The reviews are coming in
and the verdict is clear:

Cracking Health Costs and
Why Nobody Believes the Numbers
are the best books ever written.*

* By me

Getting Started on Certification: Submissions needed and pricing

I: Plausibility indicator (event rate) certification - see accompanying "DMPC Benchmarking" document if you would like to benchmark these against other health plans.

I: Incidence rates for common chronic disease events

For the following, please complete the cells using: PRIMARY CODED ER and IP ICD9 discharge codes, for commercial, (Medicare, Medicaid disabled and Medicaid TANF can be separately - there is a separate but otherwise identical Excel sheet for all). Take note:

  1. Do not "count" the number of people (two discharges for one person equals one discharge for two people), and do not take into account whether people were in a disease management program.
  2. Do not count people for whom you are secondary payer.
  3. If someone has an event straddling the year-end, count them in the year of discharge
  4. Add all the codes together and put in the box
  5. Don't be concerned with taking out false positives; they will "wash"
  6. Use admissions, not bed-days
  7. If there is a large group which came or went during the years in question which had significantly different experience from the rest of the population, either omit it in all periods or call to discuss. Examples of such groups would be government or health systems.

Complete all these cells for which you have data (including at least 99% claims runout - no IBNR)

Disease Program CategoryICD9s (all .xx unless otherwise indicated)
Asthma493 (including 493.2x)1
Chronic Obstructive Pulmonary Disease491.1, 491.2, 491.8, 491.9, 492, 494, 496, 506.4
Coronary Artery Disease (and related heart-health issues)410, 411, 413, 414
Diabetes (CAD codes above will also indicate the success of the diabetes program)250
Heart Failure428, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 425.0, 425.4
Track commercial, Medicare, Medicaid TANF and Medicaid disabled separately.

Next, complete the upper left-hand portion of a spreadsheet which may be requested from DMPC. (The remainder of the spreadsheet is optional; use of it is described in DMPC Benchmarking.doc.)

Once you receive it, complete it as follows:

Complete all these cells for years in which you have data but did NOT do disease management (C6 - yellow cells)

Complete any year for which you started a disease management program during the year (January starts would be included in the full-year cells below (I6 - yellow cells)

Complete all these cells for years in which you DID do disease management for the condition in question, starting programs as of February 1 (O6 - yellow cells)

II: Financial Measurement certification

Financial measurement certification is not done on a form, as the plausibility certification is.

For additional financial measurement certification, you will need to submit the following (note that anything related to "vendors" is obviously applicable only if it is an outsourced contract):

(1) Vendor Contract

If you want to blank out the prices or just send the portion of the contract related to measurement, that's acceptable.

(2) All reported results

All reports received by you from the vendor or all internal reports generated by you, including all methodological backup, study design information etc.

(3) All financial calculations

If you have any other savings calculations, submit them as well, even if they aren't part of formal reporting

(4) Sample report to employer

A blinded actual copy of a report sent to an employer.

Certification is awarded when the available information is deemed reasonably free of knowable error and the savings are found to be not inconsistent with what the plausibility indicators would predict.

III: Next Steps and Pricing

The price is $2000. This is "evergreen" until you receive certification or decide not to move forward further. $500 of it is due upon application. For the $500, you will receive the White Paper "Return On Investment and Savings Methodologies: the Last Word," which describes the plausibility indicators and financial reporting requirements in more detail, and which is also a valuable resource on its own, selling separately for $500 itself. The remaining $1500 is due upon the first submission of materials.

The plaque provided is "virtual," as most people have preferred, for use in Powerpoint presentations. An actual plaque may be ordered for $75.

An example of the plaque:

1493.2x is asthma with COPD. It could fit under either category but for simplicity we are keeping it with asthma

Disease Management Purchasing Consortium International, Inc. .

890 Winter Street, Suite 208
Waltham, MA 02451
Phone: 781 856 3962
Fax: 781 884 4150