Paying for Primary Care with Insurance Makes Considerable Sense

The missing part 5 of Brekke’s “Paying for Primary Care”, a comment. Under the traditional insurance model, patients may incur some administrative costs but also gain financial advantages that Gayle Brekke’s multipart “Paying for Primary Care” series fails to recognize, ignores, or minimizes. At the top of the list, insurers bring the combined strength ofContinue reading “Paying for Primary Care with Insurance Makes Considerable Sense”

Brekke’s “Paying for Primary Care”, Comment on Part 4

In the first three installments of her Paying for Primary Care series, actuary Gayle Brekke’s invoked actuarial principles and behavioral economics to scold coverage of primary care on the ground that the costs of primary care are “predictable, routine, likely events over which the customer has a great deal of control”. In her fourth installment,Continue reading “Brekke’s “Paying for Primary Care”, Comment on Part 4″

Brekke’s “Paying for Primary Care”, Comment on Part 3

In Part 3 of Paying for Primary Care, Gayle Brekke discourses on the behavioral economics of shared health cost arrangements to conclude that insuring primary care adds costs not seen in direct pay. These cost, she contends, simply add on to the 50% administrative cost burden of insurance she had already she had already declaredContinue reading “Brekke’s “Paying for Primary Care”, Comment on Part 3″

Brekke’s “Paying for Primary Care”, Comment on Part 2

In Part 1 of “Paying for Primary Care”, actuary Gayle Brekke (mis)computed the provider side administrative cost burden of paying insurance at about 28%; in a response, I showed it likely that the true number was less than 9%, indicting that Brekke had inflated by more than three fold. Now we turn to Brekke’s PartContinue reading “Brekke’s “Paying for Primary Care”, Comment on Part 2″

Brekke’s “Paying for Primary Care”, Comment on Part 1

Health Care Cost Institute data presenting the 2017 primary care costs of millions of insureds shows an average annual primary care spend for 25-50 year olds of just less than $450.. For the same period, the cost of a direct primary care for same-aged subscribers was $900. Although you might consider direct primary care forContinue reading “Brekke’s “Paying for Primary Care”, Comment on Part 1″

DPC, one year after receiving a heart transplant, prepares to have old heart reimplanted.

I’m old enough to remember pro-DPC advocacy focussed on the long, in person, face-to-face primary care visits, the very “heart of direct primary care”. Surely that’s what motivated Doctor Steve Springer when he proudly opened Southwest Louisiana’s first direct primary care clinic. I say this because it certainly wasn’t telehealth Springer had in mind. AfterContinue reading “DPC, one year after receiving a heart transplant, prepares to have old heart reimplanted.”

Do economic forces lead to healthier patients self-selecting to member- funded DPC practice?

Yes. And, favorable selection to member-funded DPC is likely even greater than that already actuarially documented for employer funded DPC. [D]o economic forces lead to healthier patients self-selecting to a DPC practice? . . . . . . The value proposition for chronically ill patients– needing frequent visits and savings on ancillary services (labs, meds,Continue reading “Do economic forces lead to healthier patients self-selecting to member- funded DPC practice?”

Fauxtrage

While strongly endorsing direct primary care, the AAFP’s May 25, 2018 position statement to CMS on direct provider contractor models invoked the structural risk that the prevailing fee for service primary care practice model incentivizes the provision of potentially unnecessary primary care services. As yet, the fee for service primary care physicians who comprise theContinue reading “Fauxtrage”

New DPC leader is incredible – unfortunately, not in the good way.

Let’s meet Cladogh Ryan MD, one of the new board members for DPC Alliance for 2021 who picked up the torch from some of those golden oldies. Dr Ryan cranked up a town meeting style event to recruit some of her Cook County, IL, fee-for-service patients into her new enterprise, Cara Direct Care. She layedContinue reading “New DPC leader is incredible – unfortunately, not in the good way.”

KPI Ninja and bad faith.

KPI Ninja missed so many boats — a whole fleet really — in its Nextera report, you may wonder whether they come to analysis in good faith. Well, there’s one note in their favor. Sometimes, KPI Ninja’s inability to make important adjustments disfavors their DPC client. In their analysis of DirectAccessMD, for example, an inducedContinue reading “KPI Ninja and bad faith.”