Creative Commons photo by jasleen_kaur via Flickr. This story by Briana Brady was first published in The Other Paper on Sept. 3, 2026. Over the more than two decades that nurse practitioner Holly Whitcomb has been providing primary care, things have changed — and it’s not just the switch to electronic records. “We used to just sit with patients and learn who they are and what they needed and what their goals were, and it was really personal,” Whitcomb said. After 24 years providing care in Hinesburg, Whitcomb is opening a new practice on Timber Lane in South Burlington. Her practice, Horizon Primary Care, offers concierge medicine, an increasingly popular model that mixes a membership fee paid by patients with insurance billing. Whitcomb said that, with this model, she wants to get back to taking her time with patients and personalizing their care — actually having the time to pick up the phone and answer a patient’s health questions. She’s not the only one making the switch. According to a Harvard study published less than a year ago, the number of practices using concierge medicine and direct primary care, which bypasses insurance entirely in favor of a membership fee, grew 83% nationally between 2019 and 2023. Susan Ridzon, the executive director of Health First, a statewide association of private practices, said that, while practices and providers using membership models still make up only a small portion of the organization’s members — about 7% — it’s been growing. “To be clear, this is a response to a payment system that doesn’t cover the work that practices are doing,” Ridzon said. For many providers making the switch to a membership system, she said, it’s a way to keep a private practice financially sustainable. The way insurance reimburses a practice not only depends on the kind of insurance, care or procedure involved, Ridzon said, but can also vary depending on the biller. Big systems like the University of Vermont have negotiating power with insurance companies. For smaller private practices, she said, they’re more often having to take what they’re offered. With Medicare, she said, there are also different fee schedules for hospital system care — and hospitals get a higher rate. “It’s really kind of obscene sometimes the differences for the exact same service,” she said. On top of that, Ridzon said, a lot of the work that goes into good primary care doesn’t get billed to insurance. That includes services like answering patients’ questions over a portal or the phone, or coordinating care with different specialists, all things Whitcomb said she wanted more time and capacity to do. Membership fees can vary across different offices and models. Concierge, which offers the membership alongside insurance billing, is often the more affordable option for patients. A look at local providers shows prices often hovering around $2,000 annually — sometimes, as in Horizon’s model, with scaled pricing depending on age or family size. Other local practices have found ways to make direct primary care work for patients as well. Beth Schiller, the nurse practitioner who owns Champlain Medical, an urgent care center in South Burlington, only offers direct primary care through a special relationship with some local employers. Schiller said that she’s been working with local employer Engineers Construction Inc. for years as Champlain Medical handles care for their workplace injuries as well as the necessary physical exams for some employees. While the company offers insurance outside her services, she said, employees are offered — and incentivized — to take Champlain Medical up on direct primary care paid for by ECI. “If the individual came to us for one primary care visit a year, which included, you know, some basic lab work, and we do EKGs and hearing tests for them,” Schiller said. “Then they have access to our facility for the rest of the year — for whatever, urgent care, primary care, essentially any of their other needs.” The relationship, she said, has made primary care visits accessible and easy to get for a group of people who might not otherwise have that. Recently, she said, doing an EKG on one patient led to a referral to a cardiologist, a stress test and a triple bypass procedure. The number of primary care doctors in the state is falling. According to a report from the Department of Health, there were 40 fewer primary care providers in 2024 than in 2022, and almost a third of Vermont’s primary care physicians are older than 60. While this doesn’t necessarily account for nurse practitioners such as Whitcomb and Schiller, Ridzon said that membership models may help sustain more doctors in the state for longer. “They’re finding a way to make it happen rather than retiring. Because a lot of them are so burnt out that they exit the field or retire,” Ridzon said. Whitcomb has been looking forward to opening her practice. She’s already begun coordinating care for some patients. “I’m not doing this to make a gazillion dollars. I’m doing this to genuinely try to take better care of my patients in the way that I think they should be cared for,” she said. Read the story on VTDigger here: More doctors are offering memberships for healthcare. ...read more read less