The Disease Management Purchasing Consortium is expanding rapidly in Medicaid. Often states “sole-source” us. We offer three different services:

1. Procurement
2. Evaluation
3. Comparisons to other states

1. Procurement

Of states which have completed a procurement successfully, the DMPC has advised the majority. There are many other states which have initiated procurement and then, once the staff becomes overwhelmed with the complexity of it and is unable to answer the bidders’ questions, the bids are often withdrawn.

The reasons for our success:

1. Experience – We don’t make the same mistakes first-timers make. Our “corporate memory” allows us to bring all learnings from previous bids to current ones
2. Disease management literacy and numeracy. —We would never make mistakes like Connecticut made (listing its cost per CHF member as $2000/year) or confuse savings and ROI, like Mississippi (“Bidders must provide a 5% net savings, meaning a 1.05 ROI” In reality, those two numbers are opposites, like when Yogi Berra told his players to “line up alphabetically by height.”)
3. Innovation – We were the first to determine how to score non-guaranteed bids against guaranteed bids, the first and so far only to measure outcomes validly, the first and only to be able to benchmark states against one another in their chronic disease measurement (see “Comparison to other states”)
4. Auditors letter – We commit to an “auditors letter” attesting to the validity of the savings derived using the contractual methodology.

Further, because we don’t add tremendous amounts of complexity to the procurement process and because of our experience, we are able to provide procurement at a much lower cost than others. We have been “sole-sourced” by several states, so you may even be able to avoid the consultant-procurement process.

2. Evaluation

DMPC undertakes more disease management outcomes evaluations than any other organization in the world.

Many of the states and health plans for which we perform these services receive Certification in Savings Measurement Validity.

Most of the states for which we provide an “auditors letter” attesting to the validity of outcomes, also receive an award from the Health Industries Research Co. naming them a “best state in disease management.”

Our evaluations are based on the translation of well-established principles of biostatistics into understandable transparent terms. We avoid the pre-post “black box’ used by actuaries for the simple reason that this is not actuarial science. It’s biostatistics. The RAND Report on disease management attests to this.

3. Comparisons to other states

Our unique database allows us to look at your own chronic disease burden and determine how well the system as a whole – including disease management – is managing it. For instance, in one disease category, you might have a high prevalence rate but the “failure rate” might be very low relative to other states. This observation would suggest that you should allocate your disease management resources to other conditions.

Or, the opposite might be true, leading to the reverse conclusion. Either way, this specific state-to-state comparison will provide insights and action implications not found anywhere else

References and qualifications

Current Medicaid Consortium members — all of which are reference sites — include Alaska, California, Florida, Illinois, Montana, New Hampshire, Tennessee, Washington, and Wyoming.

On the subject of Medicaid medical management, Consortium Executive Director Al Lewis has spoken at:

• Council of State Governments (twice)
• Women in Government (twice)
• National Medicare and Medicaid Congress (twice)
• Disease Management Association of America

In addition, Lewis has published the only peer-reviewed journal article on savings through Medicaid disease management, available free on request to any state Medicaid administrator by contacting us.