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News & ArtsTuesday, November 17, 2009
Health / Economy State's Largest Union Trust Goes with Qliance
Posted by Brendan Kiley on Tue, Nov 17, 2009 at 1:27 PM
A few days ago, a major Washington State union trust elected Qliance—a local primary-care facility—as an option in its health-benefits plan.
That's a snoozer of a lead, isn't it? Here's why it matters: Organizations like Qliance might save the American health care system. Or American health in general.
From a profile of Qliance earlier this year:
In the fall of 2005, Erika Bliss, MD, was helping a friend install a hardwood floor and got a splinter—a big one, deep under her fingernail. "I can see why they use that as torture," said Dr. Bliss, sitting in an examining room last week. "It hurt so badly, I couldn't think straight." She couldn't remove the splinter, nor could her friend. It was Sunday and her doctor's office was closed. Dr. Bliss went to the emergency room."I knew the doctors there, and they got me treated quickly and that part was lovely," Dr. Bliss said. "They injected some lidocaine into my finger, pulled the splinter, and gave me a tetanus shot. Take a wild guess how much that cost." She paused. "Twelve hundred dollars."
If Qliance, Dr. Bliss's revolutionary new medical group, had existed back then, she could've come in on a Sunday, had her splinter pulled, and left without paying a penny.
True, Qliance bought that profile in our annual Strangercrombie charity auction, but I'm glad they did—they're a fantastic, innovative organization for the insured and uninsured alike. Thankfully, their experiment is working and their influence is growing.
Qliance keeps costs down by sidestepping the entire insurance industry. The doctors provide direct care to patients for a monthly fee ranging between $49 and $129. "Think of it like a gym," one of the Qliance folks said in the profile. "You can use it as much or as little as you like."
Qliance keeps patients out of hospitals and costs down by having an on-site digital X-ray machine, a lab, and a dispensary that sells generic drugs at cost, so patients don't have to pay extreme pharmacy markup. They're open seven days a week, allowing people without health insurance to get reasonably priced primary care, preventing who knows how many catastrophically expensive visits to the emergency room.
Qliance cannot sew your arm back on or take care of your gunshot wounds—you'll still need a catastrophic insurance plan for those kinds of things. But pairing one with a Qliance membership could slash your medical costs.
Sound Health and Wellness Trust (Albertsons, Bartell Drugs, Fred Meyer, Metropolitan Market, QFC, Rite Aid, Safeway, Top Foods, and others) thought the same thing and is offering Qliance, along with a low-cost catastrophic insurance plan, as an option to its people. From the Qliance announcement:
To our knowledge this is the first union (Taft-Hartley) health care program in the nation to select an existing direct primary care medical home as an option for its members in concert with a lower-cost insurance plan, designed to cover everything outside of primary care. The projected savings for members in the Sound Health & Wellness Trust are in excess of 50%. For example, members now pay $7/week PLUS co-pays for their current PPO plan and with Qliance, they will pay $3/week with no co-pays.
I'm only surprised it hadn't happened already.
And a short video Qliance has made:
If you want to know more, the Qliance website is here.
1
Too bad that neither a Qliance membership, nor a high-deductible plan, nor a combination of the two will satisfy the minimum benefit standards outlined in HR 3962.
Have a look yourself.
"Minimum Services to be Covered," Sec 222, p. 105. Start reading at line 22.
"Benefits Standards Defined," sec 223 p. 114. Start reading at line 15.
The grand irony here is that all of the "anti-corporate" crusaders that have gotten behind this effort in an effort to stick-it to the health insurance companies are going to wind up handing over significantly more of their earnings to...health insurance companies. For care that they may or may not ever actually use. Had your tubes tied? Who cares - you'll be paying for maternity coverage. Etc, etc, etc.
*And* they'll be less price competition and transparency than we have now. I could go on, but I don't have the time, and will now resume drinking heavily.....
Have a look yourself.
"Minimum Services to be Covered," Sec 222, p. 105. Start reading at line 22.
"Benefits Standards Defined," sec 223 p. 114. Start reading at line 15.
The grand irony here is that all of the "anti-corporate" crusaders that have gotten behind this effort in an effort to stick-it to the health insurance companies are going to wind up handing over significantly more of their earnings to...health insurance companies. For care that they may or may not ever actually use. Had your tubes tied? Who cares - you'll be paying for maternity coverage. Etc, etc, etc.
*And* they'll be less price competition and transparency than we have now. I could go on, but I don't have the time, and will now resume drinking heavily.....
3
So...you pay 50 to 200 bucks on top of the 200 bucks you already pay for catasrophic care per month...
I don't see the savings. I see more being squeezed out of people who can't afford basic coverage in the first place.
I don't see the savings. I see more being squeezed out of people who can't afford basic coverage in the first place.
4
The version of HR 3962 as actually passed by the House with the "manager's amendment" allows direct primary care medical homes like Qliance when bundled with a wrap-around insurance plan that covers non-primary care to be a fully qualified option inside the insurance exchange, if together they meet all applicable requirements, which they will if coordinated. You can find this on page 97, Section 201 of the engrossed version of HR 3962 at http://frwebgate.access.gpo.gov/cgi-bin/….
With unrestricted, no-barriers (no co-pays, co-insurance, deductibles) primary and preventive care, plus chronic disease management and coordination of any needed specialist and hospital care, the savings are dramatic. Every medical home pilot in the country has demonstrated significant systemwide savings. Direct primary care practices like Qliance are like medical homes on steroids - same day unhurried appointments, seven days week, shifting costs away from expensive specialists and hospitals to inherently low, fixed cost primary care - because they have the time and incentives to REALLY take care of you. With a bundled wrap-around insurance plan, one doesn't have to double pay for primary and preventive care - once directly and once via the insurance plan; and one certainly doesn't double the cost of primary care itself with insurance reimbursement paperwork. The savings are real. The quality of care is real. The exceptional access is real. No one has forced 10,000 direct primary care patients in WA and 45,000 patients nationwide to choose this approach.
With unrestricted, no-barriers (no co-pays, co-insurance, deductibles) primary and preventive care, plus chronic disease management and coordination of any needed specialist and hospital care, the savings are dramatic. Every medical home pilot in the country has demonstrated significant systemwide savings. Direct primary care practices like Qliance are like medical homes on steroids - same day unhurried appointments, seven days week, shifting costs away from expensive specialists and hospitals to inherently low, fixed cost primary care - because they have the time and incentives to REALLY take care of you. With a bundled wrap-around insurance plan, one doesn't have to double pay for primary and preventive care - once directly and once via the insurance plan; and one certainly doesn't double the cost of primary care itself with insurance reimbursement paperwork. The savings are real. The quality of care is real. The exceptional access is real. No one has forced 10,000 direct primary care patients in WA and 45,000 patients nationwide to choose this approach.
6
I'm a huge fan of the Qliance model, and wish the entire system of primary care would instantaneously change to either a monthly-fee-for-unlimited-care or cash-only, fee for service model, so I hope that you are correct.
However, the *if* in the following statement - "if together they meet all applicable requirements" - is a very, very big if.
Forcing more people into the current system without increasing competition, price transparency, and the incentives that drive utilization will generate massive, massive costs that can only be underwritten by compulsory enrollment in comprehensive, first dollar plans. Other features like letting people wait until they're sick to enroll, community rating, etc - whatever their merits - will only make the tabs that much higher.
An approach like combining Qliance with a catastrophic plan makes an immense amount of sense, and the savings are real - but if you need to suck in trillions of dollars to pay for your disastrous health care plan - that's not a benefit, it's a problem. The money that people on a Qliance plan save - hundreds of dollars a month in most cases - is money that isn't available to underwrite the costs generated by the rest of the system. Massachusetts has already banned high-deductible plans for that reason.
I wish that there was good reason to believe that imposing the same plan on a national level will lead to a different outcome, but neither the incentive structure nor the political economy that will prevail under such a healh-services regime justifies such a wish - and I suspect that people who pay for their medical care with a combination of Qliance, catastrophic coverage, and HSA's will be attacked for enrolling in "bare bones" coverage and "not paying their fair share."
Best of all - once the "reform" is in place and the true costs are out in the open, after forcing everyone into comprehensive plans the cost overruns will be such that they'll be force to do whatever else they deem necessary to finance them. In practice - this will mean squeezing providers and rationing care - which are the primary methods used to deliver the "savings" in the vaunted medical systems that prevail elsewhere.
Qliance - I wish you the best of luck, but if you support this legislation in its current form - you are pretty much guaranteeing that you'll either be put out of business or will, at best, become civil servants with little or no control over your business model or how you deliver care.
Good luck.
More...
However, the *if* in the following statement - "if together they meet all applicable requirements" - is a very, very big if.
Forcing more people into the current system without increasing competition, price transparency, and the incentives that drive utilization will generate massive, massive costs that can only be underwritten by compulsory enrollment in comprehensive, first dollar plans. Other features like letting people wait until they're sick to enroll, community rating, etc - whatever their merits - will only make the tabs that much higher.
An approach like combining Qliance with a catastrophic plan makes an immense amount of sense, and the savings are real - but if you need to suck in trillions of dollars to pay for your disastrous health care plan - that's not a benefit, it's a problem. The money that people on a Qliance plan save - hundreds of dollars a month in most cases - is money that isn't available to underwrite the costs generated by the rest of the system. Massachusetts has already banned high-deductible plans for that reason.
I wish that there was good reason to believe that imposing the same plan on a national level will lead to a different outcome, but neither the incentive structure nor the political economy that will prevail under such a healh-services regime justifies such a wish - and I suspect that people who pay for their medical care with a combination of Qliance, catastrophic coverage, and HSA's will be attacked for enrolling in "bare bones" coverage and "not paying their fair share."
Best of all - once the "reform" is in place and the true costs are out in the open, after forcing everyone into comprehensive plans the cost overruns will be such that they'll be force to do whatever else they deem necessary to finance them. In practice - this will mean squeezing providers and rationing care - which are the primary methods used to deliver the "savings" in the vaunted medical systems that prevail elsewhere.
Qliance - I wish you the best of luck, but if you support this legislation in its current form - you are pretty much guaranteeing that you'll either be put out of business or will, at best, become civil servants with little or no control over your business model or how you deliver care.
Good luck.
7
Health reform will be a continuing process and one can only hope Health Reform 2.0 will be much more substantive in addressing costs than 1.0. Having a direct primary care option is better than not having one at all, and will move the country in the right direction over time, instead of taking ten steps backwards. And there likely will be multiple insurance plan designs ranging from 65% to over 90% actuarial value, plus the young invicibles catastrophic only plan. My guess is much will still be left to the state regulatory agencies to determine what mandated benefits must be included in the insurance coverage. This, of course, has a huge impact on cost. As any Qliance patient knows, we believe strongly in price, service and quality transparency AND in competition. What we support on the legislative front is fully consistent with those philosophies. The patient is our customer, regardless of who is paying. Our responsibilities are to them. That cannot change.
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