Making cost reduction claims more honest and helpful to decision-makers — random thoughts.

Claims of cost reductions need to look comprehensively at all costs. Consider this chart from an Iora presentation of some years ago. The net drop in spending would look a lot bigger if prescription drugs (the green bar) were not part of the picture. But, a lot of how primary care, direct or otherwise, worksContinue reading “Making cost reduction claims more honest and helpful to decision-makers — random thoughts.”

DPC and Medicaid expansion politics.

DPC docs uniformly recommend that their non-indigent patients have wrap-around insurance coverage. But for indigents, particularly for what are known as “Medicaid expansion adults” too many DPC docs are willing to push their state for an indigents’ program heavy on direct primary care coupled to, at best, skimpy coverage of downstream costs. They’re eager forContinue reading “DPC and Medicaid expansion politics.”

A moment of clarity about selection bias – at a DPC summit.

At 2019 Summit, Mike Tuggy, MD, FAAFP, presented this: What Have Primary Care Practices Provided to Employers Who Invested in Primary Care? The Results Speak for Themselves–Reports from Across the U.S.2019 DPCSummit62019 Direct Primary Care (DPC) Summit His presentation began with high praise for Qliance and others. He suggested that these models might be usedContinue reading “A moment of clarity about selection bias – at a DPC summit.”

Dr Rice's "DPC saves money" fantasy proves illusory.

When the third word of an article with a quantitative angle is hyperlinked to an article by the same author, an MD who also holds an MBA, and the linked article reveals that the author can not actually calculate “markup” correctly, look hard at both pieces. Behold Why direct primary care is the future byContinue reading “Dr Rice's "DPC saves money" fantasy proves illusory.”

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”

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.”

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.”

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. Here’s a chronological list of posts relating to AEG/WP’s “Healthcare Innovations”.