Rethinking Health Care

Most doctor-patient relationships in the U.S. involve a silent third party: the patient’s insurance company. That relationship can sometimes complicate or even dictate decisions on the patient’s care.

Family physician JENNIFER NOMIDES (pictured right) and certified family nurse practitioner KRISTIN PLEASANT (pictured left) – who are sisters – have a different vision: a Direct Primary Care model. Their Leland practice, Coastal Direct Health & Wellness, gives patients direct access to the two providers every day, round-the-clock. And there’s no insurance involved because patients pay the practice an annual or monthly fee that covers their care.

“We charge an affordable monthly fee so that you can have direct access to, and a relationship with, your healthcare provider,” the practice’s website states. “Cutting out the insurance companies allows us to have same-day appointments, less waiting, longer appointment times, the ability to be flexible with our schedule to suit yours and to give transparent prices for labs and procedures.”

“We charge on a sliding scale based on age,” Nomides says, explaining that the monthly cost ranges from $50 to $85. “We are providers 24/7. It’s not a concierge practice where we are at your beck and call, but we try to be available. We are able to cut our overhead a lot by not having to have (staff to handle) insurance and billing. Although we limit the number of patients, we still have room to grow.”

The practice, established in February 2019, employs just Nomides and Pleasant. They expect that as their patient load increases, they will hire a receptionist, but for now, the two sisters do almost everything.

“We are the ones greeting you at the door, getting the vitals and doing the blood work,” Nomides says. “Normally, we don’t have multiple patients in the office at the same time. If we need help, my husband JOSHUA YOUSE can step in. He’s a certified nursing assistant and skilled as an emergency department technician.”

A third sister, CANDACE WRIGHT, is a pediatric physical therapist and rents space for her therapy practice, Bright Beginnings, from Coastal Direct Health & Wellness. Her sisters can refer young patients with developmental delays or injuries to her for treatment, Nomides says.

Although all three sisters found their calling in the medical profession, they didn’t grow up playing doctor. Their path was influenced by their parents’ commitment to “love through service,” a mission they practiced around the world.

“Our parents were very active in the church and would take us along on global visits,” Pleasant says. “These were construction projects in Papua New Guinea and other places.”

The girls’ exposure to the critical need for health care in developing countries influenced Pleasant’s decision to go into nursing. Further experience on medical missions led her to train as a family nurse practitioner. She worked in rural health care in Burgaw for several years before moving to Wilmington and starting Coastal Direct with her sister.

Nomides’ original plan was to become a marine biologist, so she enrolled at the University of North Carolina Wilmington. At that time, the idea of medical school did not appeal. But her exposure to the lack of health care access for the poor in the U.S. and beyond nudged her in that direction. After her third year of medical school, she took a leave of absence to earn a master’s degree in public health. Her medical and public health training familiarized her with a broad spectrum of family medicine. She has also worked as a hospitalist with New Hanover Regional Medical Center (NHRMC) for more than six years and continues to serve there part-time.

“Medicine in the U.S. is very driven by specialists; family (medical professionals) refer patients to them. In our practice, we try to keep everything in our office that we can. Everything we do is well within the scope of our practice but we stay up to date on things that get referred to ortho or other specialties,” Nomides says, adding that her work as a hospitalist has acquainted her with many area specialists, which helps when her practice needs to refer its patients.

Although it is an independent practice, Coastal Direct’s electronic medical records system is compatible with ones used by other area health care providers, such as Novant, which now owns NHRMC.

To keep costs down for its members, the practice does as much lab work as it can in-house, but sometimes testing must be done by another lab. Nomides explains that Coastal Direct has negotiated cost savings with several x-ray and laboratory test providers. It also matches its patients with discount prescription programs that, according to Pleasant, provide cost savings that are similar to those offered through insurance programs.

Not all Coastal Direct’s patients lack health insurance. Some members may have high-deductible insurance. The practice also accepts Medicaid patients and may accept Medicare patients in the future.

“If you pair Direct Primary Health with high-deductible insurance, it works out great in terms of quality care for patients,” she continues.

“We very much believe in the (Direct Primary Care) model and provide stellar care with evidence-based medicine,” Nomides says. “We need to get the word out about this model, which is not widely known. Our general mission is to serve our community by ensuring that everyone has access to high-quality medical care. Kristin and I believe we are called to love our community and we do that through service.”

To view more of photographer Terah Wilson’s work, go to terahwilson.com.

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