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″

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.”

Nextera and Paladina: a race to the top of Mount Brag

In 2015, Qliance still towered over all in the world of Direct Primary Care bragging with its claim of 20% overall cost reductions. Even that, of course, was quite a come down from the extravagant claims previously spewed under the Qliance banner; fond memories still linger of those heady days when the Heritage Foundation drooledContinue reading “Nextera and Paladina: a race to the top of Mount Brag”

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.”

KPI Ninja’s Nextera risk measurement charade

Abstract: The Nextera “study” by KPI Ninja misappropriated the prestige of a Johns Hopkins research team to support its risk measurement claims; relied on an undisclosed and unvalidated methodology for obtaining population risk measurements; obtained highly dubious risk measurement results; and sharply mischaracterized the significance of those results. In the end, because applying even theirContinue reading “KPI Ninja’s Nextera risk measurement charade”

KPI Ninja’s Nextera analysis: more than enough problems.

Three major adjustments are needed, even without correcting the IP admit rate problem or arriving at a more reasonable risk adjustment. Comparing data from Nextera patients and non-Nextera patients in the SVVSD programs requires three major adjustments which KPI Ninja never attempted. Computations here. Because of the different benefit structures, the district’s claim costs forContinue reading “KPI Ninja’s Nextera analysis: more than enough problems.”