Deal­ing di­rect

To save money, these docs don’t ac­cept in­sur­ance

Modern Healthcare - - SPECIAL REPORT -

While re­tainer-based med­i­cal prac­tices of­fer­ing care known as concierge medicine have taken some heat over the years for charg­ing big bucks to pa­tients for im­proved ac­cess and added ameni­ties, some view a dif­fer­ent form of re­tainer care as a cost-sav­ing ap­proach.

Di­rect pri­mary-care prac­ti­tion­ers seek to of­fer af­ford­able re­tainer-based care that fo­cuses on well­ness and pre­ven­tion. The dif­fer­ence be­tween di­rect pri­mary care and tra­di­tional concierge care is that di­rect pri­ma­rycare providers gen­er­ally do not ac­cept any form of in­sur­ance. The idea is to free the prac­tice from the bur­den of deal­ing with in­sur­ers to of­fer hand­son, ac­ces­si­ble care at prices that are af­ford­able to the unin­sured or those cov­ered by high-de­ductible plans.

A di­rect pri­mary-care prac­tice of­fers the sim­i­lar ex­panded ac­cess to week­end hours and an in­creased fo­cus on well­ness pre­ven­tion that concierge-care prac­tices typ­i­cally of­fer. For ex­am­ple, clin­ics run by di­rect-care for-profit Qliance Med­i­cal Man­age­ment, Seat­tle, might have a pa­tient visit to deal with a per­sis­tent cough or to pass a kid­ney stone, says Dr. Gar­ri­son Bliss, chief med­i­cal of­fi­cer of Qliance, which has been in op­er­a­tion since 2007.

The com­pany’s clin­ics also of­fer un­lim­ited ac­cess to vac­ci­na­tions, women’s health ser­vices, pe­di­atric care and on­go­ing man­age­ment of chronic dis­ease.

Health­care’s cur­rent ap­proach of hav­ing in­sur­ance cover pri­mary care and cat­a­strophic-type med­i­cal care makes no sense, Bliss says. If your home­own­ers in­sur­ance pol­icy paid for the water bill, gas bill and other such costs, “it would be just as dys­func­tional as health­care,” Bliss says.

It makes more sense to take high­fre­quency pri­mary care out of the equa­tion of in­sur­ance, and al­low pri­mary-care prac­ti­tion­ers to fo­cus on well­ness and keep pa­tients out of the hos­pi­tal and its emer­gency room, he says.

“We think this is go­ing to be a re­mark­ably ef­fec­tive way to man­age health­care costs,” he says. A re­cent anal­y­sis of Qliance’s care by the com­pany found its pa­tients to have much lower ER vis­its, hos­pi­tal­iza­tions and surg­eries, among other things. In 2010, ER vis­its per 1,000 pa­tients were 65% lower at Qliance when com­pared with a re­gional bench­mark, hos­pi­tal­iza­tions were 43% lower and surg­eries were 82% lower, ac­cord­ing to the com­pany.

Qliance clin­ics charge a one-time $99 reg­is­tra­tion fee per fam­ily plus from $49 to $129 a month, de­pend­ing on a pa­tient’s age and level of care sought. A 40-to 49-year-old pa­tient who wants bed­side hos­pi­tal co­or­di­na­tion of care would pay $99 a month, while a pa­tient in the same age cat­e­gory who doesn’t want such care co­or­di­na­tion would pay $79 a month, Bliss says. The older the pa­tients, the more they pay. Clin­ics are open seven days a week and wel­come pa­tients who other­wise might go to an ER, Bliss says.

At least some mem­bers of Congress have heard about Qliance’s ap­proach, with Bliss sub­mit­ting writ­ten tes­ti­mony for a May 12 hear­ing by the House Ways and Means Com­mit­tee’s health sub­com­mit­tee that fo­cused on in­no­va­tive health­care de­liv­ery and physi­cian pay­ment re­form ef­forts.

“Our physi­cians have the time to pro­vide the 90% of care most peo­ple need to see a doc­tor for, in­clud­ing rou­tine pri­mary and pre­ven­tive care, ur­gent care and chronic dis­ease man­age­ment,” Bliss wrote in his tes­ti­mony for the hear­ing. “We in­tend to rein­sert the con­cepts of value and hu­man­ity back into the health­care sys­tem.”

Bliss notes that unions and em­ploy­ers are show­ing a lot of in­ter­est in his com­pany’s model, which he says works well when com­bined with a cat­a­strophic health in­sur­ance pol­icy.

—Paul Barr

Qliance’s Dr. Erika Bliss con­ducts a well­ness checkup. The com­pany’s clin­ics of­fer a wide ar­ray of pre­ven­tive ser­vices.

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