Contact:  Al Lewis alewis@dismgmt.com 781 856 3962

August 11(Wellesley, MA) The Disease Management Purchasing Consortium (DMPC) has announced and posted the first five recipients of DMPC ‘s new Certification in Care Management Contract Design and Negotiation.  The recipients are Karen Kraemer of HealthPartners, David W. Plocher MD Of Ingenix, Richard Safeer MD of Carefirst, Karen Smith-Hagman of EmblemHealth, and Melissa Tobler of Hays Companies.

To qualify for this lifetime Certification, an individual must have negotiated at least three care management contracts in total, with at least one avoiding at least fifteen of the eighteen most common mistakes that buyers and benefits consultants make in care management contracting.    The DMPC, which is often retained by health plans and employers to consult in situations in which a care management vendor is not performing, generally finds that the average employer contract avoids at
best one-third of these mistakes while the average contract negotiated by a health plan avoids roughly half.

Therefore, a tightly drafted contract is a rarity, and DMPC is now recognizing those individuals who have drafted such contracts, because they add value for their organizations far beyond that of the average executive involved in care management contract procurement.

“To be totally honest, it is good for our own business to recognize those individuals too,” says Al Lewis, DMPC President.  “Judging from the contracts I’ve reviewed, I am quite sure that few payer executives are aware of the huge gap between what is typically negotiated and what is vastly preferred, especially in the areas of measurement validity, definitions of commonly used terms, and contract termination/transitioning, though other issues are also often drafted poorly.”

Melissa Tobler, National Practice Leader for Health Strategies at Hays Companies, said: “Recognition from Mr. Lewis is a high honor, indeed.  But we should all remember that without educational leadership from him and a few others, valid contracting for and measurement of performance would not matter at all and savings claims would be universally accepted at face value.”

“We are vigilant in ensuring that the terms of our care management contracts include measurements of effectiveness – thereby avoiding a common mistake where performance guarantees for both clinical and process outcomes are not valued as highly as the ROI,” says Karen Smith-Hagman, Vice President, Medical Management for EmblemHealth.  “We know we serve our members well with this approach and we are pleased by this recognition of the time and effort we put into our negotiations with vendors.”

Four other individuals are under consideration for Certification right now, but Lewis expects the list to remain quite limited and exclusive, based on the number and quality of contracts he has reviewed.   “The gap between best practices and average practices in this field never ceases to boggle my mind,” says Lewis. “It’s almost as though there is a parallel universe where measurement techniques and contractual language that have long since been discredited, and outcomes claims that are mathematically impossible, are nonetheless perfectly acceptable to 80% of benefits consultants and human resource directors and 60% of health plans.  Our certification programs are designed to recognize those who do their jobs best, in the hopes that someday the entire field will evolve.  That evolution shows no signs of happening.  Indeed, savings claims for state Medicaid programs, such as North Carolina’s, have now breached the nine-figure mark.  All the more reason to provide favorable recognition for those individuals for whom reality is the major consideration in contracting and outcomes measurement.”

A complete list of the eighteen common mistakes is available at http://dismgmt.com/110care_management_cert.htm

ABOUT DISEASE MANAGEMENT PURCHASING CONSORTIUM INT’L, INC. AND AL LEWIS

DMPC (www.dismgmt.com) has been providing procurement and outcomes measurement support for health plans, large self-insured employers and states since 1995.  Google credits founder DMPC Al Lewis with having “invented disease management.”  Managed Healthcare Executive consistently ranks Lewis as the “#1 Most Influential” person in disease management.”   He has twice been named the industry’s most influential person by DMAA:  The Care Continuum.  Books include Emerging Trends in Disease Management: 2009 and Beyond (with Jill Brown) and OOBonomics:  The Best Outside-of-the-Box Economic Policy Ideas From The Site That Will Pay $1 Million for Yours, which will be broadly available in bookstores in October.  He also appears regularly on Montel Williams and other national and local TV and radio, and has published many peer-reviewed articles on the subject, most recently “How to Measure the Outcomes of Chronic Disease Management,” Journal of Population Health Management (2009;12:47-54).   His Critical Outcomes Report Analysis, Savings Measurement Validity and Care Management Contract Negotiation certifications have been earned by 150+ individuals and 30 payor organizations, listed on www.dismgmt.com.  Lewis holds two degrees from Harvard and taught economics there, and was a partner in the international management consulting firm of Bain & Co., Inc.