The Business of Health Care

Why Nobody Believes the Numbers


Did you know that the “official” industry guidelines for measuring care management outcomes are mathematically certain to overstate savings?     And that about half the companies in the DM/wellness marketplace (including carriers) have invalidating mathematical mistakes right on their websites or in their brochures?   And that others simply lie?  And that the “gatekeepers” who are supposed to prevent these mistakes – leading benefits consulting and actuarial firms – routinely make up savings figures that are simply mathematically impossible and hope they don’t get caught?

This is the first book to treat outcomes as being math-based, not faith-based.  It is aimed at the grown-up segment of the marketplace – people who really want to see how much they can save, rather than how much they can be told they can save.   A dozen hilarious case studies—and we are naming names — will include:

·         Major carriers who simply make up numbers and dare you to catch them
·         Benefits consulting firms that specialize in “validating” mathematically impossible results
·         Vendors promising savings in excess of the mathematical limit of 100%
·         Carriers/vendors that are either totally clueless and/or think you are…and make up their own metrics like “reduction in undetected claims cost,” leading one to ask how they are able to detect undetected claims cost, and/or how an employee would otherwise have filed an undetected claim

Fortunately, there is mathematical hope.  A few vendors have programs that will indeed save modest sums…but the savings are real.  This book shows how to find those vendors and – more importantly – how to validly measure their outcomes.   There is indeed a way to validly measure outcomes without using expensive consultants, but instead using what author Al Lewis calls “ingredients you already have in your kitchen.

Who Should Read Why Nobody Believes the Numbers?

If you are a physician who doesn’t understand why your contracted health plans are paying outsiders to do work that you yourselves can do, this book gives you the ammunition to discuss remedying that situation.

If you are an executive who sees “both sides of the ledger” — meaning a CFO, Executive Vice President for HR with P&L responsibility, or that rare breed of benefits consultant who can handle the truth – then order this book.  If you aren’t – meaning you believe what you are told by vendors and consultants – you should probably buy a book like Proof Positive instead so you can get really excited about how much money you can be told you are saving.    But before you do, you might ask yourself, “If we can reduce medical claims so massively with wellness, how come carriers sell wellness to their self-insured customers but don’t automatically provide it to their fully insured customers, where as carriers they themselves would reap the savings?”

You don’t even have to take our word for it.

Read the “search inside the book” excerpts from Why Nobody Believes the Numbers , the advance praise and early reviews from industry leaders such as Dr .Robert Galvin, Tom Scully, Regina Herzlinger, and James Prochaska, or the excerpt in July’s Managed Care Magazine.