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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. Michigan Purchasers Health Alliance. First, a Review of MedEncentive Identification that 2 major issues are: - Medical Illiteracy

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Michigan Purchasers Health Alliance

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  1. Michigan Purchasers Health Alliance • MedEncentive Goes to Lansing • A Proposal to the State of Michigan • Presented by Dale Moretz • September 27, 2012

  2. Michigan Purchasers Health Alliance • First, a Review of MedEncentive • Identification that 2 major issues are: • - Medical Illiteracy • - Poor Physician/Patient Communication

  3. “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

  4. Northwestern and Emory Research Team

  5. 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

  6. Poor doctor-patient communications…

  7. 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

  8. $ Savings $ $ The MedEncentive approach is fundamentally different... Consumers/ Patients Physicians Mutual Accountability Triangulation Employers/Insurers (plan sponsor/risk-bearing entity) This model has proven time and again to produce large ROI

  9. 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...

  10. 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 • Physicians are compensated $15 with each office visit • Patients earn back their office visit co-payment (experimented with $5 to $30)

  11. 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

  12. Economic Case Study of City of Duncan (in south-central Oklahoma) MedEncentive’s original and longest running demonstration 2004-2011 • Duncan's population was 22,505 in 2000 census. • The City of Duncan enrolled an average of 527health plan members, in study period, 2004-2008.

  13. 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.

  14. The Washington Trial • The Loomis Company Analysis of MedEncentive at Lourdes Health Network Debbie Hayes, Benefits Consultant, The Loomis Company

  15. 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

  16. 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

  17. Patient and physician participation in MedEncentive increased and hospitalizations decreased

  18. Patient and physician participation in MedEncentive increased and cost per member per year decreased

  19. Projected healthcare cost per member per year increased while Lourdes’ actual all-in PMPY costs decreased

  20. Total Investment $124,774 Two Year Savingsvs. Projection $1,640,945 • Two year savings vs. MedEncentive program investment = 13:1 ROI 1 Data Source: The Loomis Company 1 Projected values based on average of Kaiser HRET Employer Survey, Segal Health Trend, and U.S. Bureau of Labor MCPI

  21. We must “triangulate” the interests of the payer, physician and consumer to achieve sustained cost containment Key points… • 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 • 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 • Information therapy is only the first of multiple medical interventions that can be integrated with MedEncentive

  22. Michigan's Medicaid Costs

  23. 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.

  24. 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.

  25. 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”

  26. Savings on Medicaid benefits employers

  27. 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

  28. MichPHA’s Medicaid Proposal • Q & A • For more information: • Marilyn H Bell • 269-668-4149 • mhbell@michpha.org

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