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On Base Percentage = All Cause Mortality

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This week, Dr. Phillip Eskew, DO, JD, MBA shared a guest blog post for Elation Health’s direct care blog

Dr. Eskew founded DPC Frontier in Feb 2015. He is a direct primary care family physician and attorney. He joined ProactiveMD in Feb 2016 and is the company’s VP of Clinical Development and General Counsel.   Dr. Eskew has advised state and federal legislators about DPC legislation, and volunteers his time as the general counsel of the Direct Primary Care Coalition where he also serves as a member of the steering committee. He intends to use his diverse training to not only grow Proactive MD, but to support other DPC practices in the medical, legal, and policy arenas.

Baseball fans have always been obsessed with statistics.  For those that have not watched the film “Moneyball” the story focuses on how baseball analysts added up hits, runs, and RBIs for decades while ignoring (not even tracking) a more valuable statistic – on base percentage.  Deep down, health insurance companies already know that their current coding system is a garbage in, garbage out process. If you want proof, look no further than life insurance companies.  Life insurance applications commonly ask a variety of medical questions, but these are generally objective laboratory findings. These are not CPT code driven. They are simple, objective measurements related to lifestyle behaviors and chronic conditions that are easily trended over time.

As DPC physicians we can happily abandon 90% of the “data” tracked by the traditional system.  This data is not clinically useful. It doesn’t predict all cause mortality. Usage of this “fluff” data makes it easier for interlopers to argue their wasteful services are necessary.  We should track clinical information that is useful to us and our patients. Laboratory studies and vital signs related to chronic conditions are an obvious place to start. This kind of data is clinically actionable, allows for outlier identification, and can be presented in a trended view to motivate patients.

Whether they want to admit or not, life insurance companies are focused on one thing – when will someone die – or in medical speak does a number or lifestyle choice predict “all cause mortality.”  We will know that DPC has “made it” not when it is embraced by health insurance companies, but by when life insurance companies ask “are you a member of a DPC practice?” right after the question “are you a tobacco user?”