This may be the shot in the arm that our healthcare system needs!

By Mike Lewis

What Dr. Garrison Bliss knows, sitting in his Seattle office, he says every doctor in the country also knows: The insurance model is so broken that the only way to fix it is to abandon it entirely -- at least for the bulk of the nation's health care needs.

So, Dr. Bliss and a handful of other doctors did just that. They quit toiling for the HMO's and began working for their patients again. They founded Qliance Medical Group in Seattle, a subscriber-based primary care service.

No insurance. No limit on visits. Each appointment lasts a minimum of 30 minutes and has no maximum length. Drop-in anytime. All at an average cost of $56 a month. No screening process.

"Our application process? You ask to be a patient? We say yes," Bliss says with a chuckle.

He has reason to be happy: In less than one year, Qliance has collected 1,800 patients and expects to reach three times that. Another clinic is in the works. What's more, docs are lining up to work there. Individual patient loads average half what they are for an HMO doctor. "We're happy with where it's gone so far," Bliss says.

Qliance has a simple goal: Provide quality primary care that 70 to 80 percent of the population can afford and reduce doctor patient load -- but not pay -- for the doctors providing that care. For Bliss, and the seven other doctors who work at Qliance, it's an effort not only in medical care but also basic economics.

Under the standard insurance-based care model, doctors find out what an insurance company will pay per service and then tailor medical care to fit within that. Bliss wanted to do opposite: Find out what optimal primary care involves and then figure out what must be charged to finance that.

This is where the 30-minute visit comes in. Doctors know that half an hour is the minimum time to sort out an average patient issue. So Bliss worked backward. How many people a day would that allow? How much space do you have to leave in a day to see drop-ins? And how much to charge for all of this?

But Bliss wanted Qliance to take it even further. What would it take to limit this to primary care, and make this care affordable to 70 or 80 percent of the population? And how could a doctor provide it when "patients want and need it, and not two weeks later?," as Bliss puts it.

What they came up with was the company's Level 1 and Level 2 plans. At $56 monthly, the patient gets Qliance-style primary care. At the next level, approximately $85 monthly, hospital rounds are included for patients who regularly are hospitalized.

"In the old days, your physician came to see you in the hospital," said Norm Woo, the company's CEO. "Now, you are seen by a hospital-based internist. But they have no history with you. So the care is worse and in some cases harmful. It really helps, and it is less expensive, to have a physician who knows you overseeing your hospital visits."

Part of the problem with medical care in the United States, Bliss argues, is that the health care and insurance industries decided that primary care was worth very little, while catastrophic care, major injuries, and disease were worth a bunch. That has turned out to be an economic disaster for everyone -- except insurance companies.

"What (they) did was to pervert the concept of insurance," Bliss said, "to try to make it pay for everything in health care. And what was created was a monster that doesn't provide very good health care and provides it an enormously inflated prices."

The key, he says, is to remove cheap primary care from the insurance model and have people directly pay what it costs, which is very little. Insurance should be for infrequent, expensive procedures and spread those cost over a large number of people. Much like flood insurance for your home.

But modern medical insurance evolved into covering the frequent events too. That twist in the model takes items that were inexpensive to start with, and makes them expensive. Qliance reverses that trend, he says.

"We don't want to be an insurance company. We would love to leave the parts of health care that are expensive and potentially devastating financially (for patients) to insurance companies. We're happy to have them take care of the bone marrow transplants and the renal failures."

Getting Qliance started wasn't easy. Insurance companies, loathe to give up the money made from primary care, fought to have Qliance categorized as an insurance company, and regulated as such. This would have forced the small company to be an insurance contractor, offer the mandatory list of services, including catastrophic care, and require a $1.5 million bond, among other things.

This would have killed the Qliance model, Bliss said. "This would have made them happy because we wouldn't have existed." But in 2007, Qliance prevailed with the Washington Insurance Commissioner Mike Kreidler. By 2008, they were in business.

A more esoteric issue remains an unanswered question: Where does primary care end? Bliss said that's up to the primary care doctor's training. In other words, a Qliance doc will set a simple fracture but she won't to orthopedic-grade surgery. They'll do the mammogram, but not the mastectomy.

Even with some limits, Bliss and Woo argue that the model is the right one. Citing medical studies, Bliss said primary care covers 90 of the population's health needs. And insurance will become cheaper -- along with primary care - when it only involves supplemental catastrophic policy.

Employers have come calling, looking to both reduce costs and improve employee health care. Woo said he's not surprised. Better primary care means fewer sick days. And with unlimited visits, drop-in privileges, doctors with lighter patient loads at a reduced cost, what employer wouldn't want to take a look?

"Our motto is people should abuse primary care," woo said with a laugh. "Use it early and often."

For more information, visit Qliance online.