"This is a must-read for anyone involved in developing policy or making purchase decisions on programs that try to improve health and save money."

Bob Galvin, Chief Executive Officer, Equity Healthcare (Blackstone Group); co-founder, Leapfrog Group; founder, Bridges to Excellence

"Lewis sugarcoats the bitter medicine of math with a generous amount of humor, making this the most painless lesson in outcomes analysis ever published. The lesson: trust your own judgment."

Tom Scully, former Administrator, Centers for Medicare and Medicaid Services; Senior Counsel, Alston & Bird; Partner, Welsh, Carson, Anderson & Stowe

"Lewis has single-handedly created what industry committees have failed to create: a how-to guide for valid outcomes analysis."

Warren Todd, former President and Executive Director, the Care Continuum Alliance

Make better health care decisions by understanding your own 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 you interpret these numbers, explains why and how "experts" often make them up, and shows that you don't need to rely on expensiveand as the hilarious examples show, often numerically challengedconsultants 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

Its rare that a book about mathematics is funny. And this is not just any math: Its 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 againKhanna on Health

Digital Health Book of the YearForbes

The health care industry is fraught with numbers that both human resource professionals and health plan executives cannot believe or understand. Health care vendors routinely show you outcomes reports for your Population Health Improvement programs whose numbers are much closer to fiction than fact. But you dont know why these numbers are fictional, do you? You leaf through these vendor outcomes reports, and wonder the best way to save money for your business while providing an optimal service. Measurement of savings, whether described as Return on Investment or another term, is the most contentious issue in disease management.

Why Nobody Believes the Numbers provides information on benefits decisions that can be estimated without math, using observational data to figure out whether you are moving the needle or not. Better decisions can be made by looking critically at the data and using the information to make smart decisions in the future. For example, you can look at actual event rates over time (heart attacks, asthma attacks, etc.) and ask whether the return-on-investment (ROI) that a vendor is insisting you received is plausible given the changes in event rates over time in your population.

Why Nobody Believes the Numbers counsels the opposite of the health care industry standard. You check every piece of arithmetic you see because in this field most calculations are wrong, often to the point of being impossible. With the information provided, health plan providers and benefits departments will be able to better understand the numbers in outcome measurement reports to provide quality services and save money.

Possibly the funniest serious healthcare industry book ever. 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 lesson of Why Nobody Believes the Numbers: no need to hire fancy consultants or 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. Qualifications aren't everything. After all, Elvis didn't have a PhD in musicology and Paul McCartney can't read music.

There are serious lessons too. Why Nobody Believes the Numbers helps you interpret the numbers you get shown, and explains how to tell if they 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
• Determine whether the ROIs your vendors report are plausible or even arithmetically possible
• Synthesize all these insights into RFPs and contracts that let vendors know that you weren't born yesterday

Why Nobody Believes the Numbers introduces a unique viewpointto population health outcomes measurement: Results/ROIs should be presented as they are, not aswe 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 usingactual 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. Thebook'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 todetermine 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

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.

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 Dos and Donts (Mostly Donts) 175

Appendix: The Keys to the Numerical Kingdom 193

Authors Note on Sources 195

Notes 197

Glossary 201

About the Author 207

Bibliography and Further Reading 209

Acknowledgments 211