‘Direct primary care’ shown to please patients and reduce costs, including for imaging

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 - Steth and Piggy

Giving patients unrestricted, on-demand access to primary-care doctors for a fixed monthly fee cuts overall care costs by almost 20 percent while also improving patient satisfaction.

That’s according to an analysis of claims data by Qliance Medical Management Inc., the six-clinic, for-profit provider of direct primary care in and around Seattle.

The company combed through insurance claims filed in 2013 and 2014 for around 4,000 of its patients covered by employer benefit plans, according to a Qliance announcement. Comparing the cost of their care to that of patients who worked for the same employers but did not opt into Qliance, it found total savings of $679,000 per 1,000 Qliance patients, or 19.6 percent, on total claims.

The company said the savings derived from “a marked reduction in expensive emergency room visits, inpatient care, specialist visits and advanced radiology, which more than made up for the higher investment in primary care for Qliance patients.”

Despite the lower expenditures, patients of the practice who responded to HHS’s 2014 CAHPS survey placed it above the 95th percentile nationally in general patient satisfaction, according to the company.

The company said its analysis excluded claims incurred by Qliance patients prior to first Qliance visit.

Looking at advanced radiology, the company found that fewer exams were performed on its patients than on non-Qliance patients (310 per 1,000 versus 434 per 1,000), a difference of 29%, which rang up a savings of $82 per patient per year.

This was substantially less impressive than the savings Qliance observed for specialist visits, which realized some $436 in lower costs per patient per year.  

“At a time when our country is struggling to make healthcare less costly, our results confirm that primary care, when made more personalized and accessible to patients, can lower specialty and hospital costs, and keep people healthier and more productive,” said Qliance CEO Erika Bliss, MD, in prepared remarks.

A recent article in Time that largely lauded Qliance pointed out that there is a catch with concierge care, Qliance’s rendition of which costs around $65 per patient per month.

“Docs on the treadmill (of standard primary care) are often responsible for 2,000, 2,500 or even 3,000 patients each,” wrote journalist David Von Drehle. “Direct-primary-care doctors serve far fewer patients. In a nation where there is already a shortage of primary caregivers, this would seem to disqualify direct care as a mass solution.”

Still, judging by Qliance’s success with the model, the American healthcare system does have room for it. The company noted in its announcement that it grew 300 percent in 2014, along the way adding 15,000 new Medicaid patients and becoming the first direct primary care provider in the country to join traditional health plans on the Affordable Care Act’s health insurance exchange.