Medical startup, state partner in pilot study to curb health care costs

Starting Jan. 1, Oklahoma and MedEncentive will enter a three-year, $3.8-million-dollar health care cost-containment study involving 15,000 active Oklahoma state employees and their families.
by Paula Burkes Modified: August 18, 2013 at 3:00 pm •  Published: August 18, 2013
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Washington state obstetrician-gynecologist Jenny Vickrey used to worry about whether her patients understood and remembered everything she told them. There can be multiple reasons, and treatment options, for the symptoms patients commonly have, she said.

But these days, Vickrey said she's more confident about her patients' grasp of their conditions and adherence to treatment. That's because most, she said, are using an Oklahoma Internet-based, patented wellness product that — based on her diagnoses and best medical practices — educates them about, and tests them on, their health.

“I don't know if it's because I'm asking them to, or for a little more cash,” Vickrey said.

Patients who use the product, MedEncentive, get a portion of their co-pays waived, while participating doctors, who are rated by patients based on their adherence to recommended care, are compensated an additional $15 per office visit.

“Whichever, I see it as a tool that's been a blessing for me and my patients,” Vickrey said.

Pilot program

An eight-year-old startup, MedEncentive finally may have received its breakthrough this month, with the announcement of a $3.8 million, three-year study that will begin Jan. 1 and involve 15,000 active Oklahoma state employees and their families on the HealthChoice insurance plan. If the product pays for itself, administrators say MedEncentive will be offered to the entire 125,000 active employees on the plan, the most popular among state workers.

The announcement comes on the heels of a study by Oklahoma Watch, published Aug. 6 in The Oklahoman, which found a state employee's family of four receives an annual allowance of some $19,717 for health insurance under state statutes. While proponents believe the allowance empowers the state to offer compensation packages commensurate to the private sector, opponents feel the benefit — which covers 100 percent or more of workers' premiums — is too generous and doesn't provide adequate incentives for workers to keep their health care costs as low as possible.

Enter MedEncentive, whose executives say their product leads to better health care, better health and, consequently, cost-containment.

Company founder and CEO Jeff Greene said what's unique about the MedEncentive Program is how it uses payer-sponsored financial incentives to reward both doctors and patients for adhering to evidence-based care and healthy behaviors, provided they agree to allow the other party to confirm their adherence or, in the doctors' cases, why they deviated from recommended care.

“Unlike any other solution, this process of doctor-patient mutual accountability triangulates the interest of the payer, consumer and provider,” Greene said. “Most importantly, patients get well, and stay out of the hospital, while doctors practice better medicine,” Greene said.

MedEncentive has some 7,000 patients participating in the program from the city of Yukon to New Jersey, Pennsylvania and Washington, said Jim Dempster, national director of business development.

Doctor's orders

Three of the country's top 10 reinsurers — Sun Life Financial, New York-based AIG and IHC Risk Solutions — have agreed to offer discounts on stop-loss insurance to companies who offer self-funded health plans. But Greene said MedEncentive's goal is to integrate its product into every segment of health plans — not just self-insured health plans, but fully-insured plans and government-sponsored plans.

“We're hoping more insurance companies and employers will take a look at our tool, after we put it to the test in the Oklahoma pilot study,” Dempster said.

Forty-one school districts, state agencies and local governments across seven counties — including Oklahoma City Public Schools, the agriculture and tourism departments, Canadian County and the City of Waurika — have been selected to form the intervention group, Dempster said. The three-year pilot, he said, will involve measuring clinical and economic outcomes of participants against the rest of the HealthChoice population, based on matched ages, genders, locations and other demographics.

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by Paula Burkes
Reporter
A 1981 journalism graduate of Oklahoma State University, Paula Burkes has more than 30 years experience writing and editing award-winning material for newspapers and healthcare, educational and telecommunications institutions in Tulsa, Oklahoma...
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AT A GLANCE

• Following nationwide trends, claims costs for active state employees on HealthChoice, the most popular health insurance plan, have increased by $280.2 million — or 87 percent — over the past 10 years.

• Oklahoma has roughly 495,000 inpatient hospitalizations per year, and about 2.1 million emergency room (ER) visits.

• Among the Oklahomans insured by Medicaid, or roughly one-third of all residents, 4,837 averaged 3.9 ER visits — or 18,773 total — over the fourth quarter of 2010, the latest data available. Totals exclude visits that resulted in an inpatient stay.

SOURCES: Office of Management and Enterprise Services,

Oklahoma Hospital Association and

Oklahoma Health Care Authority.

About MedEncentive

Founded eight years ago, Oklahoma City-based MedEncentive offers a patented Internet-based patient-doctor wellness product aimed at fostering better managed care, and consequently decreased health care costs. Patients save on co-pays if they read about and take a test on their understanding and management of their conditions, based on their doctors' diagnoses and best medical practices. Participating doctors, who agree to be rated by patients based on their adherence to recommended care, are compensated an additional $15 per office visit.

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