Yesterday I had the pleasure of talking with Norm Wu, President and CEO of Qliance. Qliance is a start-up primary care concept in Seattle. I learned of them through twitter, and began communicating with Norm. We had a 30 minute conversation yesterday. These are my reflections. If I get anything wrong, Norm will let me know and I will correct my entry.

Direct primary care provide less costly retainer medicine. They charge around $50-$60 per month for primary care and full access. They do not accept any insurance; they do not bill any insurance; their members cannot bill insurance for repayment.

The physicians practice an average of 40 hours per week and follow 500-800 patients each. The office is open from 7 am to 7 pm Monday through Friday and 4 hours each on Saturday and Sunday. Obviously, if you need to see a physician outside their hours, you will see a partner. Each partner covers their fair share of weekends.

What do patients get for their monthly fee? First, they have easy access to their physician and their visits are not rushed. They can schedule telephone consultations. They have email access.

Three types of patients come to Qliance. First, working patients who choose Qliance along with high deductible catastrophic insurance. While we did not get into the details, my impression suggests that most patients save money with this combination. Medicare patients are willing to pay a fee for primary care access, even though Medicare does cover outpatient visits. Finding a physician who accepts Medicare is becoming increasingly difficult in this country, so patients are often willing to pay a monthly fee to have excellent access. It’s of course more than access – it’s about unhurried care and coordination of specialists and hospitals, the full medical home concept. Finally, Qliance reduces ~ 10% of their revenues with a combination who truly cannot afford the fees and those who receive discounts. They have provisions for temporary or permanent waving of fees.

Some of the physicians also coordinate hospital care and make hospital visits – that adds approximately $20 to the monthly fee. Otherwise, hospital care is coordinated through faxes and phone calls with the hospitalists.

Quoting from their web site:

Your monthly care fee covers the primary and preventive care services described on the Patient Services page of our website. However, at times your care may require durable medical supplies or third-party services that are not included. You may be asked to pay additional fees for items such as prescription medications, laboratory tests and outside services such as x-ray interpretation if needed. In all cases, incidental items are charged at or near our cost and their prices and relevance to your care are fully discussed with you in advance of being incurred.

If you have health insurance, you may choose to have your laboratory tests billed to your carrier as well as have prescriptions written to a pharmacy that accepts your plan.

I hope that I have described the program succinctly and clearly. I like the concept and now will give my impressions.

Since beginning this blog in 2002 I have expressed interest in alternate ways of funding primary care. The retainer movement has fascinated me, but for many patients the price made this option unrealistic. I like the cash only practices, because once you eschew insurance companies, your overhead and documentation requirements decrease dramatically. Qliance seems to combine the two concepts and provides a reasonable monthly fee (approximately $2 per day) for excellent access. The business model works because all the attention goes to patient care rather than billing and documentation. Thus the overhead decreases dramatically.

I like that Qliance does not bill insurance at all. When retainer practices also bill insurance I get the impression of greed. This model has conceptual purity – you pay for access and receive access.

I suspect that what Qliance has done is to create a financially viable patient centered medical home. The difference here is that with a smaller patient panel, the physician spends more time with patients – both in person and using phone and email contacts.

We should follow this experiment. Having enough time to devote to all ones patients improves physician satisfaction and patient satisfaction.