Of course, the crucial question in wellness is “What really motivates people?” The carrot? The stick? Neither, says a study by François de Brantes, the executive director of the Health Care Incentives Improvement Institute.

In fact, argues “Improving Incentives to Free Motivation,” the health system’s entire approach to incentives is wrong. The study primarily looks at provider motivation, but also discusses what motivates patients. Get the study at http://tinyurl.com/De-Brantes-Study.

“Many financial incentives are designed to change simple behaviors, like improving productivity in rote tasks, but do not work for more complex behaviors,” says the executive summary. “The research which this report draws on shows that they actually undermine assets like creativity and drive, which are essential to the success of health professionals.”

Health care must rely on something other than a carrot-or-stick approach. Michael W. Painter, JD, MD, says in the prologue that “the more complex the task, the less effective financial incentives directed at it are. In fact, they may even degrade desirable behavior. Financial incentives seem to dull creativity and inhibit motivation…. If your problem … requires even rudimentary cognitive skills, then rewards do not work. Plus, here’s the kicker: Larger rewards lead to worse performance.”

What really motivates people are:

  • Autonomy: the ability to direct our own lives
  • Mastery: the desire to get better at something that matters
  • Purpose: the opportunity to do what we do in service of something larger than ourselves

Too often, the incentives for patients and providers are at odds. “For example, a provider might receive a very high marginal benefit from ordering a diagnostic imaging test, while the benefit to the patient might be negative, such as a high copayment or unnecessary exposure to radiation. Conversely, a diagnostic test that is important for the patient might have very little marginal benefit for the provider. Either way, in general, the relative health benefit of services is not taken into account in most payment models or benefit designs.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.