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.”

Try due diligence before betting the health of your employees on Lee-Gross-style Direct Primary Care

In his latest Direct Primary Care slide-show brag, attributing significant overall medical cost reduction for employees electing DPC over and FFS primary care alternative offered by the same employer, Dr Lee Gross insists that the favorable results do not reflect “cherry picking”. And yet, Dr Gross fails to compare the health status of the DPC-coveredContinue reading “Try due diligence before betting the health of your employees on Lee-Gross-style Direct Primary Care”

Including Primary Care in Health Insurance Policy Coverage with Insurance Is Reasonable

The missing part 5 of Brekke’s “Paying for Primary Care”, a comment. Under the traditional insurance model, patients receiving covered primary will indirectly pay significant administrative costs, but they may also gain compensating financial advantages that Gayle Brekke’s multipart “Paying for Primary Care” series fails to recognize, ignores, or minimizes. At the top of theContinue reading “Including Primary Care in Health Insurance Policy Coverage with Insurance Is Reasonable”

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 for primary care 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 turnContinue reading “Brekke’s “Paying for Primary Care”, Comment on Part 2″

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

In the winter of 2021, actuary Gayle Brekke penned a four–part–blogpost–series arguing that the cost of insurance primary care delivery in the insurance system is at least 50% higher the cost of delivering primary care through subscription model DPC. Notably, Brekke’s work was theoretical rather than empirical; she attempted to compute the relative costs ofContinue 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 unnecessary primary care services. As yet, the fee for service primary care physicians who comprise the vastContinue reading “Fauxtrage”