MedEncentive’s Five Year Report

As many involved in the worlds of Health 2.0 and Information Therapy know, some of the most interesting experiments in the world of patient-physician engagement have been happening in the somewhat unlikely environs of small town Oklahoma. There the City of Duncan has put its employees (and their providers) into a system that incents (but doesn’t mandate) physicians to practice according to accepted guidelines, and incents (but doesn’t mandate) patients to read information prescribed by their physicians about their treatments (and tests them about it). The system then asks each party to rate the other.

It sounds simple and frankly, compared to much in health care, it is. The system is supplied by MedEncentive, an Oklahoma City firm led by the charming and engaging Jeff Greene. While I remain fascinated by MedEncentive’s program (and FD MedEncentive has sponsored the Health 2.0 Conference in the past), it’s perhaps grown a little more slowly than Jeff and other fans might have liked—given the scope of the problem.

But the results have been impressive in reducing costs (mostly by reducing hospitalizations) and increasing patient involvement. Yesterday MedEncentive released a five year retrospective. The key finding?:

City of Duncan costs for the most recent year was 8.6% less than five years ago prior to implementing the Program, which is 34.9% less than the projected costs. The resultant four year savings equates to an 8:1 return on investment. (emphasis added)

Jeff abandoned a lucrative business in physician practice management to have a go at this intractable problem. Five years on he deserves plaudits for what he and his team have achieved, and hopefully we’ll see much more innovation like this mushrooming in the future.

Given the relatively lightweight nature of the intervention, I’m amazed that many much larger payers/employers haven’t given it a try. After all, whatever else they’re doing doesn’t seem to be exactly working too well!

11 replies »

  1. EastCoaster, re: “at least 3 double-blind studies…”, etc – while you’re asking for the world with a fence around it, would you prefer picket or chain-link?

  2. Dave– What I really want for informed consent is at least 3 double-blind studies, naturalistic follow up over several years with the data to prove it and an explanation of their analytical methods. That wouldn’t really be appropriate for the general population, and I suppose that they need to have standard procedures.

  3. @Matthew Holt – This is the study that everyone has been asking for whenever we reference this great example of Ix. Thanks for calling it to everyone’s attention. re. “marketing information” ACK! I’m doing more than shuddering. 🙂 Despite the fact that my job is in marketing, patients should probably immediately recycle any marketing materials they receive from therapy manufacturers. Or at least take them with a large bucket of salt. (no offense fellow marketers)
    @Vikram C – definitely, Information Therapy can help thwart re-admission. In fact that is what Healthwise Ix Patient Instructions and Knowledgebase are designed to do. Note that Patient Instructions are not included in the MedEncentive solution in the study. They are using the Healthwise Knowledgebase – an encyclopedia of consumer oriented health information that can be prescribed by clinicians in P4P programs etc..
    @EastCoaster – I hear you about your disastisfying experience. Not the least of which was the substandard informed consent materials you received. I hope you let your care givers know you wanted better.

  4. It wasn’t information therapy. They gave me other basic level information that wasn’t produced by the device manufacturer, but they were required to give me the information put out by the device manufacturers’, and I had to sign that I had received it.
    And this is generally a very good hospital!. (Its CEO posts on this blog sometimes.) I find that the administrative people aren’t always well-informed about insurance rules, so they tell me 3 weeks in advance that I don’t need to get a referral or it’s somebody else’s responsibility to get it, and then when I get the person who knows what to do it’s 2 days before the procedure, and they tell me taht it takes 3-5 days to get one, since my doctor isn’t in the clinic on certain days.
    Unfortunately, the satisfaction survey forms I get neverf ask about billing.
    For $15 I might read it. For $50 I definitely would,but I wouldn’t really on it. I trust pubmed abstracts and social media more. I realize that I’m not typical. I suppose that I’m just peeved.

  5. Great work there. Just a few points from critic’s perspective.
    1. The savings are just on physician visits and does not cover hospitalization. It does not even cover off-hours visit to EMR.
    2. There is no mention of workplace profile of City of Duncan over the five years. It’s hard to draw realistic conclusion without thata data.
    3. I read MedEncentive’s document and Newt Gingrich’s approval note in it. I don’t think he considered this too seriously. MedEncintive is highly driven by adherance to best practices which require CER program. Newt on other hand has bitterly opposed study of effectiveness in the name of innovation. You can find that debate online at Economist.
    4. I think this program would work very well for discharge and post hospitalization phase to lower re-admissions.
    5. The MedEncintivepaper mentions ‘triangulation’, which to me now means that apart from insurance and providers, now patients also profit from sicknss.

  6. EastCoaster. I dont think this is a replacement for a good physician-patient relationship! It’s an enhancement for that. But the patients AND the physicians do get modest financial rewards for taking part (about $15 a time).
    The authors of the information therapy (Healthwise and others) would shudder if they thought they were issuing “marketing information”. So the “program” (and i use that word loosely) that you were in had little to do with information therapy.
    Eric–I;m sure Jeff Greene wouldn’t be adverse to Intel running a nationwide trial of the MedEncentive program! Perhaps you know someone who can help?

  7. How does it incent patients to read this information, because I’d only want to do it if you paid me good money. I had decided after a consult with my PCP and after doing extensive research that I wanted to get a copper IUD. I had a consult with an OB/GYN who pushed another more expensive IUD, but mostly went on about a whole bunch of options with which I was already familiar. Her attempt to insert the thing failed.
    Then I went to a specialist clinic in the same hospital where they wanted to make sure that I actually wanted the procedure done and they gave me marketing materials (per guidelines) again. Then the resident talked to me about the nuva ring–which is less convenient and more expensive over time. I guess that none of my previous discussions came up in my EMR. And her understanding of drug interactions was pretty weak.
    The resident did a fine job on the actual insertion. She had good hands, but not so many little gray cells. The patient info is so dumb that it drives me crazy. I’m glad to see that it saves money, but I’d need to get paid a hefty sum to read it.

  8. These projects are exactly what we need in order to start exploring how to reduce costs in our healthcare system long-term. It’s a compelling example of how things as simple as increased patient engagement and physician incentives can lead to sustainable change. Our next step should be to expand these sorts of projects into a nationwide research infrastructure that allows us to quickly translate them into new healthcare practices.

  9. Medencentive has a proven track record of reducing costs to employers and patients and at the same time reducing the cost of doctors. Evidence based medicine protocols practiced in a relationship of trust reduces the litigious nature of the patient doctor health system and everyone wins! Incentivized and healthy patients is the result. Keep on Jeff Greene, your vision is materializing as we knew it would!
    Dick Rush

  10. The MedEncentive solution is, as Matthew suggests, elegant in its simplicity. It promotes the long-accepted concept of rewarding desired behavior by all parties involved in a cooperative process, in this case medical treatment. The patient is rewarded financially to become educated as to nature and preferred treatment of the condition at hand and the physician is incented to practice evidence-based medicine or explain why another mode of treatment is preferable. The result is an educated, informed patient who becomes healthy more quickly at less cost. Is there any wonder that it works? Ken Schuerman