Dr Scott Breidbart Discusses When to Pay Physicians, Patients for Adherence

Patient adherence is about combining the appropriate tests, lifestyle changes and medications to produce the most optimal health outcomes, said Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth. However, he added that deciding when to pay physicians and patients for adherence and where payment may not be successful is a difficult model to tackle.

Transcript (slightly modified)

In what instances is it appropriate to pay physicians and patients for adherence?

We talk about adherence, we think about adherence in terms of what is best for the patient to have. So for example, a patient should get a flu shot. A patient should fill his or her medication and take the medication appropriately. A patient should get a hemoglobin A1C test. A patient should have a microalbuminuria test. So, adherence is both appropriate tests, appropriate lifestyle changes, and appropriate use of medication.

And the reason I mention that is it’s easier to pay a doctor to get changes that are made in 1 episode. So, I can pay a doctor to call the patient back to get a hemoglobin A1c, that’s something we can do. We can pay a doctor extra if the patient gets the microalbuminuria test.

It’s a little harder to pay a doctor extra for a hemoglobin A1C below 7 because that changes during the year. It’s a little more difficult to pay a doctor for a patient filling a drug prescription so that’s how we can decide what we might pay a doctor for as opposed to what we might not.

Paying a patient, again ignoring any regulatory difficulties in doing that, I think first we all agree that removing barriers to treatment works. So if there’s a barrier because of a high co-pay or a high-deductible plan, removing that barrier helps improve adherence. Beyond that, paying somebody to take medicine works, but the amount we’re paying has to be significant and it’s not clear that there’s any sustainable way. Or, that we could pay the kind of money that would need for someone to take a chronic medication for a chronic disease.

And we also have the problem that we know that when the payment is stopped, either because the program stops or because the member switches insurance companies, those payments stop. And we know that when the payment stops, the change made from the payment doesn’t continue.

So yes, there’s certain instances where we can pay a physician, there’s instances where we can pay the patient. For instance, if we paid a patient to get a flu shot we know the incidence of people getting a flu shot goes up and there’s certain instances where it doesn’t make sense to pay either one.