Nope.

How can we be so sure? Well, let’s consider heart disease an one example. You’ve probably spent millions of dollars managing heart disease over the last few years but you have no clue whether you’ve reduced your heart attacks. The reason you have no clue is that you don’t know what your heart attack rate is. (Don’t be embarrassed—neither does anyone else.)

If you don’t know what your heart attack rate (and angina and other ischemic event rate) is, then how would you know:

• Whether your rates have gone up or down?
• How they compare to others, meaning how much of a problem you have?

By joining the two dozen payors already in this database, you’ll learn that and more. Why is this important? Because you aren’t trying to manage everything about these patients. That’s the doctor’s and the patient’s role. You are trying to avoid unnecessary ER visits and hospitalizations associated with chronic disease. That’s the goal of disease management…so if it’s the goal, why not measure it?

As a participant, you will receive a history of your own successes in avoiding events associated with chronic disease, back as far as 2000.

You also receive a comparison of your own successes vs. other health plans in your own region, or across regions.

Here is an example of what you will receive, for asthma. This is a comparison of five plans of similar demographics, with identical datapulls and totally comparable data. There are many other comparisons too. It “tells a story” of whether the asthma DM has worked well (as for plan #5), or not at all (as for "Your plan" or #3) or moderately well (as for Plan 2 and possibly Plan 1).

ER and Inpatient Event Rate Per 1,000 Members

Primary Diagnosis of Asthma

You receive this comparison for both commercial and Medicare. You will clearly be able to tell whether your disease management program is getting results or whether you would be doing equally well without it. (Some programs are doing well. Others aren’t – we have also identified the factors most associated with successful disease management.) And you’ll be able to tell how you are doing to others, as well as identify the conditions with greatest potential.

Event avoidance is the single most important variable in determining the financial and clinical success of your DM programs, as well as the "adverse selection" of your health plan . . . and yet until now no one has tracked it in a systematic and valid way.

You also receive interpretation, consulting, "best practice" benchmarking, and other features.

You can do this at a fraction of the cost of any other way of answering these questions, with greater validity and more data. The data collection tool is easy to use, with "ingredients you already have in the kitchen." There are no fancy algorithms and no real potential for error. Further, each health plan’s data is reviewed personally by Al Lewis, and sent back for double-checking if it is outside a reasonable range without a reasonable explanation. This assures that the comparisons you see are valid ones.

In addition, you can also answer other questions, vs. others and your own history, such as:

• How much does your DM program cost vs. others, and how cost-effective is it?
• How much of a reduction in event rates do you need to pay for a program, given certain assumptions about comorbidity reduction?
• What is your rate of people being sent home from the ER vs. being admitted, for what diseases?
• How does your revascularization rate compare to others, and does revascularization have an effect on cardiac events?
• For Medicare, does your HCC coding reflect your underlying severity, or is it higher or lower than other payors relative to your severity?