In early 2017, Dr. Lexi Tabor-Manaker was frustrated with medicine. She had dreamed of being a doctor since she was a young girl, but she was beginning to question her career.
“I was just feeling the frustrations of always feeling that my day was supposed to be based on billing and the quantity of patients I could see, and that’s just never really been how I’ve practiced,” she said.
She confided in a colleague at the Veterans Health Administration who told her that the modern medical industry did not appreciate her wish to prioritize patient needs on a personal basis: “You know, Lexi, the system doesn’t value what you have to offer.”
“The system may not value what I have to offer, but the patients have always valued what I have to offer,” Tabor-Manaker said she thought to herself. “I value what I have to offer.”
And so, Tabor-Manaker, a graduate of the Michigan State University School of Medicine who arrived in Kalispell in 2007, first working at Family Health Care before joining the VA in 2015, spent months researching her options and decided to leave the bureaucratic system to establish Glacier Direct Primary Care.
Located in Kalispell, the bright, uncluttered office opened in May and is one of the first direct primary care (DPC) services for adults in the region.
DPC is a form of medical service focusing on the patient-doctor relationship. Commonly confused with concierge medicine, DPC requires patients to pay a flat monthly fee to become a member and receive access to a personal physician and routine medical care. These providers do not accept medical insurance, though they advise patients to maintain their coverage.
Philip Eskew, a physician and the founder of DPC Frontier, a DPC advocacy group, said he believes it’s illogical to “use insurance for predictable expenses,” which is common in the traditional medical system. Instead, he explained, DPC providers maintain affordable and transparent pricing, especially for patients with chronic conditions, by cutting out “third-party players.”
The website of DPC Frontier indicates there are at least 865 DPC providers throughout the nation. While the U.S. House of Representatives is currently considering a bill to allow people to use health-savings accounts for DPC services (Tabor-Manaker noted that it “would be a very big thing for businesses” interested in enrolling employees in DPC), legislation concerning DPC typically varies on a state-by-state basis.
While Montana does not have any official legislation concerning DPC, the most recent Legislature passed a Republican-sponsored bill allowing health-care providers to charge periodic fees in direct primary agreements. Gov. Steve Bullock, a Democrat, vetoed it in March 2017 using an argument common among DPC critics.
“They charge fees for treatments already covered by a consumer’s health insurance, such as preventative care that insurance covers at no out-of-pocket cost to the consumer,” Bullock’s veto announcement states.
In December 2017, however, State Auditor Matt Rosendale, a Republican, released an advisory memorandum explicitly defining DPC provider agreements as non-insurance health care options.
“Direct primary care is yet another way for consumers to access routine, preventative, or preliminary health care,” Rosendale said in a press release.
Tabor-Manaker said the memorandum made her “much more comfortable” with establishing a DPC practice. She noted that she first heard about it through a text message from Carol Bridges, the co-founder of CostCare, a medical clinic in Missoula, which transitioned to a DPC model in January. Another local doctor, Cara Harrop, recently established a DPC clinic in Polson as well.
In her first two months of operation, Tabor-Manaker said she has enrolled about 20 patients. In the new practice, she is able to spend as much time as needed with each patient, discussing topics like personalized nutrition, which she rarely had time for in the past. She said patients have her cell phone number and can contact her whenever necessary. She also offers house calls.
These days, she spends much of her time on marketing and meeting with potential patients, including small business owners interested in bolstering their employees’ medical coverage. She noted that as the boss, she determines all pricing, and that in addition to offering 20 percent discounts to veterans, she may be able to take on “scholarship” patients as the business grows.
Regular monthly membership fees range from $70 to $120 per month. Tabor-Manaker also meets with local pharmacists and medical labs to negotiate prices for her clients. She said that with some of the deals she had been able to secure, patients will save money through medication and lab costs.
Following common trends in the DPC field, she said she will explore the possibility of hiring an employee to help with office work once she enrolls 300 patients. She added that she hopes to accumulate 600 patients within the next two years, at which point she would establish a waiting list and perhaps explore the possibility of taking on a partner.
More than anything, she is extremely optimistic about her future in medicine.
“When you take out these barriers [to] make it about quality instead of quantity, you really have the time to get to know your patients so well and have that really direct relationship, which is priceless,” she said.
For more information, visit www.glacierdpc.com.