Category Archives: Current at DPC Referee

Actuarially adjusted study makes clear that Nextera’s DPC clinic was a flop.

Relying on deeply flawed studies and strained interpretations, as set out here and elsewhere, Nextera and Paladina (now part of Everside) still brag that their respective “school district” and “county government” direct primary care option programs for employer heatlh care plans produce huge overall health care cost savings. 2024 saw publication of two university doctoralContinue reading “Actuarially adjusted study makes clear that Nextera’s DPC clinic was a flop.”

That the Union County DPC experiment was a flop is clear from a careful reading of its two actuarial studies, including the one claimed to vindicate DPC.

This post in a three minute nutshell Union County created a direct primary care option for its health insured employees. There were two particularly salient features: the monthly DPC fees were extravagant; and the county sweetened the DPC option with cost-sharing reductions (CSR) for downstream care. Despite CSR, the DPC clinic was able to reduceContinue reading “That the Union County DPC experiment was a flop is clear from a careful reading of its two actuarial studies, including the one claimed to vindicate DPC.”

Brain Forrest, MD

Despite his longtime DPC advocacy, Dr Forrest’s work has yet to receive the kind of respect it truly deserves. For example, even though he publicized its astonishing findings, many do not even recall that Forrest directed a team of NCSU graduate business students in canvassing the entire Raleigh area to observe directly the amount ofContinue reading “Brain Forrest, MD”

Milliman’s valuation of DPC health care services at $8 PMPM rests on faulty data.

If I were a direct primary care practitioner, I’d be only mildly miffed at Milliman’s reducing what I do to a series of CPT codes. But I’d be furious that Milliman’s team set the value of my health care services at $8 PMPM. The $8 PMPM figure Milliman declared as the health care service utilizationContinue reading “Milliman’s valuation of DPC health care services at $8 PMPM rests on faulty data.”

No, Milliman did not find a 50% DPC savings on specialist utilization.

The Milliman team readily admitted that it was unable to assess the impact of DPC on specialist utilization. Then, it overvalued DPC contracts using exactly such an assessment. DPC advocates broadly insist that DPC members have significantly lower utilization of specialist physician services than do patients who receive primary care under the traditional FFS model.Continue reading “No, Milliman did not find a 50% DPC savings on specialist utilization.”

As important as overhead expenses are in the economics of PCP practice, expressing measured overhead costs as a percentage of revenue may be misleading.

After attaining a certain measure of success and a spreading reputation, an illustrator can vastly increase his prices and still sell his entire output, and do so without incurring added costs for pencils, paint, paper, other studio supplies or studio space. Revenue up; no change in overhead costs; overhead costs as a percentage of revenueContinue reading “As important as overhead expenses are in the economics of PCP practice, expressing measured overhead costs as a percentage of revenue may be misleading.”

Quick guide/recap for Brekke’s “Paying for Primary HealthCare” and my responses

In an e-book and blog about paying for primary care, Gayle Brekke presents an argument laced with actuarial theory and jargon, calculations, notes, and citations. An appearance of scholarly pursuit and mathematical precision is thereby created; in both blog and e-book Brekke makes clear that she is an experienced actuary who is also deep intoContinue reading “Quick guide/recap for Brekke’s “Paying for Primary HealthCare” and my responses”

The mathmatical core of Brekke’s “Paying for Primary Healthcare is not reasonably supported by the sources to which Brekke points.

Because paying for primary care with insurance incurs administrative costs not encountered in direct pay models, a case can be made that direct primary care should cost a patient less than insured primary care. But most DPC advocates are themselves PCPs and they just might have less to gain from offering discount pricing and moreContinue reading “The mathmatical core of Brekke’s “Paying for Primary Healthcare is not reasonably supported by the sources to which Brekke points.”

In rural areas, decreased primary care panel size is a problem, not a solution.

Montana’s last governor twice vetoed DPC legislation. He was not wrong. Over the last month or so, DPC advocates from think-tanks of the right have trotted out the proposition that direct primary care could be “the key to addressing disparities in health care access in underserved areas of Montana facing severe shortages of primary care”.Continue reading “In rural areas, decreased primary care panel size is a problem, not a solution.”