Direct care

Dr. Heather Linder of Telluride Whole Health is utilizing a new healthcare model called direct primary care. (Courtesy photo”

Telluride-based physician Dr. Heather Linder of Telluride Whole Health is utilizing a new healthcare model that has the potential to lower costs for her patients while boosting access to care.

In the new model, referred to as “direct primary care,” or DPC, patients pay a flat monthly membership fee that covers basic healthcare services from their primary care physician. 

Patients often then buy a health insurance or health share plan with a high deductible to cover specialty and emergency care, which DPC does not include.

At Telluride Whole Health, monthly fees begin at $79 for adults, $25 for kids, $149 for a couple and $199 for a family. 

The fee covers unlimited doctor visits; free basic testing, such as for COVID-19, strep and flu; access to discounted prescriptions and supplements; lab work at cost (a complete blood count costs less than $3); options for telehealth appointments; and use of a secure app for communicating with Dr. Linder without having to make an appointment. 

She even makes house calls.

“Many patients are asking me why I transitioned to direct primary care,” Dr. Linder said. “I enjoy spending more time with patients and doing what is right for the patient, rather than having insurance companies dictate care.”

She continued, “I am also trying to bring transparency back into medicine by providing medications and labs at cost.”

A 2018 Colorado Health Institute study compared the direct primary care model with traditional primary care and found that the average patient visit under the DPC model was 30-60 minutes, compared with 12-15 minutes for traditional primary care.

Dr. Linder, who shares an office with Dr. Carol Adams at 126 W. Colorado Ave., offers two types of appointments — 30 minutes or 60 minutes — and notes that not having to deal with insurance companies, including hiring a biller, keeps the overhead low and allows her to spend more time with her patients.

“I prefer to have longer office visits to get to the root of the problem,” she said.

Dr. Linder noted that the DPC model also allows undocumented immigrants, who are prohibited by law from accessing Medicaid, Medicare and the Affordable Care Act marketplace, to access quality healthcare.

She said she has already signed up patients from Telluride’s immigrant community.

“Tri-County Health has been super helpful with my undocumented patients,” Dr. Linder said. “I can book an interpreter through them. They have also been helping me link my undocumented patients to services.”

Dr. Linder explained that she also offers an employer plan with a discounted rate of $74 per employee.

“Costs of employee benefits like health insurance can be so high, especially on the Western Slope,” she said. “Employers have been liking this option. I can’t fix the housing crisis that has led to the employee shortage, but I can give employers a way to hopefully retain the employees they have.”

Chad Scothorn, chef/owner of the Cosmopolitan restaurant, is one local employer who is offering membership to employees that have six months or more of service.

In a press release, Scothorn said, “We care about our staff. Developing the right culture is essential to achieving a sustainable and competitive advantage. We can attract and maintain a diverse workforce with the highest-calibre skills if we take care of them. It’s that simple.” 

Dr. Linder, who previously worked at the Telluride and Uncompahgre medical centers, expressed frustration with providing care in rural communities using traditional models.

“Many patients continue to delay care due to concerns about medical costs,” she said. “Many working families make too much for Medicaid, yet struggle to afford $2,000 monthly premiums for very-high-deductible plans.”

In addition, she said, “Two-thirds of those filing for bankruptcy state medical bills as the reason, and the majority of those had insurance. It is clear that coverage does not equal care and we need a mindset shift.”

According to Dr. Linder, the downsides to traditional approaches extend to healthcare providers, as well as to their patients.

“The current system has perverse incentives to drive volume, high administrative overhead and very little price transparency,” she said. “I have witnessed some amazing and experienced providers quit practicing medicine after working in our broken system. Our community cannot afford to lose any more healthcare providers.”

Dr. Linder described DPC as a win-win, then, for the community.

“The direct primary care model brings the focus back on the patient and operates with minimal overhead by eliminating the middle man,” she said.