MedEncentive’s system allows doc and patient to declare their compliance and then agree to let the other patient confirm the compliance. And their study shows that it works. Here’s the press release on the study and here’s the study in full. (BTW Here’s their agreement with Healthwise).
Jeff Greene the CEO of MedEncentive thinks that he’s got around all the issues that block the intro to P4P (more work, no more money, transparent info they don’t trust, etc). He doesn’t approve of the stratification. “We’ve got to make the bad docs better and the good docs faster”. He thinks that we don’t need to beat up on docs, when the real increases are going to pharma and hospitals.
P4P works if docs accept it, patients are involved, and there is a positive ROI.
How do they do it? Both docs and patients get rewarded immediately when do they something good. Here’s how it works from their release:
Physicians were compensated for accessing MedEncentive’s website to declare compliance to or provide a reason for deviation from evidence-based medicine guidelines and for prescribing information to their patients for each office visit. Patients were instructed to go online to receive the prescribed information about their diagnosis and treatment and to confirm they followed the doctor’s advice in exchange for reimbursement of their office visit co-pay. Both parties were also asked to confirm the others declarations, thus creating a powerful interactive check and balance.
MedEncentive gets a PMPM payment for their service. They authenticate that EBM was used, and when they authenticate that EBM and IX were used, then they pay a spiff to the docs (20% more than standard fee) and they rebate the co-pays to the patients. And it makes overall costs go down (as it reduces hospital and pharma costs).
There’s an ability to deviate off the guideline if they have a good reason, and then they show the patient why later and let the patient comment. (The docs will soon be asked about patient compliance). The patients used computers to access the IX, and the customer (a municipality) set up computers for retirees. The consumers get $30 for reading the Ix material (which is a study and a questionnaire—like online traffic school) and then they ask them to rate the doctor. They aggregate the patients rating per doc and show them the overall score (not individual patients rating).
The docs say that it improves their productivity, as their patients are more informed. And chronically ill patients don’t want their patients to think they’re not compliant.
Jeff thinks that HMOs failed because we put all the incentives on the provider side. Now HSAs are going to put it all on the patient side. He thinks that responsibility needs to be shared and they’re calling it Interactive Accountability.
Results of the study—In Duncan OK, town of 22,000. Set it up for 60 days. Patients told, “ask doc for the info therapy Ix and get money back”, and they hand out Ix pads for docs. They then take the claims data from the employer TPA, and analyze what happened. And of course almost all the savings came from a big reduction in hospital costs. There was also a big reduction in radiology costs (that’s the only specialty that saw a reduction)! The city saw a reduction in overall costs—the city saw a reduction of 11.5% from baseline year to intervention year.