The Mutual Accountability Program (MAP) Jeff Greene CEO February 1, 2016 The State of Oklahoma Mutual Accountability Program Pilot Crisis One Our country needs to be healthier... 3 Crisis Two Our country needs better value from its healthcare delivery system... 4 Crisis Three Our country must contain healthcare expenditures... 5 Solving These 3 Crises Now Has a Name The “Three-Part or Triple Aim” Most precisely defined as simultaneously: 1. improving health and; 2. improving health care; 3. in a manner that leads to lower overall costs and a return on investment in a normally distributed population Heretofore, the Three-Part Aim has never been achieve... 6 The Obvious Solution to These Challenges Motivate Better Human Behavior By combining human factors and systems engineering with web-technology and an array of social sciences… …MedEncentive has developed a patented incentive system that has been independently validated to improve human behavior in a manner that solves the “three-part aim.” How the Mutual Accountability Program Works The Key to Health Care Cost Containment No health care cost containment solution can be sustained without balancing the interests of the essential stakeholders; like a three-legged stool Consumers/ Patients Physicians Employers/Insurers (plan sponsor/risk-bearing entity) Alignment-of-interests to create a win-win-win proposition © 2016 MedEncentive, LLC. All Rights Reserved The employer and insurer sponsored patient accountability movement Consumers/ Patients No Physician Accountability Physicians Patient Accountability • Wellness and prevention • High-deductible consumer$ driven health care • Disease/care management Employers/Insurers (plan sponsor/risk-bearing entity) Requires large financial incentives, which impedes ROI © 2016 MedEncentive, LLC. All Rights Reserved The government and insurer sponsored provider accountability movement Consumers/ Professor Christensen says: No Patient Accountability Patients Physicians Provider Accountability “In other words, ACOs hold caregivers accountable without • Capitated HMO requiring patient accountability. How can this work?” • P4P $ • Accountable Care Org. • Episodic care payments Employers/Insurers• Medical home (plan sponsor/risk-bearing entity) Limited to no proof that this approach produces an ROI © 2016 MedEncentive, LLC. All Rights Reserved The MedEncentive approach is fundamentally different “Triangulation” to achieve the “Three-part Aim” Consumers/ Patients $ Physicians Intermediary $ Employers/Insurers (plan sponsor/risk-bearing entity) This model has proven time and again to produce large ROI © 2016 MedEncentive, LLC. All Rights Reserved How the Mutual Accountability Program Works Plan sponsors (health insurers, employers and governments) underwrite the Program’s costs, arrange to have eligibility and claims transmitted to MedEncentive, pay rewards transmitted by MedEncentive, and then pocket the savings Doctors and patients earn financial rewards immediately after each office visit by voluntarily accessing MedEncentive’s website to complete an information therapy (Ix®) session © 2016 MedEncentive, LLC. All Rights Reserved 13 How the Mutual Accountability Program (MAP) Works Physicians are compensated with each office visit involving a MAP beneficiary for accessing the MAP website to: 1. Enter the patient’s name and diagnosis or respond to an email notice from MedEncentive; 2. Declare adherence or provide reason for non-adherence to an evidencebased treatment guideline related to the patient’s diagnosis; 3. Prescribe educational material from a list of articles relevant to the patient’s diagnosis as “homework” (information therapy - Ix®) 4. Agree to allow the patient to confirm the physician’s adherence to the guideline and educational material or concur with the physician’s reason for non-adherence; 5. Agree to monitor the patient’s education and declaration of adherence through the Program. Takes less than a minute, making participation in the Program one of the most lucrative services rendered in clinic. © 2016 MedEncentive, LLC. All Rights Reserved The Information Therapy (Ix) Program Basics ▪ First step – Tell the patient whether or not an evidence-based guideline fits Anti-cookbook medicine feature © 2016 MedEncentive, LLC. All Rights Reserved The Information Therapy (Ix) Program Basics ▪ Second step – Prescribe information therapy to the patient as “homework” Educational articles listed in relevancy to patient’s diagnosis © 2016 MedEncentive, LLC. All Rights Reserved How the Mutual Accountability Program (MAP) Works Patients earn back some or all of their office visit co-payment (typically $15 to $25) by accessing the MAP website, in response to an information therapy prescription letter sent to their home after each office visit, to: 1. Read the prescribed educational article relevant to their diagnosis; 2. Demonstrate their understanding of the article by passing an open-book test and/or declaring their comprehension; 3. Declare their adherence or provide a reason for non-adherence to the article’s recommendations; 4. Agree to allow their physician to review their comprehension and declaration of adherence or reason for non-adherence; 5. Rate their physician’s performance against what they’ve read and the physician’s declaration of adherence or reason for non-adherence to the recommended treatments. © 2016 MedEncentive, LLC. All Rights Reserved Why the Mutual Accountability Program Works Understanding how motivators function is essential... • Financial incentives are like a sugar high - very powerful, but they don’t last very long • Interpersonal relationships (what others think about us) are powerful and long lasting motivation • Knowledge is empowering, motivational and can last a lifetime Harnessing the power of these three motivators in a systematic manner is the key to improving human behaviors and controlling cost © 2016 MedEncentive, LLC. All Rights Reserved Mutual Accountability Program’s Scientific Basis Health literacy is the single strongest determinant of life expectancy and how much health care a person will consume in a lifetime. 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 What you don’t know can kill you… and can also bankrupt you Northwestern and Emory researchers found that health literacy is directly correlated to life expectancy Multiple studies compiled by the U.S. government found that health literacy is directly correlated to healthcare costs When people know the “how” and “why,” they are more empowered and motivated to comply with recommended treatments and adopt healthy behaviors. Behavioral science calls this the: Knowledge-Adherence Response This helps explain why the MedEncentive Program’s “information therapy” feature is so important. 22 Mutual Accountability Program’s Scientific Basis The Hawthorne effect is a psychological phenomenon that produces an improvement in human behavior or performance as a result of increased attention from superiors or persons in positions of authority and trust. In all cases, observed individuals behave or perform better than unsupervised individuals for a limited time if they suspect or know about the observation. 23 Overwhelming evidence indicates that the motivators present in the doctor-patient relationship influence behaviors... Doctor-Patient Relationship Influences Patient Engagement Release Date: November 29, 2011 | By Valerie DeBenedette, Contributing Writer Research Source: Center for Advancing Health Behavioral science refers to this phenomenon as the... Researchers asked 8,140 people in the U.S. with chronic illnesses about their experiences with their physicians, as well as about their Authority-Adherence (Obedience) Response socioeconomic status, overall health and how they make use of health services. is analogous to the Hawthorne Effect ...which Patients who perceived their physicians were involved in their carehelps were explain more likely monitor their bloodProgram’s pressure, exercise This whytothe MedEncentive “mutual five days a week and adhere to medication regimens, among accountability” feature is so important. other healthy behaviors. Harnessing the power of three motivators in a systematic manner is the key to improving human behaviors and controlling cost Program is effective because it: 1. Uses “precision-guided financial rewards” to... 2. Invoke the Hawthorne Effect and customer psychology by tapping into the doctor-patient relationship to cause a state of “mutual accountability” 3. Advance patient health literacy with what is called “information therapy” © 2016 MedEncentive, LLC. All Rights Reserved 25 The Mutual Accountability Program works because... 1. Patients don’t want their doctors to think they are health illiterate and non-compliant 2. Doctors don’t want their patients to think they practice substandard care 3. Health literacy and the Hawthorne Effect causes an improvement in medication adherence and other types of patient compliance 4. Service and image psychology causes healthcare providers to improve their performance 5. Hospitalizations decline 6. Patient accountability relieves some degree of defensive medicine 7. Cost are contained to the point a return on investment is realized Measuring How Well the Program Works Trial results and independent analyses Five year report examined the results of 7 trial installations... © 2016 MedEncentive, LLC. All Rights Reserved After reviewing MedEncentive’s Five Year Report, researchers at the University of Kansas School of Medicine (KUSM) summarized the findings in this poster, which was presented in October 2009 at the National Institutes of Health Conference on Health Literacy in Washington, DC. This earned KUSM a grant to study the results of two of MedEncentive’s trial installations, which are reported on the subsequent slides. MedEncentive’s Estimated Impacts on Employer’s Costs of Insurance and Individual Healthcare Costs: a Preliminary Case Study • Douglas D Bradham, Dr.P.H., Kansas Health Foundation Distinguished Professor of Public Health – Health Economist • Nikki Keene, MA, MPH, PhD Candidate – Behavioral Psychologist • Traci Hart, PhD , Research Assistant Professor – Human Factors Psychologist • Phillip Twumasi-Ankrah, PhD, Assistant Professor - Biostatistician • Amy Chesser, PhD, Research Assistant Professor – Healthcare Communications Department of Preventive Medicine and Public Health University of Kansas, School of Medicine – Wichita The Kansas Trial The Trial In the 2½ years afterOklahoma the Wichita Clinic implemented the Over a four yearProgram: period after implementation, the City of MedEncentive Duncan employee health plan realized a savings of • Office visits increased 13% between $3.1 and $17.7 for each $1 invested in the • MedicationProgram. adherence reported at 94% MedEncentive • Hospitalizations decreased 55% (Validated non-catastrophic and total claims expenditure against average trend over 4 years) Refer to University of Kansas School of Medicine research abstract and poster (following slide) • Located in Pasco, Washington • Founded in 1916 • Faith-based hospital system The Loomis Company Analysis of MedEncentive at • 1,100 health plan members award winning insurance Wyomissing, Pennsylvania-based Lourdes Health Network services company • Unionized workforce Founded in 1955, family-owned and to operated • Escalating healthcare costs prior adopting the Tom Forsbeg, The Loomis Company MedEncentive Program in 2008 Offices located across the country • Anparty Ascension Health facility Third administrator for Lourdes Health Network The Washington Trial • • • • Over $3M savingsvs.inHow lastcan three Three yearQuestion: savings MedEncentive program Causality theyears ROI be investment 12:1 ROI attributed to=MedEncentive? Answer: As participation in Health MedEncentive went up, health Lourdes Network Return on Investment in the MedEncentive Program literacy and medication adherence increased, while hospitalizations declined, which produced the savings... $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $0 “After analyzing the results from MedEncentive’s trials, we are impressed with the firm’s approach to mitigating healthcare costs by promoting health. Because of our confidence in the MedEncentive Program, we will provide a discount on Sun Life Stop-Loss premium to customers who participate in the program.” Scott Beliveau, Sun Life Financial Stop-Loss Vice President No stop-loss carrier has ever publically endorsed a health improvement program. Now three of the top-ten have... ...Sun Life, AIG and IHC Risk Solutions. What Others Say “After analyzing the results from MedEncentive’s trials, we are impressed with the firm’s approach to mitigating healthcare costs by promoting health. Because of our confidence in the MedEncentive Program, we will provide a discount on Sun Life Stop-Loss premium to customers who participate in the program.” Scott Beliveau, Sun Life Financial Stop-Loss Vice President “While we’ve saved millions of dollars over the years with our wellness program and MedEncentive, the most important attributes about MedEncentive are how much our employees appreciate the program, how simple it is to maintain and how very little administrative support is required. It has been a win for our organization, our employees and our physicians.” Shannon Douglas, Compensation/Benefits Manager | Human Resources Lourdes Health Network “We are very pleased with how easy the MedEncentive Program was to implement and how very little time is needed in support of this program. Our employees like the program and participation has reached over 65% within 6 months with very little effort on our part.” Erica Pridy, Benefits Director Heyco Products, Inc. Toms River, New Jersey “This is great! I like the information and getting paid to take better care of myself is the BEST idea ever!”- Elayne (Patient) “This program is easy to use! I have found the information relevant to my health care needs. The articles are easy to read and the questionnaire is quick to fill out. I appreciate this opportunity to earn some cash!”- Rhett (Patient) “This is a wonderful program. One of very few targeted to personalize my healthcare & physician relationship. I will continue to take advantage of this program as long as it is offered.”- Rita (Patient) “...I see it (MedEncentive) as a tool that’s been a blessing for me and my patients.” Jenny Vickrey, M.D., Washington state obstetrician-gynecologist and MedEncentive practitioner “MedEncentive is easy and quick to use... I think it serves as a good second opinion for me and provides valuable information to my patients. And to top it off, the program increases my reimbursement and my patients are very motivated to get their co-pays back.“ 35 Todd Clapp, M.D., Oklahoma Internal Medicine and Pediatrics, INTEGRIS Health The State of Oklahoma Mutual Accountability Program Pilot The Mutual Accountability Program (“MAP”) Pilot Project A three-year pilot involving a cohort study using an appropriate scientific •methods After reviewing the MedEncentive Program and the independent The bill that launched the pilot costs (HB1062) passed by the to principally compare per-capita of an intervention group covered that validated the program’s cost savings capabilities, by studies the MAP, comprised at 46-0 least 15,000 HealthChoice beneficiaries of schools Oklahoma Senate and the House 86-9. Broad are involved in ofthe largest health improvement/ districts, Statefrom agencies and local governments concentrated in seven Oklahoma State legislative leadership approached MedEncentive support Democrats and Republicans and fromcounties, cost containment (Three-Part Aim) experiment against a control group consisting of the remaining HealthChoice enroll-ment of about conducting a pilot with State agencies and public school organized labor,public business the medical ever attempted in the U.S.and approximately 110,000 sector employees and their communities families. The State of Oklahoma and MedEncentive districts. due to the MAP’s independent validation and MedEncentive’s willingness to subject the MAP to a public • The trial.fact that MedEncentive is one of the few vendors willing to MUTUAL ACCOUNTABILITY PROGRAM PILOT put is program to the test in a publicly scrutinized, matched-cohort study spoke volumes to the legislators and the governor. • In a time of severe polarization of the subject of health reform, no other health reform measure has been passed by an elected body in the U.S., unanimously. State of Oklahoma Pilot Patient Activity Metrics that predict success Based on our 10 years of experience, the strongest determinant of a return on investment is the Patient Success Rate Patient Success Rate = the total number of information therapy sessions ÷ the total number of office visits incurred by the covered population In our previous trials, a Patient Success Rate of 55% or greater produced a ROI in each instance Information therapy session patient testimonials and questionnaire responses are also indicators of Program efficacy 39 Overall HealthChoice Member Success Rate Progression 44.99%* as of March 14, 2014 53.72%* as of June 14, 2014 56.13%* as of September 30, 2014 57.18% for year ending December 31, 2014 58.73% for year ending March 31, 2015 60.02% for year ending June 30, 2015 61.16% for year ending Sept 30, 2015 * Success Rates computed over less than a year should be considered unofficial 40 State of Oklahoma HealthChoice Annual Member Activity By Employer Total Patient Total Patient Total Patient Total Patient Patient Ix Successes Ix Ix Successes Ix Misses Success Rate and Misses Opportunities GARFIELD COUNTY RWD #5 14 14 0 14 100.00% STEPHENS COUNTY RWD & SWM #1 14 14 0 14 100.00% TOWN OF NORTH ENID 23 22 1 23 95.65% NORMAN HOUSING AUTHORITY 119 95 24 119 79.83% JEFFERSON COUNTY 271 216 55 271 79.70% OKLAHOMA DEPARTMENT OF CAREER & TECHNOLOGY EDU 2,088 1,661 427 2,088 79.55% OKLAHOMA STATE BUREAU OF INVESTIGATION 1,648 1,221 427 1,648 74.09% OFFICE OF THE LIEUTENANT GOVERNOR 47 34 13 47 72.34% CUSHING PUBLIC SCHOOLS 818 587 231 818 71.76% STILLWATER PUBLIC SCHOOLS 3,501 2,444 1,057 3,501 69.81% DEPARTMENT OF COMMERCE 534 368 166 534 68.91% MOORE-NORMAN TECHNOLOGY CENTER 1,015 686 329 1,015 67.59% DEPARTMENT OF AGRICULTURE 1,973 1,318 655 1,973 66.80% MUSTANG PUBLIC SCHOOLS 3,576 2,349 1,227 3,576 65.69% NORMAN PUBLIC SCHOOLS 7,231 4,691 2,540 7,231 64.87% OKLAHOMA INSURANCE DEPT 559 362 197 559 64.76% DUNCAN PUBLIC SCHOOLS 2,097 1,350 747 2,097 64.38% OKLAHOMA CITY HOUSING AUTHORITY 578 365 213 578 63.15% OFFICE OF MANAGEMENT & ENTERPRISE SERVICES 7,088 4,454 2,634 7,088 62.84% OKLAHOMA MILITARY DEPARTMENT 1,308 821 487 1,308 62.77% YUKON PUBLIC SCHOOLS 2,290 1,433 857 2,290 62.58% PERKINS-TRYON PUBLIC SCHOOLS 545 341 204 545 62.57% STEPHENS COUNTY RWD #5 44 27 17 44 61.36% All Customers 68,459 41,871 26,588 68,459 61.16% OKLAHOMA HEALTH CARE AUTHORITY 2,816 1,721 1,095 2,816 61.12% ENID PUBLIC SCHOOLS 4,099 2,458 1,641 4,099 59.97% CLEVELAND COUNTY 1,554 932 622 1,554 59.97% STEPHENS COUNTY 594 354 240 594 59.60% J D MCCARTY CENTER 1,543 916 627 1,543 59.36% STILLWATER HOUSING AUTHORITY 56 33 23 56 58.93% CANADIAN COUNTY 1,032 601 431 1,032 58.24% OKLAHOMA TOURISM & RECREATION 1,907 1,100 807 1,907 57.68% OKLAHOMA HISTORICAL SOCIETY 566 320 246 566 56.54% OKLAHOMA CORPORATION COMMISSION 2,455 1,365 1,090 2,455 55.60% OKLAHOMA CENTER FOR ADVANCEMENT OF SCIENCE & TECHN 76 42 34 76 55.26% Goal 55.00% OKLAHOMA EDUCATIONAL TELEVISION AUTHORITY 248 136 112 248 54.84% CITY OF RUSH SPRINGS 41 21 20 41 51.22% STEPHENS COUNTY RWD & SWM #3 4 2 2 4 50.00% OKLAHOMA CITY PUBLIC SCHOOLS 13,998 6,960 7,038 13,998 49.72% CITY OF WAURIKA 61 28 33 61 45.90% GARFIELD COUNTY RWD #6 22 9 13 22 40.91% CITY OF GARBER 6 0 6 6 0.00% Customer 41 2015 Member Comments MedEncentive Accountability/I In 2015, Mutual Plan Members offeredx Program Patient Comments About Program Complaints - Program 2% Suggestions Requests 17% 3,008 voluntary comments through the Program Testimonials Program 81% 42 Lots of patient testimonials... “This is great! I like the information and getting paid to take better care of myself is the BEST idea ever!” Elayne April 24, 2016 “This is a wonderful program. One of very few targeted to personalize my healthcare & physician relationship. I will continue to take advantage of this program as long as it is offered.” Rita May 2, 2016 “This program is easy to use! I have found the information relevant to my health care needs. The articles are easy to read and the questionnaire is quick to fill out. I appreciate this opportunity to earn some cash!” Rhett May 25, 2016 Some complaints... “This is all part of a stupid system that keeps clerical people employed.” Eric February 9, 2016 Some patient comments are hilarious... “This is not a great program for hypochrondiacs!(sp)” Lindsey October 13, 2014 Hawthorne Effect – Doctors’ Influence on Patients’ Compliance On a scale from 1 to 10, with 10 being the most, how important is it to you that your doctor is aware that you are trying to accomplish or are accomplishing health objectives? State of Oklahoma MAP Pilot Hawthorne Effect (2016 YTD) 10.00 9.00 Doctors' Influence on Patients' Compliance 8.94 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 On a scale from 1 to 10, with 10 being the most, how important is it to you that your doctor is aware that you are trying to accomplish or are accomplishing health objectives? Health Literacy – Impact of Program’s Information Therapy On a scale of 1 to 5 (5 being the most), how helpful has this article’s information been to you in managing your disease or condition, or in maintaining your good health? State of Oklahoma MAP Pilot Knowledge-Adherence Response 5.00 4.50 2016 YTD 4.15 4.00 3.50 3.00 2.50 2.00 1.50 1.00 Using the following scale (5 being most helpful), how helpful has this article’s information been to you in managing your disease or condition, or in maintaining your good health? The Mutual Accountability Program saves lives… 48 State of Oklahoma Pilot Provider Activity Actual Provider Successes vs. Goal 50 New Provider Website Advocacy Designation © 2016 MedEncentive, LLC. All Rights Reserved Mutual Accountability Program Provider Advocates Provider Full Name Jennifer Acuna, PA Jerome L. Anderson, MD Randal Scott Baker, MD William F. Barnes, MD Douglas Wayne Brant, MD Jesse Ray Campbell, MD Craig Carson, MD Max G. Cates, MD Mary Chambers, MD Susan Chambers, MD Stephen Connery, MD Brian Ellis, MD Glynda Fox, NP Emily Friedman, MD Susan Grandle, NP Alecia A. Hanes, MD Michael Hartwig, MD Christopher Michael Herndon, MD Colin Hill, PA Deborah Huff, MD Russell Ingram, MD Mark Kowalski, MD Specialty Physician Assistant Cardiovascular Diseases General Surgery Urology Family Medicine Internal Medicine, Pediatrics Rheumatology Family Medicine Obstetrics & Gynecology Obstetrics & Gynecology Family Medicine Pediatrics Nurse Practitioner Neurosurgery Nurse Practitioner Pediatrics Family Medicine Family Medicine Physician Assistant Obstetrics & Gynecology Family Medicine Orthopedic Surgery, Sports Medicine City Oklahoma City Oklahoma City Stillwater Oklahoma City Bethany Edmond Edmond Oklahoma City Norman Oklahoma City Norman Norman Stillwater Oklahoma City Oklahoma City Yukon Perry Duncan Woodward Oklahoma City Bethany Oklahoma City State OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK 52 OK What physicians say... “MedEncentive is easy and quick to use... I think it serves as a good second opinion for me and provides valuable information to my patients. And to top it off, the program increases my reimbursement and my patients are very motivated to get their co-pays back.“ Todd Clapp, M.D., Oklahoma Internal Medicine and Pediatrics, INTEGRIS Health “...I see it (MedEncentive) as a tool that’s been a blessing for me and my patients.” Jenny Vickrey, M.D., Washington state obstetrician-gynecologist and MedEncentive practitioner © 2016 MedEncentive, LLC. All Rights Reserved MedEncentive has retained the Validation Institute to confirm our claims 54 State of Oklahoma MAP Pilot Preliminary Results Group covered by MAP 2.5% decline in total PMPY costs translated to $1.7 million savings and a 2.4:1 return on investment in the first year of the pilot Mutual Accountability Program Return on Investment Pilot's First-Year (2014) Result $3,500,000 $3,000,000 $2,942,044.60 $2,500,000 $2,000,000 $1,719,137.41 $1,500,000 $1,222,907 $1,000,000 Equates to 2.4 to 1 ROI $500,000 $0 Gross Savings MAP Costs Net Savings State of Oklahoma MAP Pilot Preliminary Results Group covered by MAP demonstrated a 10.5% greater decline in hospitalizations per 1,000 compared to the control group in the pilot’s first year Mutual Accountability Program Hospitalizations per 1,000 Pre- and Post-Implementation Trends 0.0% -2.0% -2.0% -4.0% -6.0% -8.0% -10.0% -10.5% -12.0% -12.5% -14.0% Difference Between Baseline Trend and Current Year Control Intervention Difference State of Oklahoma MAP Pilot Preliminary Results Group covered by MAP demonstrated a 4.7% greater decline in emergency room visits per 1,000 compared to the control group in the pilot’s first year Mutual Accountability Program Emergency Room Visits per 1,000 Pre- and Post-Implementation Trends 10.0% 9.1% 8.0% 6.0% 4.5% 4.0% 2.0% 0.0% -2.0% -4.0% -4.7% -6.0% Difference Between Baseline Trend and Current Year Control Intervention Difference Michigan Medicaid Pilot Proposal • Q&A • Discussion Jeff Greene jgreene@medencentive.com 405-319-8452