The Society of Actuaries (SOA) commissioned Milliman to develop this report to provide health care stakeholders (patients, payers, policymakers and actuaries) with a comprehensive description of Direct Primary Care (DPC) as well as an objective actuarial evaluation of certain claims made about the DPC model of care.

Today we sit down with one of the authors of the study, Fritz Busch, a consulting actuary at Milliman. Fritz’s experience includes 27 years as an actuary and business leader in the insurance industry.

Prior to starting at Milliman, he was with one of the larger Blue plans and had several consulting roles with McKinsey & Co. His commercial carrier experience includes a wide range of actuarial plan management functions that include reserving and annual statement work, trend analysis, commercial large group pricing, ACA individual and small group pricing, Medicare Supplement pricing, benefit plan design and product development.

At Milliman, he has successfully worked with a variety of clients including regulators, insurance company executives, and others. He is a frequent speaker at industry and public policy meetings. Primary care is a vital and even foundational component of any health care system. Primary care physicians (PCPs) are the front line of health care and are often the entry point for patients needing care. How often a patient accesses primary care, and the quality of that care, can have significant impacts on downstream costs and patient health outcomes. However, while PCPs are almost universally acknowledged as essential to achieving the health care Triple Aim of providing high-quality care, at lower cost, with improved patient experience, many health care experts describe the current state of primary care as being in crisis. This crisis is characterized by physician burnout, large PCP patient panels, low pay for PCPs relative to other physician specialties, increased administrative burden, longer work hours without increased reimbursement, an increased risk of mental health conditions and suicide, and ultimately a PCP shortage relative to market demand.

RESOURCES MENTIONED

www.milliman.com

https://www.soa.org/resources/research-reports/2020/direct-primary-care-eval-model/

https://www.dpcare.org/

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