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Gayle is joined by Daniel Cruz, health actuary and consultant, to discuss the state of the actuarial profession in light of recent communications about rating of Affordable Care Act plans. The actuarial profession plays an important role in safeguarding the institution of insurance for the benefit of society. We are a self-regulated profession. We rely on a combination of standards of practice, professionalism, examinations, continuing education, and a disciplinary review pr...

In this episode, Gayle and Joyce are joined by Dr. Lee Kurisko, a Canadian radiologist who left practice in Thunder Bay Ontario to pursue a career stateside after becoming disillusioned with Canada’s centralized approach to healthcare delivery. His firsthand knowledge of waiting lines, physician and staff shortages, and outdated imaging equipment forced a change of heart from the great confidence he initially felt in Canada’s healthcare system. He soon discovered greater efficiency and less r...

Gayle recently talked with Leo Wisneiwski, founder of Health Cost Labs (www.healthcostlabs.com) about hospital price transparency and how this newly disclosed data will be a game changer for health care expenditures. Leo described how his experiences with fee schedules and billing data at an insurer lead him to found a company that cleans hospital price data and makes it usable for brokers, employers and patients. When insurers change fee schedules, providers respond by billing th...

Greg recently completed a research report for the Society of Actuaries entitled “Uninsured Rate” Measurements and Health Policy Considerations, available at www.soa.org/resources/research-reports/2021/uninsured-rate-measurements/. He became interested in the measurement of the uninsured rate because we don’t really know the impact of reforms on the uninsured rate, and there’s no agreed-upon definition of being uninsured despite the importance of lowering the rate of uninsurance; every s...

Dr. Wendy Molaska offers many points of view about Direct Primary Care. In just over 35 minutes, we touch on all of the important aspects of DPC, examined through a variety of lenses including· Physician and patient perspectives in DPC and traditional primary care· Physicians employed by a big system vs practicing independently· Physician incentives in DPC vs in the “sick care” system·&nbs...

Fritz Busch describes being smitten with DPC the first time he heard a DPC physician talking about the model. He found the model very appealing because it seemed like it would work, it would provide better care. Fritz had always been bothered that so many physicians are burned out. He was very pleased to learn how much physicians loved practicing in a DPC model, as there was finally something that’s going directly at our physician burnout problem. Fritz wanted to study DPC, ...

You don’t want to miss this wide ranging conversation with perhaps one of today’s foremost experts on healthcare systems. Health actuary and retired Milliman Principal, Mark Litow spoke with Joyce and Gayle about how healthcare systems work, the main disconnects in the US system, and how reform efforts have led to the numerous problems we face today, including poor doctor-patient relationships, unaffordability, generational inequity, workforce challenges, and long term unsustainab...

Today’s guest was Troy Robert, who has multiple entrepreneurial ventures in the healthcare system related to physical therapy and staffing of allied health professionals. Troy explained different models of delivering and paying for physical therapy. He compares the incentives of fee-for-service and direct pay models, plus a new model that aims to change the way PT is accessed for large employer groups. This new model uses a per member per month approach and has patients acce...

Richard Young MD, family medicine physician, faculty, researcher and innovator, has spent most of his career at a safety net hospital. He details how quality metrics and payment based on CPT codes devalue the practice of family medicine. Primary care is disadvantaged compared to other specialties, with family physicians earning perhaps one half to one third what other specialists earn. Yet primary care physicians are responsible for the care of the whole patient, which often invol...

Dr. Michel Accad has a direct cardiology practice and a direct primary care practice; he has authored a book (Moving Mountains: a Socratic Challenge to the Theory and Practice of Population Medicine) and he blogs (www.alertandoriented.com) and podcasts (www.accadandkoka.com).Dr. Accad explains why he left traditional insurance-based practice and started his direct cardiology practice where patients pay directly for services and insurance is not involved. He later added a direct primary ...