The Qliance Direct Primary Care
Medical Home: Improving Care and
Reducing Costs
Presented to: CLG Employer Resources
Erika Bliss, MD – President & CEO of Qliance
August 9, 2012
Current Healthcare Costs: Fiscal Cancer
Healthcare Costs (in billions)
$80
17% of GDP, projected to be >19% by
2017
Specialty & Other
Primary care
62% of bankruptcies in 2010 were due
to medical expenses
Primary care is severely underfunded
(only represents 3% of medical
expenditures)
$2,520
Total annual healthcare costs =
$2.6T ($8047 per person per year)
Burdensome fee-for-service insurance
billing system undermines potential of
primary care
Qliance Confidential & Proprietary
2
The Effect of Inadequate Primary Care
An ineffective primary care
system pushes patients to
expensive down-stream care.
The result is an increase in
health care costs for employers
and employees.
($$$)
Emergency
Care
($$$)
Hospital
Care
Primary
Care
($$$)
Specialist
Care
Qliance Confidential & Proprietary
($$$)
End of Life
Care
Effective Primary Care Changes the Dynamic…
 Primary care can address
80-90% of medical issues
($)
Emergency
Care
 Primary care can catch
little problems
(hyperglycemia) before
they become big problems
(diabetes)
($)
Hospital
Care
Primary Care
 Robust primary care
reduces need for
expensive downstream
care
 But, good primary care
requires doctors to spend
time with their patients
($)
Specialist
Care
Qliance Confidential & Proprietary
($)
End of Life
Care
The Solution:
• Operate outside of traditional insurance
– reserve insurance for undesirable, costly events
– pay direct for primary care which is desirable and low-cost
– eliminate high administrative overhead for primary care practices
• Charge a monthly fee
–
–
–
–
low-cost: $64 per month
eliminates negative incentives of the fee-for-service system
incentivizes doctors to focus on holistic care
no co-pays or additional charges for visits and services
• Provide great access
–
–
–
–
–
limit patient panel size
offer 30-60 minute appointments
multi-modal access, including office, phone, and e-visits
extended office hours and weekend hours
24x7 physician coverage
Qliance Confidential & Proprietary
The Qliance Mission
Re-establish the direct
relationship between
doctor and patient,
allowing time to develop
trust and foster a
partnership that promotes
and sustains health.
Dedicate ourselves to
providing care that is
personal, high-quality,
accessible, and most of all,
humane.
“If you give them enough time, your
patients will tell you what is wrong with
them. Time to listen to a patient is what
is missing in today’s system.”
-Garrison Bliss, MD, Qliance Founder
Qliance Confidential & Proprietary
Qliance: All-Inclusive Primary Care
Preventive
Care
Urgent
Care
Specialist &
Hospital Care
Coordination
Wellness
Care
Enhance primary care to
increase quality & control costs
Behavior &
Lifestyle
Management
Qliance Confidential & Proprietary
Chronic
Disease
Management
Qliance Patients Use Less Downstream Care
Type of Referral
Qliance # per
Benchmark** Difference
*
year/1000
Savings
PMPY***
Specialist Visits
670
2000
-66%
$199.50
ER Visits
56
158
-65%
$153.00
Hospitalizations (visits)
34
53
-35%
---
Hospitalizations (in days)
105
184
-43%
$186.56
Advanced Radiology
300
800
-63%
$400.00
Surgeries
22
124
-82%
$306.00
3540
1847
+92%
$0****
---
---
---
$1,245.06
Primary Care Visits
Savings Per Member Per Year
* Based on best available internal data, may not capture all non-primary care claims.
** Based on regional benchmarks from Ingenix and other sources.
*** Based on average costs in WA State.
****No additional cost for additional primary care visits in the Qliance model.
Source: Qliance Medical Group non-Medicare patients, 2010 (n=3,088)
8
How Does Qliance Improve Member Health?
•Gives members the care and resources they need the way they want it.
They want:
– To feel better
– To not feel rushed, with:
 Enough time with their doctor to understand what’s wrong and
what they need to do next
 Enough time with their doctor to understand their choices
– Appointments when they need them
– Convenience (onsite lab, common DME, X-rays, etc.)
– Help over the phone or by email instead of coming in
– Expert advice on the best specialists or hospitals to get the best care
9
How Does Qliance Reduce the Overall Cost of
Care?
• By shifting focus to primary care that includes at no extra cost to
the member:
–
–
–
–
Longer appointments
Basic x-rays and labs onsite
First fill drug dispensary
Routine DME
• Establishing trusting relationship with patients so we can positively
influence their decisions and behaviors
• Being available when patients need us so they don’t have to go to
urgent care or emergency rooms
• Reducing self-referral to specialists
• Coordinating specialist, ancillary, and hospital care, making sure they
get the right care at the right time
10
Plan Integration Examples
PPO
HDHP
• Plan design & contribution can drive participation
• High deductible not required
• Higher OV copay incorporates well
• Provides soft bridge to higher deductible
• Can work well with Account Based plans (HRA)
• Put Q before HRA to maximize participation and value to employee
• Employer gets full benefit from the Qliance claims impact
• Can incorporate into plan design (tiered benefit) or just use as a network
• Provide claims history for financial analysis to show areas of savings
Self-Funded • Utilization reporting provided
• New Cigna Level-Funded Partnership with discounted rates
Our Clinics
Downtown Seattle
Kent Station
Mercer Island
509 Olive Way
Suite 1607
Seattle, WA 98101
521 2nd Place North
Suite 103
Kent, WA 98032
7707 SE 27th Street
Suite 104
Mercer Island, WA 98040
Tacoma
2420 S. Union Avenue
Suite 100
Tacoma, WA 98405
Qliance Confidential & Proprietary
Mill Creek
Guardian Family Care
(Qliance affiliated clinic)
805 – 164th Street SE
Suite 100
Mill Creek, WA 98012