Transcript Strong Primary Care is Essential toa High

QLIANCE
Your Primary Care Medical Home
The Impact of
Direct Primary Care
Medical Homes
Erika Bliss, MD, FAAFP
Family Physician, Qliance Medical Group of Washington
& Vice President of Medical Care and Quality,
Qliance Medical Management Inc.
Office: (206) 913-4711
Mobile: (206) 817-5424
Email: [email protected]
Can direct primary care save
$2.5 trillion over the next
10 years?
Strong Primary Care is Essential to
a High-Functioning Health Care System
• Sufficient to address 90% of all health
problems
• Lowers overall health care costs
• Lowers mortality
High FFS Primary Care Admin Cost
Promotes Visit Volume vs. Time with Patient
Nature of Transaction
Provider
Patient
Insurance Admin
FFS Primary Care Drives Up Healthcare Costs
Hospital Care
($$$)
Emergency
Care
($$$)
Primary
Care
End of
Life Care
($$$)
Specialist
Care
($$$)
Efficient Direct Primary Care Medical Homes
Promote Time with Patients vs. Visit Volume
Patient goes
to pharmacy
Patient has
fever and
cough
Schedule
Appointment
Patient has
Same Day
fever and
Appointment
cough
Sees patient
Diagnoses Illness
Run CBC
Onsite
KEY
Provider
Patient
Ins. Admin
Dispense Rx
Take X-ray
Onsite
Pays cash
for Rx
Patient
recovers
The Qliance Direct Primary Care Medical Home
Preventive
Care
Unrestricted office visits
Extended weekday hours
Unhurried office visits
Urgent
Care
Wellness
Care
Phone and email access
Same and next day appointments
Weekend office hours
No co-payments
Flat monthly fee
Specialist Care
Coordination
Chronic Disease
Management
DPCMH Yields
High Patient Satisfaction
•
yelp
“People, it's a miracle. I pay about $45/month for all my primary care needs (their fee is based on age).
They can do lab tests on-site for free, or a small fee if it's unusual, and they even have a pharmacy on-site that
provides most basic prescriptions for much, much cheaper than you'll get through your insurance. The
doctors are all lovely people, and can take the time to get to know you, and - most importantly
- LISTEN. They don't have to funnel patients through their office just to make a buck, so they can actually pay
attention to what you're saying, which, believe it or not, is mother-flipping crucial for an accurate diagnosis.”
•
“I've had chronic kidney problems since I was 14, and at the time desperately needed a doctor but couldn't
afford to go. When I read about Qliance's revolutionary way of approaching medicine I was in
complete blissful shock! …the doctors actually listen to the patient and provide feedback and suggestions.
Because appointments are 30 minutes to 1 hour long (or longer if needed) the doctors at Qliance can focus on
patient education and pay attention to the whole-patient, aiming to solve the problem, not just the immediate
symptoms.”
•
“The level of care, the amount of compassion, and the concept of having a voice in my
healthcare is priceless to me. I've sent friends to Qliance when they had complicated issues that other
doctors brushed aside (and they got answers!); I've sent friends who didn't have insurance and otherwise
couldn't afford care, and I'd suggest to anyone who wants a truly unique and amazing healthcare experience to
go to Qliance.”
•
“Qliance is redefining what good healthcare looks like, and honestly, you have to experience it to
believe it...”
Net Promoter Score=79%, better than Apple, Google & Amazon
1
Yelp Online Reviews, 2008-2010
The DPCMH Effect on System-wide Costs
Hospital
Care
($$$)
Emergency
Care
($$$)
Primary
Care
End of
Life Care
($$$)
Specialist
Care
($$$)
Qliance DPCMH
Decreases Non-Primary Care Utilization
Per 1000 members per year
Type of Referral
ER Visits
Hospitalizations (in days)
Specialist Referrals
Advanced Radiology
Surgeries (#/1000/year)
Surgeries (# days/1000/year)
Qliance # per
year/1000
60
136
909
414
33
83
Regional
Benchmark* Difference**
158
-62%
184
-26%
2000
-55%
800
-48%
124
-73%
168
-51%
*Based on regional benchmarks from Ingenix and other sources.
**Based on best available internal data, may not capture all non-primary care claims
Source: Qliance Medical Group non-Medicare patients, 2009 (n=2,316)
Per Capita Monthly Health Care Cost
DPCMH Delivers System-wide Savings
$268 billion annual savings
($864/person-yr. x 310 million people)
Sources: FFS cost data from seven large self-funded
groups. Includes both employer and employee
payments. Payer transaction cost estimated based on
TPA discussions. Qliance DPMH monthly fee based on
average age for self-funded groups. Qliance DPMH
non-primary care cost based on self-funded pilot impact
2010 which is consistent with Qliance 2009 Impact
Study. Excludes cost of prescriptions.
Section 10104 (3) of H.R. 3590,
the Affordable Care Act (ACA)
Allows direct primary care medical home
practices to offer coverage in the exchange in
combination with a wrap-around insurance
policy that together satisfy exchange
requirements.