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“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. Physicians. Consumers/Patients. $. $. No Physician Accountability. No Patient Accountability. Employers/Insurers.

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“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 Physicians and Employees – Part 2”

Physicians

Consumers/Patients

$

$

No Physician Accountability

No Patient Accountability

Employers/Insurers

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

  • Provider Accountability

  • Capitated HMO

  • P4P

  • Episodic care payments

  • Medical home

  • Patient Accountability

  • Wellness and prevention

  • Disease/care mgt

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
What is MedEncentive? Physicians and Employees – Part 2”

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
Why is information therapy so important? Physicians and Employees – Part 2”

Medical illiteracy and poor doctor-patient communications is a bigger problem than expected…


Health literacy drives motivation and empowerment
Health literacy drives motivation and empowerment... Physicians and Employees – Part 2”

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
Northwestern and Emory Universities Research Team Medical Literacy Study

What You Don't Understand Could Kill YouBy 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.



UCONN Reports on the Cost of Medical Illiteracy Literacy Study

NEW REPORT ESTIMATES COST OF LOW HEALTH LITERACY BETWEEN $106 - $236 BILLION DOLLARS ANNUALLYExperts discuss if improving health literacy is the solution to providing coverage for the nation’s 47 million uninsured peopleSTORRS, 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 LandroWall Street JournalJuly 6, 2010Low health literacy is a growing concern in the U.S.as medical-treatment decisions become more complex,chronic diseases more prevalent and doctors’ face timewith 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… 10 of us are afflicted with some degree of health illiteracy...

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
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 communication studies suggest?


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 co-pay rebates ranging from $5 to $30, depending upon the employer

Some Information Therapy Program basics...


Doctors can practice medencentive in two ways

Doctors can practice MedEncentive in two ways... patients

  • Real-time while the patient is in-office or shortly thereafter, or...

  • After-the-fact...

    • As a result normal insurance claim, MedEncentive sends an email

    • Time limits to respond

    • MedEncentive also sends a fax reminder

$15.00 ≈ 20% of an office visit

$7.50 ≈ 10% of an office visit


Is the patient deprived if the doctor fails to participate

Is the patient deprived if the doctor fails to participate? patients

  • 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...



patientsDoctors are asked to declare their adherence to the EBM guideline and agree to allow their pa-tients to confirm their declaration......

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


Medencentive s anti cookbook medicine feature is key to physician acceptance
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 Pro-gram allows and encour-ages 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-for-performance 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 speci-fic diagnoses, plus view previous information therapy prescriptions to the patient.


evidence-based medicine and for patient education…fast and easy...yet very important...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.

The physician’s website response triggers a patient “information therapy” prescription letter…

•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
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 demon-strates 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 are given every opportunity to learn the information and pass the test
Patients are given every opportunity to learn the information and pass the test…



Patients must agree to have their questionnaire re-sponses shared with their doctor…creating the first step toward “mutual accountability”...


The patient is also asked to rate the doctor’s perform-ance against the recommended care, which creates an even greater “check and balance”…

  • The patient must demonstrate medical literacy of the recommend-ed 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.


3/8/2008 perform-ance against the recommended care, which creates an even greater “check and balance”…

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 as another co-brand-ing opportunity and a vehicle for other patient communica-tions


Trial Results perform-ance against the recommended care, which creates an even greater “check and balance”…


Expanded trials five year report is a must read

Celebrating Five Years of Success perform-ance against the recommended care, which creates an even greater “check and balance”…

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.

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 web-based 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

Background - From 1997 though 2007, a small group of innovators consisting of practicing physicians, a medical academician, a self-insured 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

Expanded Trials – Five Year Report is a must read...


Academic acceptance of five year report and the medencentive model
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.


Amy chesser phd traci hart phd cand douglas d bradham drph

S ModelpecificCare Recommendations from Information Prescription Therapy

Amy Chesser, PhD; Traci Hart, PhD(Cand.); Douglas D. Bradham, DrPH

Using Information Therapy as a Part of Patient Care

Background:

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 rewardsto 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 consumer-grade 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.”

Table 1: Information Therapy (Ix) Process for Medical Conditions

“I have learned so much from the MedEncentive program so much more than from what my doctors are telling me.”

Patient

“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

“I was doing this for the $ but found learning more very helpful.” Patient

“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

Figure 1: Conceptual Model

Both parties agree to allow the other

party to confirm performance

OUTCOMES

% Patient Participation

% Clinician Participation

Δ Health Status

Process

of Care

Ix

Δ Health Literacy

Δ Health Cost

  • Limitations:

  • There were several limitations to this study as well as areas of opportunity for future research.

  • Current literacy outcomes are implied by pt. assessment of benefits to personal health. More direct measures of literacy need to be examined.

  • Findings are not generalizable to a broader population.

  • Need to have a comparison group to determine impact.

  • Future studies should focus on identification of disease states for vulnerable populations.

  • The role of physicians as an effect modifier needs to be further investigated.

  • Implications:

  • Medically informed and empowered person is better equipped to self-manage his/her health, which leads to lower health care costs.

  • Most people need to be financially incented to become health literate.

  • Health literacy is advanced when patients are financially rewarded to read pertinent health information and are held accountable for the knowledge by their doctor.

  • Web-based applications have a viable future for improving health literacy.

  • 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.

  • 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

  • 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.

% Clinician Non-Participation

System-generated Ix from Claim Dx

Table 2: Preliminary Results from 5 Year Data Analysis

  • Preliminary Results:

  • Doctor prescribed information rates higher than system generated information (Table 1)

  • Patient participation rates increased over time (Table 2, A)

  • Physician participation rates decreased over time (Table 2, B)

  • Ix rated as moderate to highly beneficial by patient participants (Table 2, C)

  • Creating a “culture of health” impacts health outcomes, utilization and cost containment for plan participants (Table 2, D)

  • Improved cost containment for 5 of 7 trial plans (Table 2, E)


Results from medencentive s expanded trials
Results from MedEncentive’s expanded trials... Model

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 trials1
Results from MedEncentive’s expanded trials... Model

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 trials2
Results from MedEncentive’s expanded trials... Model

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

A “Win” for Employers: ModelCase Study - Duncan, OK


Trouble in duncan

Trouble in Duncan Model

  • 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

What We Did in Duncan Model

  • 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 duncan1

What We Did in Duncan Model

Distributed Kits to employees made orientation and start-up quick and easy


Four year results rewarding better care patient education and compliance lowers cost

Total Investment $181,227 Model

Four Year Savingsvs. Projection

$1,612,985

Four Year Results: Rewarding Better Care, Patient Education and Compliance Lowers Cost

Four year program investment vs. “all-in” claims cost = 8:1 ROIBased on per Member per Year (“PMPY) data


4 years of cumulative absolute cost savings validates medencentive impact on costs

4 year average since implementing MedEncentive = 1,729.287 Model

1st Year

2nd Year

3rd Year

4th Year

4 years of cumulative absolute cost savings validates MedEncentive impact on costs

  • The 4 year average of “all-in” claims cost since implementing MedEncentive is 2.1%less than the baseline year.

Baseline Year

Based on absolute costs


4 years of cumulative absolute cost savings validates medencentive impact on costs1

1st Year

2nd Year

3rd Year

4th Year

4 years of cumulative absolute cost savings validates MedEncentive impact on costs

  • The 4 year average of “all-in” claims cost since implementing MedEncentive is 2.1%less than the baseline year.

Baseline Year

Based on absolute costs


4 year average since implementing MedEncentive = 1,048.258 MedEncentive is

1st Year

2nd Year

3rd Year

4th Year

MedEncentive’s office-based solution used in Duncan is most effective at controlling the underlying non-catastrophic costs

  • The 4 year average of non-catastrophic claims cost since implementing MedEncentive is 13.2% less than the baseline year.

Baseline Year

Based on absolute costs


1st Year

2nd Year

3rd Year

4th Year

MedEncentive’s office-based solution used in Duncan is most effective at controlling the underlying non-catastrophic costs

  • The 4 year average of non-catastrophic claims cost since implementing MedEncentive is 13.2% less than the baseline year.

Baseline Year

Based on absolute costs


4 years of cumulative cost savings based on pmpy validates medencentive impact on costs

4 MedEncentive is th year PMPY costs = $3,005 PMPY vs. Baseline = $3,287 PMPY

1st Year

2nd Year

3rd Year

4th Year

4 years of cumulative cost savings based on PMPY* validates MedEncentive impact on costs

  • 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.

Baseline Year

* Based on per Member per Year costs (“PMPY”)


A win for everyone

A “Win” for Everyone MedEncentive is

  • “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.”

    • Betty E., Duncan, OK

Triangulation

“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




What makes medencentive so effective

What Makes MedEncentive So Effective? MedEncentive is

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 sub-standard care…

In effect, MedEncentive harnesses the strength of the doctor-patient relationship to create “mutual accountability” that promotes better health and healthcare, which leads to lower costs.


What makes medencentive so effective1

What Makes MedEncentive So Effective? MedEncentive is

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
A “Win” for Physicians MedEncentive is

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 MedEncentive is

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

Pending partnerships

AMA

Connecticut State Medical Society

Idaho Academy of Family Physicians

PCPCC

Others...

Growing relationships with physician organizations...




What is in the future
What is in the future... Employers

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...


More affordable healthcare Employers

Ultimate Objective

Improved health

Better healthcare

Goals that support the Ultimate Objective

Wellness and prevention

Google and Microsoft

Personal health records

Smoking cessation

Merck

Rx compliance

e-prescribing Rx

Wellness and medical interventions that support the Goals

PCPCC

Patient centered medical home

Physician directed disease mgt

Weight mgt

Patient directed precertification

Existing customers

Adoption of health IT

Health risk assessment

Patient health literacy

and empowerment

Provider application of

evidence-based medicine

Catalyst that recruits and motivates doctors and patients to the interventions

Doctor-patient interactive incentives that achieves “mutual accountability”

Pyramid of Health and Healthcare Transformation


Success Acknowledgment


What forrester research said about phr adoption
What Forrester Research said about PHR adoption Employers

  • 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


3/8/2008 Employers

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 as another co-brand-ing opportunity and a vehicle for other patient communica-tions


Success acknowledgment an important final step
“Success Acknowledgment” – An important final step Employers

Success Acknow-ledgment creates another important check and bal-ance that is de-signed to achieve mutual account-ability between the doctor and the patient.

Congratulations for completing your informa-tion 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 accomplish-ments, 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



Types of health objectives that can be integrated with MedEncentive’s Success Acknowledgment Reward System…

The first health objective is cur-rently available for acknowledgment

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® sessions14 times in: July 2010

  • Executed a living will on: July 14, 2010

  • Completed obesitytasks assigned by my Healthways® Care Support coach on: July 20, 2010

  • Updated my personal health record on: July 31, 2010

  • The remaining health objectives are a sampling of additional interven-tions that can be conveyed electron-ically by contracted vendors to MedEncentive for inclusion in the Success Acknow-ledgment PHR Re-ward System...

Next

Exit


Actual phr test import
Actual PHR test import... MedEncentive’s Success Acknowledgment Reward System…

  • The health accom-plishments listed on the previous slide can be uploaded into the PHR in total or selectively by the patient as illustrated


Phr is updated
PHR is updated... MedEncentive’s Success Acknowledgment Reward System…


This essentially completes the medencentive success acknowledgment phr patient session
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
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
Physician acknowledgment webpage… accomplishments of their patients by email or fax…

  • 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…

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:

Save to import to electronic medical record

Print for paper chart


Phr is updated1
PHR is updated... accomplishments of their patients by email or fax…


Patients receive a confirmation email
Patients receive a confirmation email… accomplishments of their patients by email or fax…

  • Patients are in-formed when their doctors ac-knowledge their health successes

  • Patients are also informed if their doctors have not responded and are encouraged to contact their doctors to earn the rewards

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


The value proposition
The Value Proposition accomplishments of their patients by email or fax…

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 proposition1
The Value Proposition accomplishments of their patients by email or fax…

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... accomplishments of their patients by email or fax…


What have we learned

What have we learned? accomplishments of their patients by email or fax…

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
What value does MedEncentive offer or what purpose does it serve going forward?

Leonard Schaeffer, former CEO and Chairman of Wellpoint-Anthem 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

National Business Group on Health/Towers Watson Employer Survey Supports MedEncentive

  • large employers expect health inflation in 2010 will again be two to three times the rate of overall inflation at 6.5%;

  • employers cite employee and dependent health behaviors as the principal driver of cost;

  • employers recognize that incentives are needed to shape employee health behaviors; and

  • employers feel that solutions offered by health plan vendors to improve health behaviors and control costs are inadequate.

2010 annual survey of America’s largest corporations found the following:


National business group on health hewitt employee survey supports medencentive

National Business Group on Health/Hewitt Employee Survey Supports MedEncentive

  • 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

2010 annual survey of America’s largest corporations found the following:

“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

  • We must Supports MedEncentive“triangulate”

the interests of the payer, physician and consumer to achieve sustained cost containment.

Key points…

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.

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.

Information therapy is only the first of multiple medical interventions that can be integrated with MedEncentive.


Q a jeff greene jgreene@medencentive com 405 319 8450 www medencentive com

Q&A Supports MedEncentiveJeff [email protected]


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