Maine Hospital System is Trying Direct Primary Care. Is it a DINO?
A hospital in Maine is trying its hand at Direct Primary Care. Will it fail? Is it a DINO (DPC in name only)? Let’s explore. First, some background on others. We have seen a medical school try it with $1 million and fail in a year. We have seen a “tech-savvy” venture capitalist-backed company called Forward fail. We have a pretend DPC in my community just use their urgent care clinics to make contracts with employers. All of them are not the real thing.
MaineHealth is a big system in Portland and they have created Trellis Health. Interestingly, Portland, Maine, has one of the highest amounts of DPC clinics per capita in the country. It all started, I believe, with my good friend Michael Ciampi, MD. This has given MaineHealth a head start as the locals are very educated about DPC. The question I have for them is, why do it? A recent article states that Trellis is taking 700 patients at $109/month. Here is what the CEO said:
The crux of the reform is to jettison the current payment system that prioritizes assembly line style doctor’s visits, Mueller said.
That’s great. The article I read this from is here, but it is behind a paywall.
While individuals can sign up for a membership, Trellis officials said the hope is that, in most cases, employers will join the system, and cover the monthly membership fee for their workers who opt-in. Medicaid and Medicare will not pay for Trellis membership fees.
Ah, they are going for the employers and are using this as a pilot program.
Trellis Health — a wholly owned subsidiary of MaineHealth — opened its first primary care location in Portland in October 2024, with expansions expected soon in Brunswick and Biddeford. Trellis is ready to scale up if needed, officials said.
I really hate that term scale up. It screams private equity or big money backers and that is what MaineHealth is.
The primary care team at the Portland location includes a doctor, two nurse practitioners, behavioral health specialist, physical therapist, pharmacist, a nurse and other professionals.
WTF?. That’s a lot of employees. I counted 6 “others” on the website and this didn’t count front staff. Thats 13 people!!! How are 700 patients supporting this?
Tamara StClaire, president of Trellis Health, said that since its launch for MaineHealth employees last year, specialist usage among the system’s members is 47% lower than for patients who receive traditional primary care.
A couple of things to unpack there. They have a president? That’s an administrator who has to be paid a lot of money. That’s 14 people!!!
Secondly, they are bragging that there is less specialist usage. Yes!!!! That’s awesome and a benchmark we can all use in marketing DPC. That being said, MaineHealth employs these specialists and make a lot of money off their services. That can’t be good for their bottom line.
A quick summary of this so far. Trellis Health, with 700 patients, has a president, a doctor, two NPs, a behavioral health specialty, a PT, a pharmacist, other professionals, and possibly a partridge in a pear tree. This has to be a big money loser as they are all on a salary. Plus, they are not sending patients to the specialists.
Now for some bullsh%t:
The system that most closely resembles Trellis is direct primary care, which is also based on a monthly membership that prioritizes access to doctor’s visits. The model has seen some some modest growth in Maine over the past few years, but that has been limited, McDermott said, because direct primary care typically caters to upper middle class and wealthy patients.
Modest growth? Caters to upper middle class and wealthy patients? Dr. Ciampi charges $77 a month. Hey, journalist, do your homework.
They make it seem that Trellis is so original and that direct primary care is just a copycat. Sorry, it’s the other way around. Something doesn’t smell right about this whole thing.
Mueller, the MaineHealth leader, said he believes Trellis will be a “net winner” for the hospital system’s bottom lin
How? They must be bleeding cash on this. And ONE lucky doctor gets to leave his or her employment at MaineHealth in the FFS system grinding through 25 patients a day to go to Trellis Health and see 8. Who wouldn’t want that? Their other employed docs must be salivating to jump into this, if it is real.
When I visited the Trellis Health this is what I found:
The one doctor is Marty Wesolowski, DO, MBA and he is the Senior Medical Director. His LinkedIn profile has executive references all over it. It makes me wonder if he is seeing patients at all and whether Trellis Health is just similar to every other VC backed DPC look alike (DINO), where they just hire NPs to do the work.
I’m not convinced Trellis Health isn’t one big DINO in sheep’s clothing. They must be bleeding money and that is why they got the Portland Press Herald to write an article to get more patients.
There are positives to this.
“The current model of reimbursement significantly undervalues primary care,” Mueller said. “We think this is a much more sustainable way of affording primary care.”
He is right. Direct Primary Care is the answer, especially when done by independently owned DPC doctors who have skin in the game and work on a budget to make a profit. Hospital systems notoriously claim to lose money by hiring family doctors and claim they have to subsidize them to make up for it. They do this because they want the referrals back into the system. Then why do Trellis Health? My guess is they want to expand using just NPs, pay them less, and funnel massive amounts of patients from employers into the system. Eventually, they will probably cut all the fluff (the PT, the pharmacist, etc) and it will look like every other DINO we have seen before.
That’s my opinion and prediction. What’s yours? I am open to other ideas.
I agree with your assessment. DPC docs create long lasting bonds with patients who only want the docs number and access to care. Everything else is fluff and an expense.