Money don't get everything it's true; What it don't get I can't use…

According to an August 18th, 2010 Reuters article,  a new study suggests that a patient’s odds of having an orthopedic operation may depend on whether or not the surgeon has a financial stake in the treatment center. Patients receiving care for their wrist, rotator cuff or knee from a provider with ownership in the facility were up to twice as likely to have surgery compared to those treated by non-owners according to a study performed by Georgetown University’s Public Policy Institute in Washington, D.C. and published in the Archives of Surgery.

Not to put too fine a point on it, but……duh. I hope they didn’t spend a lot of money on that study.

Your lovin’ give me such a thrill,
But your lovin’ don’t pay my bills;

Financial incentives, at least in America, appear to be one of the most powerful motivators of behavior one can find.  There have been numerous studies demonstrating the somewhat insidious connection between physician financial ownership and over-utilization of services.  The Stark Law was passed more than 20 years ago for this very reason–to break the connection and remove financial incentives to over-treat.  Unfortunately they left a few loopholes, including that which result in the findings from Georgetown.

In what is not a coincidence, the providers who are paid on a fixed budget/capitated basis  are the ones that get accused of under-treating patients in order to maximize their profits.  Go figure.

But the fact is, financial incentives in health care are kind of a double-edged sword. For every negative incentive like those above, there is also a growing body of evidence that positive financial incentives may be the path to salvation when it come to positively engaging providers and consumers in a “reformed” health care system.

The best things in life are free
But you can keep ’em for the birds and bees;

Taking a page from the handbooks of parents everywhere (“if you let your little sister go with you and your friends to the movies  I’ll give you ten bucks”), there are a number of new approaches to fostering better health and preventing chronic illness that involve cold hard cash.  In a world where people won’t voluntarily give up smoking to help themselves or willingly take their diabetes medicine to prevent a slippery slide into acute illness, it appears that a dose of the Benjamins can change everything.  In a recent Newsweek article entitled Can You Bribe People to Be Healthier? it was reported that U.S. employers are using health incentives to “help replace peoples’ addiction to unhealthy behaviors with an addiction to winning. These programs are now being used by companies trying to motivate employees and beneficiaries to adopt healthy behaviors and to save on health-care costs.”

While the article acknowledges that this not yet a perfect science, there are some very encouraging results out there.  I have previously written about SeeChange Health, a Psilos portfolio company offering insurance programs that reward those who agree to engage in a widely accepted wellness and prevention activities (e.g., health screenings, taking prescribed medications and following chronic care treatment regimens). The reward to the patient, in addition to better health, is as much as $500 Simoleans.

A variety of programs have been tried, some with significant success, to financially incentivize people to lose weight and thus avoid the many diseases that have obesity at their core.  Britain’s National Health Service has been piloting a program called Pounds for Pounds that pays up to £3000 to those who meet weight loss goals.  Similar programs have been tried in the U.S. and appear to result in pretty impressive outcomes.  So there you have it:  get some dough for eating less…dough.

Another interesting program from the Hartford insurance company provides $50 to any beneficiary that will use Posit Science‘s DriveSharp brain fitness software, which they tout as a software program that is clinically proven to help drivers “think faster, notice more and react quickly”, thus avoiding dangerous car accidents that lead to expensive automotive and medical bills.

And remember those providers who game the system for financial gain?  Well there are a myriad of provider payment pilots and initiatives currently in play that capitalize on providers’ desire for financial gain to produce good not evil.   Insurance carriers, such as Blue Cross Blue Shield of Massachussetts and Michigan, have developed programs that share savings with providers when they can deliver improved quality of care.  CMS is piloting payment models that provide financial incentives to providers for reducing hospital admissions and length of stay.

This whole concept of provider payment reform is a major focus at CMS and is a cornerstone of their efforts to use innovation to improve the prospects for Medicare being around when I grow up (assuming that is possible).   For the first time since the concept of “pay for performance” has entered the healthcare lexicon (probably back in the 1990’s), there is a real movement afoot to figure out how to do it rather than how to avoid it. Some are no doubt still hoping it will just go away if they wish real hard, but they are losing ground.

It is always amazing to me that people will adopt positive behaviors if they are paid to do so but not because it can better their lives or profession.  But as they say, whatever works.  Finding methods of engaging consumers and providers to move our system to a culture of health rather than one built around care is essential to breaking the runaway cost cycle. And so we join our hands and sing:

Well, now give me money, (That’s what I want)
A lotta money, (That’s what I want)
Wo, yeah, You need money (That’s what I want)
Gimme money, (That’s what I want)
That’s what I want (That’s what I want)
That’s what I want.

Note:  Song lyrics by Barrett Strong, although popularized by the Beatles