Bonner County hears proposal for shared direct primary care clinic; no decision made

Bonner County commissioners on Feb. 12 heard a detailed presentation about a potential shared direct primary care (DPC) clinic for county employees and regional partners but did not take any vote or make a formal decision.

The workshop featured PMR Healthcare, introduced by benefits consultant Scott Burkhard, and testimony from Kootenai County Commissioner Leslie Duncan about that county’s experience operating a PMR clinic. Craig Marcroft, founder and CEO of PMR Healthcare, described the DPC approach as an employer-focused clinic model that limits patient panels to allow longer primary-care visits and provides routine labs and many generic prescriptions at no out-of-pocket cost to the employee. “DPC stands for Direct Primary Care,” Marcroft said, and he added that the clinics are designed to “give you direct access to a physician” while operating alongside existing insurance for specialty care.

PMR and the county’s consultants explained the typical contracting and cost structure. Scott Burkhard said PMR’s fixed contract figure for a Kootenai County–scale operation was “about $1.2 million,” and PMR used illustrative math of a $1 million fixed clinic cost to show how analysts model first-year budget shifts. PMR and consultants said a commonly cited breakeven participation rate is roughly 40% of plan participants but emphasized that the threshold varies with shared models and the number of enrolled employees. “If you can get 40% of your patients to use it…that’s about a breakeven point,” Burkhard said.

Supporters, including Kevin River of Bonner County Human Resources, framed the clinic as a tool to reduce high-cost, late-stage claims, improve employee access and help recruitment and retention. River said the county has struggled to secure multiple insurance quotes in recent years and argued a clinic could help control long-term claim risk. “As an employee and as the HR person…having the clinic, we could have caught some of those high claim issues earlier,” River said.

Commissioners and city officials pressed presenters on operational limits and local impacts. Jeremy Grimm, mayor of Sandpoint, asked for “critical weaknesses” and whether a single doctor could become a linchpin; PMR said clinics commonly add a nurse practitioner and can scale staff as utilization grows. Several commissioners raised optics and competition concerns about a government‑anchored clinic operating in a market with private providers. An unnamed commissioner said the proposal could be perceived as “using taxpayer dollars to compete with the private sector.” PMR responded that, in many cases, pent-up demand means local providers retain backlogs and that the clinics more often add capacity than take patients from existing practices.

Stakeholders also asked about referrals, diagnostics and pharmacy design. PMR said higher‑cost imaging like MRI would be referred into high‑performance networks or contracted vendors, while some diagnostics such as X‑ray can be added on-site if utilization supports it. PMR described a formulary process led by medical directors that is reviewed periodically; Marcroft said the goal is to avoid unused stock and to add medications when clinically appropriate.

Speakers pressed for measurable outcomes. Dr. Thomas Fletcher asked what clinical metrics would show sustained health improvements beyond utilization and satisfaction. Marcroft said PMR collects baseline physicals and follow-up data and tracks patient-level clinical indicators over time, but noted patient engagement is required to change outcomes.

No formal motions or votes occurred. Commissioners concluded by asking PMR and consultants to supply longer-term evidence from established clinics; the board requested five clinics’ data including 5‑year outcome and financial metrics and additional vendor pricing for outside services. The workshop closed with a reminder that this was an informational, data‑gathering session; consultants said they would provide requested data and follow-up information to commissioners and stakeholders. The meeting adjourned at 11:11 a.m.