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Qliance and Physician Care Direct introduce first health plan for Direct Primary Care

SEATTLE — Qliance Medical Management Inc. and Physician Care Direct (PCD) announced the nation’s first health insurance plan for Direct Primary Care, an increasingly popular model of flat-fee medical care. The offering wraps a proven insurance product around an innovative primary care platform — provided by multiple Puget Sound physician groups — to let employers better manage healthcare costs while benefiting patients and providers alike.

The Employer Health Ownership Plan (EHOP) is a healthcare purchasing strategy from PCD that combines Direct Primary Care with a method of providing self-insurance for small — and medium-size businesses. Currently, only large companies have deep enough pockets for self-insurance, which requires employers to have the cash to cover catastrophic losses but also lets them share in the savings when their workforce stays healthy and out of the hospital. The so-called “captive-based” self-insurance plan used by the EHOP creates a way for smaller employers to self-insure by spreading the risk of catastrophic costs across a pool of multiple employers.

According to the U.S. Census Bureau, nearly 40 million Americans — about one-third of the nation’s employed workforce — work for companies with 20 to 500 employees. These businesses are ideally situated to take advantage of the EHOP, which lets them add Direct Primary Care to a single plan including coverage for specialty and hospital care. Direct Primary Care delivers unrestricted access to care through longer appointments, extended hours, and phone and electronic communications with providers so patients can take care of health needs promptly and avoid downstream care and costs.

“Many small — and medium-size companies are attracted to Direct Primary Care but have struggled to find a way to pay for it, even though at Qliance we can keep their employees healthier at a lower cost than traditional medical care,” said Dr. Erika Bliss, president and CEO of Qliance, which operates five Direct Primary Care clinics in the Seattle area. “Now for the first time, this new plan lets employers of all sizes build Direct Primary Care into their health benefits without paying extra for it. They can offer an attractive perk while improving the care of their employees and driving significant savings.”

Dr. William Lawson, CEO of Physician Care Direct, said, “If you’re a typical fully insured employer today, all your healthcare costs are fixed, so neither you nor your employees will get any money back from your insurer if you are successful in reducing healthcare spending. Furthermore, physicians are accountable to the insurance company — not the employer actually purchasing the care. With this new plan, employers can save up to 30 percent of their costs by participating in a plan that is built around Direct Primary Care and promotes cost-effective care and healthy behaviors.”

Along with Qliance, two other Puget Sound primary-care provider groups will offer Direct Primary Care services under the EHOP: Puget Sound Family Physicians, which includes Edmonds Family Medicine and Snohomish Family Medical Center; and Family Care Network, based in Bellingham with clinics throughout Whatcom and Skagit counties.

“Direct Primary Care contracting with employers allows us to practice in the most efficient and effective way possible,” said David Lynch, medical director of Family Care Network. “It aligns the incentives of employer, employee and physician, lowers the barriers to primary care and also helps us to be effective managers. The PCD Employer Health Ownership Plan facilitates the right care at the right time, and will benefit our patients and our community.”

Dr. Ginger Blakeney, president of Edmonds Family Medicine, added, “We are excited by the opportunity to be part of a health plan that emphasizes the doctor-patient relationship, and offers a solution that benefits patients, providers, and employers.”

The Direct Primary Care Model

Direct Primary Care practices are designed to address approximately 90 percent of a patient’s medical issues, including all routine primary and preventive care. This includes women’s health services, pediatric care, urgent care, wellness education, ongoing chronic disease management, select on-site procedures and diagnostics, and coordination of all outside specialist and hospital care by the patient’s primary care provider. Qliance has been offering this model since 2007. With Puget Sound Family Physicians and Family Care Network now offering this service, employers have access to Direct Primary Care from Bellingham to Tacoma.

By enhancing access to unhurried, thorough care at the primary care level and eliminating co-pays and deductibles for routine and predictable services, Qliance’s Direct Primary Care model significantly reduces the cost of healthcare and keeps people healthier and more productive. Qliance studies show that self-insured businesses can lower healthcare costs by up to 30 percent by offering Direct Primary Care as an alternative to traditional insurance-based primary care.

How the EHOP Works

The majority of U.S. companies contract with insurers for healthcare benefits that remain a fixed cost throughout the term of the contract. If they reduce healthcare expenses by encouraging employee wellness, those savings benefit their insurance company. Moreover, employers’ premiums rise as health system costs increase, leaving them at the mercy of cost-shifting in an inefficient market.

Self-insurance under the EHOP converts approximately 70 to 80 percent of a company’s healthcare expense to a variable cost. As the company and the EHOP succeed in reducing healthcare spending, those underwriting profits flow directly back to the employer, who is now an owner of the “captive” insurance plan. The EHOP also includes reinsurance to limit the employer’s financial risk.

Finally, EHOP participants pay no out-of-pocket costs for care in their Direct Primary Care medical home. Having comprehensive primary care available at no cost enables employees to better manage a higher deductible for hospitalizations or specialty care.

For more information on the EHOP, visit www.physiciancaredirect.com/employers.

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