A moment of clarity about selection bias – at a DPC summit.

At 2019 Summit, Mike Tuggy, MD, FAAFP, presented this: What Have Primary Care Practices Provided to Employers Who Invested in Primary Care? The Results Speak for Themselves–Reports from Across the U.S.2019 DPCSummit62019 Direct Primary Care (DPC) Summit

His presentation began with high praise for Qliance and others. He suggested that these models might be used to entice employers into a DPC experiment. Strikingly, he did not mention selection bias or risk adjustment in connection with using these data sources to entice employers to sign up. Certainly, there was no acknowledgement that one of his poster-children, Nextera, had a very low-risk membership.

Even more strikingly, however, the talk ended up in a Q & A that focused heavily on (a) the problem of having too many high usage patients as members, and (b) being certain that potential employer contracts compensated the DPC better for riskier patients. It even reached the point of a benefits broker offering the equivalent of underwriting services for DPC clinicians.

It’s good to see some realism about selection issues deployed when it helps DPC providers . It would also be appropriate when realism might expose that selection bias might be lurking behind claims of DPC success.

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