Qliance is a Seattle-based medical practice which does not accept insurance payments or participate in the Medicare or Medicaid programs. Instead it charges patients a flat monthly fee that covers basic primary care services. (website) The monthly charge ranges from $49 to $129, depending on age and service level selected. The fee gives a patient unrestricted seven day a week access to a provider. It includes same or next-day appointments for urgent care, lengthy office visits and phone and email access to physicians. Level 1 enrollees receive care from a family medicine physician or nurse practitioner and get remote coordination of hospital care. Level 2 enrollees receive care from an internal medicine physician and have onsite hospital coordination. The practice apparently has an on-site laboratory and imaging center. The care is described as team-based and similar to a medical-home model. The fee does not include payment for hospital or other facility charges or the services of providers not employed by Qliance. Qliance patients are encouraged to purchase catastrophic or comprehensive insurance to cover other health care charges.
There are estimated to be about 50 similar medical practices around the country. Some describe themselves as offering concierge medicine; all tend to use the medical home concept to describe their approach. They claim to be offering a higher quality, more patient friendly version of primary health care. Given the level of physician frustration; it won’t be surprising to see this model continue to expand. It is unclear how large the patient market is; how many people will feel they can pay this monthly fee on top of insurance or out-of-pocket fees. There is also uncertainty caused by reform efforts and by state regulations. In the past some states have treated flat fee arrangements as a form of insurance. What these new clinic models do demonstrate very clearly is that there is a strong innovative force in American health care that if allowed to express itself may find better ways to improve medical care than Congress will.