DPC + Cat is not a good substitute for full ACA Medicaid expansion

When Brain Forrest MD, the founder of the Access Healthcare direct primary care clinic, does legislative advocacy at, for example, the United States Senate, he shows the data of the foregoing chart. It’s from a 2013 course project by three NC State post-baccalaureate management students. He advocates pro-DPC legislation, apparently telling policy makers that theContinue reading “DPC + Cat is not a good substitute for full ACA Medicaid expansion”

A calculus of mOOP

DPC practitioners seeking to recruit insured patients often tout that the cash costs for primary care services and/or for downstream services procured through the DPC entity (e.g., advanced radiology) might be lower than even the patient cost-share for the same services procured under the insurance policy, especially high deductible policies. Patients should, however, carefully considerContinue reading “A calculus of mOOP”

The only bona fide university study of DPC has a message: “There’s no data.”

Health Programs Group, University of Wisconsin School of Medicine and Public Health, Population Health Institute. Direct Primary Care (DPC): Potential Impact on Cost, Quality, Health Outcomes, and Provider Workforce Capacity, A Review of Existing Experience & Questions for Evaluation, October 8, 2019. On-line publication. The thing speaks for itself, acknowledging potential and noting absence ofContinue reading “The only bona fide university study of DPC has a message: “There’s no data.””

Spin doctor says DPC saves 85%. Don’t bet on it.

In a May 2018 “Policy Position” for the John Locke Foundation, Kathleen Restrepo wrote the following: A study conducted by University of North Carolina and North Carolina State University researchers found that patients seeking treatment from Access Healthcare, a direct-care practice located in Apex, North Carolina, spent 85 percent less on total health care spendingContinue reading “Spin doctor says DPC saves 85%. Don’t bet on it.”

Spin Doctor: DPC office visits are four times as long as PPS office visits. Don’t believe it.

“A university study found that patients treated in one Apex practice enjoyed average 35-minute office visits, more than four times longer than the average visit in a more typical practice. They also spent 85 percent less money.”  Kathlerine Restrepo, John Locke Foundation press release of March 22, 2017 As discussed in a prior post, Ms.Continue reading “Spin Doctor: DPC office visits are four times as long as PPS office visits. Don’t believe it.”

Marshall on Dershowitz; or is he talking about me on DPC?

To put it baldly, if it’s a topic and area of study you know nothing about and after a few weeks of cramming you decide that basically everyone who’s studied the question is wrong, there’s a very small chance you’ve rapidly come upon a great insight and a very great likelihood you’re an ignorant andContinue reading “Marshall on Dershowitz; or is he talking about me on DPC?”

11% claims reduction, with no adjustment for selection bias, is pretty tame.

Paladina Health maintains a news and information page on its website. As of the start of 2020, Paladina’s most recent entry of favorable cost reduction results is entitled “Paladina Health gives Akron schools a cost-saving model” and links to this Crain’s business report of an 11% reduction in claims. There was no adjustment for selectionContinue reading “11% claims reduction, with no adjustment for selection bias, is pretty tame.”

A single-post critique of AEG/WP’s recommendation on direct primary care.

1/13/2020 Update. See this post for some cost-adjusted data that suggests that direct primary care has net positive effects. My crude analysis suggesting that DPC might have worked, at least a little, maybe once, has since been firmly contradicted by actuarial evidence. Here’s a chronological list of posts relating to AEG/WP’s “Healthcare Innovations”.

A few brags from a few DPC companies is not a sound basis for public policy decisions.

Leave aside the specific critiques of the last twenty or so posts. The support for direct primary care in the report Healthcare Innovations in Georgia: Two Recommendations ultimately turns on the source material from which the report authors drew the key assumption that direct primary care reduces downstream care cost by 15%. That material comprisesContinue reading “A few brags from a few DPC companies is not a sound basis for public policy decisions.”