Primary Care With a Twist: Docs Go Uninsured

It's also better in that doctors are incented to do the right things, says Bliss.

"We don't get paid for doing stuff. We don't get paid to refer to the hospital. We don't get paid if the insurance company makes more."

Bliss is highly interested in the national appeal and scale of the idea. In fact, he's banking on it. Bliss has partnered to start up a company called Qliance, which includes Qliance Medical Group as well as Qliance Medical Management. The latter assists other practices in setting up similar insurance-free business models.

"We will provide tech infrastructure and access to patient sources we've developed. We'll also measure quality and performance, and provide access to a medical record system," he says.

Who's interested? You might be surprised.

"Anyone who now wants the price of healthcare to go down," says Bliss. "Insurance companies used to have no vested interest in lowering costs. But there are places where insurance commissioners are now saying they can't raise rates to levels they would like. When that stuff happens, insurance companies become very interested in controlling costs when they have previously looked the other way."

Bliss calls the Qliance system a "power tool for them," adding that his practice has demonstrated reduced ER use by 62%. Hospitals too, are now getting interested, he claims.

"They are in an uncontrolled cost rise environment and the ACO animal is knocking at their door. They're realizing that all of their centers of excellence, which I call centers of income, will start to be cost centers in this new world."

Put simply, they're looking for a model that can produce healthier patients at a lower cost.

Don't think Qliance is the only game in town for this kind of medical care. Deep in the health reform law is a reference to "direct practice." That's the preferred name Bliss calls his idea. And it's an option in how the insurance exchanges are allowed to be designed. Stay tuned.