Friday, September 11, 2009
Wednesday, May 20, 2009
Early last year, I converted our health insurance to an Anthem Blue Cross/Blue Shield Lumenos high deductible policy ($10K individual, $20K family). The premium was only $265/month (though it increased to $304/mo. several months later). The plan encourages a healthier lifestyle by offering preventive care routine exams and programs to kick bad habits such as smoking and overeating free of charge. The invoices from the emergency room visit have arrived. The initial charges were $1,281 for the hospital and the physician charged $528 for a total of $1,809. That's what I would have been asked to pay if I did not have insurance. Though I still pay the providers directly myself for anything under my deductible, I get the benefit of their "contracted" prices which reduced the expenses to $704 and $160, respectively or $864 total (a 52% discount). Not bad. However, I am fairly confident from my recent visit to the clinic that Qliance could have handled the situation without a trip to the emergency room. Assuming $60/month, that single visit would have paid for over 14 months of primary care at Qliance at the discounted "insured" prices and 2 1/2 years at the "uninsured" prices. That does not even factor in the prescriptions which may have been available from Qliance at a lower price. So far, the high deducible insurance plan has worked well for us but we would be prime candidates for Qliance if it were available here to mitigate some our exposure to the high deductible.
Keep up the good work.
Tuesday, March 31, 2009
Patients come to Qliance from many different places. Some come to us from excellent, long-term patient-doctor relationships, others come from having no doctor at all. Some are unaware of the challenges the current insurance-based system presents, others, like Tess, join Qliance because they are simply fed up. In the letter below, Tess shares her frustrations with her former doctor and expounds on some of the many downfalls of our current medical system.
February 16, 2009
I wanted to let you and your colleagues know the reason for my leaving your care. I have been a patient at [your clinic] for several years, but have now become a member of Qliance, a relatively new practice in downtown Seattle.
Since I am self-insured and carry a high-deductible “catastrophic” plan (for which I pay $163 monthly), I rarely come to see you unless it’s really necessary. The last time I came in was for my shoulder, which I had injured when I fell on the snow. I talked with you for maybe 4 minutes, x-rays were taken, and the visit cost me $180.
I understand that the insurance companies are really at fault here. They require you to handle a certain volume of patients, and you don’t have much time with each one. I’m sure you and your staff spend countless hours documenting every diagnosis and recommendation to the insurance companies. I’m not alone in believing that the insurance companies have become an evil pox on our medical system.
To give an even more extreme example, last year I cut my hand with a utility knife and went to the emergency room. For 4 stitches (and the appropriate cleaning and tetanus shot) I paid $1200. It’s criminal.
I recently heard about Qliance, which is a group of doctors who have formed a practice based on patients paying a monthly membership fee. They don’t accept insurance and are able to offer all kinds of preventative and simple urgent care on site, with discounted prescriptions and lab tests at just over cost. I pay $69 monthly and can see my doctor as often as I want-for no additional payment.
I went to my first visit last week and was astonished that the doctor spent over and hour with me, getting to know my medical history and me. Today I had my pap (no charge), breast exam (no charge), blood tests ($21) and some skin tags removed (no charge), which all took about an hour and a half of my doctor’s time. Finally, she has suggested I try changing from Lexapro to the generic (Citalopram Hydrobromide), which will cost $4/month instead of $93/month.
And just so you don’t assume that they are a government-supported, low-income clinic, they’re not. Their monthly membership rate is based solely on age, not income or any other factor. For more information, they are at www.Qliance.com.
I appreciate that you’ve always been kind and encouraging when I’ve come to see you. I think you’re a very nice person. However, the consistently short amount of time I spend with you when I come in for my infrequent visits often leaves me feeling like I’m a piece of meat on an assembly line. And while the medical assistants have always been polite, the office staff has always given the impression of being way overloaded, stressed and hurried. They never ask how I am, what the weather is doing or other small talk and on the phone they are clearly just trying to get to the next phone call-probably because they have too much to do among too few staff.
I’m sorry to write so negatively about your clinic, but I thought it was time to let you know. I don’t blame you personally, but rather, I blame the system where insurance companies can dictate how many patients you should see in a day or a week, and how much paperwork the support staff is require to manage. Maybe clinic like yours have a high profit margin and everyone is getting paid way too much. I kind of doubt it.
However, in writing this I realize that there is a very basic thing that your clinic and others could do if you really cared: ask your patients about how they feel about the service provided. For so long I have just assumed that the way I’ve been treated by the health care system is just something to put up with, but now I’m thinking, do you really not care to ask your patients how you’re doing and try to improve, just like most other businesses take the time to do?
Please feel free to share this letter with anyone you like, especially your partners and/or the insurance companies. I know it won’t make a big impact, but it’s time for something to change in our country’s medical system and I wanted to voice my opinion for whatever it’s worth.
I wish you well.
Tuesday, October 21, 2008
5 star rating
* * * * *
When I describe how Qliance provides medical insurance of a incomparably better quality than normal insurance, and far cheaper as well, my audience usually squints at me, squirting disbelief all over my lapel. You can read the article sourced at the end of my review, but let me explain how Qliance works.
In short:40 cents of every dollar you spend on primary care is lost to administrative overhead, such as billing, filing, and buying cute scrubs for the nurses.
Qliance charges a monthly fee for primary medical care, rather than requiring medical insurance. By doing this, they save that 40 cents from every dollar. Thuslyhenceforth, they can afford to spend more time with patients (30 - 60 minutes per visit), longer hours, same-day visits, hours 7 days a week, and provide better overall healthcare for cheaper.
Hard to believe, isn't it? People are so used to being bent over by their insurance, Qliance sounds too good to be true. I was skeptical as well, but, currently having no insurance, decided I'd sign up.
People? It's a miracle.
I pay about $45/month for all my primary care needs (their fee is based on age). They can do lab tests on-site for free, or a small fee if it's unusual, and they even have a pharmacy on-site that provides most basic prescriptions for much, much cheaper than you'll get through your insurance.
The doctors are all lovely people, and can take the time to get to know you, and - most importantly - LISTEN. They don't have to funnel patients through their office just to make a buck, so they can actually pay attention to what you're saying, which, believe it or not, is mother-flipping crucial for an accurate diagnosis.
For example: I saw my old doctor because of some lower back pain I had. After dismissively nodding and feigning concern, he bustled me out of his office in under 10 minutes saying I should try "relaxing". I went to Qliance, and guess what? It turns out my back pain was from a stop sign that had somehow been impaled into my midsection. Qliance really listens, and the results are wondrous.
But seriously: I just discovered another benefit of having a flat fee, rather than a co-pay: Doctors have no incentive to get you into their office just to milk that co-pay out of you.
(Warning: Deliciously graphic medical problem described.)
Recently, during a rowdy game of basketed-ball, my toe got stepped on. Unsheathing it from my shoe scabbard, I saw that my big toe was swollen and the nail swimming with subcutaneous blood. After calling the office and talking with my doctor on the phone, she said that if I didn't want to come in, I could just email her a picture of my toe. I did, and all in one day, entirely over phone and email, we fixed my toe good as new. Un-frickin-believable.
Keep in mind that Qliance is only primary care. If you are shot in the leg during a gang fight, they can't help you. That's ER business friend, and that's what Catastrophic insurance is for. Catastrophic covers everything outside primary, such as a broken leg or what have you. Qliance recommends using them for primary, and getting Catastropic insurance through your employer, or on your own. The best thing is that that combination is still far cheaper than if you had normal insurance covering everything.
Not only is Qliance perfect for freelancers or the unemployed, it's good for EVERYONE. It's better healthcare for cheaper. DO IT.
Thursday, September 4, 2008
CEO, Qliance Medical Management Inc.
FULL DISCLOSURE: I run Qliance Medical Management, the company that the providers at Qliance Medical Group contract with to provide its business back end services.
But I’m also a patient at Qliance and I want to report on my extraordinary experience with this practice.
When I lived in California, I used Kaiser Permanente for my health care. They are similar to Group Health here in Washington, but much bigger. My last annual physical there was all of 15 minutes long, of which half the time was spent chatting with my doc about her new twin baby boys. She basically looked in my ears and eyes, listened to my lungs and pronounced me healthy. Oh, I think she may have had me get some lab tests too, but since they were taken after my physical, we really never had a chance to discuss them live.
At Qliance, my first physical was an hour and 45 minutes long. Talk about comprehensive! We reviewed my complete medical history, my medical records from Kaiser (amazing how Kaiser somehow reduced twelve or so years into three and a half pages), the prescriptions I take and how to reduce the cost of those, the need to schedule preventive care (like the colonoscopy that Kaiser would never agree to do, even though I’m over the age at which 99% of the primary care and GI docs recommend the screening), and how to get my weight down so I’d have a reasonable BMI. Clearly, my physician had made sure she scheduled sufficient time to really focus on wellness, having reviewed my medical records ahead of time.
If you’ve never been to a practice where the IT infrastructure supports incredible patient-centered care, you have to try Qliance. How are my lab results? Let’s pull them up on the tablet PC and review them (Qliance can do a number of labs while you’re in with your provider so that the results are available while you are still there, and for ones that need to be sent out, you can come in ahead of time if you like). How much will a colonoscopy cost me? An instant message goes out to a staff member and a minute and a half later, an IM comes back with my insurance company’s reimbursement policy. One more minute and the medical assistant comes in with a 12 page print-out for me from my insurance company about why colonoscopies are needed and how often they will pay for them. A referral to a great local GI doctor is made. Have some benign but unsightly skin blemishes? A little liquid nitrogen later, they’re on their way to becoming history. All 13 of them. No need to get approval from an insurance company (approval which most likely would not have been given since it wasn’t “medically necessary”). And no extra cost, since like all procedures they can do on-site, there is no charge unless you need to keep some expensive do-hickey (like an ankle brace), in which case you just reimburse Qliance for their cost, not some inflated price that encourages them to push unnecessary stuff on you. Oh, and did I mention the hearing test I got from Qliance the next day? No additional cost, of course.
So one week later, I feel invigorated. I’ve started Weight Watchers and I email my Qliance doc my weight every Tuesday so that she can put it in my records and we can talk about how it’s going. I’ve scheduled my long past-due colonoscopy, knowing now that my insurance company will reimburse 80% even though I haven’t hit my $2,500 deductible yet. And I’ve reduced the cost of my prescriptions by one third.
Give Qliance a try. They don’t take insurance, but their flat monthly care fees are incredibly low. You can bundle Qliance with a high deductible insurance plan for comprehensive specialist care and hospital coverage. And they can even point you in the right direction for plans that complement their primary and preventive care. You’ll get phenomenal care for less money. You won’t be sorry. Tell them Norm sent you.
Tuesday, August 19, 2008
JA Jance weighs in on her experience with Qliance:
"My husband and I have been honored and privileged to have Dr. Garrison Bliss in our lives for a number of years--first at Seattle Medical Associates and now at Qliance. The idea that you can actually speak to a doctor without having to jump through hoops is something that's often not a part of today's medical care. And to have a doctor with a sense of humor? Astonishing!
We travel a lot. Sometimes we stay at very nice places; sometimes at not so nice places. After a one-night stay at one of the latter, my husband and I both came down with scabies! (Now the words 'don't let the bedbugs bite' have a whole new meaning for us.) Being able to consult with Dr. Bliss over the phone and have his help in getting in to see a physician where we were was a huge help.
Making your way through a cancer diagnosis or dual knee replacement, isn't a walk in any park, either, but having a doctor who is your advocate at finding the best people and getting you in to see them in a timely fashion is a modern-day health-care miracle. And then there's the ability to speak to your medical provider when you happen to be far away but still need help that doesn't entail going to a local ER or tracking down a new physician.
All in all, when it comes to medical care, Qliance is our cup of tea."
Different patient perspectives are always interesting to hear, but a recurring theme seems to be our ability to manage care remotely. This is always surprising to people who hear about it, but is completely normal with our operation. It is pretty darn satisfying to provide that level of care.
If you feel like adding some suspense to your reading, check out JA Jance's website, I did!
Monday, June 30, 2008
"The beginning of my job at Qliance Primary Care was a complete whirlwind -a verifiable torrent of terms and explosion of facts. Never did I think that I would become nearly fluent in healthcare plans let alone Medicare; man was I naïve. My two month mark hits less than one week from today and it occurred to me today as I spoke with a potential patient how little I knew going in and how much I know now. I had read the website, devoured the information in preparation for my interviews and even thought about what a company like Qliance might mean for healthcare in general; I thought I got it. But after two months of in depth conversations with real patients about their actual situations, I realize what sort of an impact we can have not only on individual lives, but on the country as a whole. I am drawn to Qliance because despite having dreams of clinics throughout the nation, the underlying goal is to maintain a patient centered focus through small clinics and devoted doctors. Why should this seem so revolutionary? Because it is only now that I realize how rare a thing it is a doctor who works for patients.
I recently had my final doctor’s appointment with my family physician-she was the doctor that delivered me and has seen me throughout every major medical milestone in my life and now she was retiring. As I walked through the familiar mauve door into the Polyclinic, I smiled at the faded sign reading “PLEASE let the front desk know if you have been waiting longer than 20 minutes,” (the same sign that had been there since I was an infant) and breathed in the familiar yet strangely comforting smell of sanitizer mixed with rubber. My senses reeled as if I was unceremoniously thrust back into the womb and at that very moment I realized that the past three times I had visited this office, at none of them had I actually seen my physician. Now, I am a healthy young woman, I don’t smoke nor do I drink in excess, I wear my seatbelt and, despite recent meteorological events, try my damndest to get my daily dose of Vitamin D. I have even been known to complete a triathlon or two. My point is, is that for my once per year visit (and it truly has been only once a year) I expect to see my doctor-is that too much to ask? Yet when I sat on the crinkly exam table, my back goose-bumped from the draft, I finally understood how Qliance is different and why we are, in fact, so great.Now that I am a Qliance patient, I can truly see my doctor whenever I want. Obviously she can’t work 7 days a week, but the times that I don’t see her I know that she will correspond with the treating physician to keep herself apprised of my condition."