Doctors try new models to push health insurers aside

[HuckleB]

http://www.washingtonpost.com/wp-dyn/content/article/2011/03/07/AR2011030703989.html

"Just about everyone agrees that the way we pay for primary care needs fixing. Under the current insurance model, doctors get paid for procedures and tests rather than for time spent with patients, which displeases doctors and patients alike and increases costs. Now some medical practices are sidelining health insurers entirely, instead charging patients a moderate membership fee each month. The approach gets a nod in the health-care overhaul law. But not everyone agrees it's the right way to go.

Seattle-based Qliance Medical Management's three clinics typically charge a patient about $65 a month for unlimited access to the practice's 12 physicians and nurse practitioners. (Fees vary depending on the level of service and the patient's age.) Office appointments last up to an hour, and clinics have evening and weekend hours, with e-mail and phone access to clinicians as well. Routine preventive care and many in-office procedures are free; patients pay for lab work and other outside services "at or near" cost, and they get discounts on many medications.

The average $700 to $800 per patient that Qliance receives annually in membership fees is up to three times more than a doctor in a standard insurance-based practice might make per patient, says Norm Wu, the company's president and chief executive. "So we can have a third the number of patients and get the same revenue per clinician, but with much less overhead," he says. The approach, he says, allows Qliance to funnel more money into the care itself - through longer office hours, for example, or better diagnostic equipment.

Bruce Henderson joined Qliance when its first clinic opened in 2007. Although at the time he had health insurance through his job, Henderson, now 63, was soon laid off. Now he pays Qliance $79 a month for primary care and carries a catastrophic medical plan with a $10,000 deductible, for which he pays $225 a month.

..."

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Obviously, many people couldn't afford this, but, as a nation, isn't it possible that this model could save money, and improve health care?

:shrug:

[rfranklin]

1. What it proves is that we don't need private insurers...

They do not bring anything to the table. However, they do scoop up a lot in the process.

[joeybee12]

2. +Infinity!

And beyond!

[loudsue]

8. So true. We need to outlaw health insurance companies, and extend

medicare to everyone. Supplemental or catastrophic insurance would be fine, but should never again be necessary. The insurance companies and military contractors and privatized prisons are the SICKEST aspects of our "new" economy. Soldiers should have the extra pay going to privatized mercenaries/intelligence companies, making a profit off prisoners destroys the prison AND justice systems, and health should not be covered by "insurance". We all have health. It's a twisted concept.

[MineralMan]

3. Absolutely. And a single payer system could pay an annual fee

to doctors for patients on their rolls, as long as they could record a couple of visits a year for those patients. Catastrophic coverage could be handled through a monthly premium, something like Medicare does now for seniors. I pay $109/mo out of my SS payment for Medicare, I also pay $109/mo for supplemental insurance through Blue Cross that pays all of the 20% copays.

It's really interesting to me how many insurance companies want to compete for that supplemental insurance policy. What do they know that we don't know?

[CTyankee]

4. Wow! Just $109 supplemental covering all of the co-pays. Where do you get that?

I have AARP and it's twice that per month!

[MineralMan]

10. It's a standard Blue Cross supplement, Platinum Blue.

It doesn't cover things like dental, though. It does cover just about everything else. So far, I've not paid anything out of pocket for any medical care since I was on Medicare. Here in Minnesota, almost all medical providers are Blue Cross approved, so it's all covered. I think some of the AARP plans are different from these supplements, and are more HMO-like. Is yours a Medicare Advantage plan of some kind?

Next year, when the open enrollment period happens, do some checking and see if there isn't a pure supplement plan that would work for you.

[CTyankee]

12. It's definitely NOT a Medicare Advantage Plan! AARP is a nonprofit organization.

I'll have to check out Blue Cross Platinum.

My plan doesn't cover dental either. But it does cover all co-pays. Given our luck recently with hubby having to have spinal surgery, my hernia surgeries, we see the handwriting on the wall.

We had coverage thru hubby's plan (union) for a couple of years after he got laid off but that stopped last October when he turned 70. It was great while it lasted. We paid $98 each in premiums and had a great deal on prescriptions, now it is twice that. I've had to massively cut my budget.

[MineralMan]

15. AARP actually doesn't sell you insurance.

Your AARP Medicare Supplement is provided by an insurance company. AARP just negotiates a deal for AARP members with that company.

I think it's United Healthcare, but I'm not absolutely certain.

Oh, yes, I have to mention that I don't have Part D coverage with my plan. I can get meds through the VA, so that's what I do. That saves some money on drugs, even though I take almost no prescription drugs at this time. It's also just for me, not me and my spouse, who is not old enough for Medicare yet.

[CTyankee]

19. Yes, you are right. It is United Health Care. But it isn't an Advantage plan which would

have been a lot more.

You are required to go on Part D, unless you have something like what you have with the VA or what we HAD.

I'm going to check that out next time open season comes around...I wonder if we have your plan here in CT...

[MineralMan]

23. I don't know, actually, if you have that available in CT.

I'd sure do some checking around when open enrollment comes around again. I think CT also has it's own state plan, especially for lower-income seniors. A little research might save you some money for the next year.

[CTyankee]

24. Yep. We're saving all of our receipts from everything health related, even dental.

Our tax guy said we'd have a good shot at more tax relief...

[REACTIVATED IN CT]

37. Our State Insurance Comission has great info on their

website about available Medigap coverage and costs

http://www.ct.gov/cid/cwp/view.asp?q=254482

In our area, AARP is one of the lowest cost plans. When comparing costs with other DU'ers keep in mind that our region has higher premium rates than other parts of the country.

(I'm a former Benefits Administrator at a large, multi-state law firm who used to help partners find Medigap coverage - in addition to choosing and adminstering employee benefit plans)

[silverlib]

31. What I learned about Plan F...

By law, it's all the same coverage. By law, only the price can be different. My husband uses Mutual of Omaha - different plans for different states. - under $100.

[Cleita]

21. Ding! Ding! Ding!

The fact is we need single payer or Medicare for all.

[MineralMan]

26. Yup. That's one of my primary issues.

Sadly, we lost ground in 2010. I hope we can recover and gain Congress members and Senators in 2012. It's not going to be easy to implement single payer in this country.

Personally, I think that we should have a National Health Service, with most doctors and health care facilities in this country paid by that system. A doctor or hospital could work outside of it, but would have to deal with people who could afford to pay for his or her services, since they'd get nothing from the single payer system. Some would do it, but most would opt for the sure thing, I think.

Then, to supplement the number of physicians and nurses, medical school and nursing school would be paid for by the NHS and be completely free to those enrolled. Admission would be based on nothing but ability. Many people who would make excellent doctors and other health care professionals cannot even dream of those careers. That must end, too. Health care should be a right.

[global1]

5. What Happens When A Patient Needs To Be Hospitalized Or.....

sent to a specialist that isn't in their program? It sounds like this monthly payment by a patient only takes care of the primary care of the patient. I'm thinking that the patient still needs to carry the burden of health insurance in order to cover any out of clinic expenses. How does that work?

[HuckleB]

9. Well, that's something that needs to be figured out.

What this first step shows is just how much the insurance companies take from the money we spend on health care.

[midnight]

6. I like the way these health care professionals think....

[HuckleB]

32. At least someone is trying...

[lumberjack_jeff]

7. For primary care, it seems like a good idea.

But it doesn't reduce the need for catastrophic insurance. Mr Henderson above still pays $3650/year.

[dixiegrrrrl]

28. And he has no guarentee the insur. comp. will actually pay any bills when needed.

[tavalon]

11. I've been thinking about going the qliance route

and just having an HSA for other expenses. It would be nice to cut out insurance.

[OneGrassRoot]

13. I didn't think anyone even offered catastrophic coverage only any more...

I think this is the next best thing to single payer or universal options. I wish I had this option where I live.

The insurance companies need to be removed from the equation altogether.

[cdsilv]

17. My dr. is pimping 'Concierge Service' - kind of like 'Hank Med' on the show "Royal Pains"....

...except Katy, TX ain't the Hamptons. For $184/mo I would get easy access to the doc, her cell phone number and email address and discounted fees. Anything catastrophic would have to be covered by 'traditional' insurance (EMS, Hospitalizations, labs, hi-tech procedures etc...).

Now we just need to find a way to get 'traditional' insurance to pay the 'Concierge' fee. Looked at from the outside, I could surely afford it, but I do have some crushing obligations to the IRS that get in the way. Maybe when those have passed (been paid off).

Hey, for only $300, I can get a house call!!!

[OneGrassRoot]

25. Interesting. Good luck with that. ;) n/t

[madinmaryland]

36. We had a doctor that tried that same shit, also. We dropped him faster than

a herpes infected washcloth.

He came back begging for us to return, when everyone dumped him. I used a Cheneyism to tell him what he could do.

[Edweird]

14. Yet some here insist on trying to sell the FAR RIGHT individual mandate as somehow 'progressive'.

[WolverineDG]

16. In Mark Twain's autobiography, he talks about his family paying their physician annually

it seems that you went & paid an annual fee to the doctor of your choice, then when you needed care, you just went to see him or ask him to make a house call. You didn't have to pay anything else.

Sounds like what Qliance is doing.

dg

[HuckleB]

18. Is this the full bio that was just released?

I'm going to have to get that ASAP.

[WolverineDG]

33. yes, but a word of warning

the academics got a hold of it & go on *forever* about how they did this or that or whose transcription they used & why. Then a long series of passages on President Grant. Interesting, but really? before anything about Twain's life? Sheesh. The first really good "Twain" stuff is when he describes growing up in Missouri. Then it's back to some academic crap before they let Twain loose again. I had to give up on it since the book was due back at the library & there were several holds on it.

dg

[HuckleB]

34. I yi yi.

Thanks!

[Cleita]

20. This pops up every now and then.

Patients need more than access to doctors. They need access to lab and X-rays. They need access to ERs, hospitals, other care givers and access to prescription drugs. They would still have to carry health insurance besides this. It's a win, win for the doctors, but still leaves the patient short.

[HuckleB]

30. Yet, it also cuts out overhead currently paid to insurance companies and employees who deal with ...

insurance companies. Thus, helping, if we chose to make such a system larger, to save money and have more resources for other pieces of the health care puzzle.

[socialist_n_TN]

22. It's a start anyway..........

Kind of like a co-op plan.

[HuckleB]

29. Indeed. -eom-

[RainDog]

27. kick n/t

[madinmaryland]

35. Shitty idea, unless ALL doctors follow this model.

We had a doctor here that tried to pull this shenanigan. Wanted to charge each patient $2,000 for "unlimited" access. Insurance companies will not cover this and it is questionable if flex spending will.

AND I still have to insurance coverage for the rest of our doctors: OB/Gyn, Urologist, Pediatrician, Podiatrist, ENT, Gastroenterologist, et. al.

Really shitty attempt at extorting money from patients that have insurance.