Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 10, 2019
Date Accepted: Aug 30, 2019
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Cost containment of an aligned incentive-based health literacy intervention in an employee health setting: A mixed-methods pilot study
ABSTRACT
Background:
The association of health literacy and healthcare costs, particularly hospitalizations and emergency room services, have been previously observed. Further establishing health literacy interventions aimed at reducing costs is needed. The MedEncentive Mutual Accountability and Information Therapy Program is a web-based system designed to improve health and lower costs by aligning patient-doctor incentives and elevating health literacy.
Objective:
This paper reports findings from a mixed-methods pilot study of a web-based, patient-doctor, aligned-incentive and information therapy program, in an 1,800-member employee health plan. The pilot study aimed to determine 1) the program’s quantitative impact on health, healthcare, cost, and utilization; and 2) if users’ survey responses about the program’s perceived value, reflect the quantitative outcomes.
Methods:
This pilot study utilized a mixed-methods, single within-group, pre-post, and descriptive study design. Quantitative data were analyzed using pre-post mean cost differences; descriptive statistics summarize quantitative data. Open-ended electronic survey items were used to collect descriptive data, and analyzed using thematic content analysis.
Results:
Hospitalizations and emergency room visit rates per 1000 decreased 28.9% and 15.4%, respectively, after implementing the program in 2015-17, relative to 2013-14, prior to program implementation, inclusive of all enrollees (participants and non-participants). Correspondingly, the plan’s annual per capita expenditures declined from $6,487 in the baseline year of 2014, to an average of $5,741 in 2015-17, after the program was introduced (adjusted to 2014 basis). This represents a reduction of $740 per capita, or an 11.4% decrease from the baseline year (P<0.05). Qualitative findings suggest respondents value the program, benefitting from its educational and motivational aspects to better self-manage their health.
Conclusions:
Qualitative findings indicate positive perceptions and experiences of targeted users, and analyses suggest that reported reductions in hospitalizations, emergency room visits, and per capita expenditures are likely attributable to the program. Further research with controls is needed to more completely understand the health-improvement and cost-containment capabilities of this web-based, patient-doctor, aligned-incentive and information therapy program.
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