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.

Holly Miller runs Cleveland Clinic’s MyChart. Cleveland Clinic has rolled out Epic EMR to its main campus, all its primary care clinics and about 25% of its affiliated specialists. Also rolling it out to community physicians who admit to its affiliated hospitals.

MyChart is a complex combination of a view a) into the Epic system, plus b) to their own editorial information plus c) into WebMD content (to which they supply content). The information has been empowering to patients. They can see the visit note, which includes a patient instruction function. The patient can get information about all kinds of stuff based on their own test results, connected to those results, including what the test is, what it means, and what the normal range is (plus whatever note the doctor wants to add). She has one patient who read up on diabetes in conjunction with a physicians visit, realized that she was on the verge of becoming morbidly obese, and read up on how to stop it. 70% of messages sent out are opened in the first week.

They are now starting to have information from diabetics input straight into the system, with immediate feedback on results, including surveys, information, etc, and what to do if the measure is way out of line (It also has histories, etc,etc). They’ve been running the study for a while. Only about 25% are looking at the information links they’re sent, but more are looking at lab results.

They’re pretty serious about this, and have a person who’s job it is to monitor web behavior both in terms of customer service (following up on appt requests within a certain time) and trying to figure out how to move and improve patient online behavior. Keep watching this space….with PAMF, Kaiser and Group Health of Puget Sound, these guys are leaders in the provider-based PHR world.

I’m getting a little late start this morning, and sat through a few talks without taking decent notes. Suffice it to say that Al Mulley talked about reconciling patient and physician expectations which funnily enough are not always the same. Geisinger’s Buzz Stewart is re-engineering the patient visit using structured patient history questionnaires. Ashley Peterson has a 5 years old child with severe developmental disabilities, and is very very active in her clinic in essentially managing the teams of clinicians, therapists et al that help care for her daughter. She’s really helping them redesign how they communicate with patients. She has a life most of us would just not be able to handle and she’s really pushing the barriers. Amazing, harrowing and inspiring.

Next is a session about tools being used for Ix. First up was Janet Wright, a cardiologist from Chico in a paper-based office. She’s trying to do the right thing but her job is close to impossible (similar to the Dr. Mom on THCB lately), and she’s not sure how to handle the year of the “switch” if she puts in an EMR. Then Kate Christensen from Kaiser tells up about KP.org, the patient view into the medical record. Pretty soon they’re adding things like pictures and device-entered data to all the other things that patients can already communicate (questionnaires, instant history). And she thinks that physicians will be engaged. Jeff Levin-Schertz from Partners (Mass General/Brigham) who is in charge of getting their community centered docs on board with EMR and Ix, and by the quotes he showed they’re a crotchety bunch. They offer their home grown Mass Gen system and the GE Centricity system (the old Medicalogic) to their docs, most of what their docs have they can also swivel the screen and show the patients. They do have a patient portal but at the moment it has limited functionality—but they are able to push letters, test results and other information to patients that way. There are some good results from rolling out this EMR and some keen early enthusiastic physicians. But as he says “getting physicians on board with this stuff is not easy.” Anyone who thinks it is, should read the lots and lots of comments to the “Can Doctors Ever Learn To Love The EMR” post from last December.

From the latest Harris data—Everybody wants one; nobody’s got one.

The conference has a series of  little demo sessions which look at new tools for Ix

Medseek. Spend the last ten years building web portals and content management systems for hospitals. Their 4 audiences are patients, consumers, employees and providers/physicians.

Their aim is for personalized, targeted in time and documented. What they have put into the eVisit is delivery of written documentation but done through the web. Henry Ford has implemented the MyHealth personal health site relevant to their site. They have inbox for messages, different transactions and different personalization. All this is within Medseek’s tech world (which lies ontop of their home grown EMR) or adjacent to it.

For the eVisit they first present them with a billing set-up and then a profile creation site (very similar)—then patient is matched to a record number in the HFHS EMR. Then they select their physicians—may have been instructed to do this by their physician, and might be able to tell their usual complaint or introduce a new one. Then they go through a clinical questionnaire of 15–25 minutes (like an instant medical history). Then that is all signed off one and sent to the physician. Typically at HF the doc is in the EMR when they get this and they can see the patients questionnaire. They review it as a clinical note (like a SOAP note).

Then the doc can respond within the work flow. They can either send a (secure) email back to the patient (and keep a thread of the message). The physician can end the visit with a diagnosis and a treatment, which involves entering billing and ICD9 codes. The system can add information content (e.g. Healthwise) to the doctor. That is then all documented as part of the encounter in the EMR.

At the moment HF is not really integrating this with the EMR fully (in terms of giving a health history) but this can be done.

Do already do appt requests, Rx refills. Use a CRM system to manage and mine that, and find that the most profitable patients are their online patients. Around 75,000 appt requests. generated $20m from appointment requests.

For these visits instead wanted to not do unstructured text messages (as a doc). Want instead to get the structured history (which is a version of Primetime’s).

Are not charging if they are a HAP plan member (that’s the captive plan of HFHS) but it’s going to be $20 for others.

As an extension of this HF is doing a study. 50K patients already on the portal and now releasing it for 3 clinics (out of 24) Goal is to have 12 using eVisits, 12 are a control. In a 3 year study want to look at outcomes, work days lost, etc. So we’ll let you know in 3 years.

Enhanced Medical Decisions. Has a new product called DoubleCheckMD

Most drug errors are between drugs that should be taken together, but don’t work for those patients. So they’ve built an online system that can match drugs and symptoms and figures out all the various permutations. Essentially a drug-drug-symptom interaction checker system….that can take consumer data (including OTC weird foods, herbals, grapefruit juice)

Also now are adding more than symptoms—e.g are now reading what lab tests that you should have. Here are the symptoms that you should be looking for.

Interesting product gives you back a list of symptoms from drugs, interactions, next steps and information.

Intended to be an early warning for the consumer (not a provider view) which then tells them to how to work with their physicians. Very early days and not on the web yet but well worth watching.