Why Nobody Believes the Numbers -- Contents -- Introduction -- Chapter 1 Actuaries Behaving Badly -- Some Background: We're Shocked, Shocked, to Find That Invalidity Is Going On in Here -- The Proof: Doing the Pre-Post Math for Grown-Ups -- Adding Asthmatic #2 to the disease population will exacerbate the savings misstatement because he gets added only after his high-cost sentinel event -- Using the Trend of the Non-chronic Population as a Proxy for the Chronic Population will Overstate Savings -- Epidemiology -- Math -- The Industry Counterproof to the Epidemiology and the Math -- Fixing the Problem . . . at Least in Theory -- Approximating the Valid Methodology in Practice: The Dummy Year Adjustment -- Chapter 2 Plausibility Testing: How to Measure Outcomes Using Ingredients You Already Have in Your Kitchen -- Plausibility Testing: The Event Rate Test Explained -- Examples of Event Rate-Based Plausibility Tests -- Event-Based Plausibility Tests and Dummy Year Analyses: How the two Fit Together -- How to Actually Do a Plausibility Test -- Chapter 3 Case Studies That Flunk Every Plausibility Test Known to Mankind -- The Seven Rules of Plausibility -- The 100 Percent Rule: Outcomes Cannot Explicitly or Implicitly Exceed 100 Percent -- The 50 Percent Savings Rule: In a Voluntary Health Management Program with No Incentives, Declines in Excess of 50 Percent in Any Given Resource Category Are the Result of Invalidity, Not Effectiveness -- The Nexus Rule: There Must Be a Logical Link between the Goal of the Program and the Source of Savings -- The Quality Dose-Cost Response Rule: Just as in Pharmacology, Where There Is an Observable Time-Dependent Relationship between Dose and Response, Cost Cannot Decline Significantly Faster or More Than the Related Quality Variables Improve.

The Control Group Equivalency Rule: Control Groups, If Not Prospectively Sorted into Two Similar or Equivalent Groups, Based on Objective Data, Before Members Are Even Contacted to Determine Willingness to Enroll, Are Likely to Mislead. This is Especially True of Historic Controls (Meaning Pre-Post), Matched Controls, and Using the Non-Disease Group as a Control for the Disease Group -- The Multiple Violations Rule: When One of These Rules Is Violated, Others Are Likely to Be Violated, as Well -- Chapter 4 Case Studies That Flunk Every Plausibility Test Known to Mankind and Then Some -- Case Study #1: Achieving Dramatic Reductions in Risk Factors and Medical Spending by Implementing Off-the-Shelf Wellness Programs (Not ) -- Health Plan B's Lake Wobegon Wellness Guarantee: Misunderstanding or Miscommunicating the Way Risk Factors Work -- The Wishful Thinking Multiplier: The Size and Timing of the Wellness Program Payback -- Vendor K: Immediate Savings -- Vendor L: Even more Immediate Savings -- It's a bird. It's a plane. It's Vendor M -- Vendor D Encore: The Seinfeld Approach to Wellness Savings -- Vendor N: The Claims That Didn'T Get Detected in the Nighttime (or Daytime) -- Federal Government: Plausibility-Test at a Macro Level and Do a Prospectively Controlled Trial -- Case Study #2: Raleigh, We Have a Problem -- Savings in the 0- to 1-Year-Old Category -- Inpatient Care Generally -- A Top-Down Confirmation -- But Wait-There's More. Now How Much Would You Pay? -- Oops! They Did It Again -- Conclusion and Lessons for Policymakers -- Case Study #3: Are Health Plan H's Doctors Killing Their Patients? -- Case Study #4: Vendor A Cures Health Plan I's CHF Patients -- Chapter 5 Case Studies of Where, When, and How Wellness Programs Have Actually Worked -- Case Study #1: Encouraging Health Prevention-at a Cost.

Case Study #2: Do You Really Want to Create a Culture of Wellness? Are You Sure? -- Chapter 6 Yes, Virginia, There Is a Savings Clause -- Chapter 7 Disease Management Programs That Actually Work (Pinch Me) -- Combined DM/Wellness/Incentives/Benefits Redesign: How Doing All Four in Coordination Creates Synergy -- Successes at Health Plans Who Play Nicely with Others (Meaning Their Providers) -- Harvard Pilgrim Health Care -- Providence Health Plan -- A Success Requiring Significant Investment -- Results -- The Secret Sauce -- What Do All the Examples in Chapters 5, 6, and 7 Have in Common? -- Chapter 8 Contracting/RFP Checklist of Do's and Don'ts (Mostly Don'ts) -- Category 1: Clauses Designed Specifically for Validity -- Methodology-Measuring ROI Generally -- Category 2: Clauses That Are Not Specifically Related to Metrics Validity but That Unfortunately Fit the Oscar Wilde Observation, ''Experience Is the Name You Give to Your Mistakes.'' -- Administrative Fee Breakout -- Fees, Contract Length, and Termination Requirements -- Risk-based Pricing and Guarantees -- Preparing for the End of the Contract -- The 24/7 Inbound Component of the Contract -- Dispute Resolution -- Appendix: The Keys to the Numerical Kingdom -- Author's Note on Sources -- Notes -- Glossary -- About the Author -- Bibliography and Further Reading -- Acknowledgments.