RESCINDED: ATTN: Milliman. An employer’s cost sharing plan affects claims experience.

In its recent assessment of the impact of the direct primary care model, Milliman took a two track approach. An employer ROI based approach included comparing claims experience for a group of employees who opted to receive primary care from a DPC clinic versus those using traditional FFS PCPs; in addition, the ROI analysis also assigned costs to employer of the differing cost-sharing structures the employer has required of the two groups. This computation resulted in the conclusion that in the plan under study DPC actuatlly increased employer costs.

In a second approach, however, Milliman looked only at a claim cost comparison between the two the groups. According to Milliman, “this cost comparison attempts to isolate the impact of the DPC delivery model on the overall level of demand for health care services“.[Italics in original].

In June, I wrote that, “Given that the employer offered different cost sharing regimes to the two groups, the purported isolation is simply not possible.” There followed a lengthy argument, which I now retract.

Or so I thought.

As in November of 2020, I acquired the tools to more accurately assess induced utilization. And the difference in cost sharing regimes I now understand is negligible. Based on using the CMS AV calculator to compare the plans, and CMS induced utilization proportions, I think this would make a difference of less than 0.2% in favor of the DPC/.


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