Doctors keep it simple, ditch insurance


Photo by Susan Bavisotto

Dr. Brian Forrest

This pricing structure saves their uninsured patients about 80% on their out-of-pocket costs, Dr. Forrest said. But it’s also a money saver for insured patients, he said.

The reason Access can keep the prices low is the lack of overhead costs associated with participating in insurance contracts. Dr. Forrest estimated that by not billing insurance, a typical practice can decrease its overhead costs by about $225,000-$250,000 per physician per year.

"We don’t need that heavy staffing because we’re not filing or coding or billing or anything like that," Dr. Forrest said.

Dr. Forrest’s model – known as direct primary care – has attracted interest from businesses that want to provide access to primary care to their employees.

For instance, a local sushi restaurant wanted to provide health care for its 12 employees but couldn’t afford the cost of health insurance for the group. The owner contracted with Dr. Forrest’s practice and pays $39 per month per employee.

This type of model allows patients to get nearly unlimited access to primary care at a low and predictable price. However, it doesn’t cover services outside of primary care such as specialist visits, hospitalizations, and surgeries. As a result some employers have chosen to couple the direct primary care option with high-deductible insurance plans.

Putting the focus on primary care helps keep down costs in other areas too, according to Dr. Forrest. Patients at Access have lower than average hospitalization rates, he said.

Next steps in direct primary care

The direct primary care model has advantages over simply going cash only, said Dr. Erika Bliss, the president and CEO of Qliance Medical Management, a company that has pioneered the direct primary care model on the West Coast. Qliance charges a flat monthly fee for unrestricted primary care services at its five primary care clinics in the Puget Sound area of Washington.

The biggest advantage to the monthly fee approach is that it moves away from fee for service, Dr. Bliss said. Going cash only is a start, but it still leaves physicians stuck with volume incentives.

"When you’re getting paid by the service, it changes the way you think about it," Dr. Bliss said. "You’re thinking, ‘If I’m going to make enough money, I need to see X number of patients a day and I need to get paid X amount per visit.’ It’s hard to layer on top of that true population-based care."

Qliance is taking the direct primary care model farther. Qliance, which already contracts with large employers like Expedia, is now being offered on the Washington state health insurance exchange as part of the Coordinated Care Ambetter health plan for individuals.

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