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.”

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

Update: In the fall of 2020, KPI Ninja released the first study that relies on it’s new risk information technology. I find it sadly opaque. 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 dataContinue 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.”

Downstream consequences when employers fall for non-risk-adjusted data brags.

Do you remember when Union County’s three year DPC commitment for 2016-2018 was claimed to be saving Union County $1.25 Million per year? So why did Union County’s health benefits expenditure rise twice as fast as can be explained by the combined effect of medical price inflation* and workforce growth? For the first year orContinue reading “Downstream consequences when employers fall for non-risk-adjusted data brags.”

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.”

No huge win for DirectAccessMD when employer DPC option data is compared with non-DPC cohort.

The DirectAccessMD clinic that serves the employees of Anderson County, SC, is run by a tireless advocate for, and deep believer in DPC, Dr J Shane Purcell. Here the employer, with Dr Purcell’s apparent support, has taken steps that seems to have somewhat mitigated the selection bias that is baked into most other direct primaryContinue reading “No huge win for DirectAccessMD when employer DPC option data is compared with non-DPC cohort.”

Risk adjustment, and more, badly needed for KPI Ninja’s Strada-brag

Amended 6/26/20 3:15AM The Milliman report’s insistence on the important of risk adjustment will no doubt see the DPC movement pouring a lot of their old wine into new bottles, and perhaps even the creation of new wine. In the meantime, the old gang has been demanding attention to some of the old wine stillContinue reading “Risk adjustment, and more, badly needed for KPI Ninja’s Strada-brag”