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    Innovation Evolution

    Al Lewis not only invented disease management, he advanced the idea into one of the fastest-growing healthcare disciplines in less than a decade

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    It's clear he's joker from first contact. His office voice mail message directs consultants who want to pick his brain for a project to "please have your credit card or check book handy." And although Al Lewis has an acute and well-known sense of humor, he's not kidding.

    "It's funny, but it's absolutely true," he says. "I don't give consultants free information for them to turn around and charge huge amounts of money for them."

    But his voice mail is more than his calling card; it's his model of customer service for the Disease Management Purchasing Consortium, which Lewis launched in 1995.

    "My voice mail is the epitome of my business. It fuses my customer-service philosophy together with my arrogance together with my humor," he says with a chuckle. "If you are a consortium member, you get your calls returned within one business day. This is not a sales business where perspective members get their calls returned first. It's a one-day turn around because consortium members have paid me a lifetime membership to get the best possible service.

    "You get called back in two days if you are a perspective consortium member, and I hope that perspective consortium members will understand why current members get the priority.

    "You get called back in three days if you are anyone else because I have a business to run here; I'm not a charity and I am shocked at the number of consulting firms who call me because they some how got hired by some body to get paid $100,000 or more-in the case of the big five firms and benefits consultants-to do something that I could have done for $2,000. Then they call me to explain it all to them."

    Of course, you really can't blame consultants for going to the source for disease management information. After all, Lewis helped invent the discipline during a cost-cutting brainstorming session with Humana. Back then, the consortium didn't exist, but he was doing consulting work after he left Peer Review Analysis, the company he ran before it merged with another public company to drive stock-price value. Lewis was asked to leave after the merger.

    "I was out on the street looking for some consulting to do, and I got hooked up with Humana," he says. "We literally stumbled on the idea of disease management, which at the time was basically viewed by some within Humana, and many within the health plan industry, as a plot by the pharmaceutical companies to sell more drugs.

    "We found that there was an infinite industry of independent vendors and in order to get traction, they were all willing to go at full risk with Humana. So they picked the absolute right health plan at the right time because they had more Medicare lives than basically any body, and they were one of the first health plans with a data warehouse, which hugely facilitated their ability to collect claims on all these people.

    "So Humana got started and were very exited about it and still are; they are still arguably the leading health plan in disease management."

    Leveraging the contacts he made while with Peer Review Analysis, as well as the purchasing power he was beginning to wield, he launched the consortium, which has grown to include 68 health plan members. The opportunity was the first way to lower costs for health plans while also improving quality.

    Lewis later founded the Disease Management Association of America, mainly to develop legislative influence.

    How has your demeanor helped or hindered your work in a traditionally conservative industry? There is definitely controversy around what I do. The way I diffuse the controversy is with humor. Any time you reach a certain level of visibility, you are going to have people upset with you for one reason or another. But a combination of humor and results is what keeps me going.

    You can ask around all you want, but there is no one out there who would say we could have got a better deal than we got working with Al. So it's results and it's levity.

    Do you consider the consortium a watchdog? Without a doubt. We're a watchdog for our members, and many health plans have joined after doing this on their own and realized that they needed a watchdog because the number of places where you can mess up a disease management contract is very high, and it's our job to make sure that they don't.

    Can people get a favorable contract without going through the consortium? Occasionally the answer is yes. But of those contracts that I review-oftentimes people join the consortium after they get a contract-invariably I can do better in the financials or in biostatistical soundness of the outcomes measurements.

    If you are a health plan and you join, then you get all my reports for free. What you don't get for free is the historical pricing and guarantee comparisons for every vendor, and you don't get the request for proposal, which is now in its 137th draft and has every single biostatistical issue addressed.

    So the essence of the consortium value added is two-fold: For $2,000, a payer gets all the reports and can call any time to have a DM strategy discussion-forever; it's a lifetime membership.

    The extra is the procurement, and because we have this highly refined RFP, and because we know all the quality vendors and all their pricing and all their guarantees, we will always do way better for a payer.

    Some vendors resent this. Some vendors look at who is in the consortium, and they go to other health plans that they can sell to.

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