Michigan Purchasers Health Alliance
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Transcript of Michigan Purchasers Health Alliance
Michigan Purchasers Health Alliance
MedEncentive Goes to Lansing
A Proposal to the State of Michigan
Presented by Dale Moretz
September 27, 2012
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Michigan Purchasers Health Alliance
• First, a Review of MedEncentive
• Identification that 2 major issues are:
• - Medical Illiteracy
• - Poor Physician/Patient Communication
“What factor is the strongest indicator of an individual’s health status? Is it age, income
level, race, or health literacy? Would it surprise you to know that it is literacy skills?” says Barbara A. DeBuono, MD, MPH, chair of
the Board for Partnership for Clear Health
Communication at NPSF.
The first issue that needs addressed is
health illiteracy
Northwestern and Emory Research
TeamMortality Rate Based on Medical Literacy
19%
40%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Literate Illiterate
Fiv
e Y
ear
Mo
rtal
ity
Rat
e
Poor doctor-patient communications…
• A battery of studies have determined:
• Doctors interrupt patients within the first 23 seconds
• 15% of patients fully understand their doctor
• 50% of patients comply with doctors’ orders
• Causes misdiagnosis, inferior clinical outcomes, malpractice, and higher costs
Employers/Insurers(plan sponsor/risk-bearing entity)
Physicians
No health care cost containment solution can be sustained without balancing the interests of the
essential stakeholders...like a three-legged stool
The Key to Health Care Cost Containment
Alignment-of-interests to create a win-win-win proposition
Consumers/Patients
Employers/Insurers(plan sponsor/risk-bearing entity)
$ $
PhysiciansConsumers/
Patients
This model has proven time and again to produce large ROI
Mutual Accountability
The MedEncentive approach is fundamentally different...
$ Savings
Triangulation
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.
So what is MedEncentive...
The Program basics...• Plan sponsor underwrites Program and pockets the savings
• Doctors and patients can earn financial rewards immediately by voluntarily accessing MedEncentive’s website in conjunction with each office visit
• Patients earn back their office visit co-payment (experimented with $5 to $30)
• Physicians are compensated $15 with each office visit
MedEncentive: Does it work?Independent studies of the healthcare cost containment
capabilities of the MedEncentive Information Therapy Program
Jeffrey C. Greene, CEO and Founder MedEncentive, LLC
Amy Chesser, PhD, Research Assistant Professor, Department of Preventive Medicine and Public Health,
University of Kansas School of Medicine
Tom Forsberg, Benefits Consultant, The Loomis Company
Economic Case Study of City of Duncan (in south-central Oklahoma)
MedEncentive’s original and longest running demonstration 2004-2011
1. Duncan's population was 22,505 in 2000 census. 2. The City of Duncan enrolled an average of 527 health plan members,
in study period, 2004-2008.
City of Duncan Employer's Return on Investment on the validated non-catastrophic and total claims
• MedEncentive's annual ROIs ranged from: • $3.1 to $14.5 saved for each $1 invested (e.g., patient/
physician rewards and fees), when claims costs were com-pared against the Bureau of Labor Statistics MCPI inflation for claims.
• $5.9 to $17.7 saved for each $1 invested (e.g., patient/ physician rewards and fees), when claims costs were com-pared against the Kaiser/HRET inflation for family coverage premiums.
The Washington TrialThe Loomis Company Analysis of MedEncentive
at Lourdes Health Network
Debbie Hayes, Benefits Consultant, The Loomis Company
• Wyomissing, Pennsylvania-based award winning insurance services company
• Founded in 1955, family-owned and operated• Offices located across the country• Third party administrator for Lourdes Health Network
• Located in Pasco, Washington• Founded in 1916• Faith-based hospital system• 1,100 health plan members• Unionized workforce• Escalating healthcare costs prior to adopting the
MedEncentive Program in 2008• An Ascension Health facility
Patient and physician participation in MedEncentive increased and cost per member per year decreased
Projected healthcare cost per member per year increased while Lourdes’ actual all-in PMPY costs decreased
• Two year savings vs. MedEncentive program investment = 13:1 ROI
Two Year Savingsvs. Projection
$1,640,945
Total Investment $124,774
1 Projected values based on average of Kaiser HRET Employer Survey, Segal Health Trend, and U.S. Bureau of Labor MCPI
1
Data Source: The Loomis Company
Cost Comparison to Pay-for-Performance plus Wellness Programs
SourceBeneficiary Incentive
Provider P4P Compen-
sation
Program Adminis-
trationTotal Costs
Edington $300.00 N/A N/A $300.00
Credit Suisse N/A N/A $60.00 $60.00
BTE N/A $9.26 $5.76 $15.02
Totals $300.00 $9.26 $65.76 $375.02
MedEncentive $29.12 $6.47 $36.01 $71.60
Difference ($270.88) ($2.79) ($29.75) ($303.42)
Key points…
2. Using “precision-guided, interactive financial incentives” to invoke “doctor-patient mutual accountability” is the most efficient and effective way to control costs through better health and healthcare
3. If we are not improving “patient health literacy” we are not controlling costs. Compensating doctors to prescribe “information therapy” and administer literacy tests, plus rewarding patients for demonstrating their literacy to their doctors is the best way to accomplish this priority
4. Information therapy is only the first of multiple medical interventions that can be integrated with MedEncentive
1. We must “triangulate”the interests of the payer, physician and consumer to achieve sustained cost containment
MichPHA’s Medicaid Proposal
Total Medicaid expenditures in Michigan, with the current Medicaid population, amount to approximately $8 Billion annually, about $1 Billion of which comes from state funds, with the rest being federal funds.
MichPHA’s Medicaid Proposal
With the current Medicaid population, total savings, with a 15% reduction of costs, would be approximately $1.2 Billion annually, about $150 Million of which would benefit the budget of the State.
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MichPHA’s Medicaid Proposal
• Recommended a pilot utilizing Michigan's Federally Qualified Health Centers-- serve a large proportion of Michigan's Medicaid population
• Similar demographics provide a “control”
MichPHA’s Medicaid Proposal
• ERs pay the state and federal taxes that pay for Medicaid
• Uncompensated and under-compensated care is reflected in the published prices for medical procedures, as well as being reflected in the premiums we pay for employee insurance, or reinsurance if we are self-insured
• Failure to achieve and maintain optimum health status for our citizens costs business in terms of absenteeism and unhealthy "presenteeism," and lost productivity
MichPHA’s Medicaid Proposal
Q & A
For more information:
Marilyn H Bell
269-668-4149