Transcript Jeff Greene

“Incentives--Win/Win/Win for
Employers/Insurers, Physicians and
Employees – Part 2”
by Jeff Greene
September 23,2010
The Key to Health Care Cost Containment
No health care cost containment solution can be
sustained without balancing the interests of the
essential stakeholders...like a three-legged stool
Mutual Accountability
Triangulation
Consumers/Patients
Patient Accountability$
No• Wellness
Physician
and Accountability
prevention
• Disease/care mgt
Physicians
Provider Accountability
$
• Capitated
HMO
P4P
No• Patient
Accountability
• Episodic care payments
Employers/Insurers • Medical home
Alignment-of-interests to create a win-win-win proposition
Registered trademarks of Xerox Corp., Ford Motor Co., General Motor Corp., and Center for Medicare and Medicaid Services are used for illustrative purposes only. These organizations have no relationship with nor do they endorse MedEncentive
What is MedEncentive?
A patent-pending web-based incentive system that:
•
•
•
•
•
“bolts-on” to any health plan to…
improve healthcare and health by…
rewarding both doctors and patients, interactively, to…
achieve “mutual accountability” for…
incorporating evidence-based medicine (EBM) treatment guidelines
and information therapy (Ix®)…
• all of which has been proven to control costs and align the interest of
doctors, patients and insurers/employers.
® Ix
is a registered trademark of eHealth Initiative, a not-for-profit 501 3c organization
Why is information therapy so important?
Medical illiteracy and poor doctor-patient
communications is a bigger problem than expected…
Health literacy drives motivation and empowerment...
The World Health Organization defines health literacy as:
The cognitive and social skills which determine the motivation
and ability of individuals to gain access to, understand, and use
information in ways which promote and maintain good health.
In other words, if patients are unaware, don’t understand or are
confused about treatments or the impact of unhealthy behaviors,
then they will be unmotivated and unable to maintain good
health. It is apparent that persuading a person to improve their
health when they don’t know how or why is just short of
impossible.
So, health literacy is as much about providing the motivation as it
is about empowering the individual.
Northwestern and Emory Universities Research
Team Medical Literacy Study
What You Don't Understand Could Kill You
By LINDSEY TANNER – CHICAGO - July 23 2007
Plenty of evidence suggests that having trouble understanding medical information is bad
for your health. Now new research says it could even be deadly.
“Inability to understand medical information and instructions makes it hard to manage
chronic illnesses from asthma to diabetes to heart disease,” said lead author Dr. David
Baker, chief of general internal medicine at Northwestern University's Feinberg School of
Medicine. “That in turn can lead to declining health, frequent hospitalizations and
ultimately death, especially in older patients whose health may be more precarious to begin
with,” he said.
Almost 40 percent of those deemed medically illiterate died during the study, compared
with 19 percent of those who were literate. Factoring in health at the outset and other
variables, medically illiterate patients were 50 percent more likely to die than the others.
The difference in death rates "was much higher than we expected," Baker said.
Northwestern and Emory Research Team
Mortality Rate Based on Medical
Literacy
Five Year Mortality Rate
45%
40%
40%
35%
30%
25%
20%
19%
15%
10%
5%
0%
Literate
Illiterate
UCONN Reports on the Cost of Medical Illiteracy
NEW REPORT ESTIMATES COST OF LOW HEALTH LITERACY
BETWEEN $106 - $236 BILLION DOLLARS ANNUALLY
Experts discuss if improving health literacy is the solution
to providing coverage for the nation’s 47 million uninsured people
STORRS, CT– October 10, 2007 – A new report released today from the University of Connecticut
states that the cost of low health literacy to the United States economy is in the range of $106 billion to $236
billion annually. According to the report, Low Health Literacy: Implications for National Health Policy, the
savings that could be achieved by improving health literacy translates into enough funds to insure every one of the
more than 47 million persons who lacked coverage in the United States in 2006, according to recent Census
Bureau estimates.
“Health literacy” is defined as the degree to which individuals have the capacity to obtain, process and understand
basic health information. According to the U.S. Department of Education’s 2003 National Assessment of Adult
Literacy (NAAL), which contained a health literacy component for the first time, 36 percent of the adult U.S.
population – approximately 87 million people – has only Basic or Below Basic health literacy levels.
U.S. Department of Health and Human Services says 9 out of
10 of us are afflicted with some degree of health illiteracy...
Universal Precautions: A Model for Health Literacy?
By Laura Landro
Wall Street Journal
July 6, 2010
Low health literacy is a growing concern in the U.S.
as medical-treatment decisions become more complex,
chronic diseases more prevalent and doctors’ face time
with patients more limited, today’s Informed Patient column reports.
While poor and minority groups may be disproportionately affected, HHS says the inability to
read, understand and use health-care information to make informed decisions is a problem for
nearly nine out of ten adults, cutting across all ages, races, incomes and education levels. So
the best approach might be to assume that most patients will have difficulty understanding
health information, and to present it in the simplest terms.
Poor doctor-patient
communications…
A battery of studies have determined:
•
•
•
•
Doctors interrupt patients within the first 23 seconds
15% of patients fully understand their doctor
50% of patients comply with doctors’ orders
Causes misdiagnosis, inferior clinical outcomes,
malpractice, and higher costs
What do the medical literacy and doctor-patient
communication studies suggest?
• Medical illiteracy and poor doctor-patient communication:
–
–
–
–
is a bigger problem than expected
is a leading cause of premature death
is a principal driver of health care cost
should be diagnosed and treated by physicians
• Physicians should be compensated for treating medical
illiteracy
• Patients should be rewarded for demonstrating medical
literacy
Program Description
Some Information Therapy Program basics...
• Program participation is voluntary for both doctors
and patients
• Doctors and patients can earn financial rewards
immediately for each office visit
• Physicians are compensated $15 for each office visit,
which is approximately a 20% increase, for additional
effort and responsibility, not for merely doing what
they are already being paid to do
• Patient financial rewards are in the form of office copay rebates ranging from $5 to $30, depending upon
the employer
Doctors can practice MedEncentive
in two ways...
• Real-time while the patient is in-office or shortly
thereafter, or... $15.00 ≈ 20% of an office visit
• After-the-fact... $7.50 ≈ 10% of an office visit
• As a result normal insurance claim, MedEncentive
sends an email
• Time limits to respond
• MedEncentive also sends a fax reminder
Is the patient deprived if the doctor
fails to participate?
• Patients are not deprived of their opportunity to benefit
from the program even when their doctors fail to
participate, because…
• We use diagnoses from the office visit claim submitted by
the doctor to generate the information therapy
prescription...
The Physician Log-in Screen
Doctors earn up to 20% more for declaring adherence to
evidence-based medicine and for patient education …
• Flow chart hyperlinks
allow the doctor to
review the source of
each guideline and gain
decision support
• Doctors are asked to
declare their adherence
to the EBM guideline and
agree to allow their patients to confirm their
declaration......
MedEncentive’s “anti-cookbook medicine” feature is
key to physician acceptance ...
• By selecting a reason for
non-adherence to a
guideline that is shared
with the patient, the Program allows and encourages doctors to deviate
from a guideline each
time it is appropriate...
..and the doctor still earns
additional compensation.
• This feature resolves one
of the principal physician
objections to pay-forperformance programs...
Doctors earn up to 20% more for declaring adherence to
evidence-based medicine and for patient education…fast and
easy...yet very important...
• Physicians prescribe
information therapy to
the patient by selecting
one or more relevant
articles.
• Physicians can also tag
favorite articles to specific diagnoses, plus view
previous information
therapy prescriptions to
the patient.
The physician’s website response triggers a patient
“information therapy” prescription letter…
• Letter suggests alternative web access
options so all patients can participate.
• Log-on instructions with the URL and
User ID/Password helps insure privacy.
• Allows patients a 2-week timeframe to
complete instructional course.
• Offers patient a financial incentive to
participate in the Program that can be
customized to each employer and/or
particular health promotion.
• Ix letter is initially sent by mail, but after
first prescription, patient can elect to
have future prescriptions sent
electronically.
Patients are educated with the same guideline content
as their doctor - specific to their diagnosis…
MedEncentive’s patient website provides:
•Medical information in
easy-to-understand
language (6th grade
reading level)
•Patients are required
to read and answer a
series of questions in
each section to earn
their financial reward.
The patient questionnaires create powerful behavior
shaping “checks and balances” to the physician’s input
and vice-versa when…
•The patient demonstrates medical
literacy…
•The patient records
health status…
•The patient declares
compliance to EBM…
•The patient agrees to
have responses sent
to the physician, thus
creating a powerful
compliance motivator
Patients must past a health literacy test before moving
on…
Patients are given every opportunity to learn the
information and pass the test…
Patient must declare their compliance to recommended treatments...
Patients must agree to have their questionnaire responses shared with their doctor…creating the first
step toward “mutual accountability”...
The patient is also asked to rate the doctor’s performance against the recommended care, which creates an
even greater “check and balance”…
•The patient must demonstrate
medical literacy of the recommended care before rating the doctor…
•Individual patient ratings do not
directly impact the doctor. Only
aggregate patient ratings are used
to measure physician performance.
Doctors consider this method of
quality rating to be much fairer and
more appropriate than ratings by
insurance companies or the
government using claims data or
other controversial criteria.
Timely completion of “information therapy” results in
immediate financial reward to patients for compliance
• MedEncentive
triggers an automatic
transaction notifying
the TPA to generate a
patient payment
• The voucher serves
3/8/2008
as another co-branding opportunity and a
vehicle for other
patient communications
Trial Results
Expanded Trials – Five Year Report is a must read...
Celebrating Five Years of Success
Examining a groundbreaking solution for controlling
health care costs using financial incentives to invoke
doctor-patient mutual accountability
By Jeff Greene
November 2009
Abstract
Our nation is in the midst of an important debate on health care. The issues revolve around affordability, accessibility, quality
and funding. Of these issues, the one that all experts agree must be resolved for the good of the country is the high cost of
healthcare.
Supported by years of testing and overwhelming empirical evidence by independent research, the MedEncentive Program has
surfaced as a real breakthrough in resolving the issue of healthcare affordability. This report presents the findings from five
years of testing and the independent research that validates the Program’s efficacy and its underlining design principles.
Background - From 1997 though 2007, a small group of innovators
consisting of practicing physicians, a medical academician, a selfinsured business owner, a medical practice management consultant,
and a health insurance executive sought to find ways to align the
interests of healthcare consumers, providers and insurers. After
years of studying the issues, the group concluded that the single
most pressing problem in healthcare was affordability.
Understanding that the majority of healthcare costs are driven by
people’s poor health habits and medical providers’ variable practice
patterns, the group focused on
using incentives to align these stakeholders’ interests to improve
both health behaviors and practice patterns. This thought process
led to development of what would become a web-based incentive
system called MedEncentive.
In August 2004, the first installation of the MedEncentive
healthcare cost containment program was launched with the
municipal government in Duncan, Oklahoma. This unique webbased incentive system functioned as designed and the City of
Duncan realized significant cost savings in the very first year of
installation. Two studies1,2 were published that attributed these
Academic Acceptance of Five Year Report and
the MedEncentive Model
The following slide is a poster developed by a research team
at the University of Kansas School of Medicine (KUSM) that
summarizes the health literacy findings from MedEncentive’s
Five Year Report. This poster was presented in October 2009
at the National Institutes of Health Conference on Health
Literacy in Washington, DC. This poster is an indication of a
growing acceptance of and interested in MedEncentive’s
design and trial results by academicians. The subsequent
slides present the key findings from the Five Year Report.
Specific Care Recommendations from Information Prescription Therapy
Using Information Therapy as a Part of Patient Care
Amy Chesser, PhD; Traci Hart, PhD(Cand.); Douglas D. Bradham, DrPH
Background:
Table 1: Information Therapy (Ix) Process for Medical Conditions
Unaffordable healthcare is symptomatic of three root causes:
(1) An inefficient healthcare delivery system
(2) American’s poor health habits
(3) Medical illiteracy of patients
Incentives to improve consumer health behaviors and medical provider
adherence to guidelines hold a promising key to addressing root causes and
making healthcare affordable and accessible to all Americans.
The MedEncentive® Information Therapy Program has several years’ experience
in development and successful testing of using financial rewards to both
providers and patients encouraging “mutual accountability”. Their key to success
also entails creating an environment that includes health promotion or a “Culture
of Health” and “triangulating” the interests of the health insurer, provider and
consumer. MedEncentive® uses care guidelines developed by leading medical
schools plus patient content from Healthwise®, a national resource for consumergrade health information. The term “information therapy”, and its symbol “Ix®”,
were coined by Healthwise® to mean: “providing patients with the right
information at the right time, in understandable terms, so patients can make an
informed decision about their health.”
Methods:
This study independently examined the Information Therapy Program’s
effectiveness, during a five year period across 7 companies, on key outcomes
and effect modifiers of:
(1) provider and patient participation
(2) patient satisfaction and Ix® prescription compliance
(3) changes in overall healthcare costs
“I was doing this for the $ but
found learning more very
helpful.”
Patient
When Ix
Prescribed
Clinician
(i.e. MD, DO,
RN, CNP, PA, etc.)
Ix by
Outpatient Encounter
MedEncentive
System
Figure 1: Conceptual Model
Both parties agree to allow the other
party to confirm performance
OUTCOMES
During visit or prior to
% Patient Participation
Clinician initiates process and
% Clinician Participation
office visit claim reaching
Point of Service
chooses Ix
MedEncentive
Process
of Care
Ix
Δ Health Cost
Table 2: Preliminary Results from 5 Year Data Analysis
Claim Initiated
A. Patient
Participation Rate
“We are very impressed with the MedEncentive program. The
additional information has helped us understand our health
conditions more fully. We can gain this help by using our own time,
not being rushed with the Dr’s time. We also can refur (sp) back to
this info as we need to do so. We are more relaxed as we deal with
health isses (sp) with this program. Makes life less stressful. Of
course the rewards have been a life savior (sp) to our budget as
well.”
Patient
Δ Health Literacy
% Clinician Non-Participation
System-generated Ix from Claim Dx
2-30 days
after office visit
“I had the symptoms of a sinus
infection again. With the
imformation (sp) I learned
here; to contain it before it got
any worse, I used the therapies
I learned from my last lessons
and I didn’t have to go to the
doctor. The infection got
better…”
Patient
Δ Health Status
Clinician is notified after the
fact and chooses Ix
MedEncentive uses claim to
alert clinician
Clinician does not participate
MedEncentive system
generates Ix to patient from
claim diagnosis
Secondary, Retrospective Cohort Analysis was conducted.
All participant data was transmitted to the Investigators from the Ix® Program.
Study was approved by KUSM-W IRB and qualified for a waiver of consent.
Limitations:
There were several limitations to this study as well as areas of
opportunity for future research.
(1) Current literacy outcomes are implied by pt. assessment of
benefits to personal health. More direct measures of literacy need
to be examined.
(2) Findings are not generalizable to a broader population.
(3) Need to have a comparison group to determine impact.
(4) Future studies should focus on identification of disease states for
vulnerable populations.
(5) The role of physicians as an effect modifier needs to be further
investigated.
B. Physician
Participation Rate
Preliminary Results:
(1) Doctor prescribed information rates higher than system generated information
(Table 1)
(2) Patient participation rates increased over time (Table 2, A)
(3) Physician participation rates decreased over time (Table 2, B)
(4) Ix rated as moderate to highly beneficial by patient participants (Table 2, C)
(5) Creating a “culture of health” impacts health outcomes, utilization and cost
containment for plan participants (Table 2, D)
(6) Improved cost containment for 5 of 7 trial plans (Table 2, E)
“I have learned so much from the
MedEncentive program so much
more than from what my doctors
are telling me.”
Patient
Implications:
6-30 days
after office visit
System Initiated
First Year
Company
Most Recent Year
43.8%
(1= low; 10 = high)
4.27
6
Yes
35.5%
1
84.1%
(1= low; 5= high)
E.
Did Employer Achieve
a Measure of Cost
Containment and ROI
After Implementation?
C.
Rating of Information
Therapy Benefit to
D.
Personal Health
Culture of Health
53.6%
(1) Medically informed and empowered person is better equipped to
self-manage his/her health, which leads to lower health care costs.
(2) Most people need to be financially incented to become health
literate.
(3) Health literacy is advanced when patients are financially rewarded
to read pertinent health information and are held accountable for
the knowledge by their doctor.
(4) Web-based applications have a viable future for improving health
literacy.
(5) Doctors and patients are motivated to respond to one another in
ways that improve health literacy, health and health care, which
leads to cost containment.
Results from MedEncentive’s expanded trials...
What we have learned through the year ending 6/30/2009
from 7 separate installations representing approximately
7,000 covered lives in Oklahoma, Kansas and Washington:
– 5 of the 7 installations have demonstrated or are reporting cost
savings after implementing MedEncentive (the remaining 2 are
indeterminate).
– Patient/member participation rates above 55% consistently
produced cost savings.
– The overall annual patient/member participation rate in the
Program for the year was 61.3%.
– From the trial data, financial rewards less than $15 are
inadequate to achieve patient/member participation rates
sufficient to bend the cost curve.
Results from MedEncentive’s expanded trials...
To measure the efficacy of the information therapy delivered
through the Program, all patients are required to answer the
following question:
“On a scale of 1 to 5, how helpful has this information
been to you in self-managing your health (5 being most
helpful)?”
• The aggregate score of the 13,673 responses was 4.07.
• In addition, patients are asked to voluntarily comment on the
Program. 1,194 patient/members offered comments out of 3,603
patient/member participants (33.1% response rate).
The volume and quality of these responses coupled with the
aggregate benefit score present a strong case for the clinical and
economic efficacy of information therapy.
Results from MedEncentive’s expanded trials...
Trial results for year ending 6/30/2009, cont’d...
– The overall annual physician participation rate in the Program
was 21.4%. In view of the relatively low market penetrations,
this level of overall physician participation is considered to be
good.
– Since 2006, the participation rate among the 90 physicians with
100 opportunities or more was 58.7%, clearly indicating that
market concentration has a significant impact on physician
participation.
– The highest rates of physician participation were achieved with
installations in which the local medical community had a
contractual relationship with MedEncentive.
– Physicians choose to deviate from EBM guidelines only 1.3% of
the time.
A “Win” for Employers:
Case Study - Duncan, OK
Trouble in Duncan
• Skyrocketing health care costs
• Union contract negotiations
• Tax revenues were not increasing
• Medical providers unwilling to reduce compensation
• Needed to contain health care costs while
improving care
• Other cost-control efforts not working
What We Did in Duncan
• Implemented quickly (within 30 days)
• Simple “bolt-on” to existing health plan
• Issued employee information kits
• Distributed doctors education materials
• Plan administrator sent daily claims data
• Mailed incentive payments…fast
What We Did in Duncan
Distributed Kits to
employees made
orientation and
start-up quick and
easy
Four Year Results: Rewarding Better Care, Patient
Education and Compliance Lowers Cost
$2,000,000
$1,800,000
$1,600,000
$1,400,000
$1,200,000
Total Investment
$181,227
$800,000
Four Year Savings
vs. Projection
$600,000
$1,612,985
$1,000,000
$400,000
$200,000
$-
Four year program investment vs. “all-in” claims cost = 8:1 ROI
Based on per Member per Year (“PMPY) data
4 years of cumulative absolute cost savings
validates MedEncentive impact on costs
City of Duncan
Actual Net Charges for Last 5 Years Plus Projections w/o MedEncentive
2,500,000
* Projections based on average rate
of healthcare inflation for each year
753,220
2,000,000
705,923
4 year average since implementing MedEncentive = 1,729.287
659,741
894,095
614,284
1,500,000
558,440
893,672
414,048
522,304
1,000,000
1,328,375
1,207,613
1,206,744
1,068,235
500,000
1,628,820
1,526,542
1,426,674
1,043,818
874,235
0
Baseline
Year
1st Year
2nd Year
Non-Catastrophic Costs
3rd Year
Catastrophic Costs
Based on absolute costs
4th Year
•The 4 year average
of “all-in” claims cost
since implementing
MedEncentive is 2.1%
less than the baseline
year.
4 years of cumulative absolute cost savings
validates MedEncentive impact on costs
City of Duncan
Actual Net Charges for Last 5 Years Plus Projections w/o MedEncentive
2,500,000
* Projections based on average rate
of healthcare inflation for each year
753,220
2,000,000
705,923
659,741
894,095
614,284
1,500,000
•The 4 year average
of “all-in” claims cost
since implementing
MedEncentive is 2.1%
less than the baseline
year.
558,440
893,672
414,048
522,304
1,000,000
1,328,375
1,207,613
1,206,744
1,068,235
500,000
1,628,820
1,526,542
1,426,674
1,043,818
874,235
0
Baseline
Year
1st Year
2nd Year
Non-Catastrophic Costs
3rd Year
Catastrophic Costs
Based on absolute costs
4th Year
•The 4 year “all-in”
claims cost since
implementing
MedEncentive is
20.0% less than
expected costs using
average healthcare
inflation.
MedEncentive’s office-based solution used in Duncan is most
effective at controlling the underlying non-catastrophic costs
City of Duncan
Actual Net Charges for Last 5 Years Plus Projections w/o MedEncentive
2,500,000
* Projections based on average rate
of healthcare inflation for each year
753,220
2,000,000
705,923
659,741
894,095
614,284
1,500,000
558,440
893,672
414,048
522,304
4 year average since implementing MedEncentive = 1,048.258
1,000,000
1,328,375
1,207,613
1,206,744
1,068,235
500,000
1,628,820
1,526,542
1,426,674
1,043,818
874,235
0
Baseline
Year
1st Year
2nd Year
Non-Catastrophic Costs
3rd Year
Catastrophic Costs
Based on absolute costs
4th Year
•The 4 year average
of non-catastrophic
claims cost since
implementing
MedEncentive is
13.2% less than the
baseline year.
MedEncentive’s office-based solution used in Duncan is most
effective at controlling the underlying non-catastrophic costs
City of Duncan
Actual Net Charges for Last 5 Years Plus Projections w/o MedEncentive
2,500,000
* Projections based on average rate
of healthcare inflation for each year
753,220
2,000,000
705,923
659,741
894,095
614,284
1,500,000
558,440
893,672
414,048
522,304
1,000,000
1,328,375
1,207,613
1,206,744
1,068,235
500,000
1,628,820
1,526,542
1,426,674
1,043,818
874,235
0
Baseline
Year
1st Year
2nd Year
Non-Catastrophic Costs
3rd Year
Catastrophic Costs
Based on absolute costs
4th Year
•The 4 year average
of non-catastrophic
claims cost since
implementing
MedEncentive is
13.2% less than the
baseline year.
•The 4 year noncatastrophic claims
cost since implementing
MedEncentive is
29.3% less than
expected costs using
average healthcare
inflation.
4 years of cumulative cost savings based on PMPY*
validates MedEncentive impact on costs
City of Duncan
Actual Net Charges PMPY* for Last 5 Years Plus Projections w/o MedEncentive
$4,000
Annual Claims Cost per Member per Year*
1,402
1,314
1,228
1,740
1,143
$3,000
1,039
4th year PMPY costs = $3,005 PMPY vs. Baseline = $3,287 PMPY
1,695
776
1,002
$2,000
2,472
2,247
$1,000
3,031
2,841
2,655
2,348
2,002
2,003
1,658
$0
Baseline
Year
1st Year
2nd Year
Non-Catastrophic Costs
3rd Year
Catastrophic Costs
4th Year
* Based on per Member per Year costs (“PMPY”)
•The 4 year average
“all-in” PMPY claims
cost is essentially
flat (0.6% more than
the baseline year).
•The 4th year “all-in”
PMPY claims cost is
8.6% less than the
baseline 5 years ago.
A “Win” for Everyone
“We save money and everyone loves it.”
Clyde Shaw, City Manager, City of Duncan
“If I hadn’t read my husband’s information therapy about a dangerous
side effect of medication, my husband might not be here today.”
Triangulation
Betty E., Duncan, OK
“MedEncentive is easy and quick to use... I think it serves as a good
second opinion for me and provides valuable information to my
patients. And to top it off, the program increases my reimbursement
and my patients are very motivated to get their co-pays back.“
Todd Clapp, M.D., Internal Medicine and Pediatrics, INTEGRIS Health
Research finds MedEncentive to be very inexpensive...
Cost Comparison to Pay-for-Performance plus Wellness Programs
Source
Edington
Beneficiary
Incentive
$300.00
Credit Suisse
N/A
BTE
N/A
Totals
MedEncentive
Difference
Provider P4P
Compensation
Program
Administration
N/A
N/A
N/A
Total Costs
$300.00
$60.00
$60.00
$9.26
$5.76
$15.02
$300.00
$9.26
$65.76
$375.02
$29.12
$6.47
$36.01
$71.60
($270.88)
($2.79)
($29.75)
($303.42)
Research finds MedEncentive to be very inexpensive...
Program Cost Comparison
Per Member Per Year Costs
$400
$375
$350
$300
$250
$200
$150
$72
$100
$50
$0
Comparable Program
M edEncentive
What Makes MedEncentive
So Effective?
• The process of “Declare and Confirm” or “Demonstrate and
Acknowledge” between doctors and patients invokes powerful
behavioral science:
• Studies show that patients don’t want their doctors to think they
are medically illiterate and non-compliant…
• Conversely, doctors don’t want patients to think they practice substandard care…
• In effect, MedEncentive harnesses the strength of the doctorpatient relationship to create “mutual accountability” that
promotes better health and healthcare, which leads to lower
costs.
What Makes MedEncentive
So Effective?
As you know, your responses are being made available to your
physician. On a scale from 1 to 10, with 10 being the most, how
much does the knowledge that your physician has access to your
questionnaire responses motivate you to improve your health
literacy and health behaviors?
8.7
On a scale from 1 to 10, with 10 being the most, how important is
it to you that your doctor is aware that you understand how to
self-manage your health?
8.9
On a scale from 1 to 10, with 10 being the most, how important is
it to you that your doctor is aware that you are trying to
accomplish or are accomplishing health objectives?
9.0
A “Win” for Physicians
Why physicians like MedEncentive...
• It’s good for the doctor’s patients
• It pays physicians well for services that are
fundamentally important to patients and payers
• It’s fast, easy and flexible for doctors to use
• It’s anti-cookbook
• It allows physicians to be rated in a fair and objective
manner
• It can reduce medical malpractice risk
Growing relationships with
physician organizations...
Endorsements and partnerships
Pending partnerships
• The IPA Association of America
(TIPAAA)
• Oklahoma Academy of Family
Physicians
• Michigan Academy of Family
Physicians
• Indiana Academy of Family
Physicians
• Wichita Clinic
• Northern New Jersey IPA
• Duncan Physician Association
• Integris Health System
• AMA
• Connecticut State Medical
Society
• Idaho Academy of Family
Physicians
• PCPCC
• Others...
Local Healthcare Reform: Cost Containment
Opportunities for Employers
Future Developments
What is in the future...
In the future, MedEncentive’s “triangulation” and
“doctor-patient mutual accountability” incentive
methods, which have been so successful in advancing
evidence-based medicine and information therapy, will
be brought to bear on a host of other medical
interventions that are illustrated on the following
slide...
Pyramid of Health and Healthcare
Transformation
More affordable
healthcare
Ultimate Objective
Improved Better
health healthcare
Wellness and prevention
Personal health records
Smoking cessation
Goals that support the
Ultimate Objective
Google and Microsoft
Merck Rx
e-prescribing
Patient centered medical home
PCPCC
Physician directed disease mgt
Patient directed precertification Weight mgt
Rx compliance
Health risk assessment
Wellness and
medical
interventions that
support the Goals
Adoption
of health
IT
Existing
customers
Patient health literacy Provider application of
evidence-based medicine
and empowerment
Doctor-patient interactive incentives that
achieves “mutual accountability”
Catalyst that recruits
and motivates doctors
and patients to the
interventions
Success Acknowledgment
• Patient-centered medical home ROI
enhancement
• PHR adoption
• Integration with a host of wellness,
prevention and care management
programs
What Forrester Research said about PHR adoption
• To meet their own ROI goals and employers’
expectations, health plan customer experience
professionals must give both members and providers
an extra reason to pay attention to PHRs.
• MAKE PATIENT-PROVIDER COMMUNICATION
EXPLICIT IN PAY-FOR PERFORMANCE (P4P) MODELS
Timely completion of “information therapy” results in
immediate financial reward to patients for compliance
• MedEncentive
triggers an automatic
transaction notifying
the TPA to generate a
patient payment
• The voucher serves
3/8/2008
as another co-branding opportunity and a
vehicle for other
patient communications
“Success Acknowledgment” – An important final step
Congratulations for completing your information therapy prescription! You are now eligible
to earn an additional $ xx.xx when you update
your personal health record and have your
doctor acknowledge your health accomplishments, for which he/she will also be paid.
We call this process “Success Acknowledgment.” It is
simple, yet very important. Studies indicate that when
patients inform their doctors of their health successes and
doctors acknowledge these successes, better health and
healthcare will occur.
Click “Next” to learn how Success Acknowledgment works.
Next
Exit
• Success Acknowledgment creates
another important
check and balance that is designed to achieve
mutual accountability between
the doctor and the
patient.
Integrating a personal health record (PHR) to Success
Acknowledgment...
Types of health objectives that can be integrated with
MedEncentive’s Success Acknowledgment Reward System…
Here are your completed health objectives that are pending your
doctor’s acknowledgment…
• Demonstrated knowledge of: How to Live with Hypertension and declared
adherence to the recommendations in this article
• Refilled your prescription for: Lipitor on: July 14, 2010
• Passed a drug literacy test for and declared adherence to taking: Lipitor on:
July 14, 2010
• Enrolled in a smoking cessation program on: June 14, 2010
• Completed a health risk assessment and followed-up on the findings with
Beverly Doright, M.D. on: June 7, 2010
• Had a consultation visit with Tom Smith, M.D. about back pain on: June 9,
2010
• Completed SilverSneaker® sessions 9 times in: June 2010
• Completed SilverSneaker® sessions 14 times in: July 2010
• Executed a living will on: July 14, 2010
• Completed obesity tasks assigned by my Healthways® Care Support coach
on: July 20, 2010
• Updated my personal health record on: July 31, 2010
Next
Exit
•The first health
objective is currently available for
acknowledgment
• The remaining
health objectives
are a sampling of
additional interventions that can be
conveyed electronically by contracted
vendors to
MedEncentive for
inclusion in the
Success Acknowledgment PHR Reward System...
Actual PHR test import...
•The health accomplishments listed on
the previous slide
can be uploaded
into the PHR in total
or selectively by the
patient as illustrated
PHR is updated...
This essentially completes the MedEncentive Success
Acknowledgment PHR patient session....
Once a month, doctors are informed of the health
accomplishments of their patients by email or fax…
Dear Doctor:
This email/fax is to inform you that your patients have
successfully completed one or more health objectives. If you
will simply click the link below to log-on to the MedEncentive
website to acknowledge your patients’ health successes, both
you and your patients will be compensated by your patients’
health plan.
www.medencentive.patientsuccesses.com
Studies indicate that when patients are rewarded for
reporting their health successes to their doctors, they are
more motivated to achieve and maintain better health. This
process is called “Success Acknowledgment” and our website
will explain how simple this process works.
Physician acknowledgment webpage…
Doctor:
Mary Jones successfully accomplished the following health objectives:
• Demonstrated knowledge of: How to Live with Hypertension and declared
adherence to the recommendations in this article
• Refilled your prescription for: Lipitor on: July 14, 2010
• Passed a drug literacy test for and declared adherence to taking: Lipitor on:
July 14, 2009
• Enrolled in a smoking cessation program on: June 14, 2010
Use the free text area, below, if you wish to convey a message to the patient such
as “Congratulations” or “See you soon” or some type of reminder or medical
instruction. Your message will be included in the chart note.
Select one of the following options will initiate the financial reward to you and your
patient, plus send an acknowledgment email notice to your patient:
Print for paper chart
Save to import to electronic medical record
• Doctors can
convey messages
of congratulations
to their patients
• This function can
be delegated to
office staff
• Both the doctor
and patient are
financial rewarded
when the doctor
clicks one of the
links at the bottom
of this webpage…
PHR is updated...
Patients receive a confirmation email…
Dear Patient:
This email is to notify you that Dr. Beverly Doright, M.D. and his/her staff
have acknowledged your recent health success. There is nothing further
for you to do in this regard except to enjoy your better health and the
financial reward that you have earned as a result of your doctor
acknowledging your health success.
Congratulation!
Your doctor or his staff conveyed a message to you. Enter your user ID
and password to read the message.
User Name
Password
• Patients are informed when
their doctors acknowledge their
health successes
• Patients are also
informed if their
doctors have not
responded and
are encouraged
to contact their
doctors to earn
the rewards
The Value Proposition
Once the doctor acknowledges the patient’s health
accomplishments through the MedEncentive web
portable, then MedEncentive will authenticate the
transactions and transmit financial reward approvals to
the health plan for both the patient and their doctor,
for both the Information Therapy Program and the
Success Acknowledgment Program.
The Value Proposition
Why two separate financial rewards?
• The Information Therapy reward is made to the doctor and the patient
independently. In other words, the doctor’s opportunity to earn his/her
reward is not dependent on the patient’s participation and vice versa.
• The Success Acknowledgment reward is made to the patient and the doctor
only when the doctor performs the simple task of acknowledgment.
Obviously, we want both parties to earn both rewards. However,
patients should not be deprived of being rewarded for
completing information therapy simply because their doctors
fail to acknowledge the patient’s health accomplishments.
Health literacy is simply too important. Plus, patients will switch
doctors if a doctor’s failure to acknowledge patient health
accomplishments becomes an issue...
Summary...
What have we learned?
• Our solution saves money
• Doctor-patient mutual accountability is a powerful process
• Financial incentives are necessary to invoke mutual
accountability
• Information therapy is very powerful medicine if delivered
correctly
• MedEncentive leapfrogs the issues that have plagued the
pay-for-performance movement
• If we want affordable, accessible and high quality
healthcare, we must align the interests of the insurer,
physician and consumer, and our solution accomplishes
this…
What value does MedEncentive offer or what purpose
does it serve going forward?
Leonard Schaeffer, former CEO and Chairman of WellpointAnthem said in an interview with McKinsey:
“We insurers can see the opportunities, but when we offer
solutions we're at a disadvantage relative to some third
parties. For one thing, many doctors don't trust us.”
“Unfortunately, insurance companies aren't seen (by doctors)
as sources of accurate, timely, and unbiased information,
so most likely we'll see third-party ‘infomediaries’
emerging that will gather and correlate industry data.”
National Business Group on Health/Towers Watson
Employer Survey Supports MedEncentive
2010 annual survey of America’s largest corporations
found the following:
1. large employers expect health inflation in 2010 will
again be two to three times the rate of overall inflation
at 6.5%;
2. employers cite employee and dependent health
behaviors as the principal driver of cost;
3. employers recognize that incentives are needed to
shape employee health behaviors; and
4. employers feel that solutions offered by health plan
vendors to improve health behaviors and control costs
are inadequate.
National Business Group on Health/Hewitt
Employee Survey Supports MedEncentive
2010 annual survey of America’s largest corporations
found the following:
Information seems to be the biggest obstacle for most workers:
•
58% of employees said they weren't sure which information
they could trust; and
•
54% said the information they received was confusing
“Employers are in a unique position to close that information gap
by educating their employees about health issues,” says Joann
Hall Swenson with Hewitt Associates. “Respondents were highly
in favor of personalized information, and employers will likely
have more success with programs if they tailor them as much as
possible to individual workers,” she says.
Key points…
1. We must “triangulate”
the interests of the payer, physician and consumer to achieve
sustained cost containment.
2. Using “precision-guided, interactive financial incentives” to
achieve “doctor-patient mutual accountability” is the most
efficient and effective way to control costs through better
health and healthcare.
3. If we are not improving “patient health literacy” we are not
controlling costs. Compensating doctors to prescribe
“information therapy” and administer literacy tests, plus
rewarding patients for demonstrating their literacy to their
doctors is the best way to accomplish this priority.
4. Information therapy is only the first of multiple medical
interventions that can be integrated with MedEncentive.
Q&A
Jeff Greene
[email protected]
405-319-8450
www.medencentive.com