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Updated: 7 hours ago

'Direct care’ health practices are expanding footprint in southern Maine

A storefront window reflects landscaping and has a sign. Photo / Courtesy Oakley Pine Family Medicine Dr. Erin Oakley opened Oakley Pine Family Medicine in Falmouth.
By Laurie Schreiber

Membership-based direct primary health care business are trending up.

Earlier this year, Apotheosis Health opened in Bangor. Three more practices have opened or are in the pipeline in Falmouth, Yarmouth and Kennebunk.

Oakley Pine Family Medicine leased 990 square feet of office space at 170 U.S. Route 1 in Falmouth from MSP Professionals 170 US-1 LLC. Joe Italiaander of the Boulos Co. facilitated the transaction.

Dr. John Daggett of Yarmouth Direct Primary Care leased space at 500 U.S. Route 1 in Yarmouth. Chris Gallagher of the Boulos Co. brokered he lease.

Middle Path Health PLLC intends to sign a lease for 1,022 square feet of space at 149 Port Road in Kennebunk.

Direct-care practices address rising health care costs, limited access and fragmented services. The model charges a membership fee paid by the individual to cover services and direct access to the provider, with themes that include same-day or next-day appointments and unlimited, unrushed office visits. The model doesn’t bill insurance.

Falmouth

Dr. Erin Oakley, a doctor of osteopathic medicine, opened Oakley Pine Family Medicine in Falmouth in early October. She has been caring for patients since 2016. 

Originally from upstate New York, her father was a local family doctor, which gave Oakley insight into family medicine and the value of the patient-physician relationship. 

A person poses for a headshot.
Photo / Courtesy Oakley Pine Family Medicine
Dr. Erin Oakley

After she and her husband completed their residencies in North Carolina, they moved to Maine and Oakley worked in a traditional fee-for-service clinic in Gorham.

“Over time, I began to feel that the system didn’t align with my values,” she said. “Appointments were rushed. Real connection was limited. I rarely had enough time to care for patients the way I knew they deserved — and it often came at the expense of time with my own family.”

That experience led her to direct primary care. As an osteopathic physician, she said, she’s “deeply committed to treating the whole person, not just symptoms. I believe in the body’s natural ability to heal, and in the importance of understanding the structure and function of the body as a connected whole. Those values are at the heart of my practice.”

Oakley searched several months on her own for a spot to set up the practice, then connected with Italiaander. For the direct primary care model, she said, the goal is to have low overhead in order to be low-cost for patients. 

“So I wasn’t looking for a huge space,” she said. “It would just be me and maybe one other provider eventually.”

She also wanted to be close to home. Within a week, Italiaander showed her the Falmouth lease and introduced her to the landlord, Mike Pride.

“He really cares about his tenants,” Oakley said of Pride. 

The space was largely ADA-approved with only a couple of tweaks needed, had the requisite office set-up and infrastructure and is in a building with other medical tenants.

A room has a folding bed and two chairs.
Photo / Courtesy Oakley Pine Family Medicine
The space had the requisite office set-up and infrastructure and is in a building with other medical tenants.

“It was just furnishing and getting the equipment I needed,” she said.

For the business set-up, Oakley did a lot of her own research, tapped into the New England Direct Primary Care Alliance and connected with a SCORE business mentor. The alliance provided a mentor as well. She tapped into Cultivation Studio, a branding and website design studio based in Los Angeles, for things like branding strategy and website design.

Patient capacity is around 300. She released the website in September. Some patients from her last practice have enrolled.

The startup is self-funded with an investment of about $30,000.

The direct care model is a growing trend, Oakley said.

A room has a settee and two charis.
Photo / Courtesy Oakley Pine Family Medicine
For the business set-up, Oakley did a lot of her own research, tapped into the New England Direct Primary Care Alliance and connected with a SCORE business mentor.

“It is growing exponentially,” she said. “Providers and patients are rapidly adopting direct primary care for better, affordable care.”

Yarmouth

Dr. John Daggett opened his solo practice, Yarmouth Direct Primary Care, in January. 

Growing up in Litchfield, he trained in internal medicine at Maine Medical Center after attending Northeastern University and Tufts University School of Medicine. He’s worked in rural and underserved clinics in Milo, as well as practices in Westbrook and Farmington.

“Staying connected with patients has been one of the greatest joys of my career,” he said. “It’s a privilege to advocate for and collaborate with them in their pursuit of wellness.”

In addition to primary care, Daggett worked as a hospitalist, maintaining inpatient care skills to support patients in both primary and acute care settings.

A person sits in a room that has chairs and a sideboard.
Photo / Courtesy Yarmouth Direct Primary Care
John Daggett started Yarmouth Direct Primary Care. The consult space includess a turntable, seen at left, designed to foster a welcoming vibe.

After more than eight years as a primary care doctor, he was looking for a “modern, approachable and personalized primary care experience,” he said.

Direct care, he said, is a great option for patients with and without insurance.

​With health care costs and deductibles at an all-time high, the monthly membership keeps care accessible, affordable and free from the unpredictability of conventional systems. The practice also offers seasonal memberships for visiting patients, medical assessments for tourists and visitors  and rotating schedule to the Casco Bay islands for health screenings and patient care.

Daggett has about 100 patients now, with the capacity to enroll about 400. The startup was self-funded. Keeping overhead as low as possible, he decided on a small space and performed fit-up such as installing drywall himself, and procuring artwork from patients and family. Patients started signing up fairly quickly in the first couple of months. 

For the business set-up, he consulted with others in the direct care community, hired an attorney and taught himself basics such as setting up a professional limited liability corporation. 

He recently took part in Venture Forward Yarmouth, a partnership between the town of Yarmouth and Northeastern University's Roux Institute to provide a hands-on, cohort-based program designed to help local entrepreneurs, small business owners and business leaders, scale their ventures, explore new markets and build long-term sustainability through mentorship and innovation. The eight-week program was sponsored by Yarmouth's Economic Development Advisory Board.

Daggett credited Chris Torina, director of entrepreneurship at Roux Institute, as a sounding board and mentor.

“The networking has been really exciting,” he said.

Daggett said he’s seeing a lot of demand for the membership model, and is “particularly excited to see this model benefit small businesses and their teams, particularly those providing self funded health insurance. 

He estimated there’s an approximate 60% reduction in annual health care expenses for patients working with direct care practices. 

“Working with a practice like mine,  and ensuring same day or next day access for visits, patients should rarely need urgent care or more costly avenues of care,”  he said.

Kennebunk

Kathleen McKeon said she'd like to open Middle Path Health, in Kennebunk, in late November; she’s still working through the leasing process and the permitting process with the town and the state.

The practice would provide in-office, telehealth, house call care and non-member options.

A nurse practitioner, she graduated from University of Southern Maine’s College of Nursing and has worked as a primary care provider in southern Maine since 2008.

A person poses for a headshot.
Photo / Courtesy Middle Path Health
Kathleen McKeon

McKeon was previously an herbalist and offers “natural consults” that integrate herbal and medical services.

The biggest reasons direct primary care is needed, she said, are related to access of care, insurance increases and changes and changing perspectives about the care patients want to receive. 

Most recently, McKeon worked for a small practice in Kennebunk. 

“For the last couple of years, I had been planning this change to go into my own practice,” she said.

Her assistant, Emily Hanson, would serve as clinic manager.

Minimal renovations would be needed. McKeon said she will provide $41,000 in cash for the start-up and obtained a Kennebec Savings Bank loan of $75,000, although she expects the project to come in under budget.

an exterior view of a gray-sided building.
Photo / Courtesy Middle Path Health
McKeon expects to open Middle Path Health in Kennebunk in late November.

Working with a SCORE mentor, her accountant and others, she learned business basics such as how to form a limited liability company. She created a membership benefit chart and opened social media accounts for marketing.

For McKeon, the practice is about preventive care and talking with people about options.

“I believe that patients value being seen, heard and listened to and that most are sick of having 10 minutes with a provider who spends the visit looking at a computer screen,” she said.

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