Adult primary care, age nineteen onward.

Adults age 19 and older seeking a sustained, single-clinician primary-care relationship in Ulster County, New York, who are willing to schedule annual prevention visits and to keep the practice as the central record-holder for their outpatient care.

Specifically, this monograph covers the management of: essential hypertension; type 2 diabetes (HbA1c targets per the ADA 2024 Standards of Care); chronic kidney disease stages I–III without nephrology co-management; COPD (with pulmonary co-management for FEV₁ < 50% predicted); major depressive disorder and generalized anxiety disorder when stable on a single agent; PrEP for HIV prevention per CDC clinician guidance; and routine USPSTF-aligned cancer screening, immunization, and cardiovascular risk reduction.^[01]

This monograph also covers the deliberate reduction of medication burden — deprescribing — when polypharmacy is identified. We use the Bruyère Deprescribing.org algorithms as our default reference and complete a full medication reconciliation at every annual visit.^[02]

An adult primary-care relationship at Pharos is delivered by exactly one of three clinicians — Maren Vanderlyn, MD, Otis Thackeray, MD, or Tessa Voorhies, DO — assigned at intake based on clinical fit and panel availability. You will see your assigned clinician at 82.1% of visits in the rolling twelve-month sample (n = 1,617).^[03] When your assigned clinician is unavailable you will be seen by their named partner; you will not be triaged into the first available slot regardless of person.

The visit shape is: 60 minutes for a new-patient establishment (CCH-001-NP), 40 minutes for an annual prevention visit (CCH-001-AP), 30 minutes for a chronic-disease follow-up (CCH-001-FU), 20 minutes for a brief problem-focused visit (CCH-001-BV), and 20 minutes for a virtual follow-up (CCH-001-VV). Your messages through the patient portal are answered by your clinician within one business day; messages of clinical urgency receive a same-day call from the front desk to the clinician's pager.

At every annual visit we do, in order: medication reconciliation against the dispensing pharmacy fill record; a structured social history that asks about sleep, alcohol, work, and housing; the indicated USPSTF screens for your age, sex, and risk factors; an updated home BP monitoring plan if you carry a hypertension diagnosis; a single-page printed summary of decisions made and the reason for each; and the next visit on your calendar before you leave the room.

Adults age 19 and older. We do not transition pediatric patients out of CCH-002 until age 18 inclusive; the transition is a scheduled handoff, not a birthday cutoff.

Insurance accepted: UnitedHealthcare, Aetna, Empire BlueCross BlueShield, CDPHP, MVP Health Care, Fidelis Care, traditional Medicare, and Medicare Advantage plans contracted through the foregoing carriers. We are not in network with Medicaid Managed Care; we accept a small number of straight Medicaid patients on a sliding scale.

The membership pathway (Direct Primary Care, $95/month adult) is open to uninsured patients and to insured patients who want the additional access (longer visits, direct phone access, no copay at our office). It does not replace insurance. AAFP — Direct Primary Care describes the model in detail.

• New patient (CCH-001-NP) — 60 minutes, scheduled within 10 business days of completed intake. Records request initiated by the front desk on intake submission.
• Annual prevention (CCH-001-AP) — 40 minutes, every 12 months, scheduled at the prior visit. We will not let your annual lapse beyond 14 months without phoning you twice.
• Chronic-disease follow-up (CCH-001-FU) — 30 minutes. Cadence is set by the indication: HTN every 3 months until at goal then every 6; T2DM every 3 months until at goal then every 6; COPD every 6 months baseline; CKD III every 4 months.
• Brief problem-focused visit (CCH-001-BV) — 20 minutes for one or two specific issues raised between annual visits.
• Virtual follow-up (CCH-001-VV) — 20 minutes, NY-licensed clinician on a HIPAA-aligned video platform; appropriate for medication titration, results review, brief mental-health follow-up, and most chronic-disease follow-ups when vital signs are home-monitored.

Numbers below are the rolling-12-month internal audit at v2026.04. Operational definitions follow NCQA PCMH conventions where applicable; deviations are noted.^[04]

The numbers are not intended as marketing. They are the same numbers our medical director reads quarterly to decide whether the practice is functioning. They are signed off on the day of the audit and posted unchanged.

What this service does not do well:

• Heart failure with recent hospitalization. If you have been hospitalized for decompensated heart failure within the last twelve months we will refer to MidHudson Regional Hospital or to the HealthAlliance Hospital Broadway Campus heart-failure clinic.
• Severe or refractory mental illness. CCH-003 is a medication-management service, not a partial-hospital program. Patients with active psychosis, severe self-harm risk, or histories of psychiatric hospitalization within twelve months are referred to the MVP-contracted behavioral health network or to OMH-coordinated care.
• Pain management for non-cancer chronic pain. We do not maintain chronic opioid therapy outside of MOUD and palliative pathways. (See § Contraindications.)
• Sleep medicine. We will refer to National Sleep Foundation-listed regional sleep labs (e.g., the Westchester Medical Center Sleep Center) for polysomnography rather than ordering at-home tests ourselves.

Documented complication rates from procedures are kept in CCH-005; outpatient management does not have a per-procedure complication denominator. The audit number we watch for CCH-001 is unscheduled-hospitalization rate within 30 days of a CCH-001 visit, which sits at 0.62% (n = 6,420 visits in the rolling year).

We will not establish a CCH-001 relationship for any of the following, with explicit referral targets:

1. Active hospitalization or hospitalization within the past 30 days for any reason — establish post-discharge with the discharging hospitalist's named transitional clinic, then transfer to us no earlier than 30 days after discharge.
2. Active cancer in treatment, where oncology is the central care-coordinator — we will see you for adjacent issues but will not be the medical home until treatment is complete.
3. Chronic opioid therapy outside MOUD or palliative pathways — referral to CDC clinician guidance-aligned chronic-pain centers.
4. Disability paperwork requested for an established date in fewer than 90 days from establishment — we cannot honestly attest to functional status we have not directly observed.
5. Solid-organ transplant under one year post-transplant — central management with the transplant team.
6. End-stage renal disease on dialysis — central management with the dialysis nephrology service.
7. Patients seeking primary care for the explicit purpose of obtaining a controlled-substance prescription — see CCH-003 and our controlled-substances policy.

The first visit is sixty minutes. You will spend ten of those minutes with our medical assistant doing vital signs, medication reconciliation against your pharmacy fill record, and a tobacco/alcohol/sleep screen. You will spend the remaining fifty minutes with your assigned clinician.

You should bring: a list of your current medications including supplements; the name of your current pharmacy; the names and contact details of any specialist physicians you wish us to coordinate with; the past medical record release if you have not already submitted one through the intake form; and any questions you do not want us to forget. Maritza at the front desk will print the questions for the clinician before you go back to the room.

You will leave with a one-page printed summary of decisions made, with the reasoning for each. You will leave with the next visit on your calendar.

Insurance: copays at our office are typical for primary-care visits in this region. Median copay observed at CCH-001 visits in 2025 Q4 was $25 (range $0–$60); coinsurance amounts depend on your plan. We will run a benefits check as part of the intake process and will tell you the expected amount in writing before your first visit.

Direct Primary Care membership: $95/month adult, $25/month additional family member, $10/month per child age 0–18 (see CCH-002). Membership covers all CCH-001 visits, all CCH-005 office procedures (with the exception of POC ultrasound, which is billed separately at $40 cash), and same-day acute slots under CCH-006. Membership does not cover labs, imaging, prescriptions, vaccines, or hospital-based care.

Sliding-scale cash rates are published on the membership page; nobody will be turned away for inability to pay an established copay or membership fee, but you must say so explicitly to Maritza or to the medical director — we cannot read minds.

• Concierge / boutique primary care. Not available here. We aim to be priced like a community practice and run like one. The closest concierge-style alternative in the Hudson Valley region is Crystal Run Healthcare's executive-physical service, in Middletown.
• Functional / integrative medicine. Not available here. We do not order non-evidence-based panels. Choosing Wisely lists the tests we will not order without indication. Patients seeking integrative-medicine consultation are referred to the Akasha Center in Santa Monica or to local naturopathic providers in Woodstock NY (we do not maintain a referral list, but the AANMC directory is comprehensive).
• Weight-loss medicine programs. We will prescribe GLP-1 agonists for FDA-aligned indications and BMI thresholds; we will not run a weight-loss-only program. Obesity Medicine Association finder.
• Pain management with chronic opioids. See § Contraindications. WMC Pain Management for evaluation; Pain Physician journal for an overview of multimodal management.

This monograph is co-owned by Maren Vanderlyn, MD and Otis Thackeray, MD. Tessa Voorhies, DO contributes the procedural and obstetric-coordination sections. Quarterly review of the references for currency is the responsibility of Dr. Vanderlyn.

v2026.04.22 — supersedes v2026.01.15. Significant changes: § Adverse effects updated to include the post-hospitalization heart-failure exclusion; § Outcomes table refreshed with 2026 Q1 numbers; § Cost § DPC pricing unchanged but membership-additional-family rate clarified to $25 (was ambiguous between $25 and $35 in v2026.01). Diff and superseded text on the errata page.