(Please also see our list of carriers measuring event rates validly in their disease management outcomes calculations)

There are many vendors that “show savings” and there are some vendors that measure validly, but there are only a handful of vendors that show savings (or risk improvement, if wellness) when measured validly: the ones on this list. These are quite literally the only vendors that can get DMPC — or any other organization — to write a Letter of Validation guaranteeing the validity of their savings figures, in which the validating entity itself assumes $10,000 to $100,000 in liability that the savings methodology is sound. Many actuaries and consulting firms will attest to validity if a vendor pays them enough. However, just as a sign outside a restaurant promising “fine gourmet dining” usually means the opposite, certain firms’ attestations of validity are generally “red flags,” which suggest exactly the opposite: that the vendor’s methodology is invalid.

The key: Does the letter attesting to the validity of the methodology also contain a financial guarantee that the validators themselves accept liability for the veracity of those attestations? If not, the Letter of Validation itself is invalid.

The following vendors — and only the following vendors — measure validly, for the offerings noted, with qualifications (if any) noted. If a vendor not on this list, it could not obtain a risk-bearing letter from DMPC or any other organization that verifies validity. If a vendor is on this list, it could…and did.

Each letter is different depending on the category in which the vendor competes. In wellness, for example, the Gold Standard letter is a commitment-based pledge, since today wellness vendors rarely have access to claims data and don’t plausibility-test results when they do:

1. The vendor’s front-line recommendation is to compare all risk factors on a population (90% + of the population being measured) over multiple years and that reconciliations are done based on this recommendation, with the difference in risk factors being the improvement believed to be attributable to the program
2. The vendor agrees to disclose to customers that, while they are perfectly willing to reconcile in some other way and/or reconcile only on a subset of the population, such a reconciliation will likely lead to an invalid result
3. The vendor acknowledges that neither it nor any other vendor can achieve a positive first-year ROI through a wellness program
4. The vendor will distribute the Wellness Savings Calculator along with any proposal if requested
5. The vendor will encourage the carrier to utilize Step 4 below to measure wellness impact using claims data and/or offer, as an extra service, that step.

For carriers, the letter is outcomes-based. The utilization management Gold Standard consists of the following, over multiple years:

1. Tracking grouped Episodes of Care per 1000 and admissions per 1000
2. Calculating the ratio of the latter to the former as a combined measure of how often the episode was resolvable without inpatient care
3. Repeating the exercise for groupings of cardiometabolic, respiratory, musculoskeletal, mental health and substance abuse, preference-sensitive conditions and prenatal, perinatal, and neonatal complications of birth events
4. Grouping cardiometabolic and musculoskeletal events, plus bariatric surgeries and diagnoses of obesity, into a health-sensitive conditions metagroup that captures the large majority of the utilization changes that may be attributable to wellness programs.

For other vendors that don’t fit in those categories, such as Quantum Health, NaviHealth and Electrochemical Oxygen Concepts on the charter list below, the methodologies specific to the claims must be valid in the opinion of the validator and DMPC.

Note: There is no charge for listing on this website. All that is required is a risk-bearing Letter of Validation from any qualified source, basically covering the points above. Therefore any organization that can attain such a letter has no reason not to post here and every reason to post here. It can therefore be inferred that a vendor/carrier or consultant not being listed here is offering or advising respectively, that an invalid methodology be used to measure outcomes.