unheard.”

She cites an example of a middle-aged woman looking for help and repeatedly told by previous providers that she was anxious and had arthritis. “Her symptoms were tremors, restlessness, joint pain, diarrhea, insomnia. We diagnosed thyroid disease and Crohn’s inflammatory bowel disease within the first six weeks,” Higgins says. “She was not simply an anxious woman going through menopause.” Higgins’ practice — with two physicians and two medical assistants — was prompted by her previous experience of having too many patients and not enough time allotted for patient visits. “We felt we were constantly rushing through appointments and not providing the highest level of care to our patients,” Higgins says. “This obviously feels terrible to the patients, but it feels terrible to the physician, too.”

Work satisfaction

From the physician side, the DPC model improves work satisfaction and mental health. “This will hopefully result in fewer earlier retirements and encourage PCPs to continue working,” Higgins says. “The average age a PCP leaves the workforce is now in their late 40s. This early age contributes to primary care shortages.” Since January, when nurse practitioner Kathleen McKeon opened Middle Path Health in Kennebunk, it has gained almost 80 members along with some acute care visits.

Patients text or call and can get answers to questions and medications refilled easily. “Because the clinic is welcoming and a more casual environment than typical medical offices, we have a number of people who have avoided health care for years,” says McKeon. “I also have people seeking a more natural, integrative approach for their care in my panel.” Dr. John Daggett opened his solo practice, Yarmouth Direct Primary Care, in January 2025. He trained in internal medicine at Maine Medical Center and previously worked more than eight years as a primary care doctor. Direct care, he says, is a great option for patients with and without insurance. With health care costs and deductibles at an all-time high, monthly membership keeps care accessible, affordable and free from the unpredictability of conventional systems. The practice has more than doubled over the past year. “Ultimately I think people are surprised that this model allows direct access to a physician and a chance for continuity that’s so hard to get nowadays,” Daggett says.

Building an ecosystem

Like other DPC practices, Mainely Primary Care in Kennebunk works with patients’ insurance and on building an ecosystem for people who can no longer afford insurance or are choosing to go without it, says Philip Browne, the practice’s owner and one of its three family nurse practitioners. Established in 2024, Mainely Primary Care has reached about half of its goal of 1,000 patients.

“It is part of our mission to help people not only within the traditional system, but as we see growing challenges in affordability and rising premiums, we are doing our best to provide all the care and medications we can at an affordable price,” says Browne. “And health care becomes much more affordable when paying cash instead of using insurance.” To that end, the practice includes almost all generic medications with the cost of membership.  Brand-name medications can usually be provided at a steep discount. “I have made some connections with insurance brokers who offer health shares or alternative policies that mitigate some cost/risk in case of a large medical expense outside of traditional health insurance,” Browne adds. Oakley cares for patients with a wide range of insurance situations, including Medicare, MaineCare, commercial plans, health share plans and those without insurance. “While I do not bill insurance for primary care services, patients can still use their insurance for medications, labs, imaging, specialist care and hospitalizations,” says Oakley. “The goal is to reduce overall health care costs for both the patient and the system by keeping care accessible, helping patients find affordable options and guiding them through a very complex health care system.”

Building awareness

The biggest challenge to expanding the model is lack of public awareness. Providers are working to change that. “People need help understanding the model,” says Larson. She continues, “Sometimes it helps to sit down with prospective patients and map out costs and benefits of direct primary care with different levels of insurance coverage.” Many people assume a membership model is only for wealthy patients or confuse direct primary care with concierge medicine, says Oakley. “In a concierge model, the physician typically bills both insurance and the patient, which increases administrative costs and often leads to higher monthly fees,” says Oakley. “Direct primary care is different. By not contracting with insurance, we keep overhead low and pass that value on to patients. In many cases, it results in a lower overall cost compared to what patients currently spend on co-pays, urgent care visits, medications and other out-of-pocket expenses. There are no hidden fees, which allows patients to better plan for their health care.” McKeon agrees that education is needed. But more people are coming to understand the model. “I constantly tell people that they don’t need to wait until they are sick or have a problem to come in,” McKeon says. “By providing preventative support and education, we are proactive. But people are used to waiting until they have a major problem and feel sick, so this has been a lot of the education I am doing.”

Small-employer enrollment

Awareness is growing. Word-of-mouth has been important for Higgins’ practice. “Once you have a patient understand what it is and have a positive experience, they tell everyone they know,” Higgins says. “We have probably 10 calls per day from people wanting to sign up.” Higgins and other practitioners are enrolling small employers who might be unable to afford health insurance but can pay for employee membership. Daggett, who has enrolled four small groups, says the model offers enough flexibility for him to travel periodically to the workplace. Browne and others promote awareness through community outreach such as setting up a table at local events and hosting talks. “I do a lot of meet-and-greets with small businesses that are considering ways to support their teams,” says Daggett. “That’s been a theme – how do you keep costs down when insurance costs are on the rise? A lot of businesses are taking that proactive approach.”

‘Sense of ease’

“Once people understand the model, they really embrace it,” says Oakley. “Having direct access through same-day or next-day appointments, 30-to-60-minute visits and the ability to call or text me for urgent needs has been especially meaningful. It helps patients avoid unnecessary urgent care visits, allows time to more thoughtfully manage medical conditions so specialist referrals are more appropriate, and brings a sense of ease and continuity back to their care.” Says McKeon, “Medicine has become a business of disease, but this model is a way to promote health and healing.”