The cost of monthly healthcare coverage for the Berube family was getting to be too much.
With Serena a self-employed real estate agent and John working as a part-time employee for the town of Peterborough, they were paying roughly $1,200 a month in health insurance – with a $10,000 deductible. So if either of them or their two kids got sick, it could quickly add another cost to the monthly budget. Serena estimated they were paying anywhere from $1,600 to $1,800 a month in premiums and doctor’s visits.
“They were getting to be astronomical,” Serena said. “Every time the kids needed to go to the doctor, it was another $350 and we struggled with, not for the kids, but for us, do we need to really go to the doctor?”
Then through Facebook, Serena learned about Siobhan Benham, a nurse practitioner and owner of Hearthside Family Health in Peterborough, who was offering an alternative to insurance called Direct Primary Care.
Benham had worked in a hospital and walk-in clinic setting and was starting to get burned out. Between the limited allotted time with patients and endless paperwork for insurance companies, she didn’t feel like she was giving her patients the kind of care they deserved – the whole reason she got into medicine in the first place.
Benham was familiar with the Direct Primary Care model, which has been around since the 1990s, but was more available in the Midwest and Western part of the country. She researched the concept for a few years before deciding to open her practice two years ago. Under Direct Primary Care there is no insurance involved. Benham doesn’t take any insurance. Instead, patients pay a monthly subscription and when they go into the office, there are no co-pays or questions of whether the service is covered and what it will cost.
The rates are $25 for ages 0 to 26, $50 for adults 27 to 59 and $75 for adults 60 and older. There is also a 10 percent household discount.
“Even when we paid for health insurance and office visits, we weren’t really getting the care we thought we needed,” Serena said. “And from a money standpoint, it’s been a no brainer.”
So for a family like the Berubes, they pay $135 a month and with their inclusion in a health sharing account, their healthcare out of pocket dropped to about $600 a month.
“You can anticipate costs and know what’s included,” Benham said. “I got to the point where I was saying I don’t know how much that’s going to cost or what your going to get billed.”
Jay Vanderbilt of Dublin joined Hearthside soon after Benham opened the practice. She has insurance, but it comes with a $5,000 deductible and not being impressed with what she calls “factory medicine” the Direct Primary Care approach works best for her.
“I knew I wanted something different then ‘here’s the 15 minutes the insurance company has allotted you,’” Vanderbilt said.
She feels that there’s a relationship beyond just patient and provider with Benham. She always feels like she can pick up the phone and call with a question and there’s a greater understanding of who she is and what she needs for care. Benham has even made home visits to Vanderbilt’s house.
“This is medicine in practice versus medicine as a business,” Vanderbilt said. “What makes this work is not only the model and not only the cost, but it’s Siobhan. She’s kind, caring and compassionate as a person.”
Vanderbilt said she keeps her insurance as a backup in case anything catastrophic happens, but hopes to never have to use it.
“You can’t get a lot of care for $5,000,” Vanderbilt said of her deductible.
After her previous doctor, Lisa Ramey, retired, Vanderbilt said she didn’t have a primary because she wasn’t interested in just choosing anyone. Then she met Benham.
“I felt an instant connection with her,” Vanderbilt said.
You might figure that patients would call for an appointment for the littlest things since the monthly payment was upfront and there are no surprise bills on the back end, but Benham said she has never had a patient that overuses or abuses her services.
She encourages them to call with any questions because the whole point of her practice and the Direct Primary Care model is to focus on the patient without the overriding concerns about insurance bills. Sometimes the phone calls, which Benham answers directly, turn into a quick consultation that doesn’t require an office visit. If she thinks the patient should be seen, people aren’t secretly wondering what it will cost them. She tries to see people as soon as possible, and more often than not the appointment will be that day or the next.
“Whatever it takes for you to be seen, she’ll do,” Serena said. “And she schedules plenty of time so we’re never rushed.”
As a nurse practitioner, Benham can handle a lot when it comes to patient care. She sees patients with acute illnesses like the flu or strep throat and chronic diseases like high blood pressure and diabetes. She does physicals and well visits for children, as well as stitches and skin biopsies. She offers lab work and since it doesn’t have to go through an insurance company, she can do so at a discounted rate.
Her typical visits last about an hour, so she only sees up to six patients a day. Compare that to where she was previously working where the patient load could be more than 30 in a given day.
“There are so many barriers between providers and patients,” Benham said. “This is like traditional, old medicine. You are working for the patient.”
At first, when she decided to open her own practice using a system that few of her eventual patients were familiar with, Benham was unsure of how it all would work out. To make sure she had money coming in to help support her family, she had two other jobs – teaching full-time at Rivier University and part-time at an urgent care facility in Keene – for more than a year.
Now just over two years since branching out on her own, which includes a second practice in Bedford run by her partner Tracey Bottazzi, she’s approaching her max of 200 patients. Things have been trending up so much that she will soon be adding another provider to the Peterborough location. And in her two years practicing Direct Primary Care, she’s had more than a few phone calls from providers asking how she made the switch.
“It’s definitely been a slow growth which has been nice,” Benham said
Benham estimates that about 60 percent of her patients don’t have insurance and “I’m offering them affordable primary care,” Benham said. Others do have insurance, but it is more cost-effective to pay the monthly subscription fee than pay the out of pocket deductibles. She said there are HSAs out there that can be used for Direct Primary Care.
“I’d say the outlook is very good for Direct Primary Care; there’s definitely a movement,” Benham said.
After years of practicing in traditional settings, Benham is convinced the healthcare system is broken. So she’s doing what she can to offer affordable, in-depth care for her patients.
“It’s all about the relationship,” Benham said. “We want people to feel they belong.”
For more, visit www.hearthsidefamilyhealth.com.