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'Concierge' health care for local union members

In a move believed to be unique in the country, a large statewide union is offering members reduced premiums if they choose a health-insurance package that gives them unlimited primary care through a network of flat-monthly-fee clinics that doesn’t charge patients for each office visit.

The state’s largest private-sector union is breaking with tradition to offer members a health-insurance plan that includes unlimited primary care, arranged through a clinic system that spurns the fee-for-service system and instead asks patients for a flat monthly fee.

Union members who agree to get their primary care at clinics run by Seattle-based Qliance Medical Management Inc. will pay reduced premiums for the benefit plan offered for 2012.

Qliance is part of a movement called direct-care, retainer-fee or — at the high end — concierge care.

Like other such clinics, Qliance doesn’t charge patients by the visit or require co-pays. Instead, patients pay a monthly fee. In return, the clinics offer unlimited primary care and other services such as extended office hours and telephone and email access to doctors.

The incorporation of such a direct-care clinic into a union benefit plan, believed to be the first in the nation, affects more than 10,000 people insured through the Sound Health & Wellness Trust, which offers health benefits to the United Food & Commercial Workers (UFCW) Local 21, the state’s largest private-sector union, as well as to UFCW Local 1439 and Local 367, and Teamsters Local 38.

Qliance said the benefit package would be offered in addition to the trust’s current PPO benefit plan, which covers other care such as specialists and hospitals. If union members were to select the PPO-plus-Qliance plan, their premiums would drop about $16 a month.

The Qliance package would be available to union members who live in the service area of Qliance, which now operates clinics in Seattle, Tacoma, Kent and Mercer Island, and a fifth, affiliated clinic in Mill Creek.

The trust is managed jointly by unions and employers, including grocery chains, pharmacies and several health-care facilities.

In 2009, the trust tested a pilot program that offered Qliance as a “medical home” to its members as part of a full-coverage plan. Diane Zahn, secretary of the trust and secretary-treasurer of UFCW Local 21, said in a statement that the pilot program showed the union the arrangement was a good deal.

“Through our pilot program, we were able to see how Qliance can bring down overall health-care expenditures and keep our members healthier,” she said.

In essence, the new plan makes Qliance the only “preferred” primary-care provider for those members who select it.

For individual patients, Qliance bills a flat monthly fee for core services, which include unrestricted access to all types of primary, preventive and chronic-illness care, as well as extended office hours, including weekends at some clinics, 24-hour telephone access to a doctor, same-and-next-day office visits and no co-pays.

The theory behind the direct-care practices is that patients who have better access and longer, more comprehensive visits can get the information and care they need to stay healthier and out of the hospital.

Erika Bliss, president and CEO, said while most direct-care practices have one or two doctors, Qliance is the only such system in the nation trying to reproduce its model on a large scale.

To do that, Qliance, founded in 2006, has raised about $14 million from large private investors.

Some health-care experts see such flat-fee practices as an intriguing yet controversial new model. They remove the fee-for-service system’s incentives for providers to do more than patients need, typically proving more lucrative for primary-care doctors, who are increasingly in short supply.

At the same time, doctors see fewer patients than in traditional fee-for-service models, and critics worry that it will make it harder for patients to find primary-care doctors.

Large employers have been slow to incorporate such care in benefit packages, in part because of perceived or real difficulties in coordinating with more traditional insurance plans, which typically cover primary care along with specialty, hospital and emergency care.

“We don’t know a single other direct practice that’s working with a union in any way,” Bliss said, although some direct practices work with individual employers. “That’s why we were so pleased that they were rolling this out.”