P4P For Patients
August 2, 2008 – 6:00 amIt seems the insurance companies are convinced that money talks. In this little $400,000 experiment, the patients have a 1/10 chance per day to win $10, and a 1/100 chance per day to win $100, that’s about (36.5 x 10) + (100 x 3.65) gives you a minimum of $730 a year (if the stats play out) just for taking your medication as prescribed. Not a bad deal at face value, however, there are at least two BIG problems with this simplistic approach to patient compliance.
1. This is not enforceable. I could pop a pill in my mouth and spit it out later. People have been doing this for years.
2. If patients were put on a medication that gave them side effects and stopped the medication, they’d likely get penalized and cry foul. “No” you say, “the side effect would just have to be reported to the insurance company and the patient wouldn’t get penalized.” Right… we all know that would mean another form per patient per medication for the doctor to fill out… not gonna happen!
If Aetna needs some help figuring out how to spend $400k a little more wisely, I’m sure they have several million customers who would be happy to offer more reasonable suggestions.
2 Responses to “P4P For Patients”
Great to see a post from an MD about Aetna’s Medical Adherence Lottery Trial. I have been wondering what the docs and other front liners think about this trial.
An answer to #1 could be blood tests, however wouldn’t that be creating even more work? and more costs? There is a breathalizer that is being used for another medication adherence study, but I’m sure it would drive the costs up as well.
With #2, it seems as if the Aetna trial is reward only, so if you don’t take your meds (or take the meds out of the pill box) you are not in the running for the prize. Right?
As a clarifications, it is the Aetna Foundation that is paying for the trial, not the insurance company - however the Foundation would not exist without the insurer!
It will be interesting to see the results of this trial and to see if we can “believe” the results and the measurements of true adherence. As you mention, a patient can always spit the pill out - or in this case, just take the pill out of the box to be counted. My prediction is that the trial group will be more adherent, however the real measurement will be which group actually has lower overall healthcare costs.
I would be interested to learn how many of your patients are non-adherent to their meds, how you measure this and what do you do to help them increase their medication adherence?
Thanks!
By Alex Sicre on Aug 6, 2008
Alex,
Thank you for your comment.
I don’t measure medication adherence in my office, but if I had to guess at it, I’d say that I probably have about 50% to 60% adherence. I approach medicine with the idea that I am responsible to provide the patient with information so that they can make an informed decision as to whether or not they will chose a treatment or not. Beyond that, it is the patient’s responsibility to remain adherent. I will rehash evidence and recommendations with them if needed or requested.
By Jonathan Dee on Aug 7, 2008