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



The DMPC Gold Standard: The Exhaustive Listing of Vendors/Carriers/Consultants Measuring Validly

(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.

It's been observed that this list is an agglomeration of very different companies, from very different segments of the healthcare field, offering very different products and services across the population health management spectrum up to and including comprehensive well-being-improvement solutions. This is not an accident. We accept applications from any vendor that can meet the simple rules of the pledge. This universe covers all offerings, all segments, all sizes. Even with that expansive a pool of potential applicants, these are the only companies qualifying for this free but laudatory recognition.



Vendor Measurement and/or Vendor Promise of Savings Attested to By the Auditor’s Letter Comments/Qualifications
Accordant
(www.accordant.com)
The first and as of this writing (November 2013) the only “legacy” disease management vendor to offer valid outcomes measurement using the Dummy Year Analysis proven by Why Nobody Believes the Numbers to be required in order to create the most valid pre-post measurement in the population health management field. Of course in population health there can always be confounding variables such as new drugs and/or small sample sizes and/or unobservable variables, but there are no qualifications to the statement that there is no more valid pre-post measurement in the field today. Click here for the Accordant template used to achieve this Gold Standard designation, which Accordant is graciously making publicly available in the hopes that other vendors will follow their lead.

Allone
(www.allonehealth.com)
Total risk factors on the total population are measured at regular intervals, period. Measurement is as stated in Why Nobody Believes the Numbers – Allone is the only vendor to “take the pledge” and embrace valid measurement for its wellness program. (There would be exceptions on religious grounds, and of course the customer would have to want to re-measure all employees.)

DPS Health
(www.dpshealth.com)
The first wellness vendor to show meaningful intermediate-term impact in an obesity program while both using plausibility indicators and (almost) controlling for the non-observable but critical variable of motivation Rather than aim for (or achieve) reductions in inpatient utilization (where wellness-sensitive medical events are surprisingly rare and difficult to impact in the short or intermediate term), they aimed for and achieved reductions in outpatient utilization -- especially sleep apnea complications, which in obese patients are common, discrete, and responsive to weight loss. Request a copy of their auditors letter for more information.

Electrochemical Oxygen Concepts
(www.eo2concepts.com)
A health plan will spend less on diabetic wounds (per diabetic member), period. This means fewer wounds, lower-grade wounds, and faster healing. Health plans must incentivize or require consideration of use of product as a first-line therapy before going to negative pressure or hyperbaric chambers.

Equity Healthcare
(www.equityhealthcare.com)
First healthplan services provider to show BofB reduction in trend (and outperformance of national trend) confirmed by reduction in inpatient utilization using the utilization measurement “gold standard” to capture combined impact of all UM/DM/CM/wellness activities. Sells exclusively to private equity firms and their portfolio companies, which are interested in getting savings, not showing savings. (The two concepts are polar opposites.) EH has lowered trend by total population health management, with savings confirmed by utilization reductions in the categories of care most amenable to such management.

Healthsense
(www.healthsense.com)
Whereas most vendors want to compare motivated participants to non-participants, and/or measure the difference between the high-cost baseline and the study year, in order to benefit from regression to the mean, Healthsense will offer to compare to a validly measured control group, including a study design that controls for motivation, using a "dummy year analysis." In a field notable for its lack thereof, the integrity demonstrated by Healthsense in the company's insistence on valid measurement is worthy of a Gold Standard endorsement. While other companies on this list also measure validly (hence their inclusion on the list), the difference is that Healthsense is too young a company to have outcomes yet, meaning that their insistence on validity is based on confidence and ethics only. This is a bold step for a new company and we not only wish them the best, but will be supporting their efforts with our risk-bearing Letters of Validation.

Healthways, Inc.
(www.healthways.com)
Well-Being Improvement for total populations as measured by a validated Well-Being Assessment™, allowing comparison to Gallup-Healthways Well-Being Index™ and financial translation of that change to reduced medical cost and improvement in job performance and productivity. Entire population is measured in all periods, avoiding all common measurement fallacies.. The first and, to our knowledge, only company to offer a comprehensive well-being program, Healthways has scientifically proven the correlation between well-being scores and health care cost, utilization, job performance and productivity in a way that wellness vendors haven’t. Healthways has also demonstrated the effectiveness of their Well-Being Improvement Solution in improving population well-being at Fortune 50 and 100 companies.

HR Best Practices
(www.hrbestpractices.com)
Uniquely, it's not an ROI until the client says it's an ROI. This allows the client to measure using a valid methodology. No other vendor offers anything like this. Contracts contain no third-party dispute resolution provision for financial performance disputes because there can't be a financial performance dispute. The customer is always right.

Iowa Chronic Care Consortium
(www.iowaccc.com)
An elegant "natural control" model in which the state was divided into rural and urban counties, using of course the same criteria to qualify for Medicaid. Hence the control and study populations were very similar (and very large) but there was an added control in that other event categories were tracked to see if all the events declined, which would have suggested other factors at work besides a diabetes intervention. As it happened, there was a highly significant decline in diabetes events in the study population with no change in frequency of any the other events not related to diabetes control in either the control or study populations. The full write-up is here.

The study is a model of transparency, elegance, validity and plausibility. The raw data is attached.

The Leapfrog Group
(www.leapfroggroup.org)
Using a set of transparent and fully sourced assumptions and calculations, an employer may estimate the "HIdden Surcharge" caused by medical errors in its population. The Leapfrog Group invited DMPC to participate in the development of this model in order to help ensure Gold Standard acceptability at the end of the process. They used the best available evidence and a rigorous process to build the Hidden Surcharge calculator, achieving the three goals necessary for Gold Standard certification for a model: (1) The math is correct; (2) The calculations are transparent; (3) The assumptions, all linked to authoritative sources, may nonetheless be changed by a user who prefers different assumptions. In sharp contrast to other models in which none of those factors are present, Leapfrog's is the only model in population healthcare which incorporates those three attributes.

Linkwell
(www.linkwellhealth.com)
Control and study groups are matched in motivation as well as by measurable variables. To match for motivation, one can sign up volunteers and deny a portion the intervention (as in drug studies), or -- as with Linkwell -- compare two groups that are matched where the study group is dummied without or before asking if they want to participate. All members of both groups are then compared -- in Linkwell's case also in numbers far larger and therefore more significant than any other wellness program. Therefore the claimed result is unimpeachably valid by the standards of this industry, perhaps the most statistically significant "moving the needle" in all of wellness.

No study design asterisks are necessary. One might quarrel with Linkwell's definitions of "healthy" and "unhealthy" but those definitions are clearly specified so that there is no intentionally or inadvertent misrepresentation. (Part of valid study design is acknowledging limitations.)


NaviHealth
(www.navihealth.us)
Takes full risk on all postacute spending to guarantee immediate savings, period. (Measures in utilization to avoid inflation invalidities.) There is also the possibility of a higher RAF because NaviHealth will refer people to the HCC vendor who otherwise might have been missed. Further, Stars scores should rise as well.

Nextlogical
(www.nextlogical.com)
Fees to NextLogical are driven completely by customer satisfaction, on a quarterly basis. NextLogical Benefit Strategies guarantees its service quality 100%. If they fail to deliver the level of service you expected, you can reduce their fees – all the way down to $0 – for the entire next quarter. Here’s how it works: At the end of each quarter your assigned Account Manager will send you an email asking you to rate their performance on a scale of 0-10. If your rating is ever less than “Very Satisfied” (a score of 8-10), then the fee payable to NextLogical for the next quarter will be reduced per that pre-defined schedule. A rating of 0-1 means you pay NextLogical nothing for the next quarter

Quantum Health
(www.quantum-health.com)
Reduction in utilization of (defined) high-cost resources, period. As Why Nobody Believes points out, anyone can guarantee savings against “trend,” simply by using the CCA Guidelines, which overstate trend. However, population-wide utilization reduction outcomes cannot be gamed.

stickK
(www.stickk.com)
Like AllOne, stickK wll not claim to produce a specific ROI and acknowledges that short-term wellness ROI —whether stickK’s or anyone else’s—can’t be proven.

However, the nature of the stickK intervention—“Commitment Contracts” that channel intrinsic motivation into a binding agreement to achieve a personal goal—will by definition be more effective than any goal paid for by employer incentives, according to the responsible literature on incentives.

Unlike most wellness vendors stickK also offers a B-to-C version that people pay for, which itself provides evidence of value. (Contrast this to HRAs, that nobody pays for, and telephone coaching, that few people do.) To make a Commitment Contract, a user specifies his or her goal—e.g. “I want to lose 20 lbs.”—and can then place financial stakes on the line to be forfeited if unsuccessful, invite a third-party Referee to verify progress, and add friends and family to offer encouragement.

Switchbridge
(www.switchbridge.com)
Switchbridge allows data transfer so that changing carriers or vendors does not disrupt the user experience Switchbridge solves two longstanding problems for healthplan sponsors. First, disruption occurs when carriers, vendors or wellness programs are changed/added. For instance, a new carrier has no history/knowledge of who would benefit from medical management. Switchbridge allows for “medical management transition” so engaged members experience no gaps or inconvenience. Second, Switchbridge’s seamlessly accommodates and integrates any next-generation care technology -- it will never become a "legacy system."

Strategic Benefit Solutions (a Marsh & McLennen Agency whose population management staff is based in Atlanta, Georgia) Only Why Nobody Believes the Numbers event-based metrics are used for measuring event reduction from population health management One of very few population health consulting firms backed by a DMPC Letter of Validation due to its commitment to valid metrics – measurement on the entire population, period – and not automatically linking coincidental cost reduction to risk reduction.



Disease Management Purchasing Consortium International, Inc. .

890 Winter Street, Suite 208
Waltham, MA 02451
Phone: 781 856 3962
Fax: 781 884 4150
Email: alewis@dismgmt.com