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Direct Medical Home Offers Healthcare Without Insurers

John Commins, for HealthLeaders Media, July 13, 2009

An insurance-free primary care "direct medical home" that requires patients to pay low monthly fees, but gives them 24/7 access and cheaper healthcare costs has the potential to save hundreds of billions of dollars if it's included in the national healthcare reform model, one advocate says.

Norm Wu is CEO of Qliance Medical Management, Inc., which operates one direct medical home that employs nine physicians serving about 2,500 patients in Seattle and has hopes to expand nationally. Even though their numbers are small, Wu is an unabashed enthusiast. He says the direct medical home model on a national scale could save patients and employers $300 billion to $500 billion a year "in hard-dollar, upfront savings" largely in the form of lower health insurance premiums.

"With that savings, you can provide comprehensive health coverage for every man, woman, and child in America," Wu says. "But it is hard to get that message out. People consider insurance synonymous with healthcare and it's hard to break out of that box."

Wu insists that the direct medical home model is not another form of concierge medicine that cherry picks healthy patients and shoos away the chronically ill. "We don't like that term because it smacks of elitism. We provide concierge-level service at prices that everyone can afford," Wu says.

"The people who are really attracted to us are the high utilizers," Wu says. "If you have a chronic illness we are a God send. For a flat monthly fee, you can see us as many times as you need to. We are available for phone conferences and e-mail. There is 24/7 access."

"We also have a lot of people who are reasonably healthy," he says. "They don't get sick that often, but they are health conscious so they want preventive care and when they do get sick they want to see a physician who knows them as soon as possible."

For monthly fees ranging from $39 to $79 depending upon age, Wu says Qliance patients get unrestricted primary care for vaccinations, checkups, pneumonia, minor fractures, women's health exams, and ongoing care for chronic illnesses, such as diabetes, hypertension or obesity. No one is denied care for preexisting conditions, there is same- or next-day service for urgent care, and visits with salaried, physician-employees can last 30 minutes to an hour.

Medicare/Medicaid/SCHIP patients are accepted; their coverage is not.

Lab tests, pharmacy, and durable medical equipment are not covered by the monthly fee. Instead, Wu says Qliance "passes on our wholesale costs, so there is no incentive for us to be pushing stuff off on patients that they don't need." The patients' higher out-of-pocket expenses for ancillary care are offset, Wu says, by the savings of 40% to 50% for patients, and 20% to 35% for employers when they swap their low-deductable, high-premium health insurance for either high-deductable or wrap-around coverage.

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