Dr Scott Breidbart Explains the Concerns With Paying for Adherence

Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth, explained that paying patients for adherence could be efficient when the payment initiatives are targeted towards members who have not shown to be adherent; however, he added that there are several limitations in paying for adherence, including the sustainability of the system and whether it will incentivize patients who are adherent to stop taking their medications.

Transcript (slightly modified)

What sort of payment models exist right now at EmblemHealth?

Right now, we, and other plans, pay physicians in certain circumstances. So there are metrics by which the plans are judged and those metrics, HEDIS measures, are ones that we can sometimes also judge a physician or a physician group on. So we may say to the physician group, if you have a certain number of diabetics and the percentage of diabetics who gets an A1c during this year is above 80%, we’ll pay you X dollars to the diabetic who gets it done. If it’s above 90%, we’ll pay you this much more dollars for each patient who gets the hemoglobin A1c. So that is being done.

What are the concerns about paying for adherence?

There is a concern that when the payments stop, not only does the adherence go down but there may even be a further decrement. The studies are not clear on how much paying for adherence helps, and the studies are also not all that certain on whether or not after the payments stop, the reduction in adherence is beyond the baseline. So that is a concern.

There’s also the moral hazard concern is do you pay everyone for adherence? Or do you only pay the people who haven’t been shown to adhere? Which would be a more efficient way of doing it but of course then is an incentive for people not to adhere.