Can Seattle’s Qliance model help reinvent primary care?
“Direct care practices’” in which patients a flat monthly fee for comprehensive primary care services may help cut health costs while attracting more doctors to primary care, according to a paper describing the Seattle-based Qliance primary-care model.
The paper, written by three officers of the Qliance Medical Group and an Dr. Larry Green, a professor of Family Medicine at the University of Colorado’s School of Medicine, appears in this month’s issue of the influential health policy journal Health Affairs.
The “Reinventing Primary Care” theme issue was dedicated to papers addressing the crisis in the U.S. primary care system, which is facing a critical shortage of providers just as demand for its services is expected to soar as millions of currently uninsured Americans obtain health coverage under the new health reform law.
Another paper in the same issue of the journal by authors from Group Health Research Institute and Group Health Cooperative describes Group Health’s “medical home” pilot project.
To learn about that paper read Andrew Villegas’ article: Studies: When Doctors Take More Responsibility, Care Becomes Cheaper And Better.
In the Qliance paper, lead author William Wu, the company’s president and chief executive officer, and colleagues argue that direct care practices show that it is possible to provide good primary care at affordable prices outside of the standard insurance system.
In the Qliance model of direct care, patients pay a monthly fee for comprehensive range of primary care services.
The fee is set by age, ranging from $44-84. Neither health status nor preexisting conditions affect the fee.
The fee is paid either directly by the patient or by their employer or union. Qliance does not bill insurance companies, which saves administrative costs.
Services include same day office visits any day of the week with one of the Qliance physicians or nurse practitioners, routine office testing, and such office procedures as splinting, suturing, joint injections and treatment for such acute conditions as asthma, acute pneumonia and abdominal pain.
The monthly fee does not cover emergency room visits, hospitalization, specialist consultations and other high-cost care and diagnostic testing, services which can typically be covered with lower-cost, high-deductible plan.
But even after purchasing such additional coverage can still be cheaper than enrolling in a traditional health plan, the authors write.
“When primary care at Qliance is bundled with a low-premium, wraparound insurance plan to cover nonprimary health care, patients can realize savings of 35 percent or more for comprehensive care, depending on what level of deductible they choose,” Wu and his colleagues write.
For example, the annual premium for a plan with a $1,000 deductible and 30 percent coinsurance for a nonsmoking, fifty-three-year-old male from Washington’s Premera Blue Cross is $10,068. Including the $1,000 deductible, the patient will pay $11,068 before the insurance plan pays anything, except for a periodic exam costing up to $200. As a Qliance member, the same patient can purchase a $2,500 deductible plan from Premera with comparable benefits except for the periodic exam (included with Qliance). The insurance premium costs $5,532. When the $828 annual cost of Qliance is added, the patient pays $6,360 before the insurance deductible, or a 37 percent savings compared with the lower-deductible plan.
Qliance does not accept Medicare, but the plan does have Medicare-eligible seniors enrolled who are willing to pay the fee out-of-pocket for the service the plan provides and Qliance does provide some discounted and free care to Medicare and Medicaid patients, the authors said.
Low provider turnover
The direct care model appeals to primary care providers because they have a much smaller patient load, typically carrying a panel of about 800 patients, about one-third the size primary care providers take on in a traditional practice.
Having fewer patients means a Qliance provider typically sees only about 10 patients a day with visits lasting 30 to 60 minutes.
Carrying a smaller panel enables “providers to realize the satisfaction of close patient relationships and a balanced lifestyle,” the authors write. Since the first Qliance clinic opened in mid-2007, there has been no turnover among the 13 providers, except for one who took maternity leave, they note.
Whether the direct care model saves the health system money is hard to determine, the authors note, since Qliance’s system is not linked to insurance claims data, but “provider feedback suggests that Qliance patients avoid a great deal of unnecessary secondary and tertiary care.”
To learn more:
- Read the paper A Direct Primary Care Medical Home: The Qliance Experience by William Wu, Dr. Garrison Bliss, Dr. Erika Bliss and Dr. Larry Green appears in the May issue of Health Affairs.
- Visit the Qliance Website.
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