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

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 data drawn from employment health plans that allowed employees to elect between DPC and FFS primary care options options. But the first and, so far, onlyContinue reading “DPC cherry-picking: the defense speaks. Part 2.”

DPC cherry-picking: the defense speaks. Part 1.

Jump to Part 2. Within days of the Milliman report warning of the “imperative to control for patient selection in DPC studies [lest] differences in cost due to underlying patient differences [] be erroneously assigned as differences caused by DPC”, the first rumbling of resistance from the DPC advocacy community emerged. This was a suggestion,Continue reading “DPC cherry-picking: the defense speaks. Part 1.”

Nextera’s Next Era in Cherry-Picking Machine Design

Nextera HealthCare has a hot new brag: These results were not risk adjusted. But they desperately need to be. The St Vrain Valley School District had this health benefit structure for its employees during the period studied: The school district’s 10% coinsurance rate for the PPO predates the arrival of the Nextera option. The schoolContinue reading “Nextera’s Next Era in Cherry-Picking Machine Design”

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. Implicit repudiation of a decade of unfounded brags. An admirable idea on “isolating the impact of DPC model” from the bad decisions of a studied employer. But then, a failure to realize an important prerequisite for performing thatContinue reading “The mixed bag of Milliman earns a final grade: B”

The raw downstream cost claims data fed into Miliman’s “isolation” model were imprinted with Union County’s (likely pro-DPC) model of downstream cost-sharing.

Note. The foregoing post was essentially completed and copied to Milliman in late May or early June 2020. In a footnote to an internet essay at the end of June, two members of the Milliman team presented new material addressing the issues raised below. I will address this new material in a new post. InContinue reading “The raw downstream cost claims data fed into Miliman’s “isolation” model were imprinted with Union County’s (likely pro-DPC) model of downstream cost-sharing.”

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.”

For Qliance, a plausible net savings is 6.8%

There are three main steps to get from a 19.6% savings claim by Qliance to a plausible number: (1) examining the validity of Qliance’s claim that it collected $251 more per employee than the employers were spending for fees for service primary; (2) including the drug costs which Qliance chose to omit from the dataContinue reading “For Qliance, a plausible net savings is 6.8%”

Union County Direct Primary Care in a nutshell.

Union County is estimated by Milliman to have lost money. The odds that Union County saved more than 5.2% are less than one in twenty. The odds that Union County saved 28% or anything near that are miniscule. Do you remember when DPC was claimed to be saving Union County $1.25 Million per year? SoContinue reading “Union County Direct Primary Care in a nutshell.”