Extremely Great and Incredibly Cheap

Qliance Ends the "Learned Helplessness" of the American Medical System

Extremely Great and 
Incredibly Cheap

Kelly O

This article was purchased in our annual charity auction. More info at strangercrombie.com.

STRANGERCROMBIE WINNER! This article was bought-and-paid-for in The Stranger’s annual charity auction—which this year raised more than $50,000 for the Seattle nonprofit Treehouse, helping foster kids since 1988. Thank you, everybody!

In the fall of 2005, Erika Bliss, MD, was helping a friend install a hardwood floor and got a splinter—a big one, deep under her fingernail. "I can see why they use that as torture," said Dr. Bliss, sitting in an examining room last week. "It hurt so badly, I couldn't think straight." She couldn't remove the splinter, nor could her friend. It was Sunday and her doctor's office was closed. Dr. Bliss went to the emergency room.

"I knew the doctors there, and they got me treated quickly and that part was lovely," Dr. Bliss said. "They injected some lidocaine into my finger, pulled the splinter, and gave me a tetanus shot. Take a wild guess how much that cost." She paused. "Twelve hundred dollars."

If Qliance, Dr. Bliss's revolutionary new medical group, had existed back then, she could've come in on a Sunday, had her splinter pulled, and left without paying a penny.

For the past 14 months, Dr. Bliss and a few other doctors in downtown Seattle have been running a radical experiment in health care. They've sidestepped the entire health-insurance industry by opening a practice that gives direct primary care to their patients for a monthly fee ranging from $49 to $129. "Think of it like a gym," says member services associate Meg Tronquet. "You can use it as much or as little as you like."

Qliance keeps patients out of hospitals and costs down by having an on-site digital X-ray machine, a lab, and a dispensary that sells generic drugs at cost, so patients don't have to pay extreme pharmacy markup. They're open seven days a week, allowing people without health insurance to get reasonably priced primary care, preventing who knows how many catastrophically expensive visits to the emergency room.

That saves public money, too, since many people who can't afford insurance—and whose visits to the emergency room have to be written off as a public cost—can afford Qliance. Governor Christine Gregoire's proposed budget for 2009 eviscerates public-health spending, including a $252 million (or 42 percent) cut in the state's Basic Health plan and elimination of medical care for people on the General Assistance Unemployable program. Qliance may be exactly what many of those people need.

Even people with insurance are thrilled about Qliance. Dustin Johnson, who has health insurance through his job at the nonprofit Housing Resources Group, goes to Qliance for his primary care.

"The benefits are astounding," he says. "Qliance has the only doctors with a true doctor-patient relationship with an exchange of ideas, and the attention is really remarkable." Johnson's first appointment was an hour and a half long—Qliance prides itself on unhurried appointments—in which he described his chronic kidney issues, which had him going to the emergency room several times each year. (Johnson, who is 24, has had seven surgeries for kidney stones in the last 10 years.) His doctor, Erika Bliss, said she'd do some research and get back to him.

"I've heard that before," Johnson says. "It usually means the doctor will reference a book for a minute." At his second appointment, Dr. Bliss brought in a thick stack of research, which she had read and synopsized for Johnson, then described a new strategy to treat his kidney problems. He hasn't been back to the emergency room since. He's so excited about Qliance, he's nominated them for the annual Warren Featherstone Reid Award for Excellence in Healthcare.

Some other success stories from the last 14 months at the Qliance Medical Group:

A high-school student separated his shoulder and, instead of going to the emergency room, went to Qliance, where he was diagnosed, x-rayed, treated, and given exercises to do, all for $39.

Compare that with another patient (who asked to remain anonymous for privacy reasons), a real-estate agent in Seattle, who doesn't have comprehensive insurance, only has a high-deductible plan. He cut his finger and was told by his doctor at Swedish to go to the emergency room. Ultimately, he wound up paying $700 for six stitches. When the agent first heard about Qliance from a friend, and that stitches are included in the monthly benefits, he said "couldn't believe it." He's been a member for eight months and says he couldn't be happier.

"People get so trashed out there in the insurance system," says Dr. Garrison Bliss, a founder of Qliance. "It's amazing that people put up with it—it's a kind of learned helplessness."

Another high-school student, a teenager with depression, started coming to Qliance several times a month to meet with her doctor, discuss issues, set goals, and monitor medications. Because Qliance has no co-pay and no insurance, her appointments are completely confidential. Otherwise, she may not have come in for help.

Patients with hypertension and diabetes have been able to get their conditions under control by checking in with the doctor every week—previously, they hadn't been able to afford it—preventing emergency-room visits and the worsening of their own health.

Another patient with dangerously high blood pressure had stopped seeing doctors and taking her medication because (a) it was expensive and (b) she felt like doctors weren't listening to her. Through a slow process of building rapport, one of the Qliance doctors convinced her to take a regime of blood- pressure medication and teased a family medical history out of her. The history combined with a CAT scan showed the hereditary polycystic kidney disease, which can cause brain aneurysms. (The patient's mother had died of an aneurysm at 39.) Further investigation revealed two aneurysms in the patient that were repaired last summer. The patient, according to a report from her doctor, "is alive and well, without complications. I feel that having enough time to spend with patients in order to obtain a thorough family history is what allowed me to make this diagnosis." That diagnosis probably saved her life.

Because Qliance doesn't mess with insurance, even outside consultations can be radically cheap. They've negotiated a $20 consultation rate with a radiologists' group to look at X-rays taken in the Qliance office. "You can't find a $20 X-ray anywhere," says Dr. Erika Bliss. She talks about how happy she feels being able to make decisions about care and treatments directly with her patients, without the interference of an insurance company and what it will and won't cover.

"I tell you," she says, shaking her head, "no matter what, I am never going back." recommended

Find Qliance at www.qliance.com


Comments (24) RSS

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So, I'm forced to ask, what's the downside?
Posted by Pete Mitchell on January 21, 2009 at 4:42 PM · Report this
This does kind of read like the bought this article in the Strangercrombie auction.
Posted by elenchos on January 21, 2009 at 5:33 PM · Report this
Sounds sort of like a "micro" version of the old Group Health cooperative of the 50's and 60's to me.
Posted by Q8dhimmi on January 21, 2009 at 9:42 PM · Report this
Doctors who actually LISTEN to their patients? That's hard to find at any cost... and the fact that it's actually affordable for most people is just too ironic for words.
Posted by SeattleMama on January 22, 2009 at 12:07 AM · Report this
I have bipolar disorder (currently on Lithium but having severe suicidal ideation) and HIV (high T-cells (~950) and low VL (~115), so not on ARVs). Is Qliance an option for me?
Posted by EndOfMyRope on January 22, 2009 at 6:07 AM · Report this
Oh crap, it is a strangercrombie auction winner. My browser had blocked the banner image.
Posted by elenchos on January 22, 2009 at 9:32 AM · Report this
To the person with bipolar disorder, and HIV,..YES! Qliance is for you, there are doctors who meet regularly with people living with HIV. Go NOW
Posted by qliance advocate on January 22, 2009 at 11:52 AM · Report this
The downside is not to the doctors in the system who limit their practice to 800 and charge on average $50 a month (over $480,000 a year). And the patients benefit. The loss is to the insurance companies.

They only have a few providers and in the lower tier some of them are nurse practioners (which give great care) but if every doctor did this what you would do is push low income people onto other providers. The interesting experiment would be if the State paid for some of the people with chronic conditions like diabetes (10% of all patients account for 70% of care) to use the service and compare the outcome in quality and cost. In Medicine we test everything else before we prescribe it as a solution so it is a simple test. 3 sets of patients diabetes, heart disease and depression at 3 locations. 1 at Group Health, 1 at Swedish and 1 at Qliance.

Most doc's have about 2,000 on their panel and there is a huge shortage of primary care docs so perhaps this would encourage more docs to go into primary care again? The transition will be ugly though. Think private school vs public school.
Posted by Sostane on January 22, 2009 at 1:13 PM · Report this
To the "qliance advocate". Thank you for responding to my post, but your response has pretty much indicated that Qliance would NOT be helpful. Assuming that the providers there listen as poorly as you comprehend the written word, it seems that my most pressing problems (i.e. SEVERE suicidal ideation) would be ignored to focus on something else that is not as pressing. But thanks again for responding, you've prevented me from getting my hopes up and wasting my time trying to get help from somebody who just doesn't get it.
Posted by EndOfMyRope on January 23, 2009 at 8:39 AM · Report this
sounds great, except that it misses the main point of insurance which is to provide coverage in emergencies or for seroius illnesses. what happens when your primary care doctor finds that you have cancer or a brain tumor? while insurance is certainly screwed, it does come in handy when you need surgery, chemo, or other treatments. without access to specialists and hospitals, patients could be in real danger.
Posted by mc on January 23, 2009 at 9:01 AM · Report this
I believe the idea (which for some reason is not fully articulated in this article) is to use this for regular things but keep a 'catastrophic' health insurance policy to cover true emergencies, cancer, etc. That way you're not going to the ER for a splinter.
Posted by kat on January 23, 2009 at 12:17 PM · Report this
MC- they certainly aren't advocating not having insurance. On the contrary - they are saying that insurance provides a disservice in primary care situations. The doctors at Qliance always have advocated (to me) that people should have a high deductible plan (for catastrophic illnesses or injuries that require specialists, hospital stays, surgeries, etc) but to go to them for primary care because you get better service, which translates into them catching more things that would otherwise be ignored, which leads to less reliance on insurance because issues are dealt with BEFORE they become catastrophic.

Endofmyrope - yes, the doctors at Qliance can (most likely) help you. They would address both problems and would take both situations seriously and treat you with complete respect. If you are discounting Qliance because of one persons response - that's a shame.
Posted by DJ on January 23, 2009 at 7:39 PM · Report this
EndOfMyRope: Remember this is primary care. I am not a medical professional, but you may have something more complex. You may need a specialst beyond what they may be able to do for you.

Sorry to state the obvious, but have you told the Doctor who prescribed the Lithium about your side effects?

If you doctor is no longer helpful, I would suggest you consult with them, at least for a second opinion, and if they can't help with everything, you are not out of a lot of money, and only an hour or two of time.

Please don't give up trying to get that addressed, whatever you do.
Posted by Michael J on January 23, 2009 at 8:17 PM · Report this
@EndOfMyRope, you can visit the website and get a pretty good idea of the services they provide. I'm bipolar, too, so paid special attention to their statements about mental health. They do not provide more than "primary care level" services for mental health. For me, that's okay as my illness is well managed and mostly what I need is someone to check in with now and then. Judging only by your two comments here, I'd say that you need something far more comprehensive in that department.
Posted by emily ann on January 23, 2009 at 10:34 PM · Report this
while having both catastrophic and qliance is ideal, who can afford that? for our family of four, we pay over $400 for a super high deductible, cover nothing plan. to add this service would be another $200 per month. how many consumers can do this?
Posted by mc on January 24, 2009 at 4:16 PM · Report this
MC has it right. While I appreciate the change in paradigm that QLiance represents, and it does seem that they offer a fine and mostly affordable approach to maintenance and non-catastrophic health care. But the main point of real insurance is to deal with the astronomical costs of the relatively extreme measures required when catastrophe stikes, exactly the situation where QLiance shows you the door (as I understand it. QLiance offers nothing for that, so you still need to insure yourself for the unthinkable. Suddenly that $129/month, or even less, doesn't seem so cheap when you still need to pony up for a regular policy, with a high deductible presumably.
The problem is that in hindsight it's obvious that traditional insurance should never have been allowed to apply to the routine care and screening or minor accident care. If we could uncouple that from the catastrophic coverage we could possibly begin to return to a rational system where we know our providers and vice versa. But I'm not ready to go without catastrophic coverage or pay two health insurance bills anytime soon.
Posted by Modus Op on January 24, 2009 at 9:39 PM · Report this
EndOfMyRope, call the Crisis Clinic at (206) 461-3222. They can help!
Posted by Bethany Jean Clement on January 25, 2009 at 2:24 PM · Report this
I like the idea of an unlimited monthly use Primary Care Provider (PCP) but I'm also not convinced it's a perfect solution for low income individuals (Disclaimer: Nothing really is...)

As has been pointed out, what it sounds like you are essentially buying is a PCP rider to whatever insurance policy you also carry. While many issues can be handled in the primary care setting, those at QLiance are right to suggest a catastrophic coverage plan as well. So as I've already mentioned you end up with a catastrophic plan with a PCP rider. That's actually probably very good coverage but it's not bargain basement cheap.

It's probably a very good option for a middle-class worker who doesn't get good insurance from work but has chronic health issues that need addressed many times per year.
Posted by tempo36 on March 8, 2009 at 1:10 PM · Report this
mc: Like the real-estate agent in this article, couple Qliance membership with a (relatively) cheap major medical plan to pay for the cancer treatment, surgery and road-traffic-accidents and you have yourself a workable, somewhat comprehensive model.

And EndOfMyRope: Are you really assessing the value of care at Qliance based on a posting in the comments section of The Stranger? Really?! I don't think this is a good idea. Go there yourself to see if these people can help you. You plainly need some assistance. What do you have to lose?
Posted by adovelikeboy on March 11, 2009 at 10:06 PM · Report this
Qliance hmmm. this was on my mind for a while. good article.
Posted by life on March 24, 2009 at 5:33 AM · Report this
Gee, EndOfMyRope, sounds like you're looking for any reason you can find for wallowing in your misery. How about you stop whining that nothing will ever work long enough to investigate?

Or am I being too mean? Do you need me to rubberstamp that life's a bitch,then you die and it will always suck to be you? OK. Done. Die already. If you have no wish to get off the nail you're sitting on, then shut up forever and stop wasting the oxygen of productive people who have a desire at least investigate ways to have a better life. How quintessentially Seattle is your pathetic mindset! Number 1 reason I stopped reading the Stranger.
Posted by bleedshawkblue on July 1, 2009 at 3:38 PM · Report this
Ansola 22
It's an interesting concept for anyone living downtown. I grew up without health insurance and then went on to work for a health insurance company. The individual responsibility portion is lacking in today's healthcare environment. However, when health insurance companies start pushing "wellness programs" you know it's going to lead to penalties for those who don't follow THEIR definition of wellness. I like this concept as it promotes individual responsibility. Although I am suspicious of anything FOX news promotes... Qliance be careful of going too corporate and nationalized. Would you offer contraception and abortion services?
Posted by Ansola on July 9, 2009 at 12:20 PM · Report this
Called and talked to these folks today, and I'm going to give it a try. My wife just broke her hand and we have no insurance coverage until November 2010... Urgent care would charge $1250 for a visit, X-ray, radiologist reading, splint/cast and cast removal. I figure we're only out $150 or so ($99 charge plus her monthly fee for the first month @ $64... and I hear the fee is waived if she signs up as a member). I could cover the family's wellness care for $265/mo? If it works, I'm sold. Stay tuned and I'll report on what we get for our $153.
Posted by big_john on May 17, 2010 at 4:54 PM · Report this
Income 24
How has Qliance developed since this was posted? I would be interested to read a follow-up to hear how successful the concept has been.
Posted by Income http://www.activequote.com/income-protection/ on September 28, 2012 at 9:11 AM · Report this

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