Aim and key question
Cardiovascular disease (CVD) is the leading cause of death in the United States, and clinical trials indicate that taking statins (HMG-CoA reductase inhibitors) to lower cholesterol reduces the risk of myocardial infarction by about 30%. Despite proven benefits, the relatively low cost, once-a-day dosing, and few adverse effects, the population effectiveness of statins is limited for 2 reasons. First, physicians underprescribe statins or fail to intensify treatment when indicated. Second, approximately half of patients prescribed statins discontinue usage within a year, even among those surviving acute coronary syndromes. Poor adherence is associated with worse outcomes, higher hospitalization and mortality rates, and increased health care costs among patients with CVD.
The key question being researched was whether provider behavior and its alignment with patient outcomes via incentives would yield benefits beyond “usual” care.
Intervention and design
This was one of the largest and more complex trials conducted using the Way To Health plaform across multiple organizations, associated sites, providers and patients. The study was conducted in conjunction with the University of Pennsylvania Health System, Geisinger and Harvard Vanguard.
Interventions - Primary care physicians were randomly assigned to control, physician incentives, patient incentives, or shared physician-patient incentives. Physicians in the physician incentives group were eligible to receive up to $1024 per enrolled patient meeting LDL-C goals. Patients in the patient incentives group were eligible for the same amount, distributed through daily lotteries tied to medication adherence. Physicians and patients in the shared incentives group shared these incentives. Physicians and patients in the control group received no incentives tied to outcomes, but all patient participants received up to $355 each for trial participation.
Main Outcomes and Measures - The primary outcome that was measured was the change in LDL-C level at 12 months.
Way to Health use
Enrollment: Enroll and randomize participants across the study arms
Device Data Integration: Collect data from the devices by patient
Rules Engine: Set and monitor activity and achievement vs targets
Behavioral Economics: Award cash incentives by study arm
Findings and conclusions
In primary care practices, shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a statistically significant difference in reduction of LDL-C levels at 12 months
Additionally, adherence to medications went up significantly as well.
This study is important in that it showed that incentives that align patient and provider behavior result in significantly better outcomes.