Katelyn Burkart, 29, has health insurance, but because of her plan's nearly $7,000 annual deductible, she can't really afford to use it.

"It is like pretty worthless insurance, frankly," said Burkart, who lives in Hamtramck. “It’s one of those things where if I'm in a horrible accident I can come up with $7,000, but I know I can’t do that every year.”

That is why she signed up for a relatively new health care service in Detroit, Plum Health DPC, known as direct primary care, which charges a monthly $49 fee for as-needed doctor visits — including house calls — and access to many low-cost prescription drugs and laboratory testing services. Its doctors also can be reached at all hours through texting, email or voice calls, and patients typically get same day or next day appointments.

Plum Health, which doesn't bill or accept health insurance, is one of roughly 15 direct primary care clinics in Michigan where doctors see fewer patients than in a typical primary care office, and can spend more time with each one.

This type of service is called direct primary care because doctors deal directly with patients, without any insurance companies in the middle. It is similar yet distinct from so-called concierge care, a higher-end health care service with bigger fees that is more popular with wealthy people.

Proponents say that direct primary care is growing in Michigan and across the country, in part because more people like Burkart are "underinsured" with high-deductible insurance plans that do not kick in until they've spent thousands of dollars out of pocket.

Other patients completely lack health insurance, typically because their incomes are too high to qualify for Medicaid or subsidized insurance from the Affordable Care Act's Healthcare.gov exchange, but not big enough to comfortably afford the full cost of an individual insurance plan.

"I'm taking care of the people who the traditional fee-for-service system is shutting the door on," Thomas said. "These are people who are coming to me saying, 'I haven't seen a doctor in five, 10, 20 years.' "

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Still, it's an open question whether direct primary care can scale up and become more than a niche in care health.

It also is unlikely to replace the need for health insurance. That is because direct primary care doctors still refer patients to outside specialists for more complex medical situations, anything from joint replacements to cancer. Also, primary care doctors are no substitute for an emergency room.

"Direct primary care is still a pretty small, and not by any means widespread strategy for delivering services," said Marianne Udow-Phillips, executive director of the Center for Health and Research Transformation in Ann Arbor. "Whether or not it’s going to grow over time is a real question."

A workplace perk

Direct primary care also is gaining patients from companies that have partnered with doctors' practices to offer the service as a workplace perk for their employees.

United Shore Financial Services has on-site direct primary care doctors and physician assistants for employees at its new headquarters in Pontiac. The arrangement is with SALTA Direct Primary Care, based in Troy.

“It is one of my favorite benefits," United Shore's Chief People Officer Laura Lawson said. “If you don’t feel well, you can be seen today, on-site, not have to leave work, and you can be seen typically in 20 minutes or less."

Taking care of patients

Plum Health was started in 2017 by Dr. Paul Thomas, a young Wayne State University School of Medicine graduate who grew up in Grosse Pointe and, during his medical residency, decided that he wanted to help patients in a more personal manner and setting than that of many typical doctors' offices.

"I can come into work and take care of my patients on my terms, and not be beholden to the dictates of an insurance company," Thomas, now 32, said last week in an interview.

Plum Health last month hired a second physician, Dr. Raquel Orlich, and has started to expand from 500 patients up to as many as 1,000. In September, it plans to relocate its clinic from 1759 21st St. in southwest Detroit to the ground floor of a new retail and housing development at the old Tiger Stadium site at Michigan and Trumbull called The Corner.

Thomas said his direct primary care practice is unique for the income diversity of its patients, which range from Medicaid-eligible individuals to business executives, who say they enjoy Plum Health's convenience and short-wait appointments. About 65% of Plum Health's patients have some form of health insurance, he said. The others are uninsured.

"One of my (patients) is a truck driver, and his health insurance cost is $800 a month, because he’s 63. So he says, 'I can’t afford that and I’m going to use you until I turn 65 and get on Medicare,' " Thomas said.

Low-cost drugs

Based on Thomas' ability to purchase drugs from pharmaceutical wholesalers and obtain special bargains from some drug companies, Plum Health can offer patients low prices for many common medications, including epinephrine pens, insulin, and generic Lisinopril for high blood pressure and Metformin for Type 2 diabetes.

The special pricing also holds for lab work, including blood tests and STD tests.

Patients pay extra for the tests and prescriptions in cash — an expense on top of their monthly fees. Plum Health's monthly fees rise to $69 for those 40 and over, $89 for those 65 and older. The fee is $10 per month for children under 18. There is an extra $100 charge per house call.

“We are making the money on the memberships, but then we do everything at cost," Thomas said. "The labs are at cost, the medications are at cost and procedures are at cost.”

For patients with more complex medical issues, Thomas said he can often obtain treatment recommendations from specialists through an e-consult service called RubiconMD. This service can sometimes eliminate the need for patients to visit outside specialists on their own.

Although direct primary care may be a bargain compared with the monthly cost of health insurance, it could still be a financial challenge for some lower- or middle-income people who have insurance, but can't afford direct primary care in addition to their premiums.

"That doesn't give them access to specialty care or drugs or anything else," Udow-Phillips said. “You are going to have to marry it with some other insurance plan or some other arrangement."

ContactJC Reindl: 313-222-6631 or jcreindl@freepress.com. Follow him on Twitter @jcreindl. Read more on business and sign up for our business newsletter.