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 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.”

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.”

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.

May 2020: An important study by actuaries at Milliman now suggest that 15% downstream care cost reductions are credible, affect our previous take on the AEG/WP report.

A few brags from a few DPC companies is not a sound basis for public policy decisions.

Leave aside the specific critiques of the last twenty or so posts. The support for direct primary care in the report Healthcare Innovations in Georgia: Two Recommendations ultimately turns on the source material from which the report authors drew the key assumption that direct primary care reduces downstream care cost by 15%. That material comprisesContinue reading “A few brags from a few DPC companies is not a sound basis for public policy decisions.”

Total claims cost caution: when DPC is implemented primary care claims vanish. AEG/WP’s 15% estimate is not conservative in the least.

When the direct primary advocates toss out figures about overall claims cost reductions, it’s important to carefully separate overall cost, downstream care claims costs, and overall claims costs. For example, the authors of the AEG/WP pitch for DPC in Georgia, have assumed a 15% reduction in downstream care costs and claimed that it “represents theContinue reading “Total claims cost caution: when DPC is implemented primary care claims vanish. AEG/WP’s 15% estimate is not conservative in the least.”

A possible 11% reduction in overall care cost, adjusted for risk, is suggested by Union County’s 2018 report.

NEVERMIND! In Union County adoption of a DPC option cost the county money. So say actual actuaries. I’ll leave this post essentially intact, for the record (of my folly!) Here’s some data that shows plausible overall cost reduction from direct primary care even after adjusting selection bias. It comes from the Paladina-operated clinic in UnionContinue reading “A possible 11% reduction in overall care cost, adjusted for risk, is suggested by Union County’s 2018 report.”

To learn how much direct primary care can do, try it first in the ACA-compliant, full-benefit individual market.

If Georgia must mandate the availability of direct primary care, here’s how. For some future open enrollment period, the individual market will offer paired plans that differ only by how primary care is paid for and how it is received. Bigco, for example, offers Bigco Silver FFS and Bigco Silver Direct ; MajorCo probably offersContinue reading “To learn how much direct primary care can do, try it first in the ACA-compliant, full-benefit individual market.”