Can a non-profit in rural Maine start a DPC clinic?
Northern Light Health bolted from Castine, Maine, recently leaving town without a health clinic. The Castine Community Hospital Corp has been looking at options over the past year.
That exploration was in response to the system facing financial problems, location closures, insurance disputes and other operating challenges
And what have they settled on?
A direct primary care clinic.
Such a practice could be opened in Castine as part of a community health plan or independently, according to the board.
The Castine group may not be able to have a center up and running by Feb. 27, but now aims to announce the operating structure, timeline and staffing before the end of February. For now, the board is working to determine what the organization would look like structurally and legally.
I am always curious to see how these organizations, administrations, or corporations decide how to open a DPC clinic on their own. I have seen attempts fail (University of Houston Medical School), and I have seen other ones open with no regard to financial planning (Maine Health). In fact, the article even references the latter.
Here are my questions (and predictions) for the Castine Community Hospital Corp:
- Do you have a real DPC doc consulting you? Someone who has done this independently and successfully?
- That doctor can help you open successfully and frugally. Do NOT do this on your own!!
2. Do you have a doctor who wants to work there? And will that doctor own the practice?
- If the Castine Community Hospital Corp. is going to own it and just hire a doctor, then this will fail. They won’t get a doctor, and it will end up being a revolving door of non-doctors working there. Promote this opportunity with an ownership option. Offer the doctor a financial head start and an office space already built out with equipment and staff. Eventually hand him or her the keys. That would enticing.
If anyone else has ideas or information on what is going on in Castine, please comment. Or send this along to them. ‘
As far as I know, no one has reached out to any of the OG DPCs in the state, nor have they contacted the regional DPC group, The New England DPC Alliance. But I am sure that they have hired numerous consultants who have never done this before…. I’m sure it will be fine…..
You are probably right
I was just going to post this……no one has bothered to reach out to the extraordinarily successful DPC practices in Maine. I reached out to a couple of contacts….nothing but crickets. Apparently they know more than we.
When people play with “Other People’s Money” they can’t lose. Just like U of H, they will blame everyone and everything else when it fails.
Edmund Billings MD here. I am a summer resident of Castine and am advising CCHC. We have hired DPC consultants, Health Rosetta advisors, and legal counsel who have launched DPC’s across rural US and now in Maine. We have spoken to several DPC’s in Maine and would love to expand our insights ands network. Please contact me with interested or if you would like to help. Thank you! [email protected]
Edmund Billings MD here. I am a summer resident of Castine and am advising CCHC. We have hired DPC consultants, Health Rosetta advisors, and legal counsel who have launched DPC’s across in rural US and now in Maine. We have spoken to several DPC’s in Maine and would love to expand our insights ands network. Please contact me with interested or if you would like to help. Thank you! [email protected]
Edmund Billings MD here. I am a summer resident of Castine advising CCHC on this project. They have hired consultants, Health Rosetta advisors and legal counsel: whose sole focus is DPC and COHPs and have helped launch DPCs across rural US and now in Maine. We have opened conversations with several DPC’s in Maine. Feel free to contact me if you are interested or want to help. Thank you, [email protected]
Dr. Billings,
I appreciate you joining the conversation. A few points of clarification:
You mention having “opened conversations with several DPC’s in Maine.” I’m one of the longest-operating DPC physicians in the state, a founding member of both the Direct Primary Care Alliance and the New England Direct Primary Care Alliance—and neither I nor anyone in our regional group has been contacted by CCHC or its advisors. Michael Ciampi, who commented above, is another OG Maine DPC doc. Same story. If you’ve spoken with “several DPCs in Maine,” we’d be curious who, because the established DPC community here hasn’t heard from you.
Regarding Health Rosetta: they’re a benefits advisor network focused on helping employers design health plans that incorporate DPC. That’s valuable work, but it’s not the same as knowing how to operationalize a sustainable DPC practice—particularly a nonprofit community model serving a largely Medicare population in rural Maine. These are fundamentally different skill sets.
Your invitation for us to contact you “if interested or want to help” has it backwards. CCHC is the organization attempting something new and complex. The New England DPC Alliance has 80+ practices with years of operational experience. We reached out. We were ignored. And now we’re being told we should reach out again if we “want to help.”
We do want Castine to succeed. That’s why we offered our expertise in the first place. The offer remains open—but the ball is in your court, not ours.
Jack Forbush, DO
Osteopathic Center for Family Medicine, Hampden, ME
Founding Member, Direct Primary Care Alliance & New England Direct Primary Care Alliance
Let me make sure I understand the team correctly:
Bryce Heinbaugh – CEO of an Ohio-based employee benefits consulting firm (Health Rosetta advisor). His expertise is helping employers design health plans that include DPC. That’s valuable, but it’s not the same as knowing how to operationalize a sustainable DPC practice.
Kat Nicol – DPC legal counsel in Colorado. Legitimate expertise on practice structure and compliance. But lawyers advise on legal risk; they don’t run practices.
Hint/Elation/Spruce – Software platforms. Tools are important, but tools don’t build sustainable practices.
What I don’t see on this list: anyone who has actually operated a successful DPC practice long-term. Anyone in Maine. Anyone with direct experience navigating the specific challenges of rural New England, Medicare-heavy patient populations, or community nonprofit governance structures.
You mention speaking to “several DPCs in Maine.” I’m genuinely curious who, because neither I nor anyone in the New England DPC Alliance—the regional organization specifically created to support and connect DPC practices in this part of the country—has heard from CCHC or its advisors. If those conversations happened, they weren’t with the established DPC community here.
I hope I’m wrong and Castine succeeds. But assembling a team of consultants, lawyers, and software vendors—however credentialed—is not the same as learning from people who’ve been doing this work for a decade in this region. The offer to help remains open.
Jack Forbush, DO
Osteopathic Center for Family Medicine, Hampden, ME
Founding Member, Direct Primary Care Alliance & New England Direct Primary Care Alliance