Nextera: the KPI Ninja study in a nutshell.

The KPI Ninja report ignored the effect of an HRA for non-Nextera members only. But $750 in first dollar coverage gets a cost-conscious non-Nextera employee a lot of cost-barrier free primary care for her chronic condition. And, unlike the dollars the SVVSD spends at Nextera, every HRA dollar the district covers for a non-Nextera employeeContinue reading “Nextera: the KPI Ninja study in a nutshell.”

KPI Ninja’s Nextera analysis: too many flaws to address them all.

Candor matters. Even as a cloud of tainted IP admission data looms over KPI Ninja’s analysis of Nextera’s SVVSD clinic, underneath that report there may well lie a pants-fire of misappropriated prestige. “KPI Ninja conducted risk score analysis in partnership with Johns Hopkins’ ACG® research team [.]” KPI Ninja Nextera study, versions of 10.13.20 andContinue reading “KPI Ninja’s Nextera analysis: too many flaws to address them all.”

Nextera says these average people have an IP admit rate of 246/1k.

In their path-breaking report on Direct Primary Care to the Society of Actuaries, the team from Milliman Actuaries described a model framework for an employer direct primary option. They concluded that DPC was a break-even monetary propositions when DPC monthly fees were set at an average of $60 PMPM, $720 PMPM. That modeling was basedContinue reading “Nextera says these average people have an IP admit rate of 246/1k.”

Nextera’s Next Era in Cherry-Picking Machine Design

Note: revised and redated for proximity to related material. Original version June 27, 2020. In June of 2020, Nextera HealthCare had a hot new brag: These results were not risk adjusted. But they desperately needed to be. The St Vrain Valley School District had this health benefit structure for its employees during the period studied:Continue reading “Nextera’s Next Era in Cherry-Picking Machine Design”

Medicare, dual coverage, and opt-out. The cherry on top of the cherry-picking machine for employer-based direct primary care.

In 2016, the share of people between 65 and 74 who were still working was over 25%. Any of them working at employers with more than twenty employees covered by group health plans are required by law to be included in the employer’s plan. They may also enroll in Medicare Part B. Some employer plansContinue reading “Medicare, dual coverage, and opt-out. The cherry on top of the cherry-picking machine for employer-based direct primary care.”

Two new DPC brags failed to show bona fide risk-adjusted savings; together, they make clear that DPC brags rely on cherry-picking.

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.”

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%”

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.”

DPC and the pandemic: more capable than FFS? Or less?

DPC advocates are talking a lot these days about how a pandemic shows the superiority of direct primary care. Today, I learned this. Along with individualized medicine and the flexibility of fewer patients, however, comes one negative side effect: as Dr. Donohoe puts it, “the biggest roadblock to more people doing Direct Care pediatrics isContinue reading “DPC and the pandemic: more capable than FFS? Or less?”

A moment of clarity about selection bias – at a DPC summit.

At 2019 Summit, Mike Tuggy, MD, FAAFP, presented this: What Have Primary Care Practices Provided to Employers Who Invested in Primary Care? The Results Speak for Themselves–Reports from Across the U.S.2019 DPCSummit62019 Direct Primary Care (DPC) Summit His presentation began with high praise for Qliance and others. He suggested that these models might be usedContinue reading “A moment of clarity about selection bias – at a DPC summit.”