Mutual Accountability and Information TherapySecret weapons in cost containment

Jeffrey C. Greene, CEO and Founder MedEncentive, LLC

Significant Developments

in 2011

Independent validation...

...concluding that a system involving mutual account-ability and information therapy...

works...

April 12, 2011 – U.S. patent issued

• The U.S. Patent Office issues Patent No. 7,925,519• This patent describes the method of “doctor-patient mutual

accountability” involving incentives offered by a third party payer, delivered through an Internet or telephonic interface.

• The patent contains 25 separate claims. The large number of claims were needed to capture the subtleties of our solution, which, according to the Patent Office, represents a novel and feasible invention.

• Experts agree that this method will be needed to reform health and healthcare - and to bend the cost curve...

State of Oklahoma enacts a law

• May 19, 2011 - Oklahoma Legislature passes HB1062, a that directs State Insurance Board to conduct a three year pilot with a “doctor-patient mutual accountability” incentive system involving a minimum of 15,000 teachers and State employees...

• Bill passes House 86 to 9 and Senate 46 to 0!• Broad support from Democrats and Republicans and

from labor, business and the medical communities• May 25, 2011 - Signed into law by Governor Fallin

Other States

• Mississippi – April 20• Oregon – May 4• Washington – May 5• Indiana – May 9• National Association of State Personnel Executives

(NASPE) Conference July 16 – 19, 2011 - Tennessee, New Jersey, Colorado, Virginia, and Connecticut…

Background of Solution

• Team – Self-insured business owner, medical practice management expert, practicing physicians, medical academician, health insurance executive

• The Issue - Unaffordable healthcare that is bankrupting us individually, our communities, our businesses and our country

• The Perfect Storm – Intimately engage in poor healthcare consumer and provider behavior

• The Challenge - Align the interests of the key stakeholders to produce a “win-win-win” that results in cost containment by improving health and healthcare…

What We Knew…

• Patient behavior and provider performance drive most of healthcare’s cost• The doctor-patient relationship is special• Existing solutions such as wellness and prevention,

information technology, and care management lack provider and consumer engagement and activation• Incentives work• Internet can be an effective healthcare tool• Patient health illiteracy and poor doctor-patient

communication are major causes of inferior clinical and economic outcomes• Previous attempts to control healthcare costs failed to align

the interests of the insurer, consumer and provider

Employers/Insurers

No health care cost containment solution can be sustained without balancing the interests of the

essential stakeholders...like a three-legged stool

PhysiciansConsumers/Patients

The Key to Health Care Cost Containment

Alignment-of-interests to create a win-win-win proposition

Employers/Insurers

$

PhysiciansConsumers/Patients

The employer and insurer sponsored patient accountability movement...

Requires large financial incentives, which impedes ROI

Patient Accountability•Wellness and prevention•Disease/care mgt

No Physician Accountability

Employers/Insurers

$

PhysiciansConsumers/Patients

Limited to no proof that this approach controls costs...

Provider Accountability•Capitated HMO•P4P•Accountable Care Org.•Episodic care payments•Medical home

No Patient Accountability

The government and insurer sponsored provider accountability movement...

Employers/Insurers

$ $

PhysiciansConsumers/Patients

This model has proven time and again to produce large ROI

Triangulationto

A State of Equilibrium

Mutual Accountability

The MedEncentive approach is fundamentally different...

Program Description

So what is MedEncentive...

MedEncentive is a patented, one of a kind, web-based incentive system designed to control healthcare costs by financially rewarding both doctors and patients for engaging one another in better health and healthcare.

It’s effectiveness has been proven time and again in multiple, multi-year trials, the results of which have been confirmed by independent analysts and academic researchers.

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

Doctors can practice MedEncentive in two ways...

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

• After-the-fact...• As a result normal insurance claims processing,

MedEncentive sends an email reminder• 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?

• 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...

The Physician Log-in Screen

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

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

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 can also tag favorite articles to speci-fic diagnoses, plus view previous information therapy prescriptions to the patient.

• Physicians prescribe information therapy to the patient by selecting one or more relevant articles.

• Ix letter is initially sent by mail, but after first prescription, patient can elect to have future prescriptions sent electronically.

• 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…

Patients are educated with the same guideline content as their doctor - specific to their diagnosis…

•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.

MedEncentive’s patient website provides:

•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

The patient questionnaires create powerful behavior shaping “checks and balances” to the physician’s input and vice-versa when…

Patients must past a health literacy test before moving on…

Patients are given every opportunity to learn the information and pass the test…

Patient must declare their compliance to recommend-ed treatments...

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

•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.

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

3/8/2008

• 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

Timely completion of “information therapy” results in immediate financial reward to patients for compliance

Future Developments

• Patient-centered medical home ROI enhancement

• PHR adoption• Integration with a host of wellness,

prevention and care management programs

Success Acknowledgment

What Forrester Research said about PHR adoption

• 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

• 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

Timely completion of “information therapy” results in immediate financial reward to patients for compliance

“Success Acknowledgment” – An important final step

• Success Acknow-ledgment supple-ments the Infor-mation Therapy Program by creat- ing another im-portant check and balance that is de-signed to achieve even greater 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

Integrating a personal health record (PHR) to Success Acknowledgment...

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…

Next Exit

• 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® sessions 14 times in: July 2010• Executed a living will on: July 14, 2010• Completed obesity tasks 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...

Actual PHR test import...

•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...

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…

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…

•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:

Print for paper chart Save to import to electronic medical record

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:

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.

• 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

PHR is updated...

Patients receive a confirmation email…

•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

Once the doctor acknowledges the patient’s health accomplishments through the MedEncentive web portal, 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 Proposition

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...