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.” 
Find Qliance at www.qliance.com
So, I’m forced to ask, what’s the downside?
This does kind of read like the bought this article in the Strangercrombie auction.
Sounds sort of like a “micro” version of the old Group Health cooperative of the 50’s and 60’s to me.
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.
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?
Oh crap, it is a strangercrombie auction winner. My browser had blocked the banner image.
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
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.
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.
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.
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.
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.
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.
@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.
dj,
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?
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.
EndOfMyRope, call the Crisis Clinic at (206) 461-3222. They can help!
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.
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?
Qliance hmmm. this was on my mind for a while. good article.
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.
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?
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.