Do economic forces lead to healthier patients self-selecting to member- funded DPC practice?

Yes. And, favorable selection to member-funded DPC is likely even greater than that already actuarially documented for employer funded DPC. [D]o economic forces lead to healthier patients self-selecting to a DPC practice? . . . . . . The value proposition for chronically ill patients– needing frequent visits and savings on ancillary services (labs, meds,Continue reading “Do economic forces lead to healthier patients self-selecting to member- funded DPC practice?”

Nextera and Paladina: a race to the top of Mount Brag

In 2015, Qliance still towered over all in the Direct Primary Care Bragging World with its claim of 20% overall cost reductions. Even that, of course, was quite a come down from the extravagant claims previously spewed under the Qliance banner; fond memories still linger of those heady days when the Heritage Foundation drooled overContinue reading “Nextera and Paladina: a race to the top of Mount Brag”

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 bad 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+”

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.”

11% claims reduction, with no adjustment for selection bias, is pretty tame.

Paladina Health maintains a news and information page on its website. As of the start of 2020, Paladina’s most recent entry of favorable cost reduction results is entitled “Paladina Health gives Akron schools a cost-saving model” and links to this Crain’s business report of an 11% reduction in claims. There was no adjustment for selectionContinue reading “11% claims reduction, with no adjustment for selection bias, is pretty tame.”

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.”

The two largest and most current AEG/WP examples of downstream cost reduction failed to adequately address selection bias.

“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, makes some valuable contributions to deliberations about direct primary care. The AEG/WP team clearly explained their computations and made clear the assumptions underlying their report. This facilitates the public discussion that theContinue 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.”