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



Wellness Outcomes Integrity Pledge

To the Customer or Prospective Customer or Benefits Consulting Client Receiving This Pledge:

As signatories to this pledge, our organization makes two sets of acknowledgements, one to set expectations for program outcomes, and the other on valid measurement of those outcomes.

I. Expectable Program Financial Outcomes

It is not possible for any wellness program to save money in healthcare expenses in its first year. (The exception is if the benefits design calls for penalties for those who do not participate, in which case the “savings” are attributable to the benefits design.) All situations in which savings have been “found” in the first year of a wellness program have been either due to a fortuitous change in trend (and never plausibility-tested by the wellness company, as described below) or mismeasurement. Many such examples are described in Why Nobody Believes the Numbers. Other such claims, even well-publicized ones such as Safeway’s, have been debunked in other studies. For example, in the case of Safeway, see this New England Journal of Medicine report.

Savings may be realized only according to a rough timeline, a timeline requiring much more than one year:

  1. People must be apprised of the program’s existence.
  2. They need to be ‘‘sold’’ on it and convinced to take an HRA.
  3. And/or maybe a health fair is scheduled for sometime thereafter
  4. Once people take the HRA and see their risk factors, they need to be convinced to undertake coaching or other behavior change
  5. A course of coaching or other behavior change is implemented
  6. Risk factors begin to improve
  7. Fewer events and other consequences of poor health transpire, due to the improved risk profile, thus saving money before incentives are taken into account, and unless people backslide into prior habits.

II. Measurement of Program Outcomes

The only valid measurement is to compare all risk factors on a population (90% + of the population being measured) over multiple years, as opposed to measuring on a subset of employees who were high-risk in the previous period and/or actively participated in the coaching or other intervention. The difference in risk factors would then be considered to be attributable to the program. For absenteeism, total non-scheduled paid time off, rather than absences among those targeted for an intervention, would be the valid measurement.

The vendor/consultant agrees to disclose to customers/clients that, while they are 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.

The vendor/consultant will distribute the transparent and valid Wellness Savings Calculator, along with a copy of Why Nobody Believes the Numbers.

The vendor/consultant will refrain from making claims about return-on-investment (ROI) unless the customer/client provides claims data (or is willing to extract claims data on its own) for multiple years prior to and including the program years. Once the data is provided and possibly for an extra fee, the vendor/consultant will populate a “plausibility dashboard” separating the health-sensitive events expected to decline (such as cardiometabolic events, firm-wide absenteeism, and total risk factors on the population, as described above) and the events expected to increase (such as preventive primary care visits) and tracking each group separately. Any ROI claim should be consistent with the movements in the plausibility dashboard.

For an extra fee not to exceed $5000, the vendor/consultant will retain a third-party validator, who will not only attest to the validity of outcomes measured this way, but will put at least $10,000 of its own money “at risk” behind this attestation, payable to the customer if invalidating errors in the methodology are found within the subsequent two years.

At no additional fee, the vendor/consultant will present the name(s) of at least one third-party validator that will provide this attestation. A vendor or consultant unable to find a validator willing to be paid to support these savings claims does not have a valid ROI.


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