I am no expert on health care reform or the intricacies of the looming national health insurance debates that will take center stage during the Obama administration. Writing this diary is more of an exercise in educating myself, and perhaps offering another perspective to the ongoing healthcare reform conversation. I simply provide this post as a possible forum for more educated or aware Kossacks to put in their "two cents." Look forward to your thoughts!
This week’s Stranger (Seattle alt weekly) has an article on Qliance Medical Group, a group of primary care physicians who have developed a business model that provides health care without dealing with insurance companies. Sometimes described (perhaps dismissively) as boutique care or the "concierge approach", this model writ large might provide a compelling way forward in providing more people affordable primary and preventive health care -- care that specifically cuts out the insurance middleman.
"This model is mean to bring care to millions of people, not just a few hundred."
First, I should provide a couple brief blockquotes to describe Qliance and how it works (and no, I am not affiliated in any way with the company). According to the Stranger article,
Qliance, a 15-month-old company based in a downtown Seattle clinic, saves money by cutting out the middlemen: bloated health- insurance companies that require doctors and insurance administrators to manage collections and payments on every service. Instead, Qliance charges a flat monthly fee of about $60 for basic health care.
Employers [who offer insurance to their employees] then take out a separate—and less expensive—catastrophic health-insurance policy, which covers things like car accidents and strokes. [These] employers also pay into a fund that employees can access for at-cost prescriptions from the Qliance pharmacy.
According to Qliance:
we charge an affordable monthly fee for unrestricted, 7 day a week access to a Qliance provider of your choice. 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 prescription drug dispensary.
Instead of spending [40%] of what patients pay for primary care on back office staff and accounting or giving it to the insurance company, Qliance uses it for state-of-the-art technology, more providers, longer operating hours and lower prices.
According to cofounder Dr.Garrison Bliss:
"With a monthly fee practice model," Bliss said, "we could shed the administrative overhead associated with insurance-based reimbursement and apply the savings toward lower pricing and higher physician staffing."
They created this model, Bliss said, because they had tried working within the insurance system and had seen that their costs would exceed their income unless they drastically cut staff and services. It was either that, he said, or do what the other primary-care doctors do -- increase patient encounters to 30 a day or more.
"Such a patient volume translates into long appointment lead times and time-pressured appointments -- typically 15 minutes maximum -- leaving both the patient and the physicians dissatisfied," Bliss said.
But, in simplest terms, under the monthly fee model general, non-emergency health care becomes similar to joining a 24-hr fitness gym:
- Costs are lowered due to avoiding insurance altogether, and to having in-house diagnostics like x-rays, etc.
- Patients spend more face-to-face time with their physician.
- Physicians and staff focus on the important task at hand: the health of patients, and NOT the boondoggle of insurance forms.
- Small business employers save money and can still offer benefits for catastrophic care to employees, while employees are responsible for ordinary, primary care out-of-pocket.
Further, this model appears to provide counterbalancing financial incentives for doctors to practice primary care as opposed to more specialized practices. As I understand it, one of the reasons that health care is so expensive these days for ordinary citizens is because there has been a decades-in-the-making trend toward specialization by physicians. This trend is partly because of technological advances, but primarily because insurance companies pay care providers more for those specialized services than they do for good old fashioned primary care.
My stepfather is a pediatrician, and like many doctors, the favorite part of his job is the physician-patient interaction. Wouldn't it be great if doctors could be drawn to primary care because of competitive compensation AND enjoy their work more?
It seems like the Qliance approach, in that it eliminates entirely the administrative costs in dealing with insurance, significantly increases potential income for primary care doctors as compared to specialists -- while providing more individuals greater access to health care.
On the other hand, even if this model were to become common place, insurance would still perform a necessary role (in the absence of a single-payer system) for individuals to have coverage for catastrophic or emergency health care. According to Qliance:
[P]air an individual high deductible insurance plan with comprehensive primary, preventive and wellness care from Qliance. You get the best of both worlds—less expensive insurance coverage in the event of a major medical problem, and affordable access to a family practice physician for your routine medical needs.
So... are there Kossack doctors in the house? If it becomes more commonplace for physician practice groups to organize via this sliding-scale monthly fee medical care model in order to provide primary care would health care become more affordable across the country? Can the federal government support a hybrid approach to healthcare reform that incentivizes doctors to organize in this manner and more or less relegates health insurance to catastrophic coverage?
Would AHIP and the rest of the health insurance goons lose some of their market and lobby power over time were primary care doctors across the country to utilize this business model?
UPDATE: Lots of interesting criticisms in the comments. Wish I personally had the knowledge to address these valid points, but thanks for all your thoughts. In all likelihood, this model -- even if it were to become widespread -- still would do little for those suffering from chronic conditions or those who cannot afford these services. The question is whether the business model itself improves health care for the population as a whole. I guess the jury's still out!
[See arodb's comment below for info re: boutique coverage]