Questions Raised About Oversight of Concierge-Style Health Providers

As some California health care providers move to a concierge-style direct primary care model, questions have emerged about how the state should regulate such services, the Los Angeles Daily Journal reports.

Direct primary care services typically charge patients a flat monthly fee that allows them to have a physician available on retainer. The fee also ensures that patients can receive coverage for all routine medical care.

Expected Expansion

Beginning in 2014, the federal health reform law will allow direct primary care practices to market their coverage alongside traditional health plans in health insurance exchanges.

Norman Wu -- co-founder of the Seattle-based direct primary care firm Qliance -- said the reform law will help his company extend its reach. Qliance already is looking to open clinics in California.

Questions on Regulation

In California, the agencies that regulate health insurers do not have guidelines on overseeing direct primary care practices.

The Department of Managed Health Care currently is reviewing whether to require Qliance to obtain the type of license that managed care plans need to operate in California. Managed care plans are tightly regulated in California to ensure that they have sufficient financial reserves to cover services promised to patients, who pay up front.

Marian Mulkey -- director of the Health Reform and Public Programs Initiative at the California Health Care Foundation -- said regulators likely will have concerns about the financial stability of direct primary care practices, specifically if the services were marketed as part of high-deductible health plans. CHCF publishes California Healthline (Gallegos, Los Angeles Daily Journal, 2/23).

Thomas Lanphier
Please clarify - In California, is any insurance company currently marketing a high-deductible health plan in conjunction with a 'concierge-style'direct primary care model? That would make much too much sense.

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