Transcript Slide 0
2015 WA State of Reform Health Policy Conference January 8, 2015 Fee-for-service creates waste & dysfunction in traditional primary care Possible Pneumonia Key: Practice Insurance Patient Provider 1 Direct Primary Care Changes the Dynamic • Direct Primary Care (DPC) provides primary care services directly to patients using a PMPM model • Operates either outside or alongside traditional insurance – Reserves insurance for undesirable, costly events – Lowers practice costs by eliminating fee-for-service billing Possible Pneumonia 2 Qliance Direct Primary Care Model • Relationship-centered care • Doctors are employed, salaried; encourages focus on holistic care • Limited patient panel size • Flat monthly fee for unrestricted, 7 day a week access • Operate community-based and near-site clinics • Proprietary IT platform tailored to care delivery model, supports data integration with carriers, purchasers, and other systems • Steward healthcare resources from the primary care level 3 Qliance Patients Use Less Advanced Care (Employers) Per 1,000 Qliance pts Per 1,000 Non-Q pts Difference Savings per pt per year ER Visits 81 94 -14% ($5) Inpatient (days) 100 250 -60% $417 Specialist Visits 7,497 8,674 -14% $436 Advanced Radiology 310 434 -29% $82 Primary Care Visits 3,109 1,965 +58% ($251)* Savings Per Patient --- --- --- $679 % Saved Per Patient 20% 4 Why does this work? • We don’t know for sure, but probably most of the impact is from spending more time with people • Complex disease management, case management, utilization review, and layered teams may not make much additional difference, but we need to study it • We suspect that a lot of excess care is driven not only by the usual suspects (no time to do the basics, so referring for unnecessary specialist visits and studies; fear of malpractice suits) but also by patient anxiety and lack of trust – taking time with patients alleviates anxiety, builds trust, and rationalizes care in a very low-tech way 5 Midyear Patient Experience Survey – All Qliance Patients Overall 100% 95% 90% Compares to: 85% 80% 75% • Average in Puget Sound – 73.8% (90th %ile = 82%) • 90th %ile nationally = 91% 70% 65% 60% 55% 50% Would you In general, do you During your most recommend your get the care you recent visit, was the want and need, front desk staff healthcare provider’s office to when you want and helpful and need it from the courteous? your co-workers, family and friends? Qliance clinic? • Yes, definitely Yes, somewhat No 6 Providers love the work • Get to spend time with our patients! • Get to know patients and develop deeper relationships • Intellectually stimulating • Use full breadth of our skills • Great patient feedback • Personal and professional growth • Balance between work and life • Empowered position in healthcare system 7 Qliance Owned & Operated Clinics in the Puget Sound Downtown Seattle Kent Station Edmonds Tacoma Bellevue 509 Olive Way Suite 1607 Seattle, WA 98101 521 2nd Place N Suite 103 Kent, WA 98032 7315 212th St SW Edmonds, WA 98026 2420 S. Union Ave Suite 100 Tacoma, WA 98405 333 108th Ave NE Bellevue, WA 98004 8 Who are our customers? • Individuals • Small employers • Large employers • Unions • Medicaid managed care • Health benefits exchange (ACA) 9 How DPC works with Insurance • Monthly fee • Can be base fee plus shared savings (but not a good long-term strategy) • Payment (total) more substantial than typical fee-forservice reimbursements • Qliance submits “shadow” claims data to insurer so they can capture needed data • Individuals pay one premium, can select Qliance as primary care provider 10 The Opportunity – Qliance’s Goals • Establish value of primary care • Protect the viability of independent primary care practice • Promote primary care as steward of healthcare resources • Make primary care a partner with purchasers • Make primary care a partner with patients • Make primary care a rewarding and attractive career option to grow pipeline faster • Make primary care a laboratory of innovation in medicine and technology • Use the primary care setting to generate a healthier healthcare system culture Qliance Medical Management Inc. 2101 Fourth Avenue, Suite 600 Seattle, WA 98121 Erika Bliss, MD President & CEO (206) 913-4711 [email protected] www.qliance.com