For almost a century, a local nonprofit has been tasked with providing health care for the small Hancock County town of Castine and its neighbors.
To do that, the Castine Community Hospital Corporation has for years leased operation of the center it owns to Northern Light Health.
But as insurance disputes and financial instability drag on in that system, which serves the majority of eastern and northern Maine, the Castine group is investigating options to operate more independently. The project shows how one community is responding to regional issues that have left thousands of Mainers uncertain about their future access to care they need and the insurance to cover it.
“We don’t want to be caught flat-footed if something bad happens, God forbid,” Bobby Vagt, the corporation’s board president, told the town’s select board last week.
The corporation manages an endowment to provide health care for the area. Its clinic serves about 1,150 patients and employs one full-time physician, along with additional nursing and administrative staff.
The board continues to work with Northern Light and will do whatever it can to support it, according to Vagt; the system has not proposed making changes in Castine. But because the path ahead appears rocky, the board feels it has to be prepared, members said.
This year, Northern Light has seen layoffs, hospital and clinic closures, executive resignations, financial losses, a plummeting credit rating and an ongoing insurance dispute with Anthem that could leave more than 30,000 Mainers out of network.
Federal funding cuts to Medicaid and insurance coverage have added another layer of instability for rural hospitals, which partially rely on that money to operate, though Northern Light officials said earlier this year that they don’t plan to close more facilities.
The Castine board has considered other provider networks and hired a consultant for a three-month feasibility study to evaluate other options. The study focuses on two structures that operate somewhat outside of traditional health care systems.
One is starting a community owned health plan, which is a group-based insurance model. It would require an employer to serve as an anchor, according to Vagt, so Maine Maritime Academy is joining the exploration process.
The other is opening a direct primary care practice, a model in which patients typically pay a flat fee for consistent access to an independent primary care provider without going through insurance. Castine would hope to make the services free.
That general model has been gaining traction in Maine; in the past several months, practices have opened in Bangor, Orland and Presque Isle.
The providers behind it have said they can spend more time with patients and provide better care without the demands of insurance reporting and heavy workloads. Hospitals, for their part, have said the growth in these clinics can make deepening primary care provider shortages worse, as independent providers typically take on smaller numbers of patients.
MaineHealth opened its own direct primary care practice in Portland last month, which it said would lower costs for patients and help them stay healthier.
Such a practice could be opened in Castine as part of a community health plan or independently, according to the board.
Vagt said Monday that it’s too early to know when or how any potential changes would be made, but suggested the study could find options that would also benefit Northern Light and maintain a connection with the system for referrals to specialists and higher level care, as MaineHealth did.
A $5.7 million capital campaign for renovations at the Castine center started earlier this year has also been paused as the exploration starts because of “lack of clarity about the direction and availability of healthcare services in this country,” particularly in rural areas, the board said in its statement without naming Northern Light.
The feasibility study is expected to take three months, and the board will discuss next steps with consultants at its public annual meeting at 7 p.m. Oct. 27 in the town office.