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Many people believe that investing in primary care can curtail the need for specialty care, with the thought that primary care can identify and treat many issues early on, when such treatment is less expensive. At the same time, compensation in the medical field tends to reward specialists. KFF Health news reports that the California agency tasked with slowing healthcare spending appears to be trying to rectify the situation by setting a goal for insurers to spend 15% of their budgets on primary care (up from the current 7%). At this point, there does not seem to be much incentive in place, with the possible exception that the agency might exempt insurers from a previously set annual limit of 3.5% for growth in healthcare spending.

Many people believe that investing in primary care can curtail the need for specialty care, with the thought that primary care can identify and treat many issues early on, when such treatment is less expensive. At the same time, compensation in the medical field tends to reward specialists. KFF Health news reports that the California agency tasked with slowing healthcare spending appears to be trying to rectify the situation by setting a goal for insurers to spend 15% of their budgets on primary care (up from the current 7%). At this point, there does not seem to be much incentive in place, with the possible exception that the agency might exempt insurers from a previously set annual limit of 3.5% for growth in healthcare spending.

The purported timeline is ten years, which seems ambitious given that "The agency said it will begin to collect primary care spending data in fall 2025, but that information may not be released for two more years." If insurers are unable to negotiate better prices for specialty care, it would be ironic if the growth in healthcare spending accelerates because insurers try to spend more on primary care to comply with this goal.

KFF Health News reported on a practice where some obstetrics practices will ask patients to prepay for care. One of the nuances is that providers bundle the billing for prenatal care, labor, and delivery, meaning that the final bill does not get settled until after the baby is born and that the bill tends to be larger because so many services are bundled. It appears that this practice grew out of concern for maternal health when people observed that some mothers skipped important care during pregnancy in order to avoid paying co-pays.

KFF Health News reported on a practice where some obstetrics practices will ask patients to prepay for care. One of the nuances is that providers bundle the billing for prenatal care, labor, and delivery, meaning that the final bill does not get settled until after the baby is born and that the bill tends to be larger because so many services are bundled. It appears that this practice grew out of concern for maternal health when people observed that some mothers skipped important care during pregnancy in order to avoid paying co-pays.

Understandably, providers want to ensure that they are paid for their services, and arranging prepayment helps ensure that. It is also understandable why patients might be upset at being asked for prepayment. Among other reasons, asking for prepayment implies some doubt that the patient will pay what is due.

KFF Family News reported on the president-elect's plan to promote Medicare Advantage, a scheme where private insurers can administer (and be reimbursed for) Medicare plans. Theoretically, the increased competition and the incentive that insurers can keep whatever savings they generate should lead to more efficient or higher quality care -- or both. However, the plans have been found to cost more: "In 2023, Medicare Advantage plans cost the government and taxpayers about 6% — or $27 billion — more than original Medicare, though some research shows they provide better care."

KFF Family News reported on the president-elect's plan to promote Medicare Advantage, a scheme where private insurers can administer (and be reimbursed for) Medicare plans. Theoretically, the increased competition and the incentive that insurers can keep whatever savings they generate should lead to more efficient or higher quality care -- or both. However, the plans have been found to cost more: "In 2023, Medicare Advantage plans cost the government and taxpayers about 6% — or $27 billion — more than original Medicare, though some research shows they provide better care."

One challenge reported in an earlier article is that some providers no longer accept Medicare Advantage plans, even if they accept traditional Medicare. The complication is that some patients who have been on Medicare Advantage may find it difficult to afford supplemental insurance (to cover the 20% patient responsibility) if they change back to traditional Medicare, if they have a preexisting condition. As a result, those patients may find themselves effectively stuck with Medicare Advantage.

Dentistry is one of many professions where there is asymmetry of information between the professional (dentist) and the customer (patient). Patients go to dentists because the dentists know much more about dentistry. However, KFF Health News published an article detailing how such disparity in knowledge can go wrong for the patient. The article raises the possibility that dental practices are steering their patients towards expensive treatment options, even if those options are not necessary and might even worsen patient health. The article also explores the question of whether private equity's ownership of some large dental chains might exert unwarranted influence on clinical decisions.

Dentistry is one of many professions where there is asymmetry of information between the professional (dentist) and the customer (patient). Patients go to dentists because the dentists know much more about dentistry. However, KFF Health News published an article detailing how such disparity in knowledge can go wrong for the patient. The article raises the possibility that dental practices are steering their patients towards expensive treatment options, even if those options are not necessary and might even worsen patient health. The article also explores the question of whether private equity's ownership of some large dental chains might exert unwarranted influence on clinical decisions.

A former president of the American Academy of Implant Dentistry "said he believed dentists are too ethical and patients are too smart to be pressured by private equity owners 'who will never see a patient.'" On the surface, that statement seems rather naive -- that someone would believe that an entire profession would be immune to conflicts of interest. Realistically, the speaker was likely responding in broad strokes for a good sound bite. Unfortunately, such pithy responses are not helpful when policy makers struggle with how to handle the apparently rising number of malpractice complaints.

Interestingly, the main patient featured in the article shared her experience with a dental chain that started off with a patient education consultant (apparently, a non-clinical salesperson). It was only after she agreed to a treatment plan and loan terms that she was seen by a dentist. Practices where corrective dental (or medical) care is sold before an assessment by a qualified individual seem extremely unprofessional.

KFF Health News published an article about California entering into an agreement with the developer of a online mental health app to help youth and young adults. The article focuses on the conflict of interest issue for the director of California's mental health commission. What seemed particularly interesting is that California signed a four-year $271 million contract for a free mental health app. In what appears to be the first year of the agreement, "roughly 20,000" children and young adults registered for the app, resulting in "only about 2,800 coaching sessions." If the cost of the contract were evenly spread across all four years, California appears to have paid an average of close to $97,000 for each session... which seems exorbitant, even with the current backdrop of a shortage of mental health therapists. Presumably, each of these sessions were conducted remotely.

KFF Health News published an article about California entering into an agreement with the developer of a online mental health app to help youth and young adults. The article focuses on the conflict of interest issue for the director of California's mental health commission. What seemed particularly interesting is that California signed a four-year $271 million contract for a free mental health app. In what appears to be the first year of the agreement, "roughly 20,000" children and young adults registered for the app, resulting in "only about 2,800 coaching sessions." If the cost of the contract were evenly spread across all four years, California appears to have paid an average of close to $97,000 for each session... which seems exorbitant, even with the current backdrop of a shortage of mental health therapists. Presumably, each of these sessions were conducted remotely.

While mental health is a pervasive issue, it seems that California should be able to acquire a more cost-effective solution. It appears that the director of California's mental health commission was keen on a digital solution, although it is unclear whether an expensive online presence is the best choice.