Bliss, a 60-year-old MD, and president of Qliance Medical Group in the Seattle area, hasn't "taken a nickel of insurance money since 1997," he says. Forming a practice that would survive and thrive under that model, he says, has been an "intentional effort to create an ecosystem for healthcare beginning at the foundation, which is primary care. Healthcare here is designed to get better and cheaper rather and worse and more expensive."
In short, Bliss believes in the power of shopping and the free market to cut prices for medical care, and remove the complexity—at least from the primary care system. It all began about 15 years ago, when two of his then-partners began the first monthly fee practice in the US. Patients paid a monthly fee and then were allowed to contact their doctors as much as they wanted, and see them whenever they wanted, for a flat retainer fee.
"That seemed crazy at $1000 a month," he says.
It probably was. It was also prime shooting gallery material, with detractors rightly claiming monthly fee practices were only for the rich.
So Bliss refined the offering for himself and his practice.
"I decided to do something just like that but I would do it at the lowest effective price," he says. The highest price for any of the practice's patients (usually the oldest) was $65 a month. It was $30 for children and teenagers. In return, patients got all their primary care free, including 24-hour access to physicians, clinics open 12 hours a day, and needed x-rays and lab work—and sometimes prescription drugs--is included. Further, their docs would admit them to hospital if needed.
The price has risen since then, to between $44 and $84 a month, but the services remain. That allowed his patients to obtain insurance for truly catastrophic events—at much lower rates, in most cases.
"This is a great front end for a health plan," Bliss says. "If you're offering high-deductible health plan, and making employees pay a big deductible, they're very invested in not getting into co-pays or deductibles, and you're highly invested as an employer too."
Such a system allows employers to self insure in the small-dollar arena, says Bliss, "where most insurance companies are making their money right now."