The most heavily relied-on “study”purporting to prove the effectiveness of direct primary care is an important marker in a national debate with real consequences. But it is not a study at all.
In certain quarters, anything that appears on the sacred webpages of a Heritage Foundation report is taken as gospel truth. So, when Heritage cited, and even linked, what it called “a British Medical Journal study of Qliance” that “showed” what Heritage then presented as “positive results” of a “study” very favorable for direct primary care offered by Seattle-based Qliance, the data was re-presented dozens of times.
There was one source that might have been expected to promote a favorable “British Medical Journal study of Qliance” with particular enthusiasm — Qliance itself. Rather tellingly, it didn’t. The company must have known something that was not discernible to Daniel McCorry, the Heritage graduate fellow who wrote the misleading report.
The prestigious “British Medical Journal study of Qliance” for which Heritage claimed “positive results” does not – as such – exist. The item on which McCorry relied was not a research report of empirical results; it contained no quantitative detail; it was not peer-reviewed; and it certainly was not a British Medical Journal study. It was a BMJ news feature, by a journalist rather than a scholar, that included some figures simply transcribed without evaluation from a table summarizing data compiled by Qliance itself and “published” only in a slide show targeted at potential investors in its direct primary care business. Moreover, probably to reduce the danger of liability for defrauding those very investors, the table itself bore this red flag: “Based on best available internal data, may not capture all non-primary care claims.”
But McCorry had just completed his first year of medical school at the time. perhaps Georgetown SOM does not teach its students how to critically read a medical journal until second year. Did McCorry achieve a passing grade in Georgetown’s required first-year course in evidence-based medicine, the one about “critically assessing various information sources” that “prepare(s) students to evaluate medical literature?” Did he have a problem with the BMJ paywall?
As if to underscore a real need for real research, Qliance’s self-assessments of effectiveness have varied over the years by as much as four-fold. For example, the table quoted in the October 2013 BMJ feature announced that Qliance members had 66% fewer ER visits and 65% fewer specialist visits than similar patients; less than fifteen months later, a Qliance press release reset both measures at a mere 14%. And fifteen months after that, in February 2017, McCorry, now an M.D., was still republishing in national media the older, gaudily-large figures sans the Qliance’s own warning of their severe limitations.
Serious research on Qliance’s effectiveness has yet to appear.
McCorry pulled even more impressive numbers from an actual peer-reviewed medical journal article, wasting spilling proportionally more ink in the process. Unfortunately, that American Journal of Managed Care piece was not a study of insurance-free direct primary care at all.
It’s subject was MD-VIP, a high-end concierge network that serves insurance-based primary practice physicians. McCorry simply misidentified it as a direct primary care group. MD-VIP sells an add-on package of exclusive easy access, extra screenings, and wellness benefits for which patients pay an annual fee that averages $1800. Patients still maintain insurance for all the usual primary costs; the physicians still bill for ordinary primary care; and the patients are still liable to the physicians for the usual copays and deductibles. To be fair to McCorry, he might have had to read almost eighty words of the article before reaching the first indication that the studied patients were largely insured for primary care. Now that D.M. is an M.D., I’ll bet he knows what MD-VIP actually is.
From Heritage lips to the ears of all fighters for health care freedom: the MD-VIP blunder was, like the Qliance falsehood, repeated dozens of time.
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Update: February 23, 2017. Qliance appears to be in serious trouble. Despite over $20,000,000 in annual revenues, there is a gofundme.com site seeking $1,000,000 in the next few weeks for Qliance, which has not been able to borrow what it needs. Astonishingly, the gofundme pitch quotes verbatim the outsized, outdated 2010 Qliance figures, attributing them to Daniel McCorry’s February 2017 article in Forbes, where they appear without any attribution at all.
DPC Referee 