MaineHealth is expanding a membership-based system of primary care that has the potential to change the way many people access their doctors.

Instead of making an appointment and billing through private insurance, the new primary care option — Trellis Health — will allow employers or patients to pay a monthly membership fee to gain unfettered access to a primary care team.

Appointments can typically be scheduled for the same week and health professionals are readily available for phone and email consultations, officials said. Trellis members will still have health insurance plans, officials said.

The program has been open to MaineHealth employees since 2024, with about 700 opting in. Beginning this week, it became available to the general public and employers starting at $109/month.

Dr. Andy Mueller, MaineHealth’s CEO, told the Portland Press Herald in a recent interview that this new primary care network won’t replace the system’s traditional primary care options but it will offer more direct care.

The crux of the reform is to jettison the current payment system that prioritizes assembly line style doctor’s visits, Mueller said.

“Primary care is a broken system, and we needed to do something different,” Mueller said. “So the idea is, let’s change the system and make real reforms, not small incremental changes.”

MaineHealth’s effort appears to be the first of its kind by a hospital system in Maine, Mueller said.

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.

Ashley Lasbury, who works in patient admissions at MaineHealth Maine Medical Center, said she noticed the difference from traditional primary care right away when she joined Trellis as a patient in February.

Lasbury said she has been able to address several health problems — receiving physical therapy to recover from a broken toe, and manage her weight loss medications and osteoporosis. During a recent visit, she said she talked with a pharmacist for 20 minutes about side effects from weight loss medications and making sure she wasn’t losing weight too quickly.

“It’s not rushed,” Lasbury said. “In my old office, you’d know there were other people waiting. This doesn’t feel like a production line.”

REDUCING THE BURDEN ON THE SYSTEM

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.

The program does not have immediate plans to open a pediatrician’s office, but officials said all ages will be welcome.

The primary care team at the Portland location includes a doctor, two nurse practitioners, a behavioral health specialist, a physical therapist, a pharmacist, a nurse and other professionals.

Mueller said this new system of care should reduce the burden on other parts of the health care system, such as emergency room visits and specialists.

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.

Allison Talon, a Trellis nurse practitioner, said they can reduce referrals to specialists by taking care of common ailments and other care in house, including basic gynecological services, cortisone injections, diabetes injections, physical therapy and dermatology.

Fewer specialist visits and a greater emphasis on primary care should help reduce the number of insurance claims, Trellis officials said.

Talon said she suffered from burnout as a nurse practitioner in traditional primary care before moving to the new program in March.

“I’m not crammed with back-to-back-to-back appointments anymore,” Talon said. “I can take time to sit with the patients and listen to the concerns they have.”

‘A WORTHWHILE EXPERIMENT’

Whether Trellis Health and other systems like it will transform the way primary care is delivered for most patients is unclear. Health experts interviewed by the Press Herald said efforts to improve the status quo are worth trying.

Mara McDermott, CEO of Accountable for Health, a national advocacy group for health care payment reform said, “when you’re transforming a trillion dollar health care system, it takes patience. You have to stick with it.”

There are some similar efforts occurring across the country, including at Vanderbilt University’s hospital system, said Gary Claxton, senior vice president and health insurance expert at KFF, a national health policy think tank.

“To have better coordination of care, it’s almost unquestionably better care for the patient,” Claxton said.

He said there is an added advantage when a hospital system, which controls referrals to specialists, reforms primary care payment systems.

Whether the reforms will stick and become more widespread is difficult to say, Claxton said.

“Over the decades, we go through phases of more care coordination, then it wanes, and comes back and wanes again,” Claxton said. “It’s hard to say what will be around in 10 years.”

NEW MODELS OF CARE

StClaire, Trellis Health’s president, said they visited primary care systems in Utah, Louisiana and Oklahoma that had similarities to MaineHealth’s vision, but MaineHealth “built a system from scratch.”

StClaire said creating more access for patients is challenging.

“People are used to a disjointed primary care system,” StClaire said. “I would encourage people to keep an open mind. It’s going to feel a little different, a little weird, at first.”

The problem with the traditional model, StClaire said, is that the primary care office generally doesn’t get paid for anything other than visits to the doctor’s office, so phone consultations and email communications are kept to a minimum, and the system prioritizes quick visits.

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.

Jeff Yuan, co-founder of Mending, an insurance company that offers individual and small group plans on Maine’s Affordable Care Act marketplace, said with MaineHealth launching Trellis, the membership model has a chance of growing quickly. He said Mending works closely with direct primary care physicians.

“MaineHealth brings a lot of resources, brand, trust and credibility behind shifting to this kind of model,” Yuan said.

McDermott said patients like systems where they have better access to primary care and can call for an appointment and get in within the week, rather than waiting months. A membership model attached to a hospital system has a better chance of widespread success, she said.

“The big question is can you structure this in a way that yields the savings the system needs?” McDermott said.

Mueller, the MaineHealth leader, said he believes Trellis will be a “net winner” for the hospital system’s bottom line.

“The current model of reimbursement significantly undervalues primary care,” Mueller said. “We think this is a much more sustainable way of affording primary care.”