Leave aside the specific critiques of the last twenty or so posts. The support for direct primary care in the report Healthcare Innovations in Georgia: Two Recommendations ultimately turns on the source material from which the report authors drew the key assumption that direct primary care reduces downstream care cost by 15%. That material comprises three self-reports of claimed successes in medical cost control by three direct primary care operators seeking to extend their reach by open marketing efforts.
There is, of course, nothing wrong with self-service so long as it is done in good faith. We may assume, without deciding, that Nextera’s relationship with Digital Globe, Paladina’s with the city of Arvada, and CHI ‘s individual care clinic shows some real cost-reduction success, and still ask, “Who reports the failures? ”
There are over 1200 DPC practices. Surely there are a great many marketing directors that would be happy to brag about their DPC firm’s demonstrable success in reducing downstream care costs. Just as surely, there are few who would make an effort to publicize a failure to reduce downstream costs.
On that score, note that Paladina could report cost control results for many more of its clinics than it does; it relies on two. Nextera, now with over 50 physicians, a presence in seven states, and patients in the thousands, still relies on the 200 patient DigitalGlobe study from 2015 to prove its cost-effectiveness.
The reality is that marketing involves reporting stuff that makes the marketed firm look good — and burying anything else. Scouring marketing materials and collecting press releases does not get representative results.
Any serious investigation of the effect of direct primary care on downstream care claims costs requires recognizing that collecting isolated, self-serving reports of good results tell us next to nothing. What is needed is comprehensive, objective research that detects broadly representative results of whatever stripe they may bear.
When was the last time you went to a financial services company’s website and read that the firm’s mutual funds have among the lowest returns in the industry? Or seen a city put up a sign that the local high school football team went 1-9?