Tri-Tec Manufacturing in Kent, Wash., faced a nearly 40% increase in its health care premiums at renewal in 2007 to cover 38 employees. Then after changing insurance carriers, the same scenario unfolded two years later – a timeframe during which deductibles soared from $200 to $1,500.


That’s when the company decided on a radically different approach for its March 1 annual benefits enrollment: contract with a seven-physician group called Qliance, which charges patients $49 to $129 a month based on age and desired level of care. Tri-Tec is picking up the tab for each employee, whose average cost was about $350 a month under a major medical plan.


“People will generally get more accessible and better primary care” without having to worry about rationing services, opines Rick Cordray, who handles HR and benefits for Tri-Tec, which makes naval piping equipment.


Qliance doctors are among roughly 5,000 so-called conciergists across the U.S. who charge patients monthly retainer fees for unlimited access to care – a bold approach they hope will be part of any health care reform legislation.


Arguing their case is a professional association known as the Society for Innovative Medical Practice Design. Thomas LaGrelius, M.D., who chairs the organization and runs a concierge practice in Torrance, Calif., says this model not only reduces hospitalization 53% and emergency room visits 80% but also lowers employee absenteeism because there are no restrictions on doctor visits.


Washington is the only state that has given its blessing to these physicians, who are able to accept a paid membership in their practices without being subject to strict insurance regulations. The law was broadened this year to include payments made directly from a patient’s employer. Before it was enacted, employers had to earmark physician payments from a health savings account or health reimbursement arrangement.


Some state insurance departments have challenged these prepaid deals, saying the practitioners are operating as unlicensed insurers, while insurance lobbyists consider them competition, and thus, have fought legislative efforts to exempt these practices from insurance regulations.


A bill is now pending in New York to pave the way for conciergists, whose services are being tested as part of a pilot program in West Virginia and legislation is expected to be reintroduced in Indiana to do the same.


LaGrelius says primary care medicine “has been marginalized and virtually destroyed by the third-party insurance system. You can insure triple-vessel bypasses and hip replacements. They are undesirable, occasional unexpected events. But you cannot insure the relationship you have with your primary doctor. You can buy it directly, just as you buy food and haircuts and housing and other desirable things like you might want.”


David Plocher, M.D., an independent consultant based in Minneapolis, Minn., who used to be the chief medical officer for Blue Cross Blue Shield of Minnesota, disagrees with this characterization.


He notes that the concierge model “exacerbates the shortage of primary care physicians because the retainer positions have a much smaller patient panel, since they spend much more time with them.” He says another problem is a tendency to perform unnecessary services and too many screening tests that produce false positives.

Guest blogger Bruce Shutan is a former managing editor of Employee Benefit News and a freelance writer based in Los Angeles.

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