Nextera: the KPI Ninja study in a nutshell.

The KPI Ninja report ignored the effect of an HRA for non-Nextera members only. But $750 in first dollar coverage gets a cost-conscious non-Nextera employee a lot of cost-barrier free primary care for her chronic condition. And, unlike the dollars the SVVSD spends at Nextera, every HRA dollar the district covers for a non-Nextera employeeContinue reading “Nextera: the KPI Ninja study in a nutshell.”

KPI Ninja’s Nextera analysis: too many flaws to address them all.

Candor matters. Even as a cloud of tainted IP admission data looms over KPI Ninja’s analysis of Nextera’s SVVSD clinic, underneath that report there may well lie a pants-fire of misappropriated prestige. “KPI Ninja conducted risk score analysis in partnership with Johns Hopkins’ ACG® research team [.]” KPI Ninja Nextera study, versions of 10.13.20 andContinue reading “KPI Ninja’s Nextera analysis: too many flaws to address them all.”

Nextera says these average people have an IP admit rate of 246/1k.

In their path-breaking report on Direct Primary Care to the Society of Actuaries, the team from Milliman Actuaries described a model framework for an employer direct primary option. They concluded that DPC was a break-even monetary propositions when DPC monthly fees were set at an average of $60 PMPM, $720 PMPM. That modeling was basedContinue reading “Nextera says these average people have an IP admit rate of 246/1k.”

Nextera’s Next Era in Cherry-Picking Machine Design

Note: revised and redated for proximity to related material. Original version June 27, 2020. In June of 2020, Nextera HealthCare had a hot new brag: These results were not risk adjusted. But they desperately needed to be. The St Vrain Valley School District had this health benefit structure for its employees during the period studied:Continue reading “Nextera’s Next Era in Cherry-Picking Machine Design”

HSA breaks for DPC defeat the purpose of HSA breaks

HSAs are intended to encourage more cost-conscious spending by placing more of the health care financing burden on out-of-pocket spending by the users of services, as opposed to having the costs of those services incorporated in payments shared over a wider group of plan enrollees regardless of service use. H/T Blumberg and Cope. HSAs areContinue reading “HSA breaks for DPC defeat the purpose of HSA breaks”

DPC from 30,000 feet, on September 2020

Even with all the overhead reductions that come from not taking third party payment and/or from not billing on a fee for service basis Even with those reductions transformed to increased primary care access that results in clear reductions on ED visits and other urgent care needs Still, Direct Primary Care with panels of 600Continue reading “DPC from 30,000 feet, on September 2020”

Helping those patients most dependent on DPC means defeating the DPC/HDHP/HSA “fix”.

Plus, two more reasons to reject the “fix”. Direct Primary care clinicians and advocates often point out, accurately, that they serve a broad socio-economic range of patients. The range is well illustrated by a pair of oft-appearing themes, “concierge care for the middle class” and “affordable care for those who fall between the cracks”. InContinue reading “Helping those patients most dependent on DPC means defeating the DPC/HDHP/HSA “fix”.”

DPC is way different than you paying Neflix. Notes

The State of New York has the financial capital of the country (arguably the world), has the most insurance companies in the country, and was the biggest state for the longest time. For these reasons it is generally looked to for leadership in the law on financial subjects primarily governed by state law. Here’s theirContinue reading “DPC is way different than you paying Neflix. Notes”

DPC subscriptions transfer financial risk.

Identifying DPC nonsense does not require a law degree. Watch out. Near you is a direct primary care advocate begging a legislator or regulator to make his medical practice less accountable. He is stomping his feet very, very hard and he’s shouting “This is not insurance”, “There is no risk being transferred”, or “My practiceContinue reading “DPC subscriptions transfer financial risk.”

DPC cherry-picking: the defense speaks. Part 2.

Update: In the fall of 2020, KPI Ninja released the first study that relies on it’s new risk information technology. I find it sadly opaque. Recap of Part 1 The direct primary care community has long tried to support claims that DPC reduces overall health care costs by 20% to 40% with non-risk-adjusted cost-reduction dataContinue reading “DPC cherry-picking: the defense speaks. Part 2.”