Last week I had my first meeting with my new primary care doctor. He works with Qliance Medical Group here in Seattle. I cannot tell you how pleased I am with their services. I have already recommended here looking at what they do.
On March 26th, Dr. Garrison Bliss, who founded Qliance Medical, spoke to the Washington Association of Health Underwriters about the situation of healthcare in the US, and what to do about it. If you are concerned about healthcare, for yourself or for the nation, or for both, I strongly recommend listening to this talk. Listen here.
Below I have paraphrased a little of what he said, as a teaser. The talk is really excellent.
Bliss asks, Why do we have the healthcare system we have? His answer: we designed the system to work this way, albeit not with the intention of producing the results we have produced.
He asks, with the current system, who wins?
- The best coders win (those who know how to fill out the forms.)
- The doc who gets the most HMO patients and keeps the door shut wins.
- The doc with the lowest overhead, the fewest nurses, the smallest staff, the fewest phones, the least access, wins.
- The physician who sees the most patients per hour, wins.
- The physician who does the most procedures wins – the specialists – they get paid for the procedures. For the time they spend with patients, they get the same that I’m getting paid.
- If you’ve got a sick and difficult patient in this system, and you want to win, you refer him to a specialist, and you’re done. You saw him for two minutes, and then you sent him to someone who’s going to actually have to take care of him.
- The insurance company who can enroll the most healthy employees while minimizing payouts wins.
- The insurance company that can delay payment the longest wins.
- The insurance company that successfully excludes the sickest patients wins.
- The patient that screams the loudest and demands their care wins.This is a squeaky wheel world now. If you’ve been in the hospital in recent years you know that if you have an advocate who can walk and talk you are way better off.
- The malpractice insurers are the only consumer advocates with any power right now.
Who are the losers?, he asks.
The big losers are the patients. They pay a fortune for the care that they don’t get, they don’t have any power, and they don’t really have an option. They can just pick another person off the list of physicians who are seeing 30 people a day.
In the middle of the talk, he shows two exhibits, contrasting the difference between current practices for dealing with someone who may have pneumonia with the current system (a bureaucratic mess consisting of a 20 transaction event to get one patient through an office), and the approach that he recommends, and offers through Qliance. His approach has these parts:
- You pay a monthly fee to your doctor.
- For that, you are allowed to come to his office whenever you need to. (“It sounds crazy, but that’s how it works.”)
- They are open every day. If you are sick on an inconvenient day, they’ll still be there.
- You call them up, and they promise to see you on the day that you are sick.
- You go to the office and see the doctor. The office has testing equipment and digital xray. You don’t pay for either. They have a generic formulary and often can dispense the drugs you might need right there.
Bliss says that on the basis of their experience, 40-60% of what we spend on primary care each year is pure waste, which, he adds, shows why primary care providers today have such a hard time making a profit.
Listen to this and you will know something about the current healthcare mess that would otherwise take you weeks to uncover.
Chauncey Bell Blog 
Chauncey
can you ask these folks if they know anybody in the Bay Area doing the same thing? It doesn’t appear that way, at least as far as Google knows.
I googled “concierge medicine oakland” and came up with this:
http://www.theoaklandpress.com/stories/021305/loc_20050213031.shtml
I guess that there are a lot of small practices copying this, or developing their own versions. This is one of the very first practitioners to figure out how to do it, but I bet there are a lot of possibilities emerging right now.
Chauncey,
I’ve been a member of a concierge medicine practice for a few years, and it is bliss. My understanding is that the monthly fee allows the doctor to significantly reduce the size of his panel, thereby affording her a decent lifestyle and a profitable practice. In Boston concierge medicine is very expensive – anywhere from $300 – $400 per month. I don’t know if Qliance is less, and I would be interested to know how much would a doctor have to earn in private fees, to produce both outcomes – a practice that satisfies patients and a decent lifestyle for the physician? This will vary from state to state, but perhaps some of the costs are equivalent enough to produce some models? – Terry
Thank you for the comment Terry.
To start with the money, in his talk that this posting links to, Dr. Garrison Bliss reports that he started out with a $1,000/month offer, and then split from that practice and started a new one to make the offer at a different price point. He tells the insurance underwriters that Qliance offers prices ranging from $39 to $75/month. I pay $55/month.
I will not say here how much time my physician spent with me in our first meeting. It is outside my experience of working with doctors. I will say that he went over every aspect of my current health situation at least twice, giving us both time to reflect and make sure we were not missing anything. In thoroughness, the conversation reminded me of being interviewed by an El Al security agent as I was preparing to board a flight out of Tel Aviv a number of years ago. The doctor was committed to see that I was going to have every opportunity to remain healthy.
I think the difference in prices has to do with fundamental differences in the objectives. I guess that a wide range of price points can be profitable when practitioners are not interacting with the administration of insurance reimbursements, which add up to more than 1/3rd of the direct costs of medicine in this country. I am told (and believe) that Qliance pays their physicians more than the competition, and that they are profitable. Their capacity to do that results primarily from their not interacting with the costs and complexity of insurance reimbursements. Qliance physicians see on the order of 1/4 of the patients seen by modern practitioners.
Of course the very name “concierge” comes from a service that the upper middle and upper classes are familiar with. What Qliance is aiming at is breaking the back of the mess of primary healthcare in the US, and an offer of $300-1000/month, on top of the high-deductible insurance that prudent people must carry in any event, is not an offer that will produce that kind of result.
Shameful self promotion: the offer of the new company I am working with, CareCyte, has the same characteristic: we are aiming at changing the systems, also with an offer that comes from an unexpected direction.
Best, Chauncey
Chauncey,
Nice post. The concierge physician services have been around since the late 90s or 2000 here in Florida. It is a very interesting approach to healthcare and certainly a way to get more attention from your physician. I also looked into doing this with pharmacy by offering private pharmacy consultations. Unfortunately, most people still look at their pharmacist as the guy at the drive-thru window that hands out their antibiotics. However, with patients that are on numerous medications from various doctors a private consultation really could work. The pharmacist could talk to the individual and their physicians and develop a better medication plan perhaps reducing the number of medications a patient is taking. It would be quite possible to remove a hunderd dollars or so a month from some patients drug costs. Unfortunately, there wasn’t too much market for such a service. Maybe down the road people will be more interested.
Thank you for the comment Mike.
Pls drop me a note to my email with your coordinates so that I can be in touch with you as things develop in my new business.
Best,
Chauncey
Somehow i missed the point. Probably lost in translation 🙂 Anyway … nice blog to visit.
cheers, Thesis!!
A hint of this sort of thing catching on in the SF bay area as well, and about time — my husband’s primary care doctor just closed his old practice and re-opened it under entirely new terms, similar to what you describe — for payment of a quarterly fee, you get an unlimited number of office visits ( a $15 copay ea visit, which apparently is required in CA in order to not be classed as an insurance provider) and a thorough annual physical exam. They take no insurance and do not prepare any claims. The doc takes his time and listens, reviews history, takes responsbility for the macroview of the patient’s care with specialists, etc. What a concept!
Actually, the concept of concierge physician has been successful in a narrow market for people of wealth that have elderly parents or people who have the income that they want to get at the knowledge for treatment after a challenging diagnosis.
Michael Milliken and Andy Grove had the resoources to invent a very advance form of concierge medicine when they were both treated for prostate cancer. What they did is actually a foundation for a practice of medicine called evidential where you don’t dedicate yourself to a prescribed method of care and partner with intelligent people, e.g. doctors to invest a treatment plan of health initiative for yourself that grows out of inquiry and research that draws on many different perspectives and scientific reports.
Years ago, after taking Flores first introductory program, the Action Workshop, I sent for his doctoral dissertation and wrote him a letter themed as my inquiry into what could happen if medical records could talk.
Chauncey has added to my thought and reminded me of some clear distinctions in various pieces of his writing that relate to wisdom of managing complex information and now his architecture in another entry here about the background and qualifications of a “speaker” and the speaker’s proficiency as a master, virtuoso or proficient person.
The practice of medicine versus the practice of managing good health are two other distinctions that are key.
The concierge physician as a master who is proficient in both provides much more that the breadth of most of our health care system in the US that has become a prescriptive culture.
Now through the filter of sustainability, many of us are learning that prescriptive practice does not work if you factor in multiple needs, e.g. the sustainable view of the triple bottom line. This factor is something I believe will increase in use as a filter in medicine and I am now giving that considerable thought in the new book I am writing.
Nice to see old friends here, e.g. like Terry Rosenberg.
I now live in Park City UT and welcome all my friends to visit. I am in the process of planning a two month trip early 2009 for a few months to Israel.
Chauncey, I do plan to catch up on your progress with Carecyte to see how this concept fits with my book and other things I am thinking about.
All the best,
Lavinia
Hi, Chauncey, I thought of your CareCyte work and the concierge medical services you are participating in when I read this article.
Click to access 0708_interview.pdf
Best,
Marcia
Hello,
We are in Rhode Island and have been offering services like this for many years. We are working on spreading across the country. We charge 25 – 30.00 per month…it is an incredible way to service the patient and still offer a structure that works for the practice. http://www.healthaccessri.com
Kim, Thank you for this note. You might be interested in what we are doing at CareCyte. See http://www.carecyte.com.
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