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

Complete 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, wellness, or outcomes generally will find at least some of these items helpful.

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.






“Apples to Apples” Final RFP Template; 8 pages; rfp-apples-to-apples.doc (1999-2013)

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 disease management, wellness, and 24/7 Nurselines.


11th Annual Report on the Disease Management and Wellness Industries; Best Health Plans and Vendors.pdf (2004-2012)

The Annual Report 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. 28of 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; 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.


“Cheat Sheet” for Vendors in Employer Negotiations; . How to Take Advantage of Benefits Consultants.doc (2012)

Details seven common near-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; 4 pp. Extraction Algorithms.doc (2004-2010)

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


Contracting with Vendors; 2 pp. Contracting: 18 points.doc (2009)

The 18 most common contractual mistakes in care management contracting.


Diabetes Cost Breakdown; spreadsheet; diabetes costbreakdown.xls (2012)

The field’s most comprehensive compilation of all diabetes-related morbidities, their cost, their impactability, and their relationship to total cost savings in commercial and Medicare. All this is incrementally, over a three-year period. A template sans data is available for inspection


Diabetes Economics; spreadsheet; diabetes economics.xls (2013)

Everything you need to know about entering diabetes mHealth market, contracting for mHealth, and/or investing in mHealth companies. A template sans data is available for inspection.


Disease Management Vendor Profiles; 32 pp. vendors.doc (1997-2012)

Names of 160 DM independent companies, together with (in most cases) contacts, phones and/or addresses and/or faxes, emails, key contracts, other profile information. $500 version with ratings and comments is our best-seller. Ask forthe sample page, which is free.

Disease Prioritization Matrix; discus.doc, incidenceprevalence.xls (1998-2013)

For ten different outsourced patient management opportunities, this Excel spreadsheet will tell you what your likely savings are, after you enter some “macro” costs and demographics about your plan. The “Discus.doc” companion includes a cheat sheet and an hour of consulting to help you customize your estimates


Disease Prioritization Matrix, estimated; prioritization matrix.doc (1998-2013)

Also available specifically for Medicaid

For 12 different outsourced patient management opportunities including hospitalist, compliance and population management programs, this document lists likely size of medical losses affected (roughly adjusted for Medicare and Medicaid),expected savings, ease and timing of implementation, and non-price reasons to undertake or not undertake a particular disease category.


Disproof of Care Continuum Alliance Outcomes Guidelines; 15 pages; Care Continuum Disproof.pdf (2012)

It is now proven that purchasers of wellness and disease management programs are being shown savings that are based on pre-post methodologies known to be false. This proof is available, along with a $10,000 reward for finding a mistake in it. If you’d like to waste your time trying, the rules are here.


Does Quality Matter? 3 pp. DMColumn7.doc (2001-2012)

The shocking (ok, not that shocking, but pretty counterintuitive) truth about the role of quality in DM vendor selection and the pluses and minuses of various measurement techniques for it…


Employers: Estimating “soft” savings; $12 pp Soft Savings Estimator.doc (2008-2011)

Best example of how-to estimate for time lost to absenteeism


Employers and Unions, A Primer on Disease Management; 38 slides Disease Primer.ppt (2000)

An introduction to disease management for a lay audience with more-than-usual emphasis on the health benefits for employees and correspondingly less (though still some) on financials.


Employers and Unions, A Primer on Disease Management, 3 Pages What Unions Should Know.doc (2000)

A Q&A designed to introduce unions (but can easily be customized for non-union workforces) to disease management


Employer How-To Package 7 pp. EBNColumns.doc (2005-2012)

A collection of all my Disease Management columns for Employee Benefit News. for procurement of disease management


Event Rate Measurement: A Complete Package 50 pages including slides (2009-2013) Event Rate Plausibility Suite

Powerpoint, plus data collection template, plus how-to guide for event-based measurement


How to Pay for DM Programs (5) 3 pp. DMColumn5.doc (1999-2002)

Article describing how the population-based payment mechanisms are preferred, and how to solve the problems which population-based payment mechanisms present. Also: How to evaluate and negotiate “tiered” payment systems.


Medical Home: Debunking the Myth of Savings (9,13,19) spreadsheet plus powerpoint plus backup data Medical Home Package (2009-2013)

Turns out (surprise) Bott Mercer and Milliman did the analysis wrong for North Carolina Medicaid. Instead of saving $300-million/year, the model costs $400-million/year. This package shows the whole analysis.

Medicare Stars Program Suite Medicare Stars (13,18) 9 Documents plus spreadsheet (2010)

Collection of hard-to-find public domain materials together with easily used spreadsheet facilitating the value analysis of Stars


North Carolina Medicaid Smackdown (3,9, 19) 2 pages; North Carolina Medicaid Smackdown.pdf (2012)

A must-read for anybody considering a medical homes contract of any type. A“lay” compilation of the purposeful misstatements made in order to create enough alleged savings to justify more federal funding. The more comprehensive version is available separately here.


Outcomes Measurement for Dummies...and Smarties, Presentation version; 80 pages Valid and TransparentOutcomes.ppt (2010-2013)

Powerpoint version of above


Pharmaceutical DM Strategy White Paper (3), 24 pp. Pharmaceutical DM Strategy White Paper.doc (2001-2004)

The “answer” to how apharmaceutical company should strategically view disease management, period. This document carries a considerable extra cost, which also covers a day of on-site consulting to elaborate on it. This is also fully guaranteed in advance to be the right answer, in your opinion, or you can keep the White Paper and still receive a full refund.

Predictive Modeling Effectiveness (17); 2 slides Predictive Modeling Effectiveness.ppt (2013)

Results of a careful analysis of five (unnamed) predictive modeling packages in their ability to identify the following year’s high-cost members and also members transitioning from low-cost to high-cost.


Pricing by Disease (14) 2 pp. pricing by individual disease.doc (2004-2013)

PMPM pricing by disease for the 5 key diseases, including discounts for multiple diseases – 0% and 100% risk for commercial and Medicare.


Pricing and Scoring of RFPs; spreadsheet abstract—blinded.xls (2004-2009)

PMPM 5-disease, by year and level of risk, across a range of (unnamed) vendors. Includes ROIs and effect of guarantees on pricing, savings and ROIs. Demonstrates how scoring works

Pricing and Scoring of RFPs—Medicaid; $spreadsheet Medicaid abstract.xls (2006)

Scored PMPM for Medicaid disabled bid. Demonstrates Medicaid scoring of savings , fees, and ROI.


Process Steps in Outsourcing; 5 pp. Process Steps.doc (1998-2013)

Detailed description of each of the thirty process steps involved in selecting a disease and developing an outsource program for it.


Proposals: Reading and Writing; 7 pp. Howtoreadaproposal.doc (1998)

Annotated model proposal for Member and vendor instruction and enlightenment. One of the bestsellers. Based on ESRD example but could be used for any disease.


RFP Response, Unabridged 100+ pages SampleCompleted RFP.pdf (2010)

Sample complete response (including pricing) to comprehensive RFP


Quality and Disease Management; 5 pp. Article on Quality in Disease Management.doc (2003-2005)

The straight scoop on quality measures—validity, relevance, and correlationwith actual outcomes. The only guidance you’ll ever need on how to develop a quality measurement strategy.


Request for Information for Disease Management Procurement: All the Questions You Can Think Of; 20 pp., RFI.pdf (2002-2013)

You can pick-and-choose RFI questions from this very comprehensive list andthen add your own, simplifying your own process dramatically.


Reporting Template: What you Should Demand from a Vendor or Produce as an Internal Program; 17 slides Template for Reporting.ppt (2003)

Standard set of deliverables which any program should produce for sponsor. You can use this to negotiate how much less is produced for your own ASO employer customers of various sizes


Screening Economics; spreadsheet ScreeningEconomics.xls (2013)

This is the field’s only tool that allows you to determine whether yourbiometric screening tool will save you money or cost you money. It contains“dummy” numbers based on our own work, but allows you to substitute yourown.


Staffing Summary, detailed; typical staffing summary, blinded.xls (2007)

Average of several places, 15 job titles, workload, salary range, comments;Medicaid, Medicare, Commercial. Very detailed.


Timeline and GANTT Chart for DM Vendor Selection and Contracting; 1 spreadsheet timeline.xls (2002-2010)

Developed from dozens of projects to ensure optimal implementation and to start all concurrent activities in a timely way, to prevent unnecessary delays.


Vendor Ratings; 28 pages of tables vendor ratings.doc (1999-2012)

A must-have for any health plan, venture capitalist, or vendor, period. Offered in conjunction with the vendor listings


Wellness Savings Calculator; spreadsheet wellness calculator.xls (2009-2013)

Foolproof way to tell whether your wellness program is likely to save moneyand if so, how much?




The following published and peer-reviewed articles are guest-authored by Ariel Linden DrPH, the leading DM measurement researcher in the United States. Each is available for $100 for DMPC members and $200 for non-members They would all be “15” on the number key.





Linden A, Adams J. Determining if disease management saves money: an introduction to meta-analysis. J Eval Clin Pract. In Press

An introductionto the meta-analytic technique as a means of evaluating a DM program’s overalleffectiveness across various populations, diseases, payors, etc.

Linden A, Trochim WMK, Adams J. Evaluating program effectiveness using the regression point displacement design. Eval Health Prof. In Press

An introduction to a novel evaluation design originally developed by William Trochim and Donald Campbell. In this paper, the technique is applied to various healthcare settings, in particular, where pilot programs are initiated before widespread adoption.

Linden A. What will it take for disease management to demonstrate a return on investment? New perspectives on an old theme. Am J Manage Care 2006;12(4):61-67.

A benchmarkpaper in which it is demonstrated that DM economic effectiveness should be measured via utilization and not cost. Additionally, a need-to-decrease (NND) analysis is introduced to assess whether there is sufficient opportunity for a DM program to have an impact on the population.

Linden A, Butterworth SW, Roberts N. Disease management interventions II: What else is in the black box? Dis Manage. 2006;9(2):73-85.

A follow-up paper to the earlier published DM interventions paper. Several new behavioral change models are introduced, including motivational interviewing, which is the newest technique used for health coaching.

Linden A. Evaluating the effectiveness of home health as a disease management strategy. Home Health Care Manage & Pract. 2006;18(3):216-222.

This paper raises the methodological issues facing home health programs in showing their value in disease management. It then offers several evaluation designs suited for this unique setting.

Linden A, Adams J, Roberts N. Evaluating disease management program effectiveness: an introduction to the regression-discontinuity design. J Eval Clin Pract. 2006;12(2):124-131.

This paper introduces the regression discontinuity technique, possibly the most robust observational study design that can be applied to DM program evaluations.

Linden A. Measuring diagnostic and predictive accuracy in disease management: an introduction to receiver operating characteristic (ROC) analysis. J Eval Clin Pract. 2006;12(2):132-139.

This paper introduces readers to the ROC analysis which is uniquely suited for assessing the sensitivity and specificity of predictive models and algorithms used for identifying suitable program participants.

Linden A, Adams J, Roberts N. Strengthening the case for disease managementeffectiveness: unhiding the hidden bias. J Eval Clin Pract. 2006;12(2):140-147.

Observational study designs are always subject to bias. This paper introduces a method for assessing whether results of a DM program evaluation are robust enough to overcome the influence of bias.

Linden A, Adams J. Evaluating disease management program effectiveness: an introduction to instrumental variables. J Eval Clin Pract. 2006;12(2):148-154.

Instrumental variables are typically used in econometric studies to controlfor bias. In this paper, the concept is applied to actual DM program data.

Linden A, Roberts N. Using visual displays as a tool to demonstrate diseasemanagement program effectiveness. Dis Manage. 2005;8(5):301-310.

Evaluating program effectiveness is one thing, but explaining them to stakeholders is another. This paper provides several different visual displays that will help explain the complex data used in DM.

Linden A, Roberts N. A users guide to the disease management literature: recommendations for reporting and assessing program outcomes. Am J Manage Care.2005;11(2):81-90.

Both peer-reviewed manuscripts and press releases may lack in accurate information for readers to assess their value. This paper introduces the specific criteria that should be followed by authors when writing a manuscript, and by readers when evaluating the value of the paper or press release in question.

Linden A, Adams J, Roberts N. Evaluating disease management program effectiveness: An introduction to the bootstrap technique. Dis Manage and Healt Outc. 2005;13(3):159-167.

Typically DM programs are evaluated using standard parametric statistics, such as t-tests, least-squares regression, etc., which are based on averages and standard deviations. However, much of the data used in DM is based on counts or rates, and have large variances in the data. The bootstrap technique is a non-parametric alternative that allows the evaluator to use additional measurement types that are more suitable to the data. This paper explains the technique and provides several examples using actual DM data.

Linden A, Adams J, Roberts N. Using propensity scores to construct comparable control groups for disease management program evaluation. Dis Manage and Healt Outc. 2005;13(2):107-127.

The propensity scoring technique is rapidly becoming a mainstay evaluation tool in DM. It is based on the concept of matching participants receiving the DMintervention with non-participating controls. The propensity score is a composite score of many baseline characteristics. This method, when used in conjunctionwith a sensitivity analysis (see Linden A, Adams J, Roberts N. Strengthening the case for disease management effectiveness: unhiding the hidden bias. J Eval Clin Pract. 2006;12(2):140-147), may be as robust as the randomized controlled trial.

Linden A, Adams J, Roberts N. Evaluating disease management program effectiveness adjusting for enrollment (tenure) and seasonality. Res Healthc Fin Manage. 2004;9(1):57-68.

Two important confounding variables that should be adjusted for in any DM evaluation are an individual’s length of time in program (tenure) and the calendar month (due to seasonality). This paper introduces a model that adjusts for these two variables and demonstrates how it can be interpreted.

Linden A, Roberts N. Disease management interventions: What’s in the black box? Dis Manage. 2004;7(4):275-291.

This paper introduces several basic psycho-social behavioral models that should be considered for implementing in a DM program intervention.

Linden A, Adams J, Roberts N. Evaluating disease management program effectiveness: An introduction to survival analysis. Dis Manage. 2004;7(3):180-190.

Survival analysis (also called time-to-event analysis), provides a unique method for evaluating DM program effectiveness. All participants contribute to the model, regardless of their length of time in the program. These are called censured cases and would typically not be included in standard designs if their tenure was less than 6 month or a year. This paper introduces the method and presents an actual analysis with its interpretation.

Linden A, Adams J, Roberts N. The generalizability of disease management program results: getting from here to there. Manage Care Interface. 2004;17(7):38-45.

Most studies in DM are concerned with internal validity, primarily the impact of selection bias and regression to the mean. However, external validity is equally as important. This paper introduces methods to maximize the generalizability of DM program outcomes.

Linden A, Adams J, Roberts N. Using an empirical method for establishing clinical outcome targets in disease management programs. Dis Manage. 2004;7(2):93-101.

One of the biggest problems facing DM is in knowing how to set reasonable targets for clinical outcomes. This paper provides a simple empirical method for deriving those targets.

Linden A, Adams J, Roberts N. Evaluation methods in disease management: determining program effectiveness. Position Paper for the Disease Management Association of America (DMAA). October 2003.

This paper was written at the request of the DMAA in 2003. It is intended to provide an overview of the bias inherent in the currently used total population approach and propose alternative methodologies for evaluating DM program effectiveness.

Linden A, Adams J, Roberts N. Evaluating disease management program effectiveness: An introduction to time series analysis. Dis Manage. 2003;6(4):243-255.

Time series analysis (TSA) should be used as a standard evaluation technique in DM. This paper provides a comprehensive discussion of TSA and provides direction of how it should be used and results interpreted.

Linden A, Adams J, Roberts N. An assessment of the total population approach for evaluating disease management program effectiveness. Dis Manage. 2003;6(2): 93-102.

This paperpresents a comprehensive critique of the most common methodology used for evaluating DM program effectiveness.

Linden A, Roberts N, Keck K. The complete “how to” guide for selecting a disease management vendor. Dis Manage. 2003;6(1):21-26.

As the titlestates, this is a complete guide for selecting a DM vendor.

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