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.”

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. Implicit 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. But then, a failure to realize an important prerequisite for performing thatContinue reading “The mixed bag of Milliman earns a final grade: B”

The raw downstream cost claims data fed into Miliman’s “isolation” model were imprinted with Union County’s (likely pro-DPC) model of downstream cost-sharing.

Note. The foregoing post was essentially completed and copied to Milliman in late May or early June 2020. In a footnote to an internet essay at the end of June, two members of the Milliman team presented new material addressing the issues raised below. I will address this new material in a new post. InContinue reading “The raw downstream cost claims data fed into Miliman’s “isolation” model were imprinted with Union County’s (likely pro-DPC) model of downstream cost-sharing.”

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 mildly miffed at Milliman’s reducing what I do to a series of CPT codes. I’d be more worried by Milliman’s team setting the value of my health care services at $8 PMPM. The $8 PMPM figure Milliman declared as the health care service utilization toContinue reading “Milliman’s valuation of DPC health care services at $8 PMPM rests on faulty data.”

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.”

For Qliance, a plausible net savings is 6.8%

There are three main steps to get from a 19.6% savings claim by Qliance to a plausible number: (1) examining the validity of Qliance’s claim that it collected $251 more per employee than the employers were spending for fees for service primary; (2) including the drug costs which Qliance chose to omit from the dataContinue reading “For Qliance, a plausible net savings is 6.8%”

Union County Direct Primary Care in a nutshell.

Union County is estimated by Milliman to have lost money. The odds that Union County saved more than 5.2% are less than one in twenty. The odds that Union County saved 28% or anything near that are miniscule. Do you remember when DPC was claimed to be saving Union County $1.25 Million per year? SoContinue reading “Union County Direct Primary Care in a nutshell.”

dpcreferee’s 2017 op-ed on Union County’s failure to save with DPC proved to be almost spot on.

In February 2017, I sent the op-ed piece below to the Charlotte Observer. It was not selected for publication. But it has been proven accurate in a detailed, independent study by a team of health care actuaries from the Milliman firm, known widely for its health care work. The study was prepared for the SocietyContinue reading “dpcreferee’s 2017 op-ed on Union County’s failure to save with DPC proved to be almost spot on.”