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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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MedEncentive expects significant success. “The key is holding people accountable,” Dempster said. “People don't always understand their options, and doctors don't always do what they should.”

He said studies show doctors interrupt patients after the first 23 seconds, patients understand only half of what their doctor says and only about one-third of patients nationwide fill and take their prescribed medications.

“Take diabetes,“ Dempster said. “We know how to manage it, but it's still going up. We want to educate and motivate people to be an active participant in their health.”

Educating people about managing their own health is the single most important predictor of their well-being and life expectancy, he said.

Concept study

Douglas Bradham, a professor and health economist with the University of Kansas School of Medicine at Wichita, said studies conducted there show MedEncentive works. In respective analysis of data sets involving 527 employees of the City of Duncan, the expected savings for each dollar invested by the employer was $6.94 to $11.02, averaging across five years, Bradham said.

“Savings were primarily seen in hospitalization expenses, including reduced lengths of stay,” he said. Moreover, a similar claims study, involving four years of participation by 1,021 patients of the Wichita Clinic, showed similar rates of return, he said.

Frank Wilson, administrator of the employees group insurance division of the state Office of Management and Enterprise Services, said he's “anxious to see if MedEncentive helps move the needle” in cost-containment by encouraging workers to have relationships with their primary care doctors and avoid expensive visits to the emergency room and specialists.

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, Wilson said.

He said the anticipated costs of the three-year pilot study with MedEncentive is $1.8 million in administrative fees to MedEncentive, or $3 per member per month; $1.9 million in estimated financial incentives awarded to employees and physicians, or $15 each per visit; and $100,000 in implementation fees to Hewlett-Packard, the state's third-party administrator.

“The goal is for the program to more than pay for itself,” Wilson said.

Bipartisan support

The MedEncentive pilot was initiated by House Bill 1062, authored by Sen. Josh Brecheen, R-Atoka, and Rep. Dustin Roberts, R-Durant, and passed during the 2011 legislative session. It had overwhelming bipartisan support, with a unanimous vote by senators and only nine dissenting votes in the house.

“If it at least stagnates the cost, Oklahoma will be a big winner,” Brecheen said.

“Those dollars are needed to go into classes, bridges and prisons,” he said.

An emergency room doctor for Integris Health, State Rep. Doug Cox, R-Grove, said he supports the initiative, first to improve patient care and second, to balance the state budget.

“If we can standardize care for patients, especially those with common illnesses, and get them the right treatment early,” Cox said, “We can prevent many ER visits and hospital readmissions, which will save patients money and insurance companies money.”

Emergency room care is fragmented and the most expensive care, he said. “No one needs to go there, unless they're having a heart attack at midnight.”

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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