DMPC to guarantee DM and wellness outcomes for elite group

Apr 12 2010

Al Lewis, president of the Disease Management Purchasing Consortium, Inc. (DMPC), the founder and first president of the Disease Management Association of America and the person most often credited with establishing the metrics by which disease management is measured  announced today that he will be personally validating and guaranteeing disease management (DM) and wellness outcomes for an elite, award-winning group of vendors, health plans, benefits consultants and employers.

DMPC "auditor's letters" will carry guarantees of up to $100,000 attesting that results being claimed by the DM/wellness program are valid.  This guarantee is in addition to any vendor guarantees.

"For years, I've asked vendors to guarantee results.  Now I am doing the same," Lewis said.   "Perception in this field always lags reality.  The perception in the lay press is that these programs don't save money.   The reality is that the vendors who deliver the best-run programs do save money.  I've validated this myself and now I am putting the DMPC balance sheet on the line to tell the world. I am vouching that the elite companies already on this list can achieve savings to my satisfaction, and I will do the same for other organizations that can meet that standard.  The bottom line:  I will financially guarantee any valid savings calculation." 

This elite group currently includes only organizations that have won awards from the Health Industries Research Co.  for their program quality and whose savings have been certified for validity from DMPC.   Health plans so qualified include AmeriHealth Mercy, Blue Cross Blue Shield of Delaware, BlueCross BlueShield of Vermont, Boston Medical Center HealthNet Plan, CareFirst BlueCross BlueShield, Connecticare, Fallon, Harvard-Pilgrim Health Care, Health Alliance Medical Plan, HealthPartners, and Providence Health Plans.  

"Providing this added benefit for our customers, in the form of a savings guarantee, gives us an opportunity to differentiate ourselves from the competition and show accounts that a third party validates the savings we have achieved for our clients," said Richard Safeer, M.D., CareFirst's Medical Director for Preventive Medicine. 

Procter & Gamble, which oversees an award-winning program for its own employees, is also in the group.  The State and Local Group Benefits Administrators (SALGBA) has arranged for its members with valid outcomes to receive letters too.  Tina Bowling, SALGBA Executive Director, said: "We are thrilled to be uniquely selected to provide such a valuable benefit to our members, to help cash-strapped public sector employers optimize health management program effectiveness."

The City of Savannah is the first SALGBA member to qualify for a letter.  Beth Robinson, Director of Human Resources for Savannah, said: "Al showed us, very painlessly, how to determine whether our program really was having an impact, and we were thrilled to see that it was and to qualify for this letter." 

Vendors include industry leaders Healthways, Accordant, APS, McKesson Health Solutions and ActiveHealth, as well as the leading coordinated-care vendor, Quantum Health.   While Healthways and APS are also qualified for wellness auditor's letters, the only pure wellness vendor selected is Quality Health Solutions.  The leading company with an integrated combination revenue/disease management offering for Medicare Advantage, Matrix Medical Network, is also on the list.

Healthways CEO Ben R. Leedle, Jr. noted: "This announcement is a bold step in support of our entire industry. "Healthways has long advocated for an industry-standard outcomes methodology so that customers and prospects could differentiate 'fact from fiction' in evaluating the value promises of health, wellness, prevention and chronic care programs. This initiative by DMPC moves the industry one step closer to that goal. The simple truth is that these programs are not interchangeable; different programs produce different results, and the time for purchasers to know that is before they buy, not after."

The benefits consulting firms selected for the group, The Hays Companies and Strategic Benefits Solutions (SBS), have -- almost uniquely among benefits consulting firms -- had principals pass the DMPC test to receive Certification in Critical Outcomes Report Analysis. David Rearick DO, Vice President of Medical Management for SBS, commented: "SBS believes the only way to know whether your recommendations are improving health status is measure the outcomes accurately.   Being selected as one of two 'elite' consulting firms by DMPC ensures our clients that the value we promise and deliver is indeed accurately measured."

David Matheson of The Boston Consulting Group, often credited with discovering the concept and coining the phrase of disease management, commented: "If the credit rating agencies had put themselves personally on the line the way Al is doing, we might not have had the credit crisis."  

The guarantee will generally be based on an analysis of outcomes validity using the DMPC-developed methodology to track adverse medical events.  By counting all events in all periods, as opposed to just counting events that take place among the population identified in the baseline, this methodology avoids regression to the mean.  A complete list of acceptable wellness and disease management methodologies is available from [email protected]. 

Those executives who have qualified for these letters are enthusiastic about their potential for enhancing the field's credibility.  Kara Trott, CEO of Quantum Health, is looking forward to more companies adopting these:  "We will be making our Auditor's Letters public and invite scrutiny, and look forward to others doing the same.  The more transparency in this field, the better for everyone."

Judith Frampton, RN, Vice President of Medical Management for Harvard-Pilgrim Health Care, summed up the impact that auditor's letters will have on the credibility of disease management:  "In the past our customers have had difficulty making comparisons because they understand that all disease management ROIs are not created equal. Now it should be quite clear and fair."