A Pioneer’s Response to MaineHealth’s “Revolutionary” Direct Primary Care Launch
Having practiced the Direct Primary Care model in Maine since 2013—before it even had a formal name—I find MaineHealth’s announcement both ironic and instructive. I would like to provide insight and clarification on key points from this coverage: Let me address some key points from this coverage:
On “Modest Growth” and Market Validation
The article’s characterization of direct primary care as experiencing “modest growth” fundamentally misunderstands what we’ve built. What we’ve seen is steady, sustainable growth driven by real patient outcomes and provider satisfaction—not venture capital hype or corporate mandates.
Like so many “early adopters,” when I started this model in 2013, critics dismissed it as unsustainable. Multiple healthcare organizations, including MaineHealth, were not only skeptics but active opponents of this model. In spite of their opposition, Direct Primary Care has blossomed throughout Maine and the entire country. In fact, the New England Direct Primary Care Alliance (founded in 2015 as an outgrowth of its predecessor the Maine Direct Care Network) has nearly 80 active members practicing Direct Primary Care throughout our state. As a point of reference, in 2013, there were less than a handful of us. That’s not modest growth—that’s vindication.
Who Direct Primary Care Really Serves
The suggestion that membership-based care “caters to the rich” reveals a profound misunderstanding of our patient base. At affordable monthly rates, direct primary care serves working families, small business owners, and blue-collar workers who can’t afford $8,000+ deductibles but don’t qualify for the tax-funded MaineCare program (Medicaid).
These are the people supporting Maine’s economy—contractors, restaurant workers, small farmers, independent tradespeople. They’re choosing to pay out-of-pocket for real healthcare relationships because the traditional system has failed them with assembly-line medicine and financial barriers.
My patient population—more than 80% uninsured—may chuckle at being categorized as “upper middle class and wealthy patients.”
So are you folks also going to offer wholesale pricing on lab tests and medications? You know, the kind of things I pay pennies or a few dollars for?
The Irony of Hospital System “Innovation”
MaineHealth’s Dr. Mueller states that “primary care is a broken system, and we needed to do something different.” Where was this urgency more than a decade ago?
When independent physicians like myself began offering this model:
- Hospital systems, healthcare organizations, and even State Medical Associations told us we “didn’t know what we were talking about”
- They predicted we would fail
- They showed zero interest in collaboration to reduce healthcare costs
- They actively worked against alternative payment models
Now that direct primary care has proven itself through actual patient outcomes and physician satisfaction, suddenly it’s worth adopting. But let’s be clear about what’s happening here.
The Difference Between Pioneers and Followers
Independent DPC practices like those that built this movement:
- Typically serve 300-600 patients (allowing 30+ minute visits)
- Offer 24/7 access via phone/text
- Provide affordable monthly membership fees
- Operate with minimal administrative overhead
- Focus entirely on patient care
MaineHealth’s “Trellis Health”:
- Part of a massive hospital system with corporate overhead
- Will likely face pressure to increase patient panels over time
- May prioritize metrics that benefit the parent organization
What This Really Represents
MaineHealth’s entry validates what independent DPC physicians have known all along: this model works. But it also represents the healthcare industry’s pattern of co-opting innovation after initially rejecting it.
The real question isn’t whether membership-based care will succeed—we’ve already proven that. The question is whether corporate implementations will maintain the core principles that made DPC effective: small patient panels, genuine physician autonomy, and alignment of financial incentives with patient outcomes.
Welcome to the Party (Despite Your Tardiness)
To MaineHealth and other hospital systems now embracing direct primary care: welcome. You’re more than a decade late, but healthcare transformation takes time.
I hope your version succeeds in serving patients. But let’s not pretend this is revolutionary innovation when it’s actually the adoption of a model that independent physicians have been refining for over a decade—often in the face of institutional skepticism.
Perhaps you might want to chat with the local experts—the New England Direct Primary Care Alliance—or the national group, the Direct Primary Care Alliance (founded in 2017). They’ve both had an extended hand for over a decade. Maybe now you’ll pay attention. I doubt it.
The real pioneers in this space are the independent DPC physicians who risked their careers to prove that better primary care was possible. We’re still here, still innovating, and still serving the working families of Maine who deserve better healthcare long before it became a corporate strategy.
The DPC model in the hands of corporate medicine is doomed to failure because they cannot, no matter how hard they try or how much they pretend, create the welcoming, compassionate setting so common in most DPC practices. Most DPC success is because patients get the impression that we care about them, actually hear them, and provide good medical care. Anything the disrupts those standards reduces our effectiveness; a corporate model has to put the corporation first, not the patient. We DPC doctors have to be wary of anything that dilutes the trusting relationship we have with our patients. Any contracts that we may have with any other influence, such as Taro, adds another influence that can’t be anything but restrictive. If our patients choose us themselves and we satisfy their needs, our model will flourish and grow. Independence and freedom to practice accoding to our principles has always been the foundation of our success: there is no need to mess with a success formula that has proven itself. The patient and the doctor need to be the ONLY influences in the room – beware of any other foot in the door!!
Bud Freeman, DO, Alfred, Maine