Labor Group Tests New Health Care Service

11/13/2009

It's open enrollment season. That's the time of year when people can choose a health plan. The plethora of health insurance plans with their co–pays and deductibles can make the decision tough. Members of the United Food and Commercial Workers Local 21, have another option to consider. Beginning this week the state's largest employee union will offer the Qliance plan. Qliance is not medical insurance. It's a health care service. It allows members unlimited visits to their doctor for routine care. This type of service is called direct primary care. KUOW's Ruby de Luna explains how it works.

Dr. Garrison Bliss will be the first to admit that most people who like their physicians wouldn't think of changing doctors to try their service, no matter how frustrating the current health care system is right now. But he says potential patients might like what his clinic offers.

Bliss: "No co–pays, no deductibles, no barriers. You can be seen on the day of or the next day for any urgent care issues. We're open 12 hours a day, Monday through Friday, we're open on Saturday and Sunday."

Bliss is founder and chief medical officer of Qliance. His patients pay a monthly fee, between $49 to $79. They don't need insurance to see the doctor. Their monthly fee covers all office visits, whether it's for flu symptoms, sprained ankles, basically the kind of stuff that you'd see a doctor for.

Bliss: "We even take care of broken bones here if we need to, we can do an initial splinting, we can do much of what happens in emergency rooms."

Bliss says they're set up so it encourages patients to come in with a medical problem early on. It's often easier and less expensive to treat illnesses before they become worse. Of course, patients will still need some kind of insurance to pay for surgeries or complicated procedures that require specialists.

The idea of patients paying a monthly fee for unlimited access to their physician is not new. The concept started in the mid 1990s. Back then they were called concierge medicine or boutique clinics. And with the fancy names, came expensive fees — as high as $1,000 a month. But these days, some practices charge significantly less.

Bliss liked the concept behind concierge medicine. But he didn't like how the high fees excluded most people from participating. So he decided to start a practice where patient fees are a fraction of what concierge medicine charges. And, he wasn't going to accept insurance money. Medical consultants thought that was a crazy idea. But Bliss says it actually saves money and paperwork. He says dealing with insurance forces doctors to spend more time figuring out the right billing code so they get paid. Those numbers are then submitted to the insurance company.

Bliss: "They then have to process those numbers and make a decision about whether to pay, and as most people realize, often their decision is not to pay."

So the bill gets punted back to the doctor's office where it gets recoded, and then resubmitted.

Bliss: "And then, once the insurance company has made a final decision to pay something, then they have to send an explanation of benefits to the patient and to the physician."

But that's not the end of it. A separate bill is sent to the patient, if there's money owed.

Bliss: "That whole process chews up 50 percent of the money going into primary care, and probably more."

It's also a time consuming process. Bliss founded Qliance with the help of private investors. In 2007 Qliance opened its first clinic in Seattle. To date there are direct primary medical practices in 20 states. It's small, but Bliss hopes in time direct primary care will become a national model for health care.

Katz: "I understand the motivations, but I don't think this is going to be a model that will work for the vast majority of people for a variety of reasons. "

Aaron Katz is a policy analyst at the University of Washington's School of Public Health. He notes that efforts like this reveal the flaws of the current system. Katz says the motivations are admirable — better access, more responsive providers, more time with our doctors and all that. And while the fee scale may be affordable for some, it could still be a financial burden for others.

Katz: "What we're seeing is more and more people, uninsured people who are offered coverage in their places of work, refusing that coverage because they can't afford the premium they're being asked to pay and the co–payments."

Katz says it's exciting to see new health care ideas come out. And there are lots of them. The challenge is to figure out how to make those successful models work for millions of uninsured Americans.

Qliance's Garrison Bliss thinks direct primary care can help increase access to people who now don't have health care. In September, Qliance opened a clinic in Kent.

Bliss: "We were not looking for a concierge location, we were looking for a place where we can demonstrate that the working poor can get great health care at a reasonable price, even if they can't afford it, their employers may want to help subsidize that. And that's what we're testing in Kent."

Bliss is also doing something that he tried to avoid in the beginning — work with insurance companies. Qliance will continue to operate on a monthly fee system, and it won't take insurance payments. But it's talking with some insurance companies to provide patients coverage for specialists or emergency services.

I'm Ruby de Luna, KUOW News.

© Copyright 2009, KUOW