Skillful actuarial work on risk adjustment. A clear warning against relying on studies that ignored risk adjustment. Clear repudiation of a decade of unfounded brags. An admirable idea on “isolating the impact of DPC model” from the specific decisions of a studied employer. Milliman should have recognized that the health service resources that go intoContinue reading “CHANGED GRADE: The mixed bag of Milliman earns a final grade: C+”
Author Archives: Gary Ratner
Did Ratner Industries uncover the secret of health care cost reductions?
To kick off our open enrollment period two years ago, we at Ratner Industries held a company wide employee meeting. There we dusted off our brand new offering of a high deductible plan option. To get a rough idea how many employees planned on electing each option we offered free bags of M&Ms to employeesContinue reading “Did Ratner Industries uncover the secret of health care cost reductions?”
Attn: AEG/WP. Milliman study implies 12.6% downstream care cost reductions for DPC.
The AEG/WP plan still isn’t likely to work. A $95 PMPM fee, increasing at the same rate as other medical expenses, and coupled to a 12.6% reduction down stream would evaporate all of AEG/WP’s claimed billion savings. “Healthcare Innovations in Georgia:Two Recommendations”, the report prepared by the Anderson Economic Group and Wilson Partners (AEG/WP) forContinue reading “Attn: AEG/WP. Milliman study implies 12.6% downstream care cost reductions for DPC.”
Milliman’s valuation of DPC health care services at $8 PMPM rests on faulty data.
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ATTN: Milliman. Even if Union County had not waived the $750 deductible, the County still would have lost money on DPC.
The lead actuary on Milliman’s study of direct primary care has suggested that the employer (Union County, NC, thinly disguised) would have had a positive ROI on its DPC plan if it had not waived the deductible for DPC members. It ain’t so. Here’s the Milliman figure presumed to support that point. It is trueContinue reading “ATTN: Milliman. Even if Union County had not waived the $750 deductible, the County still would have lost money on DPC.”
Risk adjustment, and more, badly needed for KPI Ninja’s Strada-brag
Amended 6/26/20 3:15AM The Milliman report’s insistence on the importance of risk adjustment will no doubt see the DPC movement pouring a lot of their old wine into new bottles, and perhaps even the creation of new wine. In the meantime, the old gang has been demanding attention to some of the old wine stillContinue reading “Risk adjustment, and more, badly needed for KPI Ninja’s Strada-brag”
DPC is uniquely able to telemed: a meme that suffered an early death.
An update to this post. Larry A Green Center / Primary Care Collaborative’s Covid-19 primary care survey, May 8-11, 2020: In less than two months, clinicians have transformed primary care, the largest health care platform in the nation, with 85% now making significant use of virtual health through video-based and telephone-based care. Larry A GreenContinue reading “DPC is uniquely able to telemed: a meme that suffered an early death.”
The Nextera/DigitalGlobe study design made any conclusion on the downstream effect of subscription primary care impossible.
The study indiscriminately mixed subscription patients with pay-per-visit patients. Selection bias was self-evident; the study period was brief; and the study cohort tiny. Still, the study suggests that choosing Nextera and its doctors was associated with lower costs; but the study’s core defect prevents the drawing of any conclusions about subscription primary care. ADDENDUM ofContinue reading “The Nextera/DigitalGlobe study design made any conclusion on the downstream effect of subscription primary care impossible.”
Iora’s Las Vegas experience is an inapt model for DPC, and shows no real cost reduction.
While DPC Coalition features an Iora Clinic in Las Vegas as a data model of the joys of direct primary care, it is simply not representative of a general population. That clinic focused on a very high need population, every member chronically ill. We are looking at people with $11,000 claim levels at 2014 prices;Continue reading “Iora’s Las Vegas experience is an inapt model for DPC, and shows no real cost reduction.”
Why is subscription DPC the precise hill on which self-styled “patient-centered” providers have chosen to make a stand?
A subscription model is not the most patient-centered way. Consider this primary health care arrangement: The plan above is price transparent to both parties. It is more transparent than a subscription plan because it is easier for each party to determine a precise value of what is being exchanged. The plan above gives a patientContinue reading “Why is subscription DPC the precise hill on which self-styled “patient-centered” providers have chosen to make a stand?”
DPC Referee 