qliance your primary care medical home erika bliss, md, faafp family physician, qliance medical...
TRANSCRIPT
QLIANCEYour Primary Care Medical Home
Erika Bliss, MD, FAAFPFamily Physician, Qliance Medical Group of Washington & Vice President of Medical Care and Quality,Qliance Medical Management Inc. Office: (206) 913-4711Mobile: (206) 817-5424Email: [email protected]
The Impact ofDirect Primary CareMedical Homes
Can direct primary care save $2.5 trillion over
the next 10 years?
Strong Primary Care is Essential toa High-Functioning Health Care System
• Sufficient to address 90% of all health problems
• Lowers overall health care costs
• Lowers mortality
Nature of Transaction
Provider
Patient
Insurance Admin
High FFS Primary Care Admin CostPromotes Visit Volume vs. Time with
Patient
PrimaryCare
SpecialistCare($$$)
Hospital Care($$$)
EmergencyCare($$$)
End ofLife Care
($$$)
FFS Primary Care Drives Up Healthcare Costs
Efficient Direct Primary Care Medical Homes Promote Time with Patients vs. Visit Volume
Provider
Patient
Ins. Admin
KEY
Schedule Appointment
Sees patientDiagnoses Illness
Take X-ray Onsite
Run CBC Onsite
Patient goes to pharmacy
Dispense Rx Patient recovers
Patient has fever and
cough
Pays cash for Rx
Same Day Appointment
Patient has fever and
cough
The Qliance Direct Primary Care Medical Home
Preventive Care
Wellness Care
Chronic Disease Management
Specialist Care Coordination
Urgent Care
Unrestricted office visits
Same and next day appointments
Unhurried office visits
No co-payments
Extended weekday hours
Weekend office hours
Phone and email access
Flat monthly fee
DPCMH YieldsHigh Patient Satisfaction
• “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...”
1 Yelp Online Reviews, 2008-2010
yelp
Net Promoter Score=79%, better than Apple, Google & Amazon
PrimaryCare
SpecialistCare($$$)
HospitalCare($$$)
EmergencyCare($$$)
End ofLife Care
($$$)
The DPCMH Effect on System-wide Costs
Qliance DPCMHDecreases Non-Primary Care Utilization
Per 1000 members per year
Type of Referral
Qliance # per
year/1000
RegionalBenchmar
k*Difference
**
ER Visits 60 158 -62%
Hospitalizations (in days) 136 184 -26%
Specialist Referrals 909 2000 -55%
Advanced Radiology 414 800 -48%
Surgeries (#/1000/year) 33 124 -73%
Surgeries (# days/1000/year) 83 168 -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)
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.
Per C
apita
Mon
thly
Hea
lth C
are
Cost
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.