AEG/WP's chosen actuary did not validate the assumption that direct primary care reduces downstream care costs.

AEG/WP report declares that “[Nyhart, an independent] actuary determined that “(1) the modeling assumptions are reasonable for this type of analysis and (2) the illustrative projections and savings are reasonable outcomes based on the modeling assumptions and data inputs selected.” This statement sounds like powerful support for report’s key assumption that direct primary care bringsContinue reading “AEG/WP's chosen actuary did not validate the assumption that direct primary care reduces downstream care costs.”

Bupkes. Nextera reported a claims cost reduction of $72 PMPM; subtracting a $70 fee, and AEG/WP's billion dollar promises fall nearly 95%.

Asked for sources supporting their assumption of 15% downstream care claims cost reduction, the authors of Healthcare Innovations in Georgia — Anderson Economic Group and Wilson Partners (AEG/WP) — point to Nextera’s contract with DigitalGlobe, as reported in Nextera’s self-published study here. And here’s the exact table from that study showing claims cost reductions forContinue reading “Bupkes. Nextera reported a claims cost reduction of $72 PMPM; subtracting a $70 fee, and AEG/WP's billion dollar promises fall nearly 95%.”

Nextera's marketing presentation establishes huge selection bias, while revealing modest evidence that Nextera cuts cost for some of its patients. But the data set is tiny, old, and contaminated by results for fee for service patients!

The basic premise of AEG/WP’s advocacy for direct primary care is succinctly stated in “Healthcare Innovations in Georgia: Two Recommendations” at page 24. “Establishing a relationship with a doctor for a fixed monthly fee can induce and empower many patients to see their primary care physician regularly, which results in decreased healthcare expenses and reducedContinue reading “Nextera's marketing presentation establishes huge selection bias, while revealing modest evidence that Nextera cuts cost for some of its patients. But the data set is tiny, old, and contaminated by results for fee for service patients!”

The two largest and most current AEG/WP examples of downstream cost reduction failed to adequately address selection bias.

Although the AEG/WP report does not support its key claim with data or citation, the report’s authors responded to my request for information by indicating their sources. One of them was an e-zine article about the CHI clinic. The other two were promotional brochures, denominated case studies used, by the DPC companies Paladina and Nextera,Continue reading “The two largest and most current AEG/WP examples of downstream cost reduction failed to adequately address selection bias.”

Why did Wilson Partners' research into DPC cost-reduction bypass uniquely available and pointedly relevant data?

As noted in a prior post, the report by the Anderson Economic Group and Wilson Partners supported the assumption that direct primary care reduces downstream care cost by 15% with nothing more than a cryptic reference to “research and case studies prepared by Wilson Partners”, presented with neither data nor citation. Initially, I thought thisContinue reading “Why did Wilson Partners' research into DPC cost-reduction bypass uniquely available and pointedly relevant data?”

Selection bias infected the best documented argument that direct primary care reduced downstream costs.

A unique and powerful opportunity for quantitatively informed assessment of such claims has come from a DPC clinic serving employees of Union County. There, health plan members are able to choose between receiving primary care in a DPC clinic or through physicians under traditional model of insurance and fee for service. Mark Watson is theContinue reading “Selection bias infected the best documented argument that direct primary care reduced downstream costs.”

The marketplace reached a judgment about direct primary care pioneer, Qliance.

Washington State is deservedly recognized as the birthplace and one of the most prominent frontiers for DPC, in large part because of Qliance. The Seattle-based DPC conglomerate is recognized as an exemplary market force in the private sector of health care. Major investors such as Amazon CEO Jeff Bezos have propelled Qliance . . .Continue reading “The marketplace reached a judgment about direct primary care pioneer, Qliance.”

"Trust us. We did studies." AEG/WP have a special way of showing that direct primary care reduces the costs of downstream care.

The focal assumption of the AEG/WP report’s calculations is that DPC membership will reduce the claims cost for downstream care by 15%, a number represented as a low end estimate. The sole support offered in the AEG/WP report for this 15% presumption is a statement that, “the factor is based on research and case studiesContinue reading “"Trust us. We did studies." AEG/WP have a special way of showing that direct primary care reduces the costs of downstream care.”

DPC advocates talk about lemonade stands. Strangely!

When an opinion piece in JAMA suggested that direct primary care might resemble primary care capitation plans sometimes tried by insurers in raising issues of allocating resources between primary care and other medical care, Kenneth Qiu, M.D. gathered enthusiastic approval from many supporters of direct primary for the following response. DPC looks like capitation butContinue reading “DPC advocates talk about lemonade stands. Strangely!”

$938,824,142. How fair adjustments to the $70 DPC assumption reduce the billion dollar savings claimed in the AEG/WP report by 85%.

A billion here, a billion there, and pretty soon you’re talking real money. Attributed to Senate Everett Dirkson (R-IL, deceased) This spreadsheet recomputes net five year savings from direct primary care if AEG/WP’s assumptions of (a) a $70 per month DPC fee that (b) stays constant for the next ten years are replaced with theContinue reading “$938,824,142. How fair adjustments to the $70 DPC assumption reduce the billion dollar savings claimed in the AEG/WP report by 85%.”