Call for Proposals Released: Examining the Effects of Doctor and Patient Participation in the MedEncentive Program on Overall Healthcare Costs

Deadline:

January 31, 2009

Program Area:

Participation/Health Compliance/Quality/Cost Containment

Purpose:

The cost of healthcare is bankrupting individuals, families, employers and businesses, our communities and our country. Everyone agrees that something must be done to fix the problem.

At MedEncentive, that is exactly what we have been doing for more than four years. We recognized that unaffordable healthcare is symptomatic of three root cases – 1) America’s inefficient healthcare delivery system, 2) American’s poor health habits and 3) medical illiteracy. Our unique web-based incentive system addresses these root causes by financially rewarding both doctors and patients for what we call “mutual accountability.” When implemented as recommended, MedEncentive has achieved high levels of patient and physician participation, which has led to substantial healthcare cost containment.

Through this solicitation, we seek proposals for projects to independently examine the effects of MedEncentive’s current information therapy application and other add-on applications on: 1) doctor and plan member participation, and 2) overall cost containment. Additional consideration will be given to proposals that also examine the effects of MedEncentive on the quality of care and clinical outcomes.

Brief Description of MedEncentive:

Unlike any other healthcare cost containment solution, MedEncentive uses financial incentives to recruit both doctors and patients to participate in evidence-based care, health education and self-management. In the process, MedEncentive taps into the doctor-patient relationship through the use of interactive checks and balances to encourage better care and healthier behavior. This revolutionary method of "mutual accountability" aligns the interests of patients, doctors and payers. The result is a "win-win-win" for these key stakeholders.

Description of Participant Opportunities and Requirements:

Employer/Payer Opportunities: The opportunities for employers and payers that choose to participate in the project are: 1) healthcare cost containment; 2) a healthcare benefit enhancement that employees and beneficiaries will appreciate; and 3) the notoriety associated with taking part in an important national evaluation. (Refer to the FAQs section for more information about participation rationale.)

Employer/Payer Responsibilities: Employers and payers will be required to implement the MedEncentive Information Therapy program and pay rewards to plan members and their physicians for successfully completing cost saving tasks. The MedEncentive program will be offered to employer and payer participants at less than cost plus a nominal gain-share if and when cost savings are achieved during the project. MedEncentive will provide planning and implementation at no cost. Employers and payers will be required to actively promote MedEncentive to plan members during the project.

Employees/Beneficiaries Opportunities and Responsibilities: The responsibilities and opportunities associated with the MedEncentive Information Therapy program for employees and beneficiaries can be summed up as:

·         ask your doctor for an information therapy prescription during each office visit;

·         complete your information therapy prescription on MedEncentive’s website; and

·         enjoy your financial reward and better health.

Refer the MedEncentive website (www.medencentive.com) for more on the employee/beneficiary opportunities and responsibilities.

Physician Opportunities – There are numerous benefits that accrue to physicians who participate in MedEncentive.  These include: 1) a means to help patients be more compliant; 2) better patient communications; 3) greater in-office productivity; 4) a measure of malpractice risk management; and 5) a source of additional revenue at an attractive rate of compensation.

Physician Responsibilities: In the MedEncentive Program, physicians need to only enroll once. Once enrolled, physicians earn additional compensation for considering evidence-based treatment guidelines and educating their patients by prescribing what is called information therapy with each office visit through MedEncentive’s website. Practicing MedEncentive takes physicians very little time. It should be noted that the program works best when physicians participate, however, it is not absolutely necessary to have high levels of physician participation in the early phases of implementation to achieve the stated objectives.

Refer the MedEncentive website (www.medencentive.com) for more on the physician opportunities and responsibilities.

Coalition and Health Plan Eligibility & Selection Criteria:

This solicitation is principally directed to coalition members of the National Business Coalition on Health, though other similar type organizations and health plans are encouraged to apply.

Proposals should demonstrate the potential to produce a high-quality, scientifically sound, independent and relevant evaluation of the MedEncentive Information Therapy program. We will assess each proposal based on the degree to which it:

·         is capable of attracting a statistically significant population of 5,000 or more health plan members from coalition employers or health plans for an April 1, 2009 project launch date;

·         is capable of attracting local physician participants over the term of the project;

·         is capable of adopting other MedEncentive applications in the project (see the description of the MedEncentive applications, below);

·         is capable of systematic and accurate collection of overall cost data (from third party administrators), comparison, and data analysis that normalizes variables to isolate the impact of MedEncentive (please describe if your comparative analysis will be trend against a historical baseline or the comparison of the demonstration population’s results against a well-matched concurrent control group or both);

·         is capable of systematic analysis of physician and health plan member participation and satisfaction (healthcare improvement and clinical outcomes analysis is not required but would be considered a plus);

·         describes the project’s deliverables;

·         provides evidence of timely access to necessary data, settings and study populations;

·         documents that the experience, qualifications and time commitment of the investigator(s) and key project staff are adequate for conducting the proposed project;

·         satisfies and justifies the grant budget and timeline (please supply a brief budget itemization); and

·         is clear and concise.

Key Dates:

·                     January31, 2009 (3 p.m. CT) - Deadline for receipt of proposals.

·                     February 15, 2009 – Selection of proposals.

·                     April 1, 2009—Start of projects.

Award:

A minimum of $75,000 is available to each successful coalition or health plan over the three year project.

Additional grants and sources of revenue may be available in conjunction with the project, however coalitions and health plans should propose only on the basis of the stated award amount.

Contact:

Jim Dempster
jdempster@medencentive.com

Related Materials:

·         Proposal Questionnaire – All applicants must respond to the Proposal Questionnaire. Click on this link to view.

·         View Solicitation’s FAQs – Read these frequently asked questions before preparing your proposal. Click on this heading to view.

Description of MedEncentive

The hallmark of MedEncentive’s programs is their use of our unique incentive system to control healthcare costs. Each of MedEncentive’s growing family of programs integrates widely recognized wellness and healthcare solutions with our incentive system to recruit doctors and patients to participate in these solutions. In the process, our methods tap into the doctor-patient relationship to instill a heightened desire to comply with recommended care and healthy behaviors. We refer to this desire to comply as “mutual accountability”, which is an efficient and effective way to improve provider performance and consumer health behaviors.

This project is intended to evaluate the MedEncentive Information Therapy Program. However, consideration will be given to proposals that also incorporate other MedEncentive programs.

Click on the links below to learn more about our current programs:

·         The MedEncentive Information Therapy Program

·         The MedEncentive e-Prescribing and Medication Compliance Program

·         The MedEncentive Health Risk Assessment Program

Description of the MedEncentive Information Therapy Program

Easy to implement and maintain, our Information Therapy Incentive Program has been proving its cost containment capabilities since 2004. The term “information therapy” and its symbol “Ix^®” were coined by Healthwise to mean: “providing patients with the right information at the right time, in understandable terms, so patients can make an informed decision about their health.”

So why did we select Information Therapy as our initial program? Studies show that people who are medically illiterate will consume more healthcare resources. In fact, these studies estimate that as much as 12% of total healthcare costs are associated with medical illiteracy. Worse yet, a medically illiterate person is twice as likely to experience premature death.

A problem closely associated with medical illiteracy is poor doctor-patient communications. Studies have found that:

·         doctors on average interrupt patients in the first 23 seconds of an encounter,

·         patients understand only 15% of what their doctors tell them, and

·         patients comply with their doctors’ recommendations only 50% of the time.

Another well-known study determined that doctors practice recommended care only 55% of the time. Furthermore, the practice of defensive medicine to protect providers against malpractice lawsuits adds 5%-9% to the total cost of healthcare.

All tolled, medical illiteracy, poor doctor-patient communications, non-recommended care and defensive medicine costs employers and insurers 25% or more in healthcare expenditures. These costs are avoidable and that is exactly what the MedEncentive Information Therapy Program does.

So how does this program work?

As with all our products, the MedEncentive Information Therapy Program is designed to engage both patients (beneficiaries) and their doctors. Health plan beneficiaries are introduced to this program by their employer or insurer with the help of MedEncentive’s Employee/Member Kit. Doctors are introduced to the Information Therapy Incentive Program in a variety of ways to include direct mailings, emails, fax notices, professional and practice manager meetings, and telephone calls. But perhaps the most common means of physician introduction is through their covered patients at the time of service.

Physicians can practice the Information Therapy Incentive Program either at the time of the in-person patient visit or after a patient visit during the normal claim-filing process or even later by responding to a MedEncentive email notification. Doctors may choose to access the MedEncentive Web site themselves or delegate this function to their staff. The point is that the program has been designed to be fast, easy and flexible for physicians to use.

Once a doctor accesses the MedEncentive website, the program presents an evidence-based treatment guideline and patient educational content specific to the patient’s diagnosis. The doctor is asked two simple, but direct questions:

·         Are you following this guideline in the treatment of this patient?

·         Which information therapy article do you wish to prescribe to this patient?

That’s it. Fast and easy. In fact, once doctors become familiar with the guidelines and their favorite articles for the diagnoses they treat most frequently, it takes less than a minute to practice the Information Therapy Program. And doctors get paid as much as 20% ($15) more for that office visit.

The doctor’s responses to these questions generate an “information therapy prescription” to the patient at the time of service or via mail or e-mail. If the doctor fails to practice the program, the patient still receives a prescription generated from the insurance claim submitted by the doctor.

The information therapy prescription directs the patient to the MedEncentive Web site where the patient is asked to read the material and answer questions that accomplish five goals:

·         Establish the patient’s understanding of his or her condition and the recommended treatments (i.e. medical literacy)

·         Report the patient’s current health status

·         Record the patient’s declaration of adherence to the recommended treatments

·         Obtain the patient’s authorization to share the patient’s understanding, health status and adherence declaration with his or her doctor

·         Rate the doctor’s care compared to the recommended care the patient just read and demonstrated he or she understood (Since the patient was the only other person present at the time of service, we believe this is the most objective and efficient way of rating doctor performance, especially compared to insurance companies or the government rating doctors based on claims data or physician reported data.)

As the patient answers the questions, he or she scores points toward a financial reward. If the patient accomplishes these five goals, then he or she will earn a financial reward such as a rebate of an office co-payment or a reduction in insurance costs or a credit to a health savings account.

What makes our program unique is that the financial rewards require both doctors and patients to declare or demonstrate compliance against recommended care and healthy behaviors, and then confirm or acknowledge the other party’s declaration. We call this process “declare and confirm.” It is this feature that taps into the doctor-patient relationship to achieve “mutual accountability.”

It follows that when doctors are judged objectively by their patients, they practice better and less costly medicine. More importantly, studies have shown that patients who are medically literate, empowered and motivated by the oversight of their doctors are more compliant and healthier. In effect, patients don’t want their doctors, who they trust and respect, to think they are medically illiterate or non-compliant. Conversely, doctors don’t want their patients to think they practice sub-standard care. MedEncentive uses financial rewards and a system of web-based checks and balances to encourage doctors and patients to respond to one another in ways that promote better medicine and healthier behaviors. We have been demonstrating for a number of years that our system leads to lower costs.

There are other important features to the MedEncentive Information Therapy Program. One such feature involves authorizing and, in fact, encouraging doctors to deviate from recommended treatment guidelines if, in the judgment of the doctor, the guideline does not fit in a particular circumstance. Our program simply asks the doctor to communicate the reason the guideline doesn’t fit to the patient. This is done through a convenient drop-down menu of reasons for deviation, which is conveyed to the patient through our Web site. We then ask the patient to express an opinion as to the doctor’s reason for deviation. This method helps insure that the doctor and patient are communicating, which is a win for the employer/insurer. This “anti-cookbook medicine” feature allows doctors to use their clinical judgment as opposed to force fitting a treatment when it is not appropriate. Only MedEncentive’s program with its process of “declare and confirm” can accomplish this important feat.

Benefits: Through the MedEncentive Information Therapy Program, doctors are well compensated for practicing a higher standard of care without sacrificing their clinical judgment. Our program can also help make doctors faster in clinic because MedEncentive serves as a patient communication tool that is much more effective and efficient than oral instructions.

Patients are financially rewarded for demonstrating medical literacy, declaring compliance to their doctor and for rating their doctor’s performance. More importantly, patients are empowered to gain and maintain better health.

Better performing doctors plus medically literate, compliant, empowered, and motivated patients equates to healthcare cost savings to the employer or insurer.

That’s a Win-Win-Win…

Description of the MedEncentive e-Prescribing and Medication Compliance Program

Everyone agrees that getting doctors to electronically prescribe drug therapies, as opposed to written prescriptions, is an important objective. Congress has in fact authorized the Medicare and Medicaid programs to make incentive payments to doctors for e-prescribing drugs. The MedEncentive e-Prescribing and Medication Compliance Program goes one important step further by engaging the patient in the process. By engaging patients, our program addresses another issue that drives costs higher – patient medication compliance. Conservative estimates place the cost of medication non-compliance at 5% of total costs. It doesn’t take an expert to understand that when patients don’t take their medications or don’t take their medications properly, bad things happen.

The MedEncentive e-Prescribing and Medication Compliance Program is unique in that it financially rewards both the doctor and the patient. Like all our products, this program taps into the doctor-patient relationship to encourage better care performance and improved health behaviors through “mutual accountability.”

Doctors e-prescribe medications through our program in a similar fashion to all other e-prescribing web-based systems. The only difference is that the e-prescribing web-application dovetails with our Information Therapy Program when medications are prescribed during an office visit. As with other e-prescribing programs, we work with the employer or insurer’s pharmacy benefit manager to suggest to doctors less expensive generic drugs and therapeutic substitutions. Doctors are also required to respond to automated drug interactions warnings caused by patients with multiple medications. Just like other systems, our program allows the doctor to select the patient’s preferred in-network or mail order pharmacy and to supply the patient with medication educational material. If available, the doctor can also be notified if and when the patient fills a prescription. Similar to the government’s e-prescribing program, our program will compensate physicians for their time and effort.

Now for the key differences that set our medication system apart. Unlike any other system, our program engages patients by financially rewarding them for accomplishing the following goals:

·         Getting their doctor to e-prescribe (Our tiered financial reward strategies pay patients the most when their doctors participate, which helps drive program success.)

·         Reading medication instructions and passing a drug literacy test

·         Declaring medication compliance

·         Agreeing to have their literacy test and compliance declaration shared with their doctor (This feature taps into the doctor-patient relationship to help improve health behaviors.)

·         Rating their doctor’s medication performance (This represents the other half of MedEncentive’s “declare and confirm” process)

Patients are financially rewarded in a variety of ways to include a full or partial rebate of their drug co-payments, or a reduction in insurance costs or a credit to a health savings account.

Benefits: The first benefit of our program is patient safety. Having doctors e-prescribe medications is simply less prone to mistakes than written or spoken prescriptions. E-prescribing also facilitates the capability to automatically warn doctors of possible drug interactions.  But perhaps the most important patient safety feature that is unique to our program is its capability to educate patients by testing their medication knowledge, and then forwarding test results to their doctors. When patients are educated about their medications, adverse clinical outcomes are less likely.

The second benefit of our program is cost containment. The first key to cost containment is to get doctors to participate. By rewarding patients for getting their doctors to e-prescribe, MedEncentive achieves much higher rates of participation.

Like other e-prescribing programs, cost containment is achieved when doctors prescribe less expensive generic drugs and therapeutic substitutions suggested to them on-line. Unlike other programs, our program also controls costs through patient medication compliance. An educated and compliant patient is less likely to develop a catastrophic condition that results in expensive solutions such as hospitalization.

Through our program, doctors are well compensated for their valuable services. Patients are financially rewarded for becoming educated, compliant and empowered. More importantly, patients realize better health. As a result of doctor and patient participation in our program, employers and insurers realize cost savings.

That’s a Win, Win, Win…

Description of the MedEncentive Health Risk Assessment Program

Health risk assessments are widely recommended as a means to identify health risks within a population of people. The shortfall of risk assessments is the aspect of follow-through and closure to prevent catastrophic health events. In other words, how does an employer or insurer motivate health plan beneficiaries to not only take a health risk assessment, but also follow-through on any risk findings? Furthermore, how can an employer or insurer make sure that the follow-up is appropriate – not too little and not too much?

The MedEncentive Health Risk Assessment Program is specifically designed to engage both health plan beneficiaries and their doctors to follow-through on health risk assessments. MedEncentive integrates with health risk assessment vendors to communicate risk factors to beneficiaries, and then structures financial rewards in a manner that compensates beneficiaries only after they complete the following prerequisites:

·         Lab testing with results directed to the beneficiary’s doctor

·         Physician exam and consultation with the doctor to discuss the risk factors and lab results

·         Demonstrate medical literacy and declare compliance to recommended care through the MedEncentive Information Therapy Program (please refer to description, above)

·         Declare medication compliance, if applicable, through the MedEncentive e-Prescribing and Medication Compliance Program (please refer to description, above)

Benefits: As with our other products, MedEncentive taps into the doctor-patient relationship to create a level of “mutual accountability” that helps insure an appropriate follow-through on health risk assessment findings. By motivating proper follow-through on identified risks, catastrophic health events can be prevented. Furthermore, by incorporating the MedEncentive Information Therapy Program, doctors are encouraged to practice evidence-based diagnostic methods and beneficiaries are empowered to partner with their doctors to prevent unnecessary tests. Beneficiaries are also empowered to self-manage their health, all of which helps control costs.

Beneficiaries win, doctors win and employers-insurers win…