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.”

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

1/13/2020 Update. See this post for some cost-adjusted data that suggests that direct primary care has net positive effects. My crude analysis suggesting that DPC might have worked, at least a little, maybe once, has since been firmly contradicted by actuarial evidence. Here’s a chronological list of posts relating to AEG/WP’s “Healthcare Innovations”.

A few brags from a few DPC companies is not a sound basis for public policy decisions.

Leave aside the specific critiques of the last twenty or so posts. The support for direct primary care in the report Healthcare Innovations in Georgia: Two Recommendations ultimately turns on the source material from which the report authors drew the key assumption that direct primary care reduces downstream care cost by 15%. That material comprisesContinue reading “A few brags from a few DPC companies is not a sound basis for public policy decisions.”

Total claims cost caution: when DPC is implemented primary care claims vanish. AEG/WP’s 15% estimate is not conservative in the least.

When the direct primary advocates toss out figures about overall claims cost reductions, it’s important to carefully separate overall cost, downstream care claims costs, and overall claims costs. For example, the authors of the AEG/WP pitch for DPC in Georgia, have assumed a 15% reduction in downstream care costs and claimed that it “represents theContinue reading “Total claims cost caution: when DPC is implemented primary care claims vanish. AEG/WP’s 15% estimate is not conservative in the least.”

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.”

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 basic premise of AEG/WP’s advocacy for direct primary care is succinctly stated in “Healthcare Innovations in Georgia: Two Recommendations” at page 24. “Establishing a relationship with a doctor for a fixed monthly fee can induce and empower many patients to see their primary care physician regularly, which results in decreased healthcare expenses and reducedContinue 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.”

Monthly direct primary care fees will not hold steady at $70 for a decade.

That alone makes the AEG/WP report off by about $500,000,000. In “Healthcare Innovations in Georgia:Two Recommendations”, the report prepared by the Anderson Economic Group and Wilson Partners (AEG/WP) for the Georgia Public Policy Foundation, the authors clearly explained their computations and made clear the assumptions underlying their report. One of the assumptions was that theContinue reading “Monthly direct primary care fees will not hold steady at $70 for a decade.”

$70 lowballs the monthly direct primary care fee.

On that score alone, the AEG/WP report is off by $750,000,000. In “Healthcare Innovations in Georgia:Two Recommendations”, the report prepared by the Anderson Economic Group and Wilson Partners (AEG/WP) for the Georgia Public Policy Foundation, the authors clearly explained their computations and made clear the assumptions underlying their report. One of the assumptions was thatContinue reading “$70 lowballs the monthly direct primary care fee.”