Description: Direct Primary Care (DPC) is a newer model of primary care delivery in which patients or employers pay for care directly on a membership basis; insurance and other third-party payment is not used. Early studies show significantly improved patient health outcomes and lower expenditures for DPC patients compared with similar patients receiving traditionally delivered primary care. Additional research is needed to better understand physician perspectives about the model and the role of patient selection in early results.In this session we discuss research projects that may shed light on the DPC model and on whether early results indicate more about the model or about the patients who use it.We discuss an SoA research project that interviews DPC physicians to better understand their views about the model and its early results. We also discuss a paper that analyzes characteristics of patients who receive primary care from a DPC physician and compares them to characteristics of patients who receive primary care in more traditional ways. This cross-sectional study surveys all adult patients of a convenience sample of several DPC practices. Variables include demographics, socio-economic status (SES), type of additional coverage (if any), whether DPC fees are paid by an employer, and self-reported health status. The Medical Expenditure Panel Survey is the main source of comparison data. For a given cohort of demographics and additional coverage, we determine whether DPC patients have similar health status, demographics and SES as non-DPC patients. This study will provide insight into the degree of selection into DPC by observable patient characteristics.

Description: This article is directed to the payors—especially self-funded employers and TPAs—that seek to improve the health of the populations they cover in addition to administering the plan. Greater use of primary care is one way to better manage the health delivery. The results should also impact costs in a measurable way. Issue No. 59

Description: Article describes enhanced primary care models and provides citations on whether or not health care savings have been achieved.

Description: On March 6, 2023, The Wall Street Journal hosted its Health Forum, a hybrid all-day event. The virtual meeting featured 11 different events. This white paper focuses on those events. The sessions were informative and fast-paced, with each one providing a quick hit of relevant and cutting-edge information around health care.

Description: This article examines the costs of mental health parity, presents the primary drivers of cost increases from legislation and shows evidence the initial cost projections were too high. From Health Section News, March 2005, Issue No. 49.

Description: This article reviews the cost of behavioral health care and looks at how the involvement of Primary Care Physicians leads to a less efficient and effective treatment and is an increasing cost many plans have yet to address. From Health Section Newsletter, March 2005, Issue No. 49.

Description: Health Watch Newsletter, May 2006, Issue No. 52. This article presents information from a recently completed client-sponsored survey of hospital contracting best practices. Individual health plans were evaluated using a structured survey document. The primary objective of the survey was to identify best practices that the client sponsor could implement to improve its already better-than-average hospital contracting practices

Description: Answers to questions that have surfaced with regard to recent trends in the use of psychiatric medications, including relative effectiveness compared to prescribing patterns, drivers of prescribing patterns, classification and indications for recently publicized drugs, role of primary care providers, preventive use ofdementia medications, and new developments in the field.

Description: This session discussion is about health care trends including current experience, measurement problems, effect of selection, and variation by size of group. Also discussed is the new Medicare RBRVS physician fee schedule, anticipated cost shifting, and AIDS. From Record of Society of Actuaries 1990 Vol. 16, No. 4A.

Description: This 1991 panel discussion is about health care trend including current experience, measurement techniques and problems, uses of trend projections, and other considerations such as the impact of selection and the impact of initial and renewal underwriting practices. From the Record of the Society of Actuaries Vol. 17, No. 3A.