The Qliance Direct Primary Care Medical Home: Improving Care and Reducing CostsPresented to: CLG Employer Resources

Erika Bliss, MD – President & CEO of QlianceAugust 9, 2012

Current Healthcare Costs: Fiscal Cancer

$2,520

$80

Healthcare Costs (in bil-lions)

Specialty & Other

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17% of GDP, projected to be >19% by 2017

62% of bankruptcies in 2010 were due to medical expenses

Primary care is severely underfunded (only represents 3% of medical expenditures)

Burdensome fee-for-service insurance billing system undermines potential of primary care

Total annual healthcare costs = $2.6T ($8047 per person per year)

The Effect of Inadequate Primary Care

($$$) Emergency

Care

($$$) Hospital

Care

($$$) Specialist

Care

($$$) End of

Life Care

Primary Care

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An ineffective primary care system pushes patients to expensive down-stream care.

The result is an increase in health care costs for employers and employees.

Effective Primary Care Changes the Dynamic…

($) Emergency

Care

($)Hospital

Care

($) Specialist

Care

($)End of

Life Care

Primary Care

Primary care can address 80-90% of medical issues

Primary care can catch little problems (hyperglycemia) before they become big problems (diabetes)

Robust primary care reduces need for expensive downstream care

But, good primary care requires doctors to spend time with their patients

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The Solution:

• Operate outside of traditional insurance– reserve insurance for undesirable, costly events– pay direct for primary care which is desirable and low-cost– eliminate high administrative overhead for primary care practices

• Charge a monthly fee– low-cost: $64 per month– eliminates negative incentives of the fee-for-service system– incentivizes doctors to focus on holistic care– no co-pays or additional charges for visits and services

• Provide great access– limit patient panel size– offer 30-60 minute appointments– multi-modal access, including office, phone, and e-visits– extended office hours and weekend hours– 24x7 physician coverage

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The Qliance Mission

Re-establish the direct relationship between doctor and patient, allowing time to develop trust and foster a partnership that promotes and sustains health.

Dedicate ourselves to providing care that is personal, high-quality, accessible, and most of all, humane.

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“If you give them enough time, your patients will tell you what is wrong with them. Time to listen to a patient is what is missing in today’s system.” -Garrison Bliss, MD, Qliance Founder

Qliance: All-Inclusive Primary CarePreventiv

e Care

Wellness Care

Chronic Disease

Management

Urgent Care

Specialist & Hospital

Care Coordinatio

n

Behavior & Lifestyle

Management

Enhance primary care to increase quality & control

costs

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Qliance Patients Use Less Downstream Care

8

Type of ReferralQliance #

per year/1000*

Benchmark*

*Differenc

eSavings PMPY***

Specialist Visits 670 2000 -66% $199.50

ER Visits 56 158 -65% $153.00

Hospitalizations (visits) 34 53 -35% ---

Hospitalizations (in days) 105 184 -43% $186.56

Advanced Radiology 300 800 -63% $400.00

Surgeries 22 124 -82% $306.00

Primary Care Visits 3540 1847 +92% $0****

Savings Per Member Per Year --- --- --- $1,245.06* Based on best available internal data, may not capture all non-primary care claims. ** Based on regional benchmarks from Ingenix and other sources.*** Based on average costs in WA State.****No additional cost for additional primary care visits in the Qliance model.Source: Qliance Medical Group non-Medicare patients, 2010 (n=3,088)

How Does Qliance Improve Member Health?•Gives members the care and resources they need the way they want it. They want:– To feel better– To not feel rushed, with:

Enough time with their doctor to understand what’s wrong and what they need to do next

Enough time with their doctor to understand their choices

– Appointments when they need them– Convenience (onsite lab, common DME, X-rays, etc.)– Help over the phone or by email instead of coming in– Expert advice on the best specialists or hospitals to get

the best care

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How Does Qliance Reduce the Overall Cost of Care?• By shifting focus to primary care that includes at no

extra cost to the member:– Longer appointments– Basic x-rays and labs onsite– First fill drug dispensary– Routine DME

• Establishing trusting relationship with patients so we can positively influence their decisions and behaviors

• Being available when patients need us so they don’t have to go to urgent care or emergency rooms

• Reducing self-referral to specialists• Coordinating specialist, ancillary, and hospital care,

making sure they get the right care at the right time

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Plan Integration Examples

PPO• Plan design & contribution can drive

participation • High deductible not required • Higher OV copay incorporates well

HDHP• Provides soft bridge to higher deductible• Can work well with Account Based plans (HRA)• Put Q before HRA to maximize participation

and value to employee

Self-Funded

• Employer gets full benefit from the Qliance claims impact

• Can incorporate into plan design (tiered benefit) or just use as a network

• Provide claims history for financial analysis to show areas of savings

• Utilization reporting provided• New Cigna Level-Funded Partnership with

discounted rates

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Our ClinicsDowntown Seattle509 Olive WaySuite 1607Seattle, WA 98101

Kent Station521 2nd Place NorthSuite 103Kent, WA 98032

Mercer Island7707 SE 27th StreetSuite 104Mercer Island, WA 98040

Mill CreekGuardian Family Care (Qliance affiliated clinic)805 – 164th Street SESuite 100Mill Creek, WA 98012

Tacoma2420 S. Union Avenue Suite 100Tacoma, WA 98405

Opening soon in

Bellevue!