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Why Nobody Believes the Numbers: Distinguishing Fact from Fiction in Population Health Management

ISBN: 978-1-118-31318-3
240 pages
June 2012
Why Nobody Believes the Numbers: Distinguishing Fact from Fiction in Population Health Management (1118313186) cover image

Why Nobody Believes the Numbers introduces a unique viewpoint to population health outcomes measurement:   Results/ROIs should be presented as they are, not as we wish they would be.  This viewpoint contrasts sharply with vendor/promoter/consultant claims along two very important dimensions:

(1)     Why Nobody Believes presents outcomes/ROIs achievable right here on this very planet…

(2)   …calculated using actual data rather than controlled substances.

Indeed, nowhere in healthcare is it possible to find such sharply contrasting worldviews, methodologies, and grips on reality. 

Why Nobody Believes the Numbers includes 12 case studies of vendors, carriers, and consultants who were apparently playing hooky the day their teacher covered fifth-grade math, as told by an author whose argument style can be so persuasive that he was once able to convince a resort to sell him a timeshare. The book's lesson:  no need to believe what your vendor tells you -- instead you can estimate your own savings using “ingredients you already have in your kitchen.” Don't be intimidated just because you lack a PhD in biostatistics, or even a Masters, Bachelor's, high-school equivalency diploma or up-to-date inspection sticker.  

Why Nobody Believes the Numbers explains how to determine if the ROIs are real...and why they usually aren't. You'll learn how to:

  • Figure out whether you are "moving the needle" or just crediting a program with changes that would have happened anyway
  • Judge whether the ROIs your vendors report are plausible or even arithmetically possible
  • Synthesize all these insights into RFPs and contracts that truly hold vendors accountable for results
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Introduction xiii

Chapter 1 Actuaries Behaving Badly 1

Chapter 2 Plausibility Testing: How to Measure Outcomes Using Ingredients You Already Have in Your Kitchen 35

Chapter 3 Case Studies That Flunk Every Plausibility Test Known to Mankind 53

Chapter 4 Case Studies That Flunk Every Plausibility Test Known to Mankind and Then Some 73

Chapter 5 Case Studies of Where, When, and How Wellness Programs Have Actually Worked 125

Chapter 6 Yes, Virginia, There Is a Savings Clause 141

Chapter 7 Disease Management Programs That Actually Work (Pinch Me) 151

Chapter 8 Contracting/RFP Checklist of Do’s and Don’ts (Mostly Don’ts) 175

Appendix: The Keys to the Numerical Kingdom 193

Author’s Note on Sources 195

Notes 197

Glossary 201

About the Author 207

Bibliography and Further Reading 209

Acknowledgments 211

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AL LEWIS, President of the Disease Management Purchasing Consortium, is widely credited with inventing disease management and was named "the national leader in analyzing care management outcomes" in the 9th Annual Report on the Disease Management and Wellness Industries. He provides procurement and outcomes consulting to health plans and human resources/benefits departments, and administers the industry certification program in Critical Outcomes Report Analysis. He holds undergraduate and graduate degrees from Harvard.

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“It’s rare that a book about mathematics is funny. And this is not just any math: It’s population health analysis. This is the stuff that employers, benefit managers, CFOs and many others want to know: how to figure out if an intervention “worked” and reduced costs.”—Employee Benefit News

“Do yourself a favor and buy this book.  And, keep it handy the next time you entertain a DM/wellness proposal or examine data submitted to you by your vendor.  You will never read those proposals or reports the same way again”—Khanna on Health

“Digital Health Book of the Year”—Forbes

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July 13, 2012
Make Better Healthcare Decisions by Understanding the Data

Behind every health plan and benefits department decision are the numbers that illuminate and drive the cost of coverage. An easy-to-follow guide to population health management, Why Nobody Believes the Numbers helps readers interpret these numbers, explains why and how "experts" often make them up, and shows that you don't need to rely on expensive—and as the hilarious examples show, often numerically challenged—consultants and vendors to do evaluations. Why Nobody Believes the Numbers gives you the tools to:

  • Figure out whether you are "moving the needle" or just crediting a program with changes that would have happened anyway
  • Determine whether the ROIs your vendors report are plausible or even arithmetically possible (the majority aren't)
  • Synthesize all these insights into RFPs and contracts that let vendors know that you weren't born yesterday
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