Relying on deeply flawed studies and strained interpretations, as set out here and elsewhere, Nextera and Paladina (now part of Everside) still brag that their respective “school district” and “county government” direct primary care option programs for employer heatlh care plans produce huge overall health care cost savings. 2024 saw publication of two university doctoralContinue reading “Actuarially adjusted study makes clear that Nextera’s DPC clinic was a flop.”
Tag Archives: Union County
That the Union County DPC experiment was a flop is clear from a careful reading of its two actuarial studies, including the one claimed to vindicate DPC.
This post in a three minute nutshell Union County created a direct primary care option for its health insured employees. There were two particularly salient features: the monthly DPC fees were extravagant; and the county sweetened the DPC option with cost-sharing reductions (CSR) for downstream care. Despite CSR, the DPC clinic was able to reduceContinue reading “That the Union County DPC experiment was a flop is clear from a careful reading of its two actuarial studies, including the one claimed to vindicate DPC.”
Milliman’s valuation of DPC health care services at $8 PMPM rests on faulty data.
If I were a direct primary care practitioner, I’d be only mildly miffed at Milliman’s reducing what I do to a series of CPT codes. But I’d be furious that Milliman’s team set the value of my health care services at $8 PMPM. The $8 PMPM figure Milliman declared as the health care service utilizationContinue reading “Milliman’s valuation of DPC health care services at $8 PMPM rests on faulty data.”
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?”
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.”
CHANGED GRADE: The mixed bag of Milliman earns a final grade: C+
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 specific 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: C+”
Milliman’s valuation of DPC health care services at $8 PMPM rests on faulty data.
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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.”
DPC Referee 