Employer Incentivized DoctorPatient EvidenceBased Medicine Protocol Adherence Program
Employer Incentivized Doctor/Patient Evidence-Based. Medicine Protocol Adherence Program HR Specialty Products & Services Catalogue Executive Summary A No Frills Distillation of Vendor’s Marketing Collateral Thomas A Ference President & CEO Human Resources Mining & Distribution Co Locating, Validating and Accelerating HR Innovation Office: 219 -662 -0201 Cell: 630 -240 -2583 Fax: 219 -661 -0236 e-mail: tference@hrmdco. com Website: www. hrmdco. com
Employer Incentivized Doctor/Patient Evidence-Based -Medicine Protocol Adherence Program • Payers have developed tactics to make employees accountable (e. g. Value-Based Design, Wellness) and providers accountable (e. g. Episode of Care Payments, Pay-for-Performance) to the benefit plan but not the employee/patient and the doctor mutually accountable to one another • Example: Doctors spend 49 seconds during visit telling the patient what they need to know about taking a new medication • Up to 50% of patients leave their doctor’s office not understanding what they are told to do • This 10+ years-in-the-making, Saa. S-based patented system manages incentives and processes for both the physician and the patient to be guided by evidence-based-medicine protocols
Employer Incentivized Doctor/Patient Evidence-Based -Medicine Protocol Adherence Program • Works where patients receive an “Information therapy (Ix)” and are compensated from the benefit plan for both demonstrating medical literacy and declaring to their doctor compliance with the health recommendations made by their doctor • Also, doctors are equally compensated from the benefit plan for declaring adherence to the evidence based guideline and treating the patient’s medical illiteracy by prescribing “Information (Ix)” • The system manages 117 guidelines that cover between 50% and 55% of the total employer spend • 100% of office visits/diagnoses are covered by Ix, whether the doctor participates or not • Average patient participation rate of 65% • Creates win-win for employer-patient-physician • ROI = Range of 3: 1 to 17: 1 in independent studies
Current Status of Cost Containment & Accountability Solutions Consumers/ Patients No Physician s Yes Employers/Insurers Have Not Produced Consistent , Measurable ROI
Completion of the Accountability Cycle NEW Patient Accountability with Employer/Insurer • Wellness and prevention • High-deductible consumerdriven health care • Disease/care management • NEW Assured adherence to EBM guidelines with Physician • Information Ix • Mutual declaration of adherence to EBM guidelines • Patient & physician dollar incentives paid from benefit plan for adherence • Vendor measured ROI All 3 Stakeholders Aligned Employer/ Insurer EBM = Evidenced Based Medicine Physician Provider Accountability With Employer/Insurer • Capitated HMO • P 4 P • Accountable Care Org. • Episodic care payments • Medical home • NEW Assured adherence to EBM guidelines (or reason for variance)
Six Year Results: Rewarding Better Care, Patient Education and Compliance Lowers Cost Total Investment $333. 367 Six Year Savings vs. Projection $2, 073, 905 Six year program investment vs. “all-in” claims cost = 6. 2: 1
Next Steps • This product/service is contained in the HR Specialty Products & Services Catalogue™ • Operational level details about this particular service provider can be obtained in conference with the vendor • The HR Mining &Distribution Co. is an independent and contracted representative of the vendor • Upon your request, we will arrange for an introduction that can range from a simple, quick conference call to a services overview / system demo • Tom Ference 219 -662 -0201 (Chicagoland area) or tference@hrmdco. com • Thank you for your potential interest in this fresh thinking
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