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.”
Tag Archives: selection bias
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.”
Nothing huge, but a possible small win for DirectAccessMD cost reduction claims.
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 “Nothing huge, but a possible small win for DirectAccessMD cost reduction claims.”
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 importance 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”
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 prevents the drawing of any conclusions about subscription primary care. ADDENDUM ofContinue 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. There are aspects they don’t talk about. The Milliman study’s survey — the same survey DPC advocates turn to when emphasizing, for example, how much telemedicine DPC clinics do — indicated that over a third ofContinue 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.
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. The report’s authors put a great deal or energy into demonstrating that billion dollar savings could beContinue reading “A single-post critique of AEG/WP’s recommendation on direct primary care.”