Jed Aldridge, a retired firefighter in the Seattle suburb of Kent, Wash., can count on his doctor to see him on one day’s notice, spend an hour with him, and answer e-mails late at night. What his doctor won’t do: accept his health insurance.
Aldridge, 63, is among 4,000 patients in the Seattle area who buy their primary care directly from a group of three clinics called Qliance Medical Group. In exchange for monthly fees between $50 and $130, depending on age, Qliance patients can see their doctors as often as they want. “I feel like I have an advocate for my health,” Aldridge says.
Over the past decade, many doctors have established “concierge” practices that offer highly attentive care to ultrawealthy customers who pay hundreds or even thousands of dollars a month. Qliance founder and internist Garrison Bliss watched as some of his former partners started one of the first concierge practices, known as MD2, in 1996. “I had no interest in a $1,000-a-month practice with 50 patients,” Bliss says. Instead, he adapted the idea for middle-class patients who paid him $65 a month. He eventually had 800 patients, about one-third the number he handled when he accepted insurance. After 10 years of running his own small practice, he opened the first Qliance clinic in Seattle in 2007, which he envisioned as the start of a national network. Now his three clinics have eight doctors and two nurse practitioners. None handles more than 800 patients.
The model eliminates the cost of collecting money from insurers, which Qliance says can eat up $16 of a $60 payment for an office visit, or more than a quarter of a practice’s revenue. Qliance doctors’ income isn’t tied to the number of procedures they do, so they see fewer patients and spend more time with them. Although Qliance doesn’t disclose revenue, Bliss says his earlier, subscription-based practice was “break-even on Day One” and that “this [model] is profitable on very low monthly fees.” Bliss wants to open clinics in every state and has raised $13.5 million from investors including tech moguls Jeff Bezos and Michael Dell.
Patients’ monthly fees cover preventive care, basic tests, advice, treatment for chronic conditions, and simple emergency procedures such as stitches and X-rays. Patients still have to pay for prescriptions, specialists, and hospital expenses. Most have insurance to cover at least some of those costs. According to the company, Qliance patients make fewer trips to hospitals and specialists because of the more attentive primary care and incur 22 percent less in medical costs annually than average. Bliss believes the model could help reduce health-care costs nationwide: “We see this as an enormous, almost unlimited marketplace,” he says.
Qliance Chief Executive Officer Norm Wu wants to partner with insurers to combine the group’s primary care with high-deductible insurance plans that cap patients’ out-of-pocket fees for services that Qliance doesn’t cover. He says such a package could be sold on the state exchanges that, under the 2010 health reform law, are supposed to be running by 2014. Such an arrangement could save individuals in the Seattle area 40 percent to 50 percent, vs. today’s comprehensive plans, Wu estimates.
Qliance’s appeal may be limited to a narrow market of people with the means to pay for high-caliber service, says Robert Berenson, a physician and former Medicare official who is now an Urban Institute fellow. “These guys are responding to public demand that at least some people with resources are able to get a different level of access,” he says. He wants to see Qliance-type care available through the existing insurance system. “I like what they do,” he says. “I just am doubtful that it can spread very widely.” He adds that even good primary care combined with high-deductible insurance falls short of comprehensive coverage and “by no means is it adequate.”
Aldridge, the retired firefighter, says Qliance is worth the cost. He and his wife each pay Qliance about $70 per month and make four or five office visits a year. They also consult with doctors by phone or e-mail, methods traditional practitioners avoid because they can’t bill insurers for them. The Aldridges both have insurance to cover other care but appreciate the attention they receive at Qliance. “What I’ve been disenchanted with in the medical field is over the years it has evolved into 10-minute bits of medical advice,” he says.