Tag Archives: Al Lewis

Saving on Employee Health Benefits: Would you Hire this Consultant?

Over the years as an HMO executive and later founding a disease management and Healthcare IT company, I have analyzed a lot of medical claims and quality data. One of the largest was an analysis of a State Medicaid program with about 675,000 beneficiary lives with two years of inpatient, outpatient and pharmacy claims. The pharmacy file alone contained about 15 million prescription fills.

More recently I became certified as a Professional by the Care Innovations Validation Institute and sit on their Advisory Board. This certification tested my ability to look at data and decide whether the outcomes reported were likely to be valid or not.  As you look for vendors or consultants I would suggest you start with the Validation Institute. The following example is a good reason why.

Cruising around the web looking at various healthcare consulting firms and company websites I came across  a company that is targeting employers and claims they  have vetted and can bring in vendors to lower the costs for a company’s self funded health plan. Their website says they can identify, evaluate, oversee, manage and report on the vendors they propose.

On their home page is a chart used to show the savings an employer can expect to see by implementing their various cost saving approaches.  Can you spot the flaw(s)?

 

high-performing-network-chart1

 

Let’s start with the first and most glaring error and its on the first line. Continue reading

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The Validation Institute and Certification – Stand out from the Crowd

Validation-Institute-Standard-Full-Color-RGB

 

As many of you know, I am on the advisory board of the Care Innovations Validation Institute.  This is an important organization for the Population Health and Wellness industry. The advisory board is chaired by Dr. David Nash, Dean of the Jefferson College of Population Health.

Our industry is facing some questions; one need only look at the multitude of population health and wellness vendors and their reports of amazing outcomes to know that something is not right.  RAND has published some very good studies (here, here and here)  that showed limited to negative returns from various wellness and employe health improvement programs and Al Lewis has published many examples in his books (here and here)  and on his website.  While on the other side, Ron Goetzel at the Institute for Health and Productivity Studies within Johns Hopkins Bloomberg School of Public Health,  has a whole section devoted to programs that do work.

Last year the Population Health Alliance held a debate between Ron and Al. The event was standing room only and came to the conclusion that many of the programs do not work, while a few very well designed and implemented programs do.

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Update to: The Dodo Bird and Employee Wellness Programs – The Phone Call

11/6/16

News Flash, The Dodo Bird is Still Alive:

Well another year has rolled around and I was talking to the person who’s experience with their wellness program I had discussed below. Lo and behold, the problems I had originally documented continue. This is a common example and explains why so many wellness programs should be discontinued.

It was time for next years enrollment period for her insurance and she needed to get a number of points, schedule a coaching visit and get her biometrics and lab work completed to qualify for the premium differential.

The lab work requirement upset her as she had just gotten all the lab work done by her PCP the month earlier, but no, those lab results couldn’t be used. So the vendor repeated all the lab work her PCP had done and more, most of which were absolutely unnecessary based upon USPSTF guidelines. But hey let’s go ahead and waste some money and do a few unnecessary tests.  That’s become the norm for many a wellness program.

As for getting the points, she recorded her exercise by selecting the boxes to document 30 minutes per day. That was the correct answer. Wink…

She was also required to speak with a coach so she had previously set that up, and when asked by the coach if she could take up some new behaviors,

said “oh yes that’s a good idea, I will.”  Wink..

The coach asked if she could follow-up in 3 months

“of course” she said

During the follow-up call, she dutifully reported to her coach that in fact the suggestions were a good idea and yes she had changed her behavior. Wink, wink…

“Congratulations” said the coach as she documented her successful intervention in the wellness vendors system.

Premium differential achieved.

I know exactly what this vendor’s annual report will look like. They’ll be touting all the calls they made, engagement they got, and behavior change achieved.

Don’t you just love self reported data.

Perhaps the vendor involved should call the Validation Institute and get some suggestions on how to measure their program so they can actually understand that their reported results are just plain wrong.

I can hear Al Lewis saying “I told you so”, but perhaps more interesting would be calling this vendor to testify and document why their program should be continued as part of the AARP lawsuit against the EEOC.

For the original story keep reading

Original Post

Given todays news report that the Feds say “Smokers are Lying on Obamacare Enrollment Forms” I thought I would publish this post written well over a year ago.  Seem’s it’s not just those enrolling on the exchanges who may be misrepresenting this important information, probably in ways you’d never think.

We have a crisis in the wellness program industry.

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2015 PHA Forum: Where Population Health Policy, Innovation and Education Converge

You’re familiar with the term “population health” through posts, articles and discussions with peers. Now come learn how we all can effectively operate within the framework of population health and strengthen the population health management programs within our respective organizations.  I’m hoping you can join me Nov. 2-4, 2015 in Washington, DC for the Population Health Alliance (PHA) 16th annual Population Health Forum  – where population health policy, innovation and education converge.

Policy

Get the most recent population health policy updates from those directly shaping it. Participate in a lively and enlightening debate between industry veterans Al Lewis and Ron Goetzel. And, while at the nation’s epicenter of policy and politics, hear firsthand from keynote speakers Eleanor Clift and Mark Siegel how the upcoming Presidential campaign and soon-to-be-changing Administration may impact our industry.

Innovation

Learn the latest technological advances, research and case studies from industry leaders who will share how participants can apply this insight in moving a population toward healthier lifestyles.

Education

Receive continuing medical education (CME) and Continuing Education Units (CEU) units through a series of interactive workshops where the practitioners share industry best practices that participants can put to use within their own organizations.

No other conference combines fresh insight on population health policy with practical, applicable knowledge shared by the industry’s leading players. Here is a link with additional information and registration details.

I hope to see you there!

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“Welcome to Health: Population 1” the PHA Forum

Blank Highway road sign.

This years PHA Forum has The Great Debate during the Executive Institute between Al Lewis and Ron Goetzel on Wellness Programs and ROI, but the PHA Forum also has incredible keynotes, programming and networking.

The theme is “Welcome to Health: Population 1”. Why? Because we recognize that the person is critical, we move populations one person at a time. So whether you are into politics, a hospital or provider group doing population health, an employer, a health plan, looking to network with experts or someone who needs CME’s or CEU’s the PHA Forum has something for you.

We are all in this mission together to improve the lives and health of the people we serve, our community, patients, employees, family and friends and yes even ourselves. Come to the PHA Forum and learn real and useful insights from people who are actually doing it.

Early bird rates are still available and we have special really discounted rates for government personnel, employers and students. So join me and others in our nations capitol November 2-4 to learn, network and come together to create a true system of population health.

See you there.

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