![\"health](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/09\/health-care-medical-stethoscope-610x428.jpg\")
Creative Commons photo by jasleen_kaur via Flickr.<\/p>\nCreative Commons photo by jasleen_kaur via Flickr.<\/p>\n
This story by Briana Brady was first published<\/a> in The Other Paper on Sept. 3, 2026.<\/p>\n Over the more than two decades that nurse practitioner Holly Whitcomb has been providing primary care, things have changed \u2014 and it\u2019s not just the switch to electronic records.<\/p>\n \u201cWe 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,\u201d Whitcomb said.<\/p>\n Reader-powered for 17 years<\/p>\n More than 500,000 people read VTDigger each month. Will you help keep this free public service strong?<\/p>\n 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.<\/p>\n Whitcomb said that, with this model, she wants to get back to taking her time with patients and personalizing their care \u2014 actually having the time to pick up the phone and answer a patient\u2019s health questions.<\/p>\n She\u2019s not the only one making the switch.<\/p>\n 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.<\/p>\n 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\u2019s members \u2014 about 7% \u2014 it\u2019s been growing.<\/p>\n \u201cTo be clear, this is a response to a payment system that doesn\u2019t cover the work that practices are doing,\u201d Ridzon said.<\/p>\n For many providers making the switch to a membership system, she said, it\u2019s a way to keep a private practice financially sustainable.<\/p>\n 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\u2019re more often having to take what they\u2019re offered. With Medicare, she said, there are also different fee schedules for hospital system care \u2014 and hospitals get a higher rate.<\/p>\n \u201cIt\u2019s really kind of obscene sometimes the differences for the exact same service,\u201d she said.<\/p>\n On top of that, Ridzon said, a lot of the work that goes into good primary care doesn\u2019t get billed to insurance. That includes services like answering patients\u2019 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.<\/p>\n 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 \u2014 sometimes, as in Horizon\u2019s model, with scaled pricing depending on age or family size.<\/p>\n 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\u2019s been working with local employer Engineers Construction Inc<\/a>. for years as Champlain Medical handles care for their workplace injuries as well as the necessary physical exams for some employees.<\/p>\n While the company offers insurance outside her services, she said, employees are offered \u2014 and incentivized \u2014 to take Champlain Medical up on direct primary care paid for by ECI.<\/p>\n \u201cIf 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,\u201d Schiller said. \u201cThen they have access to our facility for the rest of the year \u2014 for whatever, urgent care, primary care, essentially any of their other needs.\u201d<\/p>\n 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.<\/p>\n The number of primary care doctors in the state is falling<\/a>. 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\u2019s primary care physicians are older than 60.<\/p>\n While this doesn\u2019t 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.<\/p>\n \u201cThey\u2019re 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,\u201d Ridzon said.<\/p>\n Whitcomb has been looking forward to opening her practice. She\u2019s already begun coordinating care for some patients.<\/p>\n \u201cI\u2019m not doing this to make a gazillion dollars. I\u2019m doing this to genuinely try to take better care of my patients in the way that I think they should be cared for,\u201d she said.<\/p>\n Before you go, I have one favor to ask.<\/p>\n If you value reporting like the story you just read, help make the next one possible.<\/p>\n For 17 years, VTDigger has reported the news Vermonters need without putting it behind a paywall. That only works because readers choose to support it.\u00a0<\/p>\n During our Fall Member Drive, we\u2019re working to raise $100,000 to keep our reporters digging, asking questions and following the facts wherever they lead.<\/p>\n If you value VTDigger, please support it<\/a> with a gift today.<\/p>\n Brendan Kinney Latest stories<\/p>\n \t\t\t\t\t\t\t\t \t\t\t\t\t\t\tby Tierney Flavin<\/a> \t\t\t\t\t\t\t\t \t\t\t\t\t\t\t\t![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/09\/VTD_Fall-drive-2026.png\")
<\/a><\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/09\/Brendan-Kinney-Headshot.jpg\")
<\/p>\n
CEO, VTDigger<\/p>\n
\n\t\t\t\t\t\t\t\t\t\t\t\t![\"Somber](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/09\/naturalization-7-20260911-1200x900.jpg\")
\t\t\t\t\t\t\t\t\t\t\t\t<\/a><\/p>\n
\n\t\t\t\t\t\tSeptember 11, 2026, 5:59 pmSeptember 11, 2026, 5:59 pm\t\t\t\t<\/p>\n
\n\t\t\t\t\t\t\t\t\t\t\t\t![\"Teachers](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/09\/Groton_VT_9-27-25b-1200x900.jpg\")
\t\t\t\t\t\t\t\t\t\t\t\t<\/a><\/p>\n
\n\t\t\t\t\t\t\t\t\t\t\t\t![\"Vermont](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/09\/VT-almanac-stacck-books.jpg\")
\t\t\t\t\t\t\t\t\t\t\t\t<\/a><\/p>\n