I recently had a sandwich prepared with white wheat bread. It is essentially whole wheat bread “disguised” as traditional white bread. The intent I guess is to provide for me a healthier option without me really knowing it. Not sure this qualifies as innovation or marketing.
The same is true of for IBM’s decision as reported in Oct 29th WSJ article regarding dropping co-pays for primary care visits. IBM is one of largest employers in the US and spends about $1.3 Billion on healthcare. Because they are self-insured, they carefully watch every dollar spent in the medical system. It is their belief that they can save significant money by incentivizing folks to use primary care physicians by eliminating co-pays so they can get earlier diagnoses that can save more expensive visits to ER’s and specialists. I will let you decide whether this is innovation or marketing.
Contrast this to the incentive system in Massachusetts “global payment” system which creates tremendous incentives to render as little care as possible. If your care costs less than an annual allotment, then they (medical providers or a hospital) keep the unused amount. While the pendulum on too much care in the US is undeniable, its compete counter of too little is equally as bad.
My post last week on “bundling” creates a financial incentive for a patient to choose a provider within a set system-the patient essentially gets a cash rebate under that demonstration project (side note: this worked real well in the auto industry).
I seriously doubt IBM will save money under their initiative since primary care docs are in a shortage and patients will simply get frustrated and pay the co-pay to see a specialist. All IBM needs to do is look at Massachusetts primary care waiting in their system which is 2–3x national average!However, I do think that all of these marketing tactics can be replaced by real innovation- which would take into account best current evidence, utilization data analysis, and some element of financial incentives to drive patient choices.
Here is a start of a list for PT that tries to couple this concept:
1. Pay patients $20 rebate for seeing a PT for musculoskeletal cervical or lumbar pain. They first follow a simple online or iphone/blackberry app that largely eliminates the major red flags that would guide them to a more appropriate provider. The $20 would be well spent. Savings on imaging and drugs would be astronomical.
2. Any service done thru physician self-referral has an additional $200 co-pay. Routine lab and X-ray would not be included.
3. Patients have zero co-pay if they pro-actively pick their personal family physical therapist who is board certified or resident trained and who actively participates in 3rd party outcomes. Their personal PT also agrees to answer emails/texts/phone calls about routine musculoskeletal complaints and provide a free fall balance screen once the patient turns 60.
Combining evidence and incentives vs. marketing. That just might get us to some real answers.
Thoughts?
