Meaningful Use and Pay for Performance – two of the most talked about programs in healthcare IT over the past several years. They are both based on the premise that if you want to drive behavior change among providers and improve quality of care, you need to offer financial rewards to get results.
But what about the consumer? We have now entered a new era in healthcare where the consumer is rightfully front and center – AHIP is even calling 2014 the “Year of the Consumer.” Payers, and other population health managers, who until recently viewed consumers as claims, now want to “engage,” “motivate” and “delight” them.
The challenge, however, is that we are giving consumers more responsibility, but not making them accountable for the quality of care they provide for themselves.
As a country we have spent tens of billions of dollars on Meaningful Use incentives and Pay for Performance programs for clinicians. Providers need to demonstrate they are making the best choices for patients, being efficient and coordinating care.
They need to educate patients and give them access to information based on the belief that if patients are informed, they will take responsibility and action. Unfortunately, this seems like a “Field of Dreams” spinoff – “If we say it, they will act.”
However, that movie has a different ending. The intentions are good, but the flaw is that consumers don’t simply need more information. They need personalized guidance and support, and they need to feel like they have a financial stake in the game.
So the big question is – why aren’t we spending more time thinking about how the concepts behind “meaningful use” and “pay for performance” could be used as a way to get consumers engaged in their health? Yes, clinicians are important as they direct approximately 80 percent of the healthcare spend in our “sick-care” health system.
However, what most people do not realize is that 75 percent of healthcare costs are driven by preventable conditions like heart disease and type-2 diabetes. And while some consumers may throw up their hands and blame genetics for the majority of their health issues, it’s a fact that 50 percent of what makes us healthy is under our control – as opposed to 20 percent for genetics.
So what if we made wearable technologies such as FitBit more “meaningful” for the consumer? Instead of just tracking steps, what if consumers were financially rewarded for taking steps to improve their health (pun intended) through health premium reductions, copay waivers or even gift cards?
Consider a scenario where an individual who was identified as being pre-diabetic and then took action to prevent the onset of diabetes. What if we required that proactive person to pay less in premiums than someone who was not taking any initiative to improve their health? That would clearly be very motivating.
I believe that consumers who take responsibility and show accountability for their health should be rewarded. I am not advocating creating massive government programs like the ones we have seen on the provider side. Rather, I encourage more population health managers to follow the lead of a handful of innovative organizations who are beginning to recognize the power of motivating consumers to optimize their health.
To truly make a difference in healthcare, we need to do more than reshape the system around the consumer. We need to get them involved in a meaningful way by creating meaningful incentives for them to take action.
Michelle Snyder (@mnsnyder) is Chief Marketing Officer at Welltok, Executive in Residence at InterWest Partners and a Start-up Advisor.
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The lower the actuarial value of a plan–the percentage of covered costs the plan provides–the more the patient pays OOP. In the bronze plans this is 60%. They are thinking of a copper plan with an AV of 50%. The more the patient pays, the less sense it makes to tell the patient anything: benefits, drugs, advance directives, etc. At 50% AV one really has a partnership between the insurer and the patient and the structure of the insurance should logically change dramatically so that the insurer listens to the patient…a lot. He should tell the insurer what he wants and he should expect compliance some of the time.
Beneficiary education will help this power shift come about. It is a strange reality.
and performance depends a lot on communication
Allan your suggestion looks great academically but in reality it is not going to work because of various reasons. For example it is already a big debate that is it necessary to spend that much amount in health care as an Meaningful Use Incentive.
Why Should Health Consumers Be Paid for Performance its their health they already get benefit when they get good services if you are thinking to make him/her morally strong then I think its quite helpful.
The marketplace is the most efficient mechanism for people to deal with others and build an economy or progress technologically, etc.
Some have tried to destroy the marketplace in healthcare and seeing that their solutions don’t work try to reinstate it artificially (under their personal control) which generally makes little sense.
Marketplace: willing buyer and willing seller the combination of which increases the size of the pie.
Give me smarter patients and I will give you better results.
I have to disagree MD as Hell.
I think you should have said ‘Give me smarter voters and I will give you better results.’
The logical conclusion of Ms. Snyder’s argument is we need to install monitors in people’s bodies to make sure they are behaving the right way, and lockouts on access to foot and drink to make they behave the right way. If they want insurance, that is. Sound like science fiction? Nope. Technologically feasible.
I prefer the old-fashioned term patient. And the patient’s incentive should be good health.
Very interesting you bring up that point. I deliberately chose the term “consumer” meaning the 85% of people who are “consumers” – they are generally healthy (may have a chronic condition they are managing) most of the time and are thinking about managing controllable health factors and how they can stay healthy and not become a “patient”. I wish everyone valued good health while they had it but unfortunately most people don’t until they become patients..
Financial incentivization of behavior (and sometimes outcomes) has been used for years in as an employer-sponsored health insurance adjunct, sometimes for the whole insured population, sometimes as a disease management tool.
Thank you for the comment. I agree employers have led the way in this regard albeit with mixed results. What I hope to see is going to the next level – don’t just pay people to take fill out HRAs and do Biometric testing – personalize it based on an individuals interests, motivations, health status, benefits, etc. Most programs are a one size fits all for a whole population or a defined population (e.g. all diabetics)
“So the big question is – why aren’t we spending more time thinking about how the concepts behind “meaningful use” and “pay for performance” could be used as a way to get consumers engaged in their health? ” … “We need to get them involved in a meaningful way by creating meaningful incentives for them to take action.”
Sounds like you are looking for a functioning marketplace.
One can dream…..I do believe that as we see more transparency and new competitive dynamics in the market we will start to see if “function” a bit more like other industries – by adding in more rewards/incentives and even loyalty type programs which we know have been successful in other industries it will be very interesting to see if we can shift from our system focus on “sickcare” to “healthcare”
That is what physicians are trained to do, treat sick patients. Preventative care requiring physician involvement is very limited.
In every other industry the customer pays the bill himself.
I absolutely agree and we are moving at least a bit more towards that – average out of pocket spend on healthcare is now second highest across all categories, only below housing. I believe as people have to pay more out of pocket financial incentives will actually have more of an impact.
The patient will become very involved if we let them have their money to spend as they see fit. it will be totally clear what is valued by the patient and what is BS at best and corruption as usual.
They don’t want that to occur because they wish to siphon off a bit for themselves either in money or power.