If not, I wonder if they should be. Through the magic of Twitter, I learned yesterday (after the outage) of Qliance Primary Care. This company provides affordable (for many) primary care and eschews all insurance payments.
Qliance is a medical practice that specializes in comprehensive primary, preventive and wellness care. Qliance operates outside the insurance system. As a result, the practice does not bill insurance plans or receive payment from insurance carriers for the services provided.
Instead, Qliance charges a monthly fee ($49 to $79) for unrestricted, 7 day a week access to a Qliance provider. Qliance features same or next-day appointments for urgent care, unhurried 30 to 60 minute office visits, 24 hour phone and email access to a physician and the convenience and cost savings of an on-site x-ray, laboratory and “first-fill” prescription drug dispensary.
Each Qliance physician and nurse practitioner works with a small, limited number of patients so the care they provide is personal, thorough and professional. When patients join Qliance, they get complete primary and preventive care coordination and management to address a wide range of health issues including chronic diseases. Best of all, health care decisions are made between patients and their providers in a comfortable, unhurried, patient-centered setting.
This model, costing < $1000 per year, seems to be having great success. The company is expanding and opening new sites in Seattle.
Why would patients pay out of pocket for primary care? I suspect that these practices provide a comfort and convenience. These practices are patient centered. The economics work, because once you eschew insurance, then your overhead drops dramatically.
I believe that patients (I include myself) are willing to pay for personalized care. Access and time are valuable commodities. Most patients “know” that access and time lead to higher quality care.
So I have started following Qliance on Twitter. I am interested in their business model. I believe they likely are providing true primary care.
Most primary care physicians see too many patients because the Medicare/private insurance model rewards short visits. Retainer medicine allows the physician to spend enough time with each patient.
Bravo!
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In the last year or so I have seen several other reports, sometimes from small local newspapers, of similar practice arrangements. It looks promising
I would love to be able to work in that type of environment where one doesn’t have to answer to the insurance conglomerates. I do have some of those features in the rural health office that I work in. We have onsite lab, pharmacy, and X-ray capabilities. I tend to take longer with my patients and they appreciate it. Because I’ve become much busier, it’s taking much more speed than I like to in order to get them in and out in a reasonable period of time. This forces me to take charts home to work on after hours and it’s eating into family time. I’m glad that I love being a nurse practitioner so much and that I love taking care of my patients or I would be burning out right now.
Currently most patients with chronic diseases are seen around four times a year for between $40-$90 an office visit with the average around $55. Insurance companies and Medicare collect thousands of premiums from patients, employers, and taxpayers. The primary care providers get a very small piece of the pie. Most my my HMO/PPO contracts have clauses that state I have to be availabe to my patients 24/7 or have arrangements for coverage 24/7. I had to weed out the patients the first few years in practice who called me for pap smear results or other routine results at 7 PM at night or who called me at 3 AM for 5 days of a dry cough. Under the current system most care is free and work outside of office visits cannot be billed to the insurance companies or the patients.
Part of the problem with our current payment system is the AMA and their magic CPT codes. The CPT codes that are payable for office visits do not cover paperwork, phone calls, etc. Other CPT codes exist for phone calls and paperwork, but Medicare and most private insurance plans refused to reimburse for them. Regarding visit times, extended visit codes exist, but most private plans only add $20 extra for an extra 15 minutes with the patient, when that same 15 minutes would be another $55 with an established patient. A comparison is my accountant, who charged me $90 for an email asking how much taxes I should pay on a retirement contribution. A final thought is that retainer practices usually entail younger or wealthier patients, as most Medicare and Medicaid patients cannot afford retainer practices.
What’s interesting about Qliance is that it is not really a retainer practice. Most concierge or retainer practices charge a year fee (sometimes quite hefty) which usually includes a physical, but the fee is generally just for access, not care. Most retainer/concierge physicians charge their patients for services rendered and also do not accept insurance.
The Qliance model basically says that for about $600-$950 a year paid in monthy installments, all your primary care needs can be covered AND you can have pretty good access. This model, and not the traditional retainer model, might be a good PCMH model that most can afford.
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