Montana has a reputation as a home to independent spirit and innovative ideas. It is no surprise Montana is one of a wave of states in recent years codifying direct primary care (DPC) as an option for families and individuals to receive quality, personalized medical care without the usual bottlenecks of insurance approvals and hidden hospital fees. Often, DPC provides the added benefit of not having to visit an office or sit in a waiting room with other ailing patients. And, medical providers and practitioners are finding new satisfaction in their work.
Long waits for doctors and specialist appointments, quarrels with insurance companies over coverages, and the increased separation of doctors and patients wedged apart by administrative staff had become a common complaint – with both doctors and patients. Not all patients were satisfied with institutional healthcare offerings, and sought to find their own treatments. The people of Montana demanded better access to healthcare options. In 2021, the state legislature passed – and Gov. Gianforte signed into law – SB-101, which defined DPC and the guidelines that were to be followed by practitioners. The law was later amended under SB-374 to allow dispensing of medicines by DPC providers. Montana was the 31st state to pass DPC legislation.
Simply described, DPC practitioners charge an annual fee or subscription for services, instead of per-visit billing, usually submitted to an insurance carrier. Subscribers pay an annual fee ranging from $1,000 to $20,000, depending on the selected care provider and services offered. In return, the subscriber has access to 24/7/365 medical care. That often includes doctors making home visits to treat whole families, or simply providing individual care to a patient. Karis Medical Services in Helena (formerly Riverwood Health) treats DPC patients at their homes within a 100 mile radius of the city, and arrives in a fully equipped van, capable of performing simple lab tests, blood pressure tests, vaccinations and cancer screenings – all on site. There are a few local DPC practitioners – also known as “concierge medical” and “boutique medical” – listed in Jefferson County, including Rocky Mountain Health & Healing.
Laura Rear, a Nurse Practitioner with a doctorate in Pediatric Neurology, runs Rocky Mountain Health and Healing. She said that when she worked for a large medical institution, she was required to see about 3 patients an hour, about 15-20 minutes each. Rear said some of the doctors she worked with saw 2,000-5,000 patients a year. “There’s no way you can develop any kind of personal care plan with someone in that amount of time,” Rear said.
Rear’s patients at Rocky Mountain Health and Healing can expect about a two hour introductory meeting, with subsequent visits usually lasting about an hour. The patients Rear works with have her personal cell phone number, and can contact her anytime of day. All patients are visited in their own homes, where Rear can help better establish a personal relationship and perform what she terms as “functional medicine”. Rear investigates root causes for ailments and disease and doesn’t just treat symptoms. “Sometimes we just go through their pantry and throw out the stuff that’s not doing them any good,” Rear says. “You won’t get that from a traditional doctor.” Rear says she now sees about 3-4 patients on a regular basis, all of whom say they appreciate the personalized care they receive.
For Rear, the benefit of using a DPC billing model means a guaranteed income, and allows her to focus more on her practice and her patients. Rear currently has no staff; she handles all the calls and requests herself. She says that allows her to really get to know the person she works with, maintain good patient records, and make sure what she can provide will be positive.
With a DPC plan, patients are able to customize their healthcare needs. Some may require a full M.D., others may simply want flu shots for their family, or assistance with better nutrition and healthy lifestyle changes. If care is needed beyond what a DPC doctor can provide, they are able to make referrals to medical specialists for additional tests and treatments.
Independent Insurance Agents of Montana representative and former State Insurance Commissioner Bob Biscupiak told The Monitor, “The Concierge Medical Services approach to medical care is growing in popularity. Patients join [as] a member and have access to the doctor around the clock.”
Healthcare providers using the DPC model and health insurers both emphasize that DPC is not a replacement for a traditional health insurance plan. DPC does not cover many costs outside of the home visits by the practitioner. For instance, if an injury needs splinting or casting, the victim must go to an urgent care facility. Similarly, with specific tests and imaging work performed by specialists, an insurance provider is usually necessary. Biscupiak notes: “Concierge providers may or may not submit services to the insurance companies. I believe most do not file claims with insurance companies to avoid administrative costs.”
DPC may not be the best option for everyone, because it still has limitations and access to more sophisticated and expensive treatments might still require the need for standard health insurance coverage. But evidence of the multiple DPC treatments centers throughout Montana and the number of satisfied doctors and their patients suggests it does provide a valuable alternative to the standard healthcare insurance process that aggravated so many people in Montana. And, that independent spirit may lead to a new healthcare revolution.
