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January 13, 2013 | By Dr.Ferdowsi — As states gear up to establish health insurance exchanges by 2014, one provision in the federal health care reform law has gone largely unnoticed. Yet experts say it could open the door to a new medical practice model called direct primary care.
Direct primary care is viewed as one way to improve access to affordable health care by charging patients a monthly fee of less than $100 for unlimited access to primary care, eliminating the need for insurance. It will be available to consumers on the state health care exchanges established by the Patient Protection and Affordable Care Act.
Although it may be new to most people, direct primary care has been flourishing in Washington state since 2007 when physician Garrison Bliss opened the first practice.
The concept initially was not universally embraced by state officials who were concerned that direct primary care would “cherry pick the wealthiest and the healthiest” patients, Bliss says. There was also confusion over how these practices would be regulated. Despite the skepticism, Qliance had the support of some influential believers, such as Amazon founder Jeff Bezos and Dell Computer pioneer Michael Dell. Both are major investors in Qliance, which declines to disclose its revenue.
Today Qliance operates five clinics in Washington. The largest is in Seattle, which employs six full-time doctors and a nurse. As of 2011, there are 24 direct primary care practices in the state serving 10,525 patients.
The concept has proven to be popular among small and midsize employers, many of which pay for part of their employees’ membership fee. About 60 percent of Qliance’s clients come from small to midsize businesses and unions, but the company is in negotiations with a major employer that wants to develop an onsite direct primary care clinic.