Rewards programs are a facet of life.
When you fly on the same airline a lot, you get rewards. When you stay the same hotel a lot, you get rewards. Credit card companies, grocery stores, coffee shops all offer their consumers rewards—even 10-year-olds have reward programs. Do your homework, get a few gold stars, and you get a prize. Now it’s healthcare’s turn to get in on the fun.
The potential is certainly there. A recent report that appeared in Health Affairs detailed how UnitedHealthcare used an “earn-back” reward program, which provides positive financial incentives through reduced premiums to employees who meet certain health targets, to improve the quality and reduce the cost of care for its employee population.
Over the first two years of the program, 82 percent of employees earned points and improvements were made in all quality measures. In total, UnitedHealthcare employees saved $107 million in healthcare costs over three years of the program. Using this study as its backdrop, authors of that Health Affairs study argued that healthcare organizations, specifically payers, could benefit from efforts to promote activated beneficiaries.
Even though this concept is still mostly foreign in hospital and provider settings, leaders at the Jersey City Medical Center have embraced it. Jersey City Medical Center, a multi-specialty regional referral and teaching hospital with 326-beds in the New York City metropolitan area, has used a rewards program and a web-based platform to change the behaviors of its chronic disease patient population, especially within its accountable care organization (ACO).
Evolution of a Program
The “Wealth for Health” program allows patients to earn rewards like gift cards through engagement activities like disease education and getting their blood pressure checked. According to Susan Walsh, M.D., the ACO medical director, the idea for the rewards program comes from Douglas Ratner, M.D., chairman of medicine at Jersey City Medical Center.
Susan Walsh, M.D.
“Dr. Ratner realized about 20 years ago that the knowledge was out there on how to live a healthy lifestyle, but only 3-5 percent of the American public did everything right. They ate right, exercised, they mitigated their risk for chronic disease, even things like wearing seatbelts and helmets,” Dr. Walsh says. “He knew we had to do something different, and he sort of took from the airline rewards program. How do you get people to do want them to do – fly on your airline, live healthier? Well people do things for immediate incentives.”
The word immediate is highly significant. People respond to immediacy and short-term incentives, more so than someone telling them, “If you don’t get your blood pressure check out now, you may have a stroke in 10 years.” Dr. Ratner tried out this program at a company in Pennsylvania to great success and has since developed it for specific chronic diseases.
Ratner brought the idea to Jersey City Medical Center, and put Walsh in charge of implementing it. The provider’s ACO has a good chunk of patients, she says, who are at risk for chronic disease, have one chronic disease, or are currently managing multiple chronic diseases. The program presents various opportunities for each of those patient groups to earn rewards, and to use Wealth for Health champions, who help coordinate everything for the provider.
Unlike the one Ratner used 20 or so years ago, the program at Jersey City Medical Center is very much web-based, and available on different mobile platforms. We realized that we’re a wired, mobile organization, and Jersey City is a wired city. When I came on, he [Ratner] asked me to take this manual system and make it so it was web-based and computer friendly,” Walsh says.
Thus, there is a web-based platform where Wealth for Health members can track their accounts and view educational videos (from the Chicago-based Emmi Solutions) on their disease for reward points. In the future, Walsh says, the provider would like tie this website in with the patient portal and the patient’s electronic medical record (EMR), so they can rely on less self-reporting for different metrics. It would also like to connect the portal and the Wealth for Health program in general, to the additional, local providers where their patients are treated.
The program hasn’t garnered specific results yet, Walsh says, but Jersey City Medical Center is starting to see a decrease in visits to the emergency department, up to 37 percent. She says they are starting to put together data in other areas—medication adherence, outcome method.
With no direct revenue coming from this kind of program, the provider has to rely on moral reasons for its continuance. Mainly, Walsh says, it’s the right thing to do. However, she notes that the program’s management relies on significant revenue, and the provider gets mostly reimbursed per visit or per diagnosis, making it a challenge.
“But we think in the future, revenue and incentives will tie into doing the right thing. So we’re setting up this program because we’ll be ready to go when the way we pay for healthcare continues to change,” says Walsh.