Tag Archives: Validation Institute

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)?

 

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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

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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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Marketing Presentations: You Never Know What you May Learn.

I was on a call the other day with a company that provides a targeted consumer engagement platform based on psychographic data that is used to “bucket” people into one of a few groups and then send targeted messaging to them via different communication systems. When they got to their results slide my antenna went up.

Here were two of their claims directly off of the PowerPoint slide:

  • 72% of at risk employees joined a diabetes education program versus 10% nationally
  • A personalized patient messaging program created an additional $70,000 in revenue per month for a 300 physician group.

So I asked a few questions:

Me ” What data source did you use to claim that 10% of employees typically enroll in a diabetes education program?”

Him “We looked at the Rand Report (The DOL) Study which showed that 21% of employees typically engaged and then…(wait for it, wait for it)… only 50% of companies have programs, so that’s how we came up with the 10%”

To say I was incredulous would be a huge understatement.

So I asked to clarify

“So, you are counting the 50% of people who have no access to a program to begin with?”

Him “Yes”

Me “that’s just not right”

Him “Well it is true on a national basis”.  (On a side note this also may or may not be true on a national basis; just because 50% of companies don’t have a program does not mean that 50% of the employees don’t, depends on the companies in each group and their employee size.)

I was finally able to get him to admit, that the statistics he used might be a problem, when he then said “The original program was done with on-site staff enrolling employees and they were getting over 50% engagement.”

So the truer statement is they went from somewhere north of 50% to 72%, not bad, but much different than from 10% to 72%.

Now I dug into the second issue, the $70,000 per month. So I asked about this,

Him “yes, they told us that the program had increased their revenue by $70,000 per month.”

Me “lets do some calculations. It’s a 300 physician group, correct?”

Him “yes”.

Me “So lets assume that each physician generates $500,000 in annual revenue, that’s $41,666 per month. Multiply that by 300 and they are generating about $12,500,000 per month. $70,000 is just over one half of one percent of $12,500,000. That’s peanut’s, now take that and divide it by 300 physicians that equals $233 per month per doctor. Or maybe 4 office visits.”

Him “but wait, that’s profit, does the slide say revenue?”

Me “Yes it does”

Him “oh I need to correct that”

Me “yep, and still, so if its ‘profit’ they generated an additional $233 per doctor? Still seems rather small.

Him “Well that’s the number they gave us.”

Word to those who are looking for vendors and being presented with marketing materials: Ask a few Questions; you never know what you may learn.  Perhaps I should refer them to the Intel Care Innovations Validation Institute.  Full disclosure, I am on the Validation Institute’s  advisory board.

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