Healthier patients
happier providers
a stronger America


June 11, 2013
  CNN Money
Fed up with declining payments and rising red tape, a small but growing number of doctors is opting out of the insurance system completely. They're expecting patients to pony up with cash. Some doctors who have gone that route love it, saying they can spend more time with and provide higher-quality care to their patients. Health advocates are skeptical, worrying that only the wealthy will benefit from this system.

May 29, 2013
  Chicago News Tribune
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.

May 16, 2013
  MD News
Forbes reports that about 4,400 physicians now practice concierge-style medicine, a form of primary care characterized by a retainer-style fee in return for enhanced access to physician care. What makes physicians decide to become concierge doctors? Are the trade-offs — such as handing out one’s personal cell phone number — worth it? And are there ethical consequences?

May 14, 2013
Direct primary care (DPC) is a model in which practices charge patients a monthly fee in exchange for access to a broad range of primary care services. The AAFP recently established a policy on direct primary care and created a frequently-asked-questions document for members.

May 9, 2013
  Concierge Medical Journal
As patients and physicians face the full implementation of The Affordable Care Act many are looking for alternatives. Concierge medicine and Direct Primary Care offer this alternative.

April 18, 2013
  HL7 Standards
There is a growing movement in primary care to new retainer-based practice models attracting doctors, patients, investors, and developers. These new, more affordable membership practices provide a “direct” doctor-to-patient relationship – some are concierge medicine, others a hybrid model, direct primary care or cash only practices.

April 4, 2013
  Kaiser Health News
It’s not just sore throats and flu shots anymore. Walgreens today became the first retail store chain to expand its health care services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol. The move is the retail industry’s boldest push yet into an area long controlled by physicians, and comes amid continuing concerns about health care costs and a potential shortage of primary care doctors.

April 1, 2013
  California Healthcare Foundation
This issue brief describes the landscape of DPC practices, which collectively have more than a half million people on their rolls.It explores the opportunities and challenges for the DPC model,especially in light of the Affordable Care Act(ACA), and legislation in some states providing for the retainer practice model.

March 19, 2013
  Healthline News
Physicians and patients alike are growing tired of our healthcare system—the endless wait times, hurried office visits, and financial burdens—which is why primary care alternatives, such as direct primary care, also known as concierge medicine, and "scope of care" bills are gaining attention.

February 1, 2013
Health Care of the Future: Concierge medicine’s next big challenge is fitting in. The first generation of most innovations is beyond the reach of the masses. But if someone truly builds a better mousetrap, the product and price will evolve until the benefits outweigh the costs and the masses embrace it.

December 13, 2011
  Inside Health Policy
Bipartisan Bill Would Let Medicare, Duals Join Direct Pay Primary Care. Bipartisan legislation introduced by Rep. William Cassidy (R-LA), a physician and community clinic founder, would create a new CMS demonstration program allowing Medicare and dually eligible beneficiaries to participate in practices that do not accept insurance but charge a monthly flat fee for all primary care services. Cassidy tells Inside Health Policy that the direct pay care (DPC) model has greater potential to drive efficiency in health care than the far more celebrated accountable care organizations (ACOs) established under the health reform law.

October 24, 2011
  Modern Healthcare
While retainer-based medical practices offering care known as concierge medicine have taken some heat over the years for charging big bucks to patients for improved access and added amenities, some view a different form of retainer care as a cost-saving approach.

September 19, 2011
Direct Primary Care: RIP Marcus Welby "Physicians in North Carolina, Seattle, Northern California and elsewhere are proving what the rest of the world already knows. Highly functioning primary care results in less money spent and better health outcomes."

September 12, 2011

August 11, 2011
  The Huffington Post
The Decline Of Primary Care: The Silent Crisis Undermining U.S. Health Care

June 23, 2011
  US News & World Report
"Primary care offices have historically handled patients with urgent problems by assigning one doctor "acute care" responsibilities for the day or squeezing extra patients into already crammed schedules. The downside: Patients can end up seeing doctors who are unfamiliar with their medical histories, harried due to time pressures, or both, which raises the risk of misdiagnosis or improper treatment. That's why some practices (including the federally funded Veterans Heath Administration clinics) have switched to "advanced" or "open-access" scheduling. Rather than scheduling a visit weeks or months in advance, patients can call for an urgent or routine appointment the day before or the same day they want to be seen."

June 21, 2011
  Time Magazine: Healthland
"MedLion charges Vigna-Bony $50 per month, with an additional $10 surcharge per visit. Other such services include Symbeo Health in Bloomfield, N.J., Access Healthcare in Apex, N.C., and Qliance in Seattle, which is backed by Amazon founder Jeff Bezos and other investors. The specific terms and fees vary by service. For instance, Qliance charges each of its 4,000 patients $49 to $89 per month, depending on age. Some providers require year-long contracts, while others let members cancel at any time. What they all share is a monthly fee of no more than $89, no need for patients to have health insurance, and no limits on pre-existing conditions."

June 20, 2011
  American Medical News
"Washington -- Holders of certain tax-exempt health spending accounts again could use the funds to buy over-the-counter drugs without physician prescriptions under a provision in a Senate bill unveiled in late May."

June 3, 2011
Bicameral Legislation Would Designate Monthly Fees for Direct Primary Care Practices as Qualified Expenses for Pre-tax Health Expense Accounts (HRAs, HSAs and FSAs)

April 12, 2011 Health Care Reform Offers New Challenges, Opportunities for Small Businesses
“For Frank Riordan, vice president and co-owner of Becker Trucking in Seattle, saving money on health insurance meant taking a different route: direct primary care medical homes. This relatively new class of health care provider, authorized through the PPACA, allows patients to receive a variety of primary care services for a fixed monthly fee -- typically less than $100 per month. The medical home model is designed to save money by eliminating insurance-related overhead costs from the health care process.”

April 6, 2011
  Fortune: Health Care Reform Can’t Work Without More Doctors
“In 2010, for example, only one medical school graduate in six chose primary care. Family doctors, internists and pediatricians constitute just one-third of the physician workforce today versus 50% in 1950, and the share is falling fast. Virtually every rural area in America needs more primary care doctors, and can't find them.”

March 9, 2011
  WTOP Radio, Washington, DC: A health care trend to substantially lower monthly premiums
"A West Coast trend that makes monthly health care payments more affordable is catching on across the country. "Direct pay primary care" is the kind of medical care that some rich folks already get, where you pay a set monthly fee for unlimited visits to the doctor. Now there's a move to make it affordable for the rest of public."

March 8, 2011
  Kaiser Health News: Some Medical Practices Move To Monthly Membership Fees For Patients
"Just about everyone agrees that the way we pay for primary care needs fixing. Under the current insurance model, doctors get paid for procedures and tests rather than for time spent with patients, which displeases doctors and patients alike and increases costs."

February 25, 2011
  Hartford Courant: Offering Medical Service, No Insurance Allowed
"It's also an example of a growing grass-roots movement among some primary-care doctors in the U.S. to cut out the insurer as a billing middleman. Charging patients a monthly fee at half the price of cable television is an attractive way to offer some medical services to the uninsured, or people who have limited, high-deductible health plans, the doctors say."

February 23, 2011
  San Francisco Daily Journal: New Direct Primary Care Plans Bypass Insurers and Regulators
"Direct Primary Care is an outgrowth of what's known as 'concierge' practices. Concierge practices target wealthy clientele, who pay a doctor a retainer on top of their regular insurance for top-of-the-line primary care, home visits and spa-like atmosphere. Direct primary care, with its lower rates and traditional medical services, is considered the middle-class version."

November 22, 2010
  Huffington Post: “Do It Yourself Health Reform”
"As a country, on average we spend well over $7000 per year for every man, woman and child each year on health care. Many people don't realize it as the actual expenditures are spread across many different line items. However, many of us are now experiencing the reality of the proverbial frog that has been in water where the temperature has been steadily increasing. Before we boil, we need to make a change."

November 1, 2010
  Money Talks News
Stacy Johnson explores the notion of "Health Care without Insurance - $50/month?"

October 22, 2010
  Inside Health Policy: “Washington Gov Asks HHS To Embrace Flat-Fee Primary Care Practices In Exchanges”
"The provision — championed by members of the state’s congressional delegation — was 'designed to encourage the growth of a promising new health care delivery system that is proving beneficial not only to the state of Washington, but also throughout the country,' she told HHS Secretary Kathleen Sebelius in a recent letter urging her to embrace the model when she writes reform regulations."

October 18, 2010
  Internal Medicine News: Direct Primary Care Practice Model Eyed to Trim Health Care Spending
"Physicians who practice in clinics where patients pay a set monthly fee for virtually unlimited primary care services say that the practice model, which they’ve dubbed “direct primary care medical home,” can provide high-quality care and potentially can lower health care costs more effectively than the patient-centered medical home model."

October 1, 2010
  The Physician’s Foundation: “Health Reform and the Decline of Physician Private Practice”
A White Paper Examining the Effects of The Patient Protection and Affordable Care Act On Physician Practices in the United States. Includes results of Physicians and Health Reform, a survey of 100,000 physicians.

May 4, 2010
  Health Affairs: A Direct Primary Care Medical Home: The Qliance Experience
"Medical home models providing direct primary care can enable comprehensive primary care and improved access at affordable prices by operating outside the insurance system."

April 4, 2010
  King 5 TV News: Doctors Using Flat Fee System
Jean Emerson of King 5 News introduces the "flat-fee system" of direct primary care.

March 29, 2010
  Associated Press
The health care overhaul is likely to strain America's primary care doctor shortage, according to a recent study.

March 23, 2010
  Health Care Legislation Paves Way for Direct Primary Care
A provision in H.R. 3590, the Patient Protection and Affordable Care Act, signed into law by the President, creates an affordable new choice for individuals and businesses by allowing flat-fee direct primary care practices to compete within the state-based insurance exchanges where many Americans and small businesses will be able to shop for health coverage beginning in 2014.

March 22, 2010
  Primary Care Shortage Could Crimp Overhaul
From National Public Radio: For all the changes put in motion by yesterday's historic vote passing health care overhaul, an expansion of coverage for tens of million of uninsured people raises a really big question: Who will take care of them all? It's already tough to find a primary care doctor in many parts of the country.

December 19, 2009
  Marketwire: Primary Care Doctors See Hope in U.S. Senate Action
Primary Care Doctors See Hope in Today's U.S. Senate Action That Could Deliver More Americans Lower-Cost Alternatives to Health Insurance:

New Amendment Allows for Flat-Fee Direct Primary Care Practices Nationwide to Compete in Proposed Insurance Exchange, Modeled From House Version

December 2, 2009
  Huffington Post
Health Care Reform Irony: Thousands Could Be Denied Low-Cost Coverage

November 9, 2009
  Our statement on the passage of the Affordable Healthcare for America Act
Dr. Garrison Bliss sent out a press release on behalf of the Direct Primary Care Coalition. The press release comments on the passage by the U.S. House of Representatives of H.R. 3962, the Affordable Healthcare for America Act. Passage of the H.R. 3962, the Affordable Healthcare for America Act by the U.S. House of Representatives this weekend means that the approximately 45,000 Americans who have elected to receive their medical care through a direct primary care medical home will continue to have that option – for now.

November 6, 2009
  Seattle Post-Intelligencer
Blogger Dave Chase gives a nod to direct primary care in The Seattle Post-Intelligencer: I'm a free market guy but observing what was going on had me seriously considering that some kind of government system might be the only way out of this mess. That is, until I heard about "concierge medicine" several years ago. Rather than focus on the fact that it was initially being delivered to the wealthy, I thought it wouldn't be much different than flat screen TVs. That is, initially only the wealthy could afford it but the model would rapidly evolve and be available to the masses at a much more approachable price point after it proved itself.

October 28, 2009
"With some form of health insurance overhaul likely to accelerate the trend of rising practice costs coupled with declining reimbursement for physicians, some doctors will join those who have already exited a practice model funded by insurance payments. Physicians such as Garrison Bliss, MD, a Seattle-based primary care physician and vascular surgeon John Kenagy of Belmont, MA, disgusted with governmental and insurance company constraints on how they practice medicine, have escaped health care hell by stepping away from the madness. They hearken back three-quarters of a century to pioneers like Dr. Fred Mott, an internist who established a cooperative prepayment plan for physicians serving Depression-era farmers at risk of losing their farms due to ill health."

October 15, 2009
"Could there be a low-cost, high quality fix for much of what ails American health care - a fix that requires no new legislation and no additional taxes? Could such a fix help stem the exodus of primary-care physicians from medical practices and restore the personal relationship between patients and doctors? And could it possibly originate in Seattle, the city that gave us grunge rock and entertains tourists by throwing fish?"

October 7, 2009
VentureBeat takes a look at how "information technology drastically brings down cost and improves productivity in other sectors, healthcare remains a “cottage industry” with many barriers and inefficiencies. Healthcare really is the last frontier where technology innovations can drive profound changes and grow brand new business models."

October 1, 2009
  DB's Medical Rant
Dr. Bob Centor continues to push on insurance-free primary care in his well-read blog, DB's Medical Rants.

September 29, 2009
  The SunBreak
The SunBreak Asks: Can Qliance Revive Primary Health Care? Dr. Garrison Bliss calls our health insurance dependency "learned helplessness," and likes to reference Marcus Welby when talking about the direct primary care. "You can design this so that 80 percent of American can pay for primary care out of pocket. And the other twenty percent could do it with some subsidy," he argued. "I'd like to prove that." His first point is that whether you're insured or not, if you want or need quality primary care, you're mostly out of luck."

September 28, 2009
Dr. Norm Wu contributes to It's About Health Care, Not Health Insurance. Dr. Wu says,"Health care reform discussions almost always revolve around health insurance, as if care and insurance are synonymous. Understanding the difference can lead to the delivery of better care for less money, and help break the health care reform logjam in Congress."

September 8, 2009
David Goldhill, who wrote an article in Atlantic Magazine called "How American Health Care Killed My Father" and is interviewed on CNN about his concerns about health care.

September 5, 2009
  Seattle Voices
Dr. Garrison Bliss from Qliance talks about the availability and affordability of direct primary care to Seattle Voices host Eric Liu.

September 3, 2009
  The New York Times
David Brooks from The New York Times talks about how he would help President Obama prepare for his health care speech to Congress.

September 1, 2009
  The Atlantic
In The Atlantic, David Goldhill sheds light on why America's insurance-centric structure needs to be changed and direct primary care has emerged as a result of America's fraying insurance system.

August 25, 2009
Dr. Vance Harris, a primary care physician, writes an insightful piece for CNN about how health care reform assumes doctors will be available. This is an unfortunate assumption. Find out why a number of primary care doctors are dropping out of the business.

August 21, 2009
  The Kent Reporter
The Kent Reporter takes a look at a direct primary practice in Seattle leaving insurance out of it and creating a new health-care network. Patients can receive comprehensive primary and preventive-care by paying a monthly fee, like a subscription.

August 19, 2009
Millions of uninsured and underinsured Americans need cheaper health care. Nancy Mann Jackson takes a look at some affordable consumer options like direct primary care in her article.

August 14, 2009
  Puget Sound Business Journal
The Puget Sound Business Journal reports how the direct primary care model is catching the interest of some venture capitalists.

August 14, 2009
On, Aqiylah Collins notes direct primary care as an option for the millions of Americans without health coverage just want to see a doctor.

August 9, 2009
  ABC News
ABC News features direct primary care providers in “Cutting Out the Insurance Company.” ABC compares the flat rate health care as an insurance alternative as easy as a gym membership.

August 4, 2009
  Q13 Fox News
Q13 Fox News in Seattle, Washington covers how direct primary care providers can help save money for doctor and patients. Meanwhile, congress works on its new plan to give health care to everyone, direct primary care providers offer a successful alternative solution.

August 1, 2009
  Your Health Care Today
Erik Smith from Your Health Care Today writes about direct primary care practice in Seattle, Washington. Smith explains, "Here’s something even more telling. The idea works by cutting out insurers at the most basic level of care, and by leaving out the kind of high-level care that hospitals provide. But now one of the state’s leading insurance companies and one of the state’s most advanced hospitals are getting into the business themselves."

July 29, 2009
  Real Change
Assistant editor, Rosette Royale, of Real Change wrote an important piece on direct primary care. Royale notes how important health care is for every single person and direct primary care is a great approach to ensuring the well-being of our friends, families, and communities.

July 13, 2009
  The Huffington Post
Terry Leach reminds readers that,"for every 1% uptick in the unemployment rate, approximately 1 million Americans stand to lose their health insurance." Leach makes a valid argument in her blog post: Barack Obama Stay Home: Health Care Reform Is Dying To Hear From You.

July 13, 2009
  The Huffington Post
Nick Hanauer, a Seattle-based entrepreneur and venture capitalist, makes a strong case for direct primary care listing four key ways: 1) No insurance means lower upfront costs. 2) Monthly care fees align incentives. 3) Coordinated, high-quality care and downstream savings. 4) Increased provider and patient satisfaction.

June 20, 2009
  The Washington Post
This Washington Post article explains how "there are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system."

May 14, 2009
Chapin Henry, Director of Business Development at Qliance, explains how a Washington-based direct primary care practice can provide patients with better heath care and help patients save money.

May 12, 2009
  Just Cause
Mike Lewis' article feeds readers the bottom line, "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."

February 3, 2009
  HIS Talk
Dr. Garrison Bliss is interviewed on HIS Talk, which focuses primarily on hospital-related IT topics.

February 2, 2009
Qliance is featured on CNN/ as one of the six entrepreneurial companies are doing to fix health care.

January 21, 2009
  The Stranger
Dominic Holden of The Stranger sheds light on why using Seattle direct primary care practice is beneficial for employers.

January 21, 2009
  The Stranger
Writer Brendan Kiley tells us why people with and without insurance are thrilled about a new approach to primary care.

January 21, 2009
  The Stranger
Dr. Garrison Bliss, a primary-care internish in Seattle for 30 years, explains how he has "watched medical care descend into a deep abyss—one in which quality, access, and cost have all been severely compromised."

January 18, 2009
  The Seattle Times
The Seattle Times' Carol M. Ostrom takes an interesting look at "the brave new experiments, the out-on-a-limb efforts to provide a model to reinvent and—their proponents hope—resuscitate primary care, the care most patients need most often."

December 22, 2008
Following up on their December 3rd article, continues its investigation with an in-depth look at why Qliance chooses to operate outside of traditional insurance. Offering an objective perspective, writer Luke Timmerman seeks to understand why Qliance does not bill traditional insurance yet still advocates for high deductible plans. Timmerman discovers how Seattle direct primary care practice does what it does and still provides exceptional primary care.

December 3, 2008
Nick Hanauer, a Seattle venture capitalist, spoke passionately at Seattle University on Wednesday night about new venture companies and cited Qliance as an example of a great start-up. Speaking to a room of nearly 130, Mr. Hanauer described a few particular attributes of attractive start-ups; what to look for and what to avoid. Speaking specifically about Washington-based direct primary health care practice, Mr. Hanauer articulated why he is so excited about the possibilities this model presents to the healthcare industry.

November 21, 2008
  Puget Sound Business Journal
Many local employers in the south Puget Sound region are showing their support for Qliance-and are not afraid to say so. The Green Room and Partners, both production companies with health care concerns, spoke with the Puget Sound Business Journal about the possibilities it presents. By pairing a direct primary care practice with an Health Savings Account (HSA) or a high-deductible traditional insurance plan, employers, workers and individuals alike are able to experience the benefits of primary care, while sill saving money.

March 26, 2008
  Washington Association of Health Underwriters' 2008 Symposium
An insightful and at times humorous presentation by Dr. Garrison Bliss to health insurance brokers at the WA Association of Health Underwriters' 2008 Symposium about the forces that are driving the health care crisis in this country and how the simple economic model of direct primary care practices may hold the key to reviving the ailing industry.

March 3, 2008
  Harvard Medical School Weekly
Harvard Medical School Weekly concludes new Seattle direct primary care model "has the potential to grow significantly, to serve millions of people instead of thousands."

January 23, 2008
  The Stranger
This half op-ed, half feature story by Dr. Norm Wu discusses the demise of the caring family doctor who always had as much time as his patients needed. He was so wonderfully portrayed from 1969 to 1976 in the popular ABC television series Marcus Welby, MD.

January 21, 2008
Last December, Dr. Garrison Bliss accepted the Pioneer in Medical Practice Award from Consumers for Healthcare Choices. In this just released video, Dr. Bliss describes the genesis of his vision for patient-centered care using a direct practice model.

November 2, 2007
  Senator Chris Marr speaks at Qliance Launch Party
Senator Chris Marr, co-sponsor of the Innovative Primary Health Care Delivery Senate Bill 5958 that supports the Qliance model for primary care, described how “direct practice medicine is very elegant in its premise of putting doctors and patients at the center of the health care equation while reducing cost. Even more compelling is how this high touch primary care model works to improve the efficacy of preventive care.” Senator Marr concluded his remarks by saying that, “This piece of health care policy improves quality and cost, without additional government intervention and regulation, and on top of that, without requiring additional state funding. As a state policy maker, that’s like the trifecta.”

November 2, 2007
  Governor Chris Gregoire speaks at Qliance Launch Party
Governor Christine Gregoire discussed the need for innovation and risk taking in serving the uninsured and especially the under-insured. “Our theme is: drive up safety, drive up quality, drive down costs. So what you are doing here with your vision is really what we’ve been trying to embrace. But we can’t achieve it if we simply look at it through the old same lenses that we’ve had historically,” said the Governor. “What Qliance has as a vision and a model is to allow doctors to do what they love and what they feel passionate about, to give patients like the two from whom we have heard tonight what they so richly deserve at an affordable cost and with high quality. It is patient safety. It is driving down costs. So I come simply to say, thank you to those who are investing. Thank you to those of you who are providing the care. Thank you to those of you who are getting the care.”

August 5, 2007
  The Entrepreneurial MD
Dr. Garrison Bliss is interviewed on The Entrepreneurial MD. Read about how Dr. Bliss "pushes a medical practice model to its limits."

July 3, 2007
  The Seattle Weekly
Seattle Weekly writer, Nina Shapiro, explains how a Seattle direct primary care practice is an affordable option to low-income patients.

May 25, 2007
  Puget Sound Business Journal
The Puget Sound Business Journal explains how a direct primary care practice in Seattle challenges the status quo with their monthly fee model.

May 3, 2007
  Governor Chris Gregoire's Newsroom
This bill is a watershed event for Washington-based direct primary care practices. Entitled “Creating Innovative Primary Healthcare Delivery,” it acknowledges that primary care practices that bypass insurance by charging patients a direct monthly fee to avoid the high overhead costs and restrictive care associated with insurance reimbursement are not insurance companies, health carriers, health maintenance organizations nor health care services contractors. As such, it enables direct primary care providers to offer affordable prices for high quality, high access unhurried care, while providing substantial consumer protection.

August 31, 2006
  New England Journal of Medicine
Thomas Bodenheimer, M.D. gives an excellent analysis of primary care in the New England Journal of Medicine. Fortunately, "primary care professional societies are designing and testing new practice models."


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Primary Care:

Essential to Good Health

Primary care includes disease prevention, health maintenance, patient education and counseling, diagnosis and treatment of acute and chronic illnesses. It spans preventive care (such as immunizations and check-ups), routine treatment of common injuries and complaints, and maintenance for ongoing health issues.

Primary care is the foundation of good health. It's the key to preventing debilitating and expensive problems. A health care solution that doesn't address primary care is no solution at all.