House looking at "direct primary care" model for Florida

Primary care doctors are often the lowest paid providers but they can play a key role in transforming the health care delivery system and, perhaps, expand access to health care under the Affordable Care Act.

So says physician Garrison Bliss, co-founder of a successful direct primary care practice called Qliance. Bliss traveled from Washington state to Florida this past week to provide members of the  House Subcommittee on Health Innovation a  primer on “direct primary care.”

Bliss was part of a panel that included Lee Gross, a North Port physician; Florida – National Federation of Independent Business lobbyist Bill Herrle; and Jay Keese, lobbyist for the advocacy group, Direct Primary Care Coalition.

Subcommittee on Health Innovation Committee Chairman Kenneth Roberson told lawmakers on the panel that the subcommittee going to “examine further if there is any unnecessary regulatory barriers to establishing direct primary care practice models for physicians here in Florida.”

Direct patient care can take many different forms. A central tenant, though, is that direct primary care doctors get paid a set fee, either a monthly, quarterly or annual payment, and then provide care to the patient for that fee. Patients are able to get same-day or next-day appointments and they often have around-the-clock access to the doctor’s staff. Patients are charged costs for tests and services that aren’t covered under the flat fee.

Bliss says the savings are significant, as high as 20 percent.

In most direct patient care practices, insurance companies aren’t billed. Doctors are freed up to spend more time with their patients and patients are able to choose the doctor they want to see.

Primary care services are covered under the set fee — which ranges in price but generally hovers around the $50 per month mark. Direct care patients are encouraged to carry major medical for catastrophic events that require hospitalization or surgery.

Direct patient care started in Washington state more than 20 years ago, with Bliss’s former partners who catered to the rich and preferred to call the model “concierge care.” It spread across the United States, including Florida.

Today, seven states already have laws on the books that make clear that the system is not “health insurance” and does not need to be regulated as such, Direct Primary Care Coalition lobbyist Keese said. Those states are Washington, Louisiana, Utah, Oregon, West Virginia, Michigan, and Arizona.

Nine other states are considering passing similar legislation. Herrle told the House subcommittee that he’d like to see Florida added to that list.

Herrle’s group led the lawsuit against the Affordable Care Act, commonly called Obamacare. He said his association represents small businesses that have grappled with the increasing costs of health care for more than a decade. Direct patient care is a “disruptive delivery model,” he said, and could be exactly what the system needs.

Started in 2007 as Seattle Medical Associates, Qliance has grown exponentially over the years since being founded in 2007. It now provides care to 35,000 patients and has partnered with a Medicaid managed-care organization to provide care to Medicaid patients. It also has partnered with an insurer on the state of Washington’s state run health insurance exchange.

House Speaker Steve Crisafulli said in an interview FloridaPolitics.com last week that direct primary care is an area he’s interested in potentially pursuing.

“I’m interested and supportive of the concept. If we are able to work on access to provide better care … let’s have those conversations.”