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TRENDING STORY … “Qliance pivots toward employers in a post-ACA health insurance market. PLUS, DPC “C-Suite” Weigh-In.

Additional Commentary (SEE BELOW) obtained from A Few of DPC’s C-Suite Executives and Physicians 

Plus, DPC Journal interviews with: James J. Eischen, Jr., Esq., Partner at HIGGS, FLETCHER & MACK LLP; Dr. John Blanchard, CEO of Premier Private Physicians Management, LLC in Michigan; Zak Holdsworth, CEO of Hint Health; Michael Tetreault, Editor in Chief of The DPC Journal and CMT; Dr. Samir Qamar, CEO of MedLion; Bill Cossart, CEO/Founder of MedFirst Partners; and others … weigh-in on what this means for future of DPC.

By Annie Zak, Staff Writer, Puget Sound Business Journal

Dr. Erika Bliss of Qliance.

Dr. Erika Bliss of Qliance.

AUGUST 6, 2015 – Seattle-based health clinic chain Qliance is feeling the impact of the Affordable Care Act, and tweaking its business model in response.

Qliance has long been a provider of primary care to employers, unions, Medicaid and uninsured individuals. But CEO Erika Bliss said that since the 2010 passage of the ACA, more employers have been coming to Qliance with questions about how to tie together new health care innovations that are cropping up in hospitals and primary care settings.

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dpc white papersThose include telemedicine, employee wellness programs, patient engagement strategies and more.

As a result, Qliance is now pivoting its business model toward employers and planning to make all of those services available in one place. The company just raised about $2.7 million from existing investors, partly to upgrade its software systems to provide these types of services.

“We’re trying to take all of our learnings and build the next generation of Qliance,” she said. “We’ll have to invest in technology and partnerships and revamping how we do things. We’re focusing on employers.”

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EMPLOYER and PHYSICIANS working together … this topic was “TOP of MIND” in Atlanta, GA last week as a large group “plenary session” which was held at The Westin Peachtree Plaza. DPC Journal Publisher and Managing Director, Catherine Sykes and Worksite Rx’s Chairman, Bill Bennett, met with physicians to discuss these strategies in a session called “DPC2MD: Strategies on how more physicians can work with employers.” The session noted … “For employers and insurers, however, [retail] clinics are already offering a way to reduce costs for noncritical conditions for employers. To further unpack emerging free market healthcare trends, a study by researchers at the RAND Corporation estimated that more than a quarter of emergency room visits could be handled at retail clinics and urgent care centers, creating savings of $4.4 billion a year.

DPC Editor in Chief alongside DPC Doctors Clint Flanagan, MD (Nextera in CO.) and Dr. Robert Lamberts, MD (Augusta, GA), emphasize the importance of DPC coupled with employer partnerships last weekend (Aug 1, 2015) at the Atlanta Concierge Medicine Assembly.

A DPC panel discussion also mentioned employers. Panel Members included: Clint Flanagan, MD (FAR LEFT, Nextera in CO.) and Dr. Robert Lamberts, MD (MIDDLE, Augusta, GA). During the panel, DPC Journal Editor, Michael Tetreault (right) asked Dr.s Flanagan & Lamberts about the importance of DPC, rural and metropolitan clinics, growth strategies, multi-site impact and what impact employer partnerships will have in DPC — (Aug 1, 2015) at the Atlanta 2015 Concierge Medicine Assembly.

The fact that the uninsured rate in Washington state dropped significantly in the last year gave the company incentive to change the way it works.

“Especially in Washington state since we had such a success in expanding Medicaid and with the health insurance exchange. … What I expected to see was employers pulling out of providing benefits. But in Washington state, they’re staying in,” Bliss said.

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Schimpff, MD: Employer-sponsored primary care: An explanation

Individuals pay Qliance a flat monthly fee for primary care services. The company is now developing a tiered payment model for employers, depending on the needs of employees.

SOURCE: http://www.bizjournals.com/seattle/blog/health-care-inc/2015/08/qliance-pivots-toward-employers-in-a-post-aca.html

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The bigger change is coming from big employers with the muscle to design custom plans: anywhere from 500 to several hundred thousand employees.

“Those employers tend to be what’s called self-insured,” Bliss explains, which means they pay the claims themselves. “So whatever savings accrue to the plan, that’s theirs, that’s money that goes to their bottom line.”

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For Qliance’s institutional customers, Bliss says the savings have been in the neighborhood of 20%. Expedia uses Qliance for the 2500 employees at its Seattle heaquarters.

But Arnold Milstein says DPC providers are still too small to appeal to companies that are more spread out.  “It’s very difficult to create a different solution for employee benefits in every single locality.”

Milstein directs the Center for Clinical Excellence at Stanford. As DPC does become more common, Milstein expects uneven results. “Like so many things in American healthcare that theoretically could save money, my guess is that some forms of this will be highly successful at saving money, and some will not only not save money, but cost more money,” Milstein says.

RELATED “Employer Partnership” NEWS from The NY TIMES (JULY 2015):

“Retailers have left it alone for decades, but now they see opportunity because traditional providers have not always been responsive to the changing needs of consumers, which creates opportunities for others to step in,” said Mark Grube, managing director of Kaufman Hall, an Illinois consulting firm to the Boston Globe (August 9, 2015).

CVS’s new anti-tobacco stance has helped it forge affiliations with employers interested in reducing healthcare cost expenditures and regional hospitals.*

Before CVS went tobacco-free, negotiations with local health systems were awkward, Mr. Merlo said during a recent analyst conference call.

“Consumers are saying: I want all of that at a place near my house that’s open on Saturdays, when it’s convenient for me. I want that place to post prices. It’s in CVS’s interest to pull in more and more pieces of that puzzle,” said Ceci Connolly, managing director of PwC’s Health Research Institute. CVS might have more sway reducing health care costs in its role as a middleman between drug companies and patients with drug benefits.

DPC doctors, Clint Flanagan, MD of Nextera Healthcare in Colorado and Dr. Robert Lamberts of Augusta, GA note in a DPC Panel discuss held in Atlanta, GA in August 2015, that reducing health care spending, however, may turn out to be complicated for the smaller DPC practice. Lacking time, literature, talking points, data and resources, regional [Retail] healthcare centers are already looking at contracting with employers and designing a referral system for specialists and primary care.

DPC doctors, Clint Flanagan, MD of Nextera Healthcare in Colorado and Dr. Robert Lamberts of Augusta, GA participate in a DPC Panel discuss held in Atlanta, GA in August 2015.

The company is expected to start shifting the balance between end users on one hand, and drug manufacturers and wholesalers on the other. A new partnership with Rush University Medical Center in Chicago will involve patient referrals and shared electronic health records. Anthony Perry, vice president for ambulatory care and population health at Rush, said that traditional health care providers and companies like CVS could be natural allies.The flip side, he said, is that CVS can refer people with more serious ailments, but no primary care doctor, to Rush. “So CVS can now say: You need to see a primary care doctor, and we can connect you.”

SOURCE: *http://www.nytimes.com/2015/07/12/business/how-cvs-quit-smoking-and-grew-into-a-health-care-giant.html?_r=0

ADDITIONAL DPC INSIGHT into EMPLOYER Partnerships and DPC, the impact of Retail Healthcare/Employer Partnerships and more.

John Blanchard, M.D., doesn't bill health insurers for services. Instead, through his Premier Private Physicians PLC office in Troy, he sells subscriptions for primary care to patients at about $200 a month.

John Blanchard, M.D., doesn’t bill health insurers for services. Instead, through his Premier Private Physicians PLC office in Troy, he sells subscriptions for primary care to patients at about $200 a month.

“The volume to value paradigm shift in health care is driven by employers, powered by technology. The message is loud and clear if you are shopping for value in health care those of us in Direct Primary Care open for business,” said John Blanchard MD  CEO Premier Private Physicians Management LLC.

“MedLion has always been focused on the employer market,” said Dr. Samir Qamar, CEO of MedLion.

“As the direct care movement continues to evolve, it is important that providers evolve with it and continue addressing the needs of payers, whether they are consumers, employers, or more traditional plans who are starting to see the benefits of the model. I think Qliance is an excellent example of a provider who is learning and adapting to the market and this evolution of their strategy seems like a solid path forward,” said Zak Holdsworth, CEO, Hint Health.

Bill Cossart, President & CEO of MedFirst Partners.

Bill Cossart, President & CEO of MedFirst Partners.

“We have a Third Party Administrator who immediately saw the benefits a corporate physician can bring to a self funded employer,” said Bill Cossart, CEO/Founder of MedFirst Partners, a consulting firm that assists Direct Primary Care (DPC) physicians with their entry into DPC. “Even smaller companies can easily adopt DPC.  The employer sees the rebates and the employees love the level of service with a 24/7 DPC Phyicisian and the Doctor gets to practice medicine the way they always dreampt about.  Everyone wins. There are no losers in this arrangement.”

“Retail primary clinics will compete for employer-funded opportunities,” says James J. Eischen, Jr., Esq., Partner at HIGGS, FLETCHER & MACK LLP. “DPC physicians with persistent patient panels and persistent connectivity with patients are more likely to deliver consistently connected care management versus a retail clinic experience. [Remember], the problem with HMOs was not cost, it was lack of patient direct investment and misaligned reimbursement causing an impersonal and disconnected PC/patient relationship. Retail clinical medicine seems poised to pose the exact same problems: lack of PC/patient relationship, lack of direct patient investment, potentially too impersonal.”

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SCHIMPFF, MD: Will direct primary care be offered by employers?

James J. Eischen, Jr., Esq., Partner at HIGGS, FLETCHER & MACK LLP

James J. Eischen, Jr., Esq., Partner at HIGGS, FLETCHER & MACK LLP

“An enlightened approach would continue to seek direct patient/employee monthly contribution as an investment in better health, have plans/employers also contribute toward DPC fees because that makes good business sense (saves money, solid ROI),” adds Eischen. “Let’s stop defining DPC as never accepting plan dollars in either proposed state legislation or generally. Let’s stay open to what plans and employers may be willing to contribute, keep an open door to plans and employer funding, and see the integrity of DPC as based on direct patient investment to a PC provider for persistently connected high-touch primary care.”

“Employers, both large and small, are struggling with the staggering costs of healthcare in this country,” said Mason Reiner, CEO at R-Health. “They are desperately seeking innovative solutions that involve something other than shifting ever more costs to employees and their families. Independent primary care physicians can be an employer’s most valuable ally as they seek ways to improve the care their plan members receive while controlling costs. When given the rare opportunity to sit in the same room with independent primary care physicians to discuss healthcare, employers find the DPC physician perspective both eye-opening and refreshing.”

DocPreneur Press & The DocPreneur Institute, together, provide fact-based, common-sense, non-fiction education and resources that give HOPE to physicians, their staff and the consumer audience at-large interested in learning more about the modern-day free market healthcare delivery marketplace, which includes: Concierge Medicine; Retail Clinics; Nurse-in-a-Box Kiosks; Cash-Only Clinics; Urgent Care Centers and Direct Primary Care (DPC).

DocPreneur Press & The DocPreneur Institute, together, provide fact-based, common-sense, non-fiction education and resources that give HOPE to physicians, their staff and the consumer audience at-large interested in learning more about the modern-day free market healthcare delivery marketplace.

RESOURCES … WHAT ORGANIZATIONS IN DPC HAVE ALREADY MADE THE PLUNGE INTO DPC and are WORKING WITH EMPLOYERS IN THEIR LOCAL MARKET? Additionally, what insight/resources are available for DPC Doctors? (In random order below)

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FORBES: ‘WeCare Clinics, Iora Health, Qliance Medical Management, MDVIP, and OneMedical have all reported reductions in total healthcare costs for their patients of 15% or more versus population norms*.’

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