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.”

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 prevent the drawing of conclusions about subscription primary care. UPDATED JUNE 2020.Continue reading “The Nextera/DigitalGlobe study design made any conclusion on the downstream effect of subscription primary care impossible.”

A single-post critique of AEG/WP’s recommendation on direct primary care.

May 2020: An important study by actuaries at Milliman now suggest that 15% downstream care cost reductions are credible, affect our previous take on the AEG/WP report. Here’s a chronological list of posts relating to AEG/WP’s “Healthcare Innovations”.

Three bad ways to bet the health of Georgia citizens on direct primary care.

Every published claim that direct primary care makes a significant dent in necessary health care spending is dubious at best. See, for example, here, here, here, here, here, here, here, here, here, here and here. When the data from the Union County clinic — a Georgia Public Policy Foundation favorite — is age-adjusted, it indicatesContinue reading “Three bad ways to bet the health of Georgia citizens on direct primary care.”

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.”

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!

UPDATE 5/31/2019. This needs a correction, but I want to leave it intact below for the record. I have in the title above and the text below that the Nextera data is contaminated by FFS patient data. This is not correct. To preserve HSA tax advantages, many of the Nextera patients did not want toContinue 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.

Note: In 2020, I posted an updated assessment of 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 asContinue reading “The marketplace reached a judgment about direct primary care pioneer, Qliance.”