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″
Tag Archives: direct primary care
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″
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 (Everside): a race to the top of Mount Brag
Updated 9/4/21 In 2015, Qliance still towered over all in the Direct Primary Care Bragging World 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 FoundationContinue reading “Nextera and Paladina (Everside): 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.”
Nextera’s Next Era in Cherry-Picking Machine Design
Note: revised and redated for proximity to related material. Original version June 27, 2020. In June of 2020, Nextera HealthCare had a hot new brag: These results were not risk adjusted. But they desperately needed to be. The St Vrain Valley School District had this health benefit structure for its employees during the period studied:Continue reading “Nextera’s Next Era in Cherry-Picking Machine Design”
Medi-Share gives its Christian take on DPC downstream cost savings: $31 — a year.
Christian Care Ministry (“Medi-Share”), whose 400,000 members account for more than a quarter of health cost sharing members nationally, recently acted to allow some of its members to receive credit for their entire direct primary care membership fees up to $1800 per year. That there is a certain synergy between DPC and health cost sharingContinue reading “Medi-Share gives its Christian take on DPC downstream cost savings: $31 — a year.”
Medicare, dual coverage, and opt-out. The cherry on top of the cherry-picking machine for employer-based direct primary care.
In 2016, the share of people between 65 and 74 who were still working was over 25%. Any of them working at employers with more than twenty employees covered by group health plans are required by law to be included in the employer’s plan. They may also enroll in Medicare Part B. Some employer plansContinue reading “Medicare, dual coverage, and opt-out. The cherry on top of the cherry-picking machine for employer-based direct primary care.”
DPC Referee 