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.”
Tag Archives: cost reduction claims
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.”
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.”
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 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 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 than 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 costsContinue reading “Brekke’s “Paying for Primary Care”, Comment on Part 1″
DPC Referee 