There is nothing so powerful as an idea whose time has come."

--Hugo

DOCUMENT LIBRARY

 

Each of the documents described below was developed as part of Consortium efforts to facilitate disease management contracting.  Almost any individual or organization with an interest in disease management will find at least some of these items helpful.  In order to facilitate document selection, each item is marked with one or more of eleven codes:

 

 

Code

Description

 

1

Helpful in evaluating vendors for employers and health plans

 

2

Supports benchmarking of internally developed or outsourced programs

 

3

Of strategic interest to vendors, pharmaceutical companies, health plans, employers or investors

 

4

Good data on industry

 

5

Intended for contracting and/or implementation assistance

 

6

Process Facilitation

 

7

Helpful for payors “building” programs internally or vendors  designing them for sale

 

8

Legal and Regulatory Issues

 

 

9

Especially for Medicaid

 

10

Especially for “builders”

 

11

Especially for Employers

 

12

Especially for Vendors selling to non-Consortium-member Employers

 

13

ROI/Savings measurement and assistance

 

14

Pricing Benchmarks

 

15

Peer-reviewed insights into methodology for DM

 

16

Especially for wellness

 

17

Especially for Predictive Modeling

 

18

Especially for Medicare Reimbursement Strategy

 

All document page listings are single-spaced, 10-point type, unless otherwise indicated or obvious from the context.  Page numbers are approximate and will vary according to the configuration of the software package into which they are downloaded.   Prices listed are for non-members.  Every document is free for payor members.   Credit cards are accepted.  Prices are for electronic transmission only.  Any other type of transmission has a $10 service charge/article and a $50 minimum.  The year in parentheses represents the year of authorship.  If updated, the year of the most recent update appears following the authorship year.

 

If you are interested in measurement you may click here to look specifically at the “Measurement Package” of materials, which may be ordered in toto at a significant discount to individual pricing

 

TITLE AND BASIC INFO

SUMMARY DESCRIPTION

Accelerating Implementation (5); $20; 2 pp. Dmcolum1a (1999-2002)

Honestly, not much help for the aficionado. Anyone really interested in this topic should get “Process Steps in Outsourcing” instead. However , if you just want the “big three” ways to speed implementation explained, try this one.

Accreditation/RFI Standards (1,2,3,4,5) $200; 22 pp; accreditation.doc

(1998—2001)

A complete copy of the information historically sought for Consortium vendor Requests for Information in CHF, diabetes, asthma, and COPD. Best if used in conjunction with Request for Information examples

Accreditation/RFI standards for ESRD (1,2,3,4,5) $200, 21 pp.

AccreditationESRD.doc (1998-2002)

A complete copy of the information sought for Consortium vendor Requests for Information in ESRD.

Acquisitions (3) $100; 2pp; DMColumn8.doc (2000)

4 Lessons any potential acquiror should learn from the recent Landacorp acquisition of Promedex and PatientCentrix—two high-quality companies they were able to obtain at distress prices.

“Apples to Apples” Final RFP Template (1,5,6,11), $2000, 8 pages; rfp-apples-to-apples.doc (1999-2007)

The “special sauce” that ensures getting a “goof-proof” bid from finalist vendors, with near-absolute comparability between bids and assumptions. No meaningful biostatistical or measurement fallacies are possible in responding to this. Available free only as part of a brokered bid process, to full Consortium members only. Otherwise, $2000. Available for COPD, CHF, CAD (especially CAD), diabetes, cancer, asthma, ESRD, population management.


Asthma, Codes for Stratification (2,4,5,7,10), $500; 2 pages asthma codes.doc (2000-2004)

Concise “consensus” of in/out and red/yellow/green claims-and drug-based stratification criteria compiled from various sources and reviewed by pulmonologist panel. Much better at avoiding “false positives” and “true negatives” than any current vendor or public-domain tool based on claims and/or drugs.

Balancing Your Medicaid Budget (9); $500; 28 slides; Balancing Your Medicaid Budget.ppt (2002-2003)

Overview of all the opportunities available to Medicaid programs in all medical management areas, including dual-eligibles and TANF as well as disabled.

Benchmarking of Chronic Disease Event Trend (2,13); $1000; package of spreadsheet, slides, overview and sample report benchmarking.zip (2007) MEMBERS ONLY

Reasonably valid, reliable, and easily executed way to check your DM success against benchmarks in the field and against your own history. It avoids the complexity and regression to the mean associated with typical pre-post outcomes measurement.

Best Health Plans and Vendors in Disease Management (3,4,11); $1000 non-members; $500 members; 20 pp. Best Health Plans and Vendors.pdf (2004-2007)

The Health Industries Research Companies has made this report exclusively available to DMPC members at half price. It selects the 30 best health plans, employers and states, and 11 best vendors in disease management and has other information on the industry, its growth prospects, and the role of pharmaceutical companies. 28 of the 30 health plans are DMPC members. Note: this is the only document not free with full payor membership.

Biggest Mistakes in Disease Management Contracting (5,13), $300; 3 pp. The Biggest Mistakes in Disease Management Contracting.doc (2001-2002)

A compilation of the six biggest contracting mistakes in DM, essential for any health plan or other payor to know.

Biometric monitoring: A Report and Vendor comparison (1,3,4,5), $200; 53 pp. of tables; biometric monitoring.doc (2001)

Along with an introduction, 10 companies’ biometric monitoring offerings compares side-by-side.

Budget by Cost Component for DM Program (2,7), $500; 1 slide; dollars spent.ppt (2002 - 2006)

Summary of DM program spending per claims dollar. Spending is broken down into 9 cost categories. It represents an average of 3 vendors and 3 health plans for which data was received (a total of 18 average datapoints). In addition, a full call-center staffing model for Medicaid and Medicare is typical staffing.xls

Budget for plans building their own DM programs (10); $500, excel spreadsheet, Direct Cost Budget.xls (2003)

If you are setting up your own program, you can use this to budget manpower, printing/fulfillment, and telephone expense, by disease.

“Build” vs. “Buy” caveats (2,5) $20; 4 pp.;artchfbu.doc (1997)

A series of case studies in CHF which highlight stumbling blocks of one plan’s “build” strategy, in order to allow other plans to anticipate the same.


“Build” vs. “Buy”: The Last Word; (2.5) $300; 3 pp. + 20 slide poweropint DMColum1.doc, build-vs-buy.ppt (2000-2007)

The decision rule to determine which to do in what circumstances, period.

Cardiac Package for “Building” programs internally (2,5,7,10) $2000 non-members; $1000 members. 2 Spreadsheets Cardiac Package.xls (2002)

  1. ROI analysis by cost component for internal cardiac program, both <65 and >65, easily laid out to become “transparent” for any user.

  2. Average of several health plans’ incidences and prevalences for 6 cardiac-related events and procedures

“Cheat Sheet” for Vendors in Employer Negotiations (5, 11,13) $500 non-members; $200 members; 3 pages. How to Take Advantage of Benefits Consultants.doc (2004)

One of two top-selling items (the Vendor Directory with Comments being the other). Details seven common (if not universal) mistakes in benefits consultant RFPs and contracts, and how many vendors take advantage of those mistakes to create savings metrics which ensure they will “hit their numbers.”

Claims Patterns Identifying Members (10,13); $200; 4 pp. Extraction Algorithms.doc (2004-2006)

Official DMPC claims extraction algorithms (the patterns of claims) for CAD, CHF, diabetes, COPD. (Asthma is a combination of extraction and stratification and is Asthmacodes.doc)

Conference listings for 2008; free Conference Listings (2008)

Identifies particulars and contact points for all DM-oriented conferences.

Consultants, Disease Management (3,4); $100; .

Disease management consultants.doc (1997-2007)

A critique of a number of well-known consulting firms, some recommended and some not, for assistance with large-scale disease management beyond the scope of the Consortium’s telephone advisory services.


Contact Names in Health Plans Responsible for DM (3); $1000; 6 pp. Disease Management Contacts.doc (1998-2004)

A listing of DM contact people within seventy+ health plans. Intended to save vendors some amount of the time and effort required to identify potential buyers. Also includes comments on who’s buying what and (occasionally) comments about what they are looking for. Note: may not be used to contact DMPC members directly

Contractual Clause Review (5) $100—as is; $1000—including customization; 4 pp.