Validated Organizations

Overview Table View

Product and Service Vendors

Accordant logo
Arche Healthcare logo
Evolent Health logo
Evolent Health logo
Happy Whole Human, LLC logo
Healthentic logo
Healthsense logo
Healthways, Inc. logo
It Starts With Me Health logo
Kinesis Health Technologies logo
The Leapfrog Group logo
Lucina Health logo
MedEncentive logo
Nuspine, Inc. logo
Predilytics, a Welltok Company logo
PSC Healthcare logo
Quantum Health logo
Quizzify logo
Remedy Analytics logo
Splashlight Solutions logo
stickK logo
[US Health Center’s] Predictimed logo
U.S. Preventive Medicine (USPM) logo

Member-Facing Organizations

Blue Cross Blue Shield of Louisiana logo
Blue Cross Blue Shield of Rhode Island logo
BlueCross BlueShield of South Carolina logo
Harvard-Pilgrim Health Care logo
MCCI Medical Group logo
Nova Healthcare Administrators logo
Presbyterian Healthcare Services logo
Procter & Gamble logo
Providence Health Plans logo

About this Validation

Accordant

As part of its validation, Accordant commits to having its contract language meet the industry’s most valid measurement of outcomes, changes in event rates over time across the population, adjusted using a dummy year analysis. While in population health there can always be confounding variables such as new drugs and/or small sample sizes and/or unobservable variables and/or secular trends, there are no qualifications to the statement that there is no more valid pre-post measurement commonly used in the field today.

Click here for the Accordant template used to achieve their validation, which Accordant is graciously making publicly available in the hopes that other vendors will follow their lead. Note also in the link that their asterisk highlights other possibilities for error.

Accordant Template Used

Validation Details

Name : Accordant
Category : Disease Management
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Arche Healthcare logo

Arche Healthcare is a medical device and healthcare service company addressing diabetic foot care, and the $30 billion cost of diabetes-related wounds and amputations. In an increasingly outcomes driven healthcare environment, Arche’s proprietary IT platforms offer healthcare providers, health plans and other healthcare stakeholders, seamless and compliant healthcare delivery tools to help prevent the 1st wound.

The model, informed by the latest evidenced-based research on diabetic foot health, demonstrates the results of a comprehensive Lower Extremity Amputation Prevention (LEAP) initiative and the clinical and economic impact that early risk identification and stratification can have on a diabetes population.

As is the case with “financial spreadsheet validation” according to the rules of the Validation Institute, users may change assumptions in order to model different impacts on prospective results.

Validation Details

Name : Arche Healthcare
Category : Disease Management
Type : Financial Spreadsheet

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Blue Cross Blue Shield of Louisiana

Blue Cross and Blue Shield of Louisiana offers Office of Group Benefits members a comprehensive population health management program. This program combines case management, disease management and utilization management efforts with the Quality Blue family of value-based reimbursement and provider engagement programs, most notably Quality Blue Primary Care (patient-centered medical home model) and Quality Blue Value Partnerships (Accountable Care Organization model).  As of the end of 2014, there were 34,599 OGB members who were part of Quality Blue Primary Care.

Using this integrated population health approach, Blue Cross and Blue Shield of Louisiana achieved a chronic disease event rate for Office of Group Benefits members that is significantly below both the Southern regional average and the state government average.

Blue Cross is the only health plan operating in Louisiana that has achieved event rates this favorable, measured validly. Because they reflect both cost and health status, event rates are the most important outcome both for OGB as well as for its employees.

Validation Details

Name : Blue Cross Blue Shield of Louisiana
Category : Wellness-Sensitive Medical Events
Type : Commercial Health Plan

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Blue Cross Blue Shield of Rhode Island

Blue Cross of Rhode Island developed perhaps the most valid and detailed analysis of their comprehensive patient-centered complex case management program ever done at a health plan. It is especially challenging because the cases are moving targets, claims decline following an inpatient stay anyway due to regression to the mean, and all eligible members are contacted, leaving none for the control group. BCBSRI was able to overcome these obstacles, and achieve validation, by putting members in 4 categories

  1. Triaged out – these patients should improve on their own
  2. Engaged—these are the ones who case managers managed
  3. Declined—these are the members who decided their situation was under control
  4. Tried to reach—these members probably needed the help but couldn’t be found.

In order, the cost improvements should match the categories, with “triaged out” having the greatest decline and “tried to reach” the smallest over an equivalent period.

Specifically the results were as follows, with cost improvement on the left axis. The cost decline in “triaged out” approached 40% while “tried to reach” declined much less than 10%. This result matched the hypothesis and lends great credibility to the claim that engaged members’ cost improvements were attributable to the program.

In the News

Validation Details

Name : Blue Cross Blue Shield of Rhode Island
Category : Wellness-Sensitive Medical Events
Type : Commercial Health Plan

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Blue Cross Blue Shield of South Carolina

BlueCross BlueShield of South Carolina offers large employer groups a comprehensive population health management program. This program combines case management, utilization management, disease management, wellness efforts, patient centered medical homes and value based incentives. At the end of 2015, there were approximately 379,000 members eligible to participate in some aspect of population health management.

Using this integrated approach to population health, BlueCross BlueShield of South Carolina achieved a chronic disease event rate for the large employer group that is below the National average and the State Government average.

BlueCross is the only health plan operating in South Carolina that has achieved event rates this favorable, measured validly. Because they reflect cost and health status, event rates are the most important outcomes for both the large employer as well as for its employees.

Validation Details

Name : BlueCross BlueShield of South Carolina
Category : Wellness-Sensitive Medical Events
Type : Commercial Health Plan

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Evolent Health

For its Complex Care management offering, Evolent Health performed a dummy year analysis as required by the Validation Institute for outcomes measurement involving high-cost or high-risk cohorts that are likely to show regression to the mean. The dummy year analysis matches the entire exposed and control populations, not just managed members, removing self-selection bias, which may otherwise contribute to better performance of managed patients as compared to unmanaged patients.

Individual outcomes measures between the exposed and control populations were plausible, showing cost avoidance in overall medical and pharmacy spend. Using our standard of validity that an outcome must be measured using the most valid type of measurement in current common use, the Validation Institute is pleased to confer Financial Outcomes Validation for Evolent Health.

Validation Details

Name : Evolent Health
Category : Care Management
Type : Average Savings Achieved for Customers

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Evolent Health

Evolent’s transition-of-care program showed significant savings using the Validation Institute’s preferred dummy year analysis methodology. The validity of the result is confirmed by its conformance with the specific rule of validity that the savings should appear in exactly the categories in which you would expect savings (readmissions and post-acute care), while costs increased, due to utilization increases, in the categories in which one would expect an increase, primary care and specialist visits. The actual figures cannot be shared because they are being prepared for peer-reviewed publication. Nonetheless Validation Institute can attest that Evolent’s programs met the standards for both savings and plausibility.

Validation Details

Name : Evolent Health
Category : Care Management
Type : Average Savings Achieved for Customers

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Happy Whole Human logo

Happy Whole Human provides an online program that assesses 28 different aspects of a balanced life. The program then supplies supports and coaching to improve areas that are in need of improvement. HWH validly and accurately measures participants’ change in perceived health status, turnover intention, and presenteeism.

Validation Details

Name : Happy Whole Human, LLC
Category : Well-Being
Type : Outcomes Measurement

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Harvard Pilgrim Health Care

Harvard Pilgrim has achieved a substantial reduction in chronic disease events over a decade-long period.

Validation Details

Name : Harvard-Pilgrim Health Care
Category : Chronic Disease Events
Type : Commercial Health Plan

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Edison Health

Healthentic is the first and as of now, only health analytics and insights tool to allow users to track wellness-sensitive medical events using the valid methodology endorsed by the Validation Institute, as well as other groupings (ambulatory care-sensitive events, maternity events, etc.) using the same methodology applied to different ICD9s.

Validation Details

Name : Healthentic
Category : Health Analytics
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Healthsense

Whereas most vendors want to compare motivated participants to non-participants, and/or measure the difference between the high-cost baseline and the study year, in order to benefit from regression to the mean, Healthsense will offer to compare to a validly measured control group, including a study design that controls for motivation, using a “dummy year analysis.”

Study Design

In the News

Validation Details

Name : Healthsense
Category : Monitoring
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Healthways

Well-Being Improvement for total populations as measured by a validated Well-Being Assessment™, allowing comparison to Gallup-Healthways Well-Being Index™ and financial translation of that change to reduced medical cost and improvement in job performance and productivity*. Entire population is measured in all periods, avoiding all common measurement fallacies of the “volunteer effect” and regression to the mean.

* Assuming a causal relationship, which we believe we have observed but is not provable absent a randomized control trial, which employers are reluctant to do.

Validation Details

Name : Healthways, Inc.
Category : Well-Being
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

It Starts With Me Health logo

It Starts With Me Health endeavors to support overall employee health for clients and our employees/health plan members. We heartily endorse the Employee Health Vendor Code of Conduct, which states that any health and wellness programming should do no harm to employee health, employee morale, corporate integrity or employee/employer finances.

Employee Benefits and Harm Avoidance

It Starts With Me Health will recommend health & wellness efforts that are done “with and for” employees & health plan members, not “to” them.

Our focus will be on the promotion of personal well-being of employees, identification and/or avoidance of potentially negative health outcomes for employees/health plan members, analyzing data, and assistance in improving the financial stability of the health plans of our clients.

Our choices and frequencies of suggested health interventions, testing, and educational materials will be as generally consistent as possible with expert guidelines such as Harvard Medical School, the United States Preventive Services Task Force (USPSTF), the CDC, and Choosing Wisely (an initiative of the American Board of Internal Medicine). This is done in an effort to minimize over-programming, over-spending, overwhelming, over-screening, over-diagnosis, and over-treatment. As a specific example, we will discourage our clients from implementing universal financial incentives for annual checkups.

We will recommend to our clients that potential programs and services be evaluated to ensure that employees will not be singled out, fined, or embarrassed for any reason due to our health status.

Respect for Corporate Integrity and Employee Privacy

When analyzing our data or other client vendor data, we will provide unfiltered, unbiased, & unspun data, good or bad, so that our clients can make sound business decisions about their mix of services and vendors.

We will not share employee-identifiable health data with employers.

Commitment to Valid Outcomes Measurement

Our relevant staff will understand USPSTF guidelines, employee harm avoidance, wellness-sensitive medical event measurement, and outcomes analysis.

If clients wish to engage in health improvement programs internally or via other vendors, we will recommend that we include warnings of any adverse effects that participants might encounter (e.g. with the popular “Biggest Loser” competitions, the programs should be accompanied by warnings regarding potential unhealthy eating behaviors, weight-cycling, awareness of issues with other health conditions and/or medications, and poor long-term results that can result).

In addition, we will advise our clients that for true measurement of any type of cessation or reduction program (weight loss, tobacco, etc….), vendors should be required to provide aggregate reports that outline both immediate improvement and most importantly, the true measure of success – the continued maintenance of that improvement by each individual for at least 12 months.

Our contractual language and data reports will be valid. If we must measure outcomes using other than one of the valid techniques, we will disclose the invalidity (such as “healthy volunteer bias” or the “natural flow of risk” or ignoring dropouts) that is likely to cause savings to be overstated. If we use a participants-vs-non-participants methodology, we will disclose that in the three instances in which we were tested, we were shown to be invalid.

Validation Details

Name : It Starts With Me Health
Category : Wellness
Type : Contractual Language & Employee Health Program Code of Conduct

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Kinesis Health Technologies

Kinesis offers two different possible commitments, depending on one’s starting position, that the Validation Institute has deemed to be valid. Due to the rate of falls in the elderly population, the comparison would need to be over at least 50,000 senior-years in both the before and after populations before a conclusion can be drawn.

If you already have a falls intervention and have been tracking falls using an objective indicator such as ICD9s, Kinesis commits to a reduction in the rate/1000 of falls, if the QTUG assessment is substituted for the current assessment and the total spent on post-assessment intervention is not reduced. (This assumes no significant change in average age or percentage of members over 80. However, changes in these variables can be adjusted for.)

Alternatively, if you do not already have a post-assessment falls intervention, Kinesis proposes that your senior population be split. Key demographics and history to be roughly equalized for this commitment are: average age, percentage over 80, gender (overall and in the percentage over 80), and history of falls. (Long-term care residents get excluded or can be included if indeed you have the opportunity to implement your own falls assessment in those settings.) If indeed you spend equal amounts of money/1000 on both groups prospectively on falls assessment and subsequent prevention for individuals deemed to be at risk of falls, Kinesis commits to a relatively lower fall rate in the Kinesis group than in the other group.

Validation Details

Name : Kinesis Health Technologies
Category : Monitoring
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

The Leapfrog Group

Using a set of transparent and fully sourced assumptions and calculations, an employer may estimate the “HIdden Surcharge” caused by medical errors in its population. The Leapfrog Group invited DMPC to participate in the development of this model in order to help ensure this level of validity at the end of the process. They used the best available evidence and a rigorous process to build the Hidden Surcharge calculator, achieving the three goals necessary for certification of their model and financial spreadsheet validation: (1) The math is correct; (2) The calculations are transparent; (3) The assumptions, all linked to authoritative sources, may nonetheless be changed by a user who prefers different assumptions. In sharp contrast to other savings models in which none of those factors are present, Leapfrog’s model incorporates those three attributes. For more details, click on this link http://www.leapfroggroup.org/employers-purchasers/hidden-surcharge-calculator

Validation Details

Name : The Leapfrog Group
Category : Non-Profit
Type : Financial Spreadsheet

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Lucina Health

Lucina Health provides an analytics tool that predicts a mother’s risk of having a pre-term birth. The risk score reflects data from a health risk assessment medical and pharmacy claims. Care management resources can then be directed to mothers at higher risk. The patient’s score is updated as new data is available on a patient.

It uses valid statistical models, selected after thorough exploration of different approaches. Its data sources are credible and reliable. In addition, the tool itself will be updated annually, so that it will reflect new trends and maintain its valid standing.

Validation Details

Name : Lucina Health
Category : Health Analytics
Type : Medicare Management Service Organization

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

MCCI Medical Group

With a focus on comprehensive patient health as well as an emphasis on provider education, communication and cooperation, while eliminating the distance between its patients and their physicians through community healthcare centers, MCCI Medical Group has been able to dramatically reduce heart events and outperform national heart event rate averages in the adversely selected Corpus Christi and San Antonio markets.

Validation Details

Name : MCCI Medical Group
Category : Chronic Disease Events
Type : Medicare Management Service Organization

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Medencentive logo

MedEncentive’s preferred contractual methodology for testing and reporting on the efficacy of its program to control healthcare costs adheres to the Validation Institute-endorsed rules of plausibility in study design covered in Why Nobody Believes the Numbers.

First, we match whole groups of covered (intervention) and non-covered (control) people (subjects) in randomized control trials (RCT), rather than participants vs. non-participants in the intervention group. In other words, within the intervention group, we seek to recruit participants, but we measure the entire intervention group, including non-participants, against the entire control group, consistent.

Second, we apply widely recognized experimental methodologies that are designed to isolate the impact of our program by controlling for or matching on factors such as demographics, health status, and other known variables.

Third, we are committed to demonstrating that claims of cost savings attributable to our program can be shown to be as a result of the program’s features – such as information therapy to promote health literacy – and their association with expected outcomes in areas such as hospitalizations, ER usage, office visits, medication adherence, etc.

Fourth, we actively seek and are committed to public sector, open access studies, including RCTs, that are designed, evaluated, and/or peer reviewed by qualified and independent experts in the field of population health and related disciples, such that the outcomes of these studies can be authenticated and certified according to the Validation Institute rules.

In addition to the contractual language itself, we plausibility-check to ensure compliance with the “Every Metric Can’t Improve Rule” (meaning certain utilization categories, like physician office visits and drug use, should increase in order to plausibly claim that a reduction in avoidable hospitalizations was caused by taking steps to avoid those hospitalizations), and the “Quality Dose-Cost Response Rule” (meaning that, for example, a reduction in avoidable hospitalizations can be associated with a corresponding level of participation by doctors and patients in the program that is logical).

Further, MedEncentive will write into every contract its commitment to the Employee Health Program Code of Conduct, as a key contractual term.

Validation Details

Name : MedEncentive
Category : Health Literacy
Type : Outcomes Measurement Contract Language & Employee Health Program Code of Conduct

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Nova Healthcare Administrators

Nova Healthcare Administrators has worked with its largest account to dramatically reduce chronic disease events by laser-focusing on early identification, significantly increasing the likelihood of timely intervention. Specifically, Nova analyzed pharmacy and claim data to identify high-cost opportunities for health management and plan sponsor savings. By modifying the health plan design and increasing outreach to those identified as diabetic, this client significantly improved patient compliance with medical protocols and reduced its health care costs. Working together, Nova and its largest client engaged this population in maintaining better health by reinforcing ongoing care and support for chronic conditions, avoiding costly urgent and emergent care alternatives. (Note: Due to data availability, early figures for diabetes results may be inaccurate.)

Validation Details

Name : Nova Healthcare Administrators
Category : Chronic Disease Events
Type : Third-Party Administrator (TPA)

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

NuSpine logo

Nuspine offers an online back pain management program. Validation Institute assisted with selection, development and implementation of three measures: correlation of days’ participation in Nuspine and improvement in StarT Back scores; comparability of Nuspine results to usual care; and cost-effectiveness of Nuspine compared to usual care.

Validation Details

Name : Nuspine, Inc.
Category : Patient Coaching
Type : Outcomes Measurement

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

PSC Healthcare

The Validation Institute reviewed Predilytics’ Analytic Design Plan (ADP) for a health plan, which outlined:

· the objectives of the Medication Adherence project,
· the method for achieving those objectives, and
· the statistical and quantitative metrics that are used to document model validation.

The Validation Institute reviewed Predilytics’ program evaluation which described how the models were used in a health plan’s operational call center to improve medication adherence for their members.

Predilytics’ evaluation of the predictive models and the operational recommendations reflect a well-grounded understanding of how predictive models perform and accurate assessment of the value of the insights created by these models to inform resource deployment within healthcare operations.

Within that program evaluation, Predilytics used additional statistical analysis to isolate the incremental performance of the predictive model above and beyond call center efficiency gains. Overstatement of attribution is commonplace in predictive modeling in population health, but the model was very carefully designed not to overstate attribution of the Predilytics’ intervention to the outcomes. The one aspect of this study in which overstatement might have been taking place is that the customer service representatives making the outbound calls got better at calling members over the course of the study. As a result, calls towards the end of the period were more successful. Predilytics pointed out this potential confounder to the validator and estimated the impact of it, rather than wait for the validator to point this out to them.

Consequently, the Validation Institute is able to provide validation for Predilytics, as they are well above the standard of using a methodology that is equivalent to or better than the most valid standard commonly used in their segment of the industry.

Validation Details

Name : Predilytics, a Welltok Company
Category : Health Analytics
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Presbyterian Healthcare Services

Presbyterian Healthcare Services has implemented an employer-specific care model that resulted in keeping a large local employer’s wellness sensitive medical event rate far below national benchmarks, as the graph below depicts. Additionally, PHS meets or exceeds MCG Well Managed for this group on 320 of 341 Inpatient DRGs.

Validation Details

Name : Presbyterian Healthcare Services
Category : Wellness-Sensitive Medical Events
Type : Commercial Health Plan

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

P&G

Procter & Gamble combines disease management, wellness and benefits design to encourage compliance to significantly reduce avoidable medical events over a multiyear period.

Validation Details

Name : Procter & Gamble
Category : Chronic Disease Events
Type : Employer

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Providence Health Plans

Providence has dramatically reduced chronic disease event rates through a combination of disease management, gap-in-care programs and engagement with providers to understand variations in care. Providence also displays individual physician performance in managing chronic conditions on their provider directory, to inform and assist members when choosing a primary care physician (PCP).

Commercial Event Rate Trends for Providence Health Plans

Validation Details

Name : Providence Health Plans
Category : Chronic Disease Events
Type : Commercial and Medicare Health Plans

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

PSC Healthcare

PSC Technology Incorporated (d.b.a., PSC Healthcare) Guarantee

With 23,000 or more covered person-years (this means that at least that many people for one year, or, for example, a quarter that many people for four years) and 25% of employees and dependents over age 45, PSC Healthcare will reduce the inpatient and ER incidence for the full list of AHRQ preventable medical events plus common complications of diabetes starting in Year 3.

We are willing to adjust the ICD9 benchmark, at the request of the Client, by the change, up or down, in these ICD9s using HCUP inpatient utilization trend data for the state(s) where the customer is primarily located.

This guarantee exemplifies valid metric measurement. PSC Healthcare is focusing only on the diagnosis codes that the Agency for Health Research and Quality says can be addressed.  PSC Healthcare is measuring events across the population (thus avoiding participant bias, a common and well-understood invalidator), and emphasizes ER and inpatient event avoidance. Furthermore, PSC Healthcare includes the secular event rate trend into the event rate tally to avoid taking credit for reductions (such as in heart events) that would have, statistically speaking, taken place anyway.

Validation Details

Name : PSC Healthcare
Category : Care Coordination
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Quantum Health

A reduction in utilization of (defined) high-cost resources has been consistently demonstrated, on the total population, thus avoiding the common fallacies of the volunteer effect and regression to the mean. Further, the supporting materials show that the overall cost reduction is driven by utilization reductions in the categories of utilization in which one would expect declines, creating a “nexus” between the intervention and the outcome.

Validation Details

Name : Quantum Health
Category : Care Coordination
Type : Average Savings Achieved for Customers

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

PSC Healthcare

The following validation is a review of the guarantees offered by Quizzify to its customers.  These guarantees are fully disclosed on the Quizzify website, which is the sole source for the data reviewed.

The focus of validation review was on whether the Quizzify guarantees apply clear and valid measures.  Two guarantees met the standards for validation: cost and utilization; and engagement.  (Note: Quizzify may offer other guarantees which have not been validated.)

Cost and Utilization

Text of the cost and utilization guarantee Part I:

If the client splits its population, Quizzify guarantees that the medical and wellness program costs per person will trend more favorably in the Quizzify cohort than the conventional wellness cohort.  Under the guarantee, expenses for catastrophic or outlier events are excluded.  Thus, costs for a single person that exceed $50,000 (or some other amount) would be excluded; the first $50,000 would, however, be included.  An “outlier cutoff” figure will be agreed upon ahead of time by Quizzify and the client and will apply to the before and after assessments of both groups.

This guarantee is valid assuming that the two cohorts are similar except for their exposure to wellness or Quizzify programs.  By using a per person measure, the guarantee ensures that population changes do not distort results.  This is a valid and consistent method for ensuring that extraordinary expenses do not skew the results.

Text of the cost and utilization guarantee Part II:

If the client does NOT split the population in half but rather offers Quizzify as the lead program, Quizzify guarantees a reduction (vs. history) in the following two categories:

1. Wellness-sensitive medical event rates, as defined by Gowrisankaran et al. (Health Affairs March 2013, Vol. 32, No. 3 pp. 477 – 485)

2. A grouping of any 50 items of utilization that are proposed by the client as being overused in their population, such as CT scans. These items will have to be identifiable through simple diagnosis, procedure or drug codes, to facilitate reconciliation. Measures will be done per capita and will not use diagnosed patients as a denominator.

This form of the guarantee is also valid, as it cites a source for defining wellness-sensitive medical event rates.  It applies a rate to the measure.  Allowing the client to define overused procedures is also valid, limiting it to procedures that can be identified using the available data sources.  Further, the guarantee specifies that diagnosed patients will not be used as a denominator for calculating rates; rather, all rates will be calculated per capita.

Engagement

Text for engagement guarantee:

Companies measure engagement different ways. No matter what way is used, Quizzify guarantees that the non-engaged population will decline by half, up to 10% in total. Example: if the client has a 90% engagement rate, Quizzify will increase that to 95%.  If the client has a 20% engagement rate, Quizzify will increase that to 60%.  The requirements for this guarantee are:

1. The client must measure the same way (survey instrument and communication channel) in both periods and both populations, over the same time intervals and

2. The client must maintain the same incentives or penalties during the time period.

This guarantee is valid and enforceable, even if the survey instrument used has not been validated.  Using the same instrument at the same time interval for both groups ensures that results are based upon an underlying consistency.

Disclaimers of Review

This review was limited to the descriptions of the guarantees published on Quizzify’s website.  This review also relied upon the website’s statement that the ROI reporting applies valid measurement tools; a review of the ROI report was not undertaken.

Summary

Quizzify delivers wellness education to employees in unique, entertaining, and effective quizzes.  Quizzify guarantees that participants will have lower medical costs and higher engagement levels than participants in traditional wellness programs.  These guarantees apply valid measures, giving clients a clear and objective method to assess performance.

Validation Details

Name : Quizzify
Category : Health Literacy
Type : Outcomes Measurement Contract Language & Employee Health Program Code of Conduct

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Lucina Health

Remedy Analytics analyzes data that contains up to 600 data fields per claim of an employer’s raw prescription claims data. The data is disseminated in order to determine the proper adjudication of every claim for comparison to the actual adjudication and calculation imposed by the PBM. Remedy technology uncovers the adjudication and calculations methods that cause the actual discounts to be artificially inflated. The pricing, adjudication and calculation model created by the PBM is often misaligned with employer expectations created in the contract. Collecting, dissecting and warehousing every claim provides a check-and-balance on PBM reporting.

In particular, the two examples below are validated as ways in which improper discounts can be adjusted using Remedy:

1. PBMs often misclassify sole-source and patent-litigation generics (which typically carry far lower discounts than established generics) as brand-name drugs. This misclassification also causes the brand-name discounts to appear larger than they are.
2. PBMs often capture automatic discounts from retail pharmacies without assistance from a PBM.

Validation Details

Name : Remedy Analytics
Category : PBM Analytics
Type : Average Savings Achieved for Customers

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >

About this Validation

Splashlight logo

Predict & Prevent Primary Claims
“The Coaching Choice”

1. Splashlight Solution’s predictive analytics will accurately identify and stratify the high risk and rising risk individuals using three years of historical health claims and workers’ compensation claims. They use the first two years of data to build the model and the third year to prove validity. While many vendors promise a reduction in cost of the highest-cost or highest-risk segment, they recognize that this cohort regresses to the mean, and a demonstration of effectiveness requires showing savings after making a “dummy year adjustment” to account for that regression effect. Splashlight will contract to show savings validly, taking that adjustment into account.

2. Prior to beginning their Prevent services, Splashlight provides a benchmark of predicted future medical costs for health claims and workers’ compensation medical claims. Using their validated predictive analytics methodology they then adjust for those ICD10 codes that are mutually agreed with their clients to be impactable through their prevention services. They will apply measures that are attributable to The Coaching Choice solutions which they expect to result in a reduction of overall costs by at least 5%.

3. Splashlight’s contractual language and outcomes reporting will be transparent and plausible. All research limitations (e.g., “participants vs. non-participants” or the “natural flow of risk” or ignoring dropouts) and methodology will be fully disclosed, sourced, and readily available.

4. Splashlight will measure the actual savings realized each quarter and annually and adjust their savings totals accordingly to show the total costs and savings for the client. Further they will guarantee in their contracts that their costs will not exceed more than 40% of the actual savings achieved over a three year period. If the actual annual savings have not exceeded annual costs after a six month period to adjust for delays in claims received, then Splashlight will continue to provide services at no charge for up to an additional year or until the actual savings are realized through validated measures.

5. The participant experience will be tracked for all participants with the following expectations:
80 percent of the identified population will participate in The Coaching Choice program.
80 percent of participants in The Coaching Choice program will report their willingness to recommend the program to others.
80 percent of participants in The Coaching Choice program will report their improved confidence in their ability to manage their healthcare.
80 percent of the participants in The Coaching Choice program will report that it improved their quality of life.
80 percent of the participants in The Coaching Choice Program will report positive personal experience as a result of participation.

Validation Details

Name : Splashlight Solutions
Category : Predictive and Preventive Health
Type : Contractual Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
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About this Validation

Stickk

stickK will guarantee that if half the population is offered the stickK “commitment contract” intervention and half is offered another incentive approach of comparable expense, that the half that is made the offer (even including non-participants) will show a higher rate of adoption of the behavior and/or achievement of outcome and/or satisfaction.

Validation Details

Name : stickK
Category : Incentives
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
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About this Validation

US Health Center

US Health Center PredictiMed

PredictiMed™ Guarantee

With 23,000 or more covered person-years (meaning at least that many people for one year or, for example, a quarter that many people for four years) and 25% of employees and dependents over age 45, we will reduce the inpatient and ER incidence for the full list of AHRQ preventable medical events plus common complications of diabetes starting in Year 3.

If the customer would like to, we can adjust the ICD9 benchmark by the change, up or down, in these ICD9s using HCUP inpatient utilization trend data for the state(s) where the customer is primarily located.

This guarantee exemplifies valid metric measurement. US Health Center’s Predictimed is focusing only on the diagnosis codes that the Agency for Health Research and Quality says can be addressed, is measuring events across the population (thus avoiding participant bias, a common and well-understood invalidator), and emphasizes ER and inpatient event avoidance. Further, Predictimed incorporates the secular event rate trend into the event rate tally to avoid taking credit for reductions (such as in heart events) that would have, statistically speaking, taken place anyway.

Validation Details

Name : [US Health Center’s] Predictimed
Category : Care Coordination
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
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About this Validation

Providence Health Plans

US Preventive Medicine (USPM) is the first and as of now only wellness company to achieve a sustained and significant reduction in wellness-sensitive medical events (asthma, cardiac events, COPD, congestive heart failure and diabetes) across that portion of its entire book of business for which comprehensive claims data was available (see chart below). The reduction achieved by USPM significantly outpaced the much smaller national decline in these events, as evidenced by both the database maintained by the Disease Management Purchasing Consortium (through 2014) and the federal Healthcare Cost and Utilization Project (HCUP) database (through 2013). USPM is further the only wellness company willing to contractually commit to being measured on this metric in future contracts. This makes USPM the only wellness company to measure validly, achieve significant event reduction when measured validly, and offer valid contractual metrics.

Commercial Event Rate Trends for Providence Health Plans

Validation Details

Name : U.S. Preventive Medicine (USPM)
Category : Wellness-Sensitive Medical Events
Type : Outcomes Measurement Contract Language

Certificate of Validation :

This organization has been awarded the Certificate of Validation by Care Innovations™ Validation Institute.
Learn More >