Two recent DPC brags fit together in a telling way. Nextera Healthcare reported non-risk-adjusted claims data indicating that employees of a Colorado school district who selected Nextera’s DPC option had total costs that were 30% lower than those who selected a traditional insurance option. But that employer’s benefit package confers huge cash advantages (up toContinue reading “Two new DPC brags failed to show bona fide risk-adjusted savings; together, they make clear that DPC brags rely on cherry-picking.”
Category Archives: Current at DPC Referee
Nothing huge, but a possible small win for DirectAccessMD cost reduction claims.
The DirectAccessMD clinic that serves the employees of Anderson County, SC, is run by a tireless advocate for, and deep believer in DPC, Dr J Shane Purcell. Here the employer, with Dr Purcell’s apparent support, has taken steps that seems to have somewhat mitigated the selection bias that is baked into most other direct primaryContinue reading “Nothing huge, but a possible small win for DirectAccessMD cost reduction claims.”
Do bears sh. . .ake cherries out of trees? Selection pressure is built into DPC choices for any population with a normal deductible.
At last, it dawns on me. Selection bias is baked into virtually every DPC cake.* Direct primary care usually comes with a significant price and a package of financial incentives revolving around primary care (and, sometimes, around some downstream care). For some, the game may be worth the candle. The incentives, typically the absence ofContinue reading “Do bears sh. . .ake cherries out of trees? Selection pressure is built into DPC choices for any population with a normal deductible.”
Epiphany. Dr Gross’s risk adjustment metholodogy for direct primary care stands contrary to contemporary understandings of how to assess the relative expected costs of differing populations.
Dr. Lee Gross’s Epiphany Healthcare provides DPC services for some of the employees and some members of of some of their families at a hospital in Florida. Some hospital employees decline Epiphany; they and some members of their families receive instead traditional insurance based primary care. Unusually for such arrangements, a recent assessment of theContinue reading “Epiphany. Dr Gross’s risk adjustment metholodogy for direct primary care stands contrary to contemporary understandings of how to assess the relative expected costs of differing populations.”
CHANGED GRADE: The mixed bag of Milliman earns a final grade: B
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: B”
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 alsoContinue reading “RESCINDED: ATTN: Milliman. An employer’s cost sharing plan affects claims experience.”
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.
If I were a direct primary care practitioner, I’d be mildly miffed at Milliman’s reducing what I do to a series of CPT codes. I’d be more worried by Milliman’s team setting the value of my health care services at $8 PMPM. The $8 PMPM figure Milliman declared as the health care service utilization toContinue reading “Milliman’s valuation of DPC health care services at $8 PMPM rests on faulty data.”
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.”
DPC Referee 