Ever need to wait a week or more to see your primary care
doctor? Perhaps you should follow the lead of Debra Sallee, 58, a
Seattle hair salon owner. For a flat fee of $79 a month, she can
see her family physician as often as she wants--with no co-payments
or health insurance forms. "It's just so convenient. They are at my
beck and call," she says.
For several years, Sallee has been a member of Qliance, a
primary care provider with four locations in and near Seattle. Her
fee pays for round-the-clock e-mail or Skype access to the medical
staff as well as same- or next-day (or evening) appointments for
non-emergency medical care.
Sallee and Qliance are part of a growing movement known as
direct primary care. For a set monthly fee, patients receive a full
range of preventive services, such as wellness examinations,
screenings and basic mental health care. Qliance also provides
urgent care, including treatments for respiratory infections.
Monthly fees are based on age, ranging from $54 to $89.
Direct primary care is an outgrowth of a concept known as
concierge care, which provides unlimited access to physicians for
hefty premiums ranging from $2,000 to $5,000 a year. Direct primary
care provides many of the same services at a much lower price,
eliminating the administrative costs and hassles of insurance.
"It's concierge care for the masses," says Dr. Erika Bliss, a
family physician and chief executive officer of Qliance. More than
80 medical practices nationwide belong to the Direct Primary Care
Coalition. (Some members offer higher-priced concierge
The trend has had an impact on concierge care. "We've seen more
and more demand," says Dan Hecht, chief executive officer of MDVIP,
a Boca Raton, Fla.-based concierge care company, with 565
affiliated physician practices in 40 states. MDVIP's 200,000
patients each pay between $1,500 and $1,800 annually--a lower price
than many concierge competitors.
Primary care providers typically provide most of a patient's
care, including coordinating the oversight of patients with
diabetes, asthma, heart ailments and other chronic conditions.
Providers such as Qliance and Cambridge, Mass.-based Iora Health
also coordinate all specialist and hospital care.
When Your Insurance Falls Short
Direct primary care may be a good option for those without
insurance or who have high-deductible policies, such as Sallee. She
pays a health insurer $311 a month for a policy with a deductible
of $2,750, which she considers "catastrophic" insurance for
high-cost hospital services. She pays Qliance separately.
Many employers who offer high-deductible plans are paying the
fees for direct primary care. In these cases, the employer-based
insurance covers the costs of specialists, hospital care and major
tests once the patient meets the deductible.
Employers and unions pay Iora Health $50 a month to cover each
worker and retiree in the Boston area; Dartmouth, N.H.; Las Vegas;
and Brooklyn, N.Y. "Our practices aren't designed for rich people
to have conveniences," says Dr. Rushika Fernandopulle, chief
executive officer of Iora Health.
Direct primary care could get a big boost next year. Under the
federal health care law, these practices will be able to operate in
state-based health insurance exchanges. However, insurers on
exchanges must offer a basic benefits package that includes
hospital, drug and other coverage, so direct primary care practices
will likely team up with other health plans.
If you're considering a direct primary care practice, get a list
of provided services and talk with a physician in the practice.
Also, some practices that are similar to concierge care may accept
insurance but charge a monthly fee for extra services. For options
in your area, visit the Web site of the Direct Primary Care