SALTA and Ameriflex Report a 71% Drop in Hospital Admissions. The Release Doesn't Say How Many Employees It Counted.

SALTA Direct Primary Care and the benefits administrator Ameriflex say their employer program cut inpatient hospital admissions by 71%. They also report a 2.2x return on investment over five years.

Those figures come from a joint press release issued October 14. If you sell DPC to employers, a benefits manager may forward it to you this week. Before that happens, you might want to know what the release says and what it leaves out.

What the program is

SALTA is a membership primary care group with clinics in Auburn Hills, Clarkston, Shelby Township and Troy, Michigan. Ameriflex administers tax-advantaged accounts for employers, including HRAs and HSAs.

The setup is simple. An employer funds a health reimbursement arrangement through Ameriflex, and the HRA pays SALTA’s fixed monthly DPC fees with pre-tax dollars. A software company called Accresa handles eligibility, splits the payments and sends the employer a single invoice.

That plumbing is what the partners are selling, and the release says so. SALTA founder and CEO Dr. John Blanchard is quoted naming “two of the most significant barriers to employer-sponsored DPC: compliance and the complex administration of eligibility, enrollment, and billing.”

The numbers as published

The release attributes the results to “a five-year tracking study.” Here is what it reports:

• A 2.2x return on investment over five years and $13.84 million in total savings
• Annual cost growth of 0.9%, against what it calls a 6.2% “expected industry trend for similar employer groups”
• 31% fewer emergency department visits and 71% fewer inpatient admissions
• An ER return rate of 23% for SALTA patients and 42% for “traditional primary care groups”
• $2.90 million in net annual savings per 1,000 enrolled lives “after covering all program costs”

What the release doesn’t say

It doesn’t name who ran the tracking study. It doesn’t say how many employers took part or how many employees were enrolled. It doesn’t describe the comparison group, or say whether the 71% is a before-and-after change or a gap between DPC members and non-members.

That last point matters most. Employees who choose a DPC option can differ from those who don’t. The Society of Actuaries flagged exactly this criticism in its own study of the model, noting that skeptics say observed savings may be “driven by patient selection.”

The release doesn’t name a source for the 6.2% trend figure either. It also doesn’t define how the 2.2x return was calculated.

One label deserves a second look. The release files the ER return figure under the heading “Lower Readmission Rates.” An ER return and a hospital readmission are different events, and the release reports no readmission figure.

The dollar figures are also hard to reconcile from the outside. Divided by five, $13.84 million comes to about $2.77 million a year. The release separately reports $2.90 million in net annual savings for every 1,000 enrolled lives. The first is labeled total savings and the second net savings, so they may not measure the same thing. The release gives no enrollment count that would let a reader check either one.

The counterargument

The strongest case for SALTA’s numbers is that their direction matches what independent research has found.

In 2020 the Society of Actuaries published a Milliman evaluation of one employer’s DPC option. After adjusting for age, gender and health status, it found DPC was associated with a 12.64% drop in overall demand for care. Emergency department use fell 40.51%. That ER drop is larger than the 31% SALTA reports.

So a DPC program cutting ER visits is plausible. It has been measured by actuaries with a stated method.

The claim gets weaker past that point. The same study found a 19.90% lower inpatient admission rate, and it was not statistically significant because there were too few admissions over the two years analyzed. SALTA reports a 71% drop with no sample size attached.

The cost result runs the other way. After the membership fee and plan design changes, Milliman estimated that adding the DPC option increased the employer’s total nonadministrative plan costs by 1.3%. In Milliman’s central estimate, fewer ER visits did not turn into net savings for that employer.

None of this proves the SALTA figures wrong. Different employers, different populations and five years instead of two could all produce different results. The funding vehicle differs too. The Milliman employer covered the DPC membership fee directly, and SALTA’s employers cover it through an HRA.

But a benefits manager holding both documents will notice that the one with a published method found fewer ER visits and nonadministrative plan costs 1.3% higher. The one reporting a 2.2x return doesn’t say how it got there. If you’re pitching an employer on outcomes, the method behind your number is part of the pitch.