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Winds WNW at 10 to 15 mph.. February 14, Nurse practitioner Juana Ambriz de Williams runs a new direct primary care practice, Dunes Family Clinic in Valparaiso, that offers unlimited physical and mental health visits for a monthly subscription.

Nurse practitioner Melissa Grcich runs a new direct primary care practice, Matron Health in Valparaiso, that offers unlimited physical and mental health visits for a monthly subscription. From left, nurse practitioners Juana Ambriz de Williams and Melissa Grcich recently opened direct primary care practices in Valparaiso that offer unlimited visits for a monthly subscription. They felt hamstrung by the appointment quotas, by only getting to spend between 10 and 15 minutes with each patient and by only being able to address one health condition at a time.

And to get around the bureaucracy that limited their time with patients, neither of them accepts health insurance, instead offering unlimited visits — in person, by text, by email — for a monthly subscription.

So-called direct primary care, also known as subscription medicine, is on the rise in Northwest Indiana and the state as a whole at a time when many Americans are unsure about their future health coverage. Another local provider, Dr. Timothy Ames, has had a direct primary care practice in Portage since About a dozen, or less than 1 percent, of the Indiana State Medical Association's 8, members work in subscription medicine. Nationally, roughly 3 percent of family doctors practice direct primary care, according to the American Academy of Family Physicians.

Advocates say the model is a good fit for people with no insurance or high deductibles, as well as individuals who require chronic disease management.

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What makes the new Valparaiso clinics unique is that they also offer mental health services as part of the package. Ambriz de Williams has a psychiatric nurse practitioner on staff for medication management and therapy, while Grcich employs a social worker who provides counseling for anxiety and depression. This opens up access to mental health care in Northwest Indiana. At their old jobs, the two nurse practitioners said they never felt they had enough time with their patients. They say regular primary care offices have to book a certain number of people per day to meet their high overhead costs.

Grcich said her patients often wouldn't follow up on their condition after they got a big, unexpected bill in the mail, disrupting the continuity of care. I'm done with this. Ambriz de Williams, who also communicates with her patients through the Spruce app, previously worked at a safety-net clinic where many of the patients had multiple chronic conditions.

But because the appointments were so rushed, she was often only able to treat one condition at a time. They say regular primary care offices have to book a certain number of people per day to meet their high overhead costs. Grcich said her patients often wouldn't follow up on their condition after they got a big, unexpected bill in the mail, disrupting the continuity of care.

I'm done with this.

Ambriz de Williams, who also communicates with her patients through the Spruce app, previously worked at a safety-net clinic where many of the patients had multiple chronic conditions. But because the appointments were so rushed, she was often only able to treat one condition at a time. She said she can now spend an hour or longer with a patient if need be.

Older clients have told her they haven't had that comprehensive a physical since they were children; one compared it to "s medicine. Grcich sees patients 17 and older and doesn't take any kind of insurance, and focuses on women's health and heart failure, while Ambriz de Williams cares for patients of any age and accepts only traditional Medicare.

Both clinics say they will work with uninsured patients to find them inexpensive lab testing, medications and specialists. The two nurse practitioners predict that with all the uncertainty in health care now, the number of local direct primary care clinics will continue to grow.

They hope to form a coalition of local subscription medicine providers. Giles is the health reporter for The Times, covering the business of health care as well as consumer and public health. He previously wrote about health for the Lawrence Kansas Journal-World. He is a graduate of Northern Illinois University. Whenever Giles Bruce posts new content, you'll get an email delivered to your inbox with a link.

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