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Qliance Direct Primary Care Medical Home Model Decreases


									             Qliance Direct Primary Care Medical Home Model
                  Decreases Downstream Healthcare Costs
                                   By Dr. Erika Bliss, March 2011 (Updated to Include 2010 Data)

As healthcare costs continue to rise, there is                                                  health care matters. Qliance offers appointments
increasing interest in the potential for the                                                    seven days a week, with extended hours Monday
Patient-Centered Medical Home (PCMH) to deliver                                                 through Friday. Patients can also be in contact with
better care and savings. Some PCMH projects                                                     their primary care provider by phone or email, and
around the country are beginning to demonstrate                                                 enjoy unrestricted 30-60 minute appointments.
modest savings, but it remains a question how many                                              When the office is closed, patients always have direct
practices will be able to implement the kind of                                                 phone access to a physician for urgent matters.
changes required to perform at the same level.
                                                                                                Qliance eliminates the costs and time associated with
Qliance, a Direct Primary Care Medical Home                                                     insurance billing and fee for service, allowing
(DPCMH) based in Seattle, Washington, has                                                       providers to invest all their time and energy in
demonstrated substantial downstream savings in its                                              providing exceptional access and high quality care for
first few years of operation. Analysis of internal data                                         their patients. Since primary care, when operating as
as well as total claims data from self-insured                                                  it is supposed to, can address up to 90% of patients’
companies whose employees select Qliance for their                                              healthcare needs, Qliance is able to diminish its
primary care show that, under the Qliance model,                                                patients’ dependence on the more expensive parts of
utilization of emergency room, hospital, specialty                                              the system.
care, advanced radiology and surgical care are
greatly diminished. This decrease in utilization                                                Patient response to Qliance has been extremely
translates to a savings of approximately 22% in                                                 positive. Patients appreciate the low cost, excellent
overall healthcare costs.                                                                       access and amount of time their doctor is able to
                                                                                                spend with them. Online reviews and responses to
The DPCMH model as delivered by Qliance offers                                                  patient    satisfaction    surveys     have     been
exceptional access at a low monthly fee, outside of                                             overwhelmingly positive.
insurance. Patients pay between $49-$89 per
month based on age for its core service, regardless                                             Initial Qliance data demonstrate a significant
of health status. There are no barriers to utilizing                                            reduction in utilization of downstream medical
primary care services, as there are no co-pays and                                              services. Table 1 outlines the results of our analysis
patients can be seen same or next-day for urgent                                                of the under-65 population in 2009 and 2010.

                                                                                TABLE 1
 Type of Referral                                  Qliance # per year, per 1000 patients Regional Benchmark* Difference**

                                                                2009                       2010                                                     2009   2010
                                                                60                           56                            158                      -62%   -65%
                                                                136                         105                            184                      -26%   -43%
 Specialist Visits                                              909                         670                           2000                      -55%   -66%
                                                                414                         300                            800                      -48%   -63%
                                                                33                           22                            124                      -73%   -82%
 Primary Care Visits                                            4040                       3540                           1847                    +100%    +92%
*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) and 2010 (n=3,088)

     Chart 1 shows the actual costs for medical care for                                           Section 1301(a)(3) of the Affordable Care Act will
     seven self-insured companies that have shared claims                                          help make these savings possible by allowing direct
     data with Qliance, split between primary care in                                              primary care medical homes, coupled with a suitable
     gray and non-primary care in blue. Based on                                                   wrap around insurance product, to be offered in the
     non-primary care actual claims savings from early                                             exchanges. This legislation, sponsored by members
     Qliance pilots, if everyone in the U.S. received their                                        of the Washington State delegation, is based on the
     care under this model, it could save at least $268                                            Washington State Direct Practice Law.
     billion annually. While this scenario is unlikely to
     happen, if even 10% of the population received care                                           If the U.S. Department of Health and Human
     in the DPCMH, it could save $27 billion per year.                                             Services, in the rule-making process, facilitates the
                                                                                                   DPCMH model’s development in other states
                                                           CHART 1                                 around the country, there is potential to see dramatic
                                                                                                   savings and a transformation of how healthcare is
                                  DPCMH Delivers System-wide Savings                               delivered in this country.

                                                     $268 billion annual savings                   As healthcare costs and insurance premiums
                                       $350           ($864/person-yr. x 310 million people)       continue to rise, demand is growing for less
                                                                                                   expensive, better quality health care options. The
                                                                         }                         direct primary care medical home model is already
                                                                                                   providing significant cost reductions - up front and
Per Capita Monthly Health Care Cost

                                                                                                   downstream - and offering high quality care, often
                                                                                                   better than what patients have previously been able
                                                                                                   to experience. For more information about the
                                                                                                   Direct Primary Medical Home Model, visit
                                                                                                   Erika Bliss, MD is a family physician with Qliance Medical
                                       $100                                                        Group of Washington PC, and Chief Quality Officer for
                                                                                                   Qliance Medical Management Inc. Dr. Bliss trained at
                                                                                                   Swedish Family Medicine in Seattle. She received her
                                                                  $9        $64                    undergraduate degree in History at San Francisco State
                                                     $31                                           University and an MA in Latin American Studies at
                                         $0                                                        Stanford University before attending UC San Diego for
                                               Free-for-Service        Qliance DPCMH               medical school.

                                      Non-Primary Care                 Payer Primary Care
                                      Primary Care
            Source: Qliance Medical Group patients and employers,
            January through June 2010. The fee-for-service cost data is
            from seven large self-funded groups, and includes both
            employer and employee payments. The fee-for-service payer
            transaction cost is estimated, based on discussions with third-
            party administrators. The Qliance DPCMH monthly fee is
            based on the average age of patients in self-funded groups. The
            Qliance DPCMH non-primary care cost is based on an impact
            study of self-funded groups in 2010, and is consistent with the
            Qliance 2009 and 2010 impact studies.


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