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. 2019 Oct 17;21(10):e14772.
doi: 10.2196/14772.

Reduced Hospitalizations, Emergency Room Visits, and Costs Associated with a Web-Based Health Literacy, Aligned-Incentive Intervention: Mixed Methods Study

Jeffrey C Greene  1 , Jolie N Haun  2 , Dustin D French  3 , Susan L Chambers  4 , Robert H Roswell  5
Affiliations

Reduced Hospitalizations, Emergency Room Visits, and Costs Associated with a Web-Based Health Literacy, Aligned-Incentive Intervention: Mixed Methods Study

Jeffrey C Greene et al. J Med Internet Res. .

Abstract

Background: The association between health literacy and health care costs, particularly for hospitalizations and emergency room services, has been previously observed. Health information interventions aimed at addressing the negative impacts of inadequate health literacy are needed. The MedEncentive Mutual Accountability and Information Therapy (MAIT) Program is a Web-based system designed to improve health and lower costs by aligning patient-doctor incentives.

Objective: In this mixed methods study of a Web-based patient-doctor aligned-incentive, information therapy program conducted in an 1800-member employee health plan, we aimed to (1) determine the program's quantitative impact on hospitalization and emergency room utilization and costs, and (2) assess survey responses about the program's perceived value.

Methods: We used a mixed methods, single within-group, pre-post, descriptive study design. We analyzed quantitative data using pre-post mean utilization and cost differences and summarized the data using descriptive statistics. We used open-ended electronic survey items to collect descriptive data and analyzed them using thematic content analysis.

Results: Hospitalizations and emergency room visits per 1000 decreased 32% (26.5/82.4) and 14% (31.3/219.9), respectively, after we implemented the program in 2015-2017, relative to 2013-2014. Correspondingly, the plan's annual per capita expenditures declined US $675 (95% CI US $470-865), or 10.8% ($675/$6260), after program implementation in 2015-2017 (US $5585 in 2013-2014 dollars), relative to the baseline years of 2013-2014 (US $6260; P<.05). Qualitative findings suggested that respondents valued the program, benefiting from its educational and motivational aspects to better self-manage their health.

Conclusions: Analyses suggested that the reported reductions in hospitalizations, emergency room visits, and costs were associated with the program. Qualitative findings indicated that targeted users perceived value in participating in the MAIT Program. Further research with controls is needed to confirm these outcomes and more completely understand the health improvement and cost-containment capabilities of this Web-based health information, patient-doctor, aligned-incentive program.

Keywords: aligned incentives; health care costs; health literacy; information therapy; mutual accountability; cost control.

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Conflict of interest statement

Conflicts of Interest: The authors respectfully wish to report potential conflicts of interest represented by financial benefit. JCG is the cofounder, chief executive officer, and part owner of MedEncentive, LLC, and receives no compensation from MedEncentive except for supplemental health insurance, valued at less than US $1000 per month. JCG is the inventor of the MedEncentive Mutual Accountability and Information Therapy Program’s patented process, trademarked as the Trilateral Health Accountability Model, in which he holds a royalty interest. SLC is cofounder and part owner of MedEncentive, LLC. She is also a royalty holder in the Company’s inventions. Both JCG and SLC are board members of MedEncentive, but neither is compensated in this role. As part owners and royalty holders, and in their aforementioned roles with the Company, JCG and SLC could financially benefit from the publication of this paper.

JNH and DDF received a consultation fee to provide expertise and support in the analysis, interpretation of data findings, and development of this manuscript. JNH and DDF do not have equity in the Company, nor is their payment contingent on the success of the Company; they do not sit on board or committee for the Company.

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