Jeff Greene did not set out to change the world, or even to change the nature of the relationship between physicians and their patients. What he did set out to do was to keep his company from going out of business.
What he built was an online system that allows doctors and patients to communicate in ways that they each understand, but more importantly, to set performance goals for each other and to support each other in achieving those goals.
The business he saved was in practice management, which gave him insight into the arcane world of medical care and payment. He became a professor of practice management at the Pell Center at the University of Oklahoma, and wrote a book on the subject. He also became a self-insured business owner.
"Every day, I saw my overweight, diabetic employees going off to the same physicians that were my clients, demanding this or that pill, and billing Mr. and Mrs. Greene. My business could have gone broke paying my insurance bills. Being in the business, I knew that was a microcosm of what is broken about our entire national health-delivery system. I was the one paying the bills, but I did not know what I was paying for."
Even worse, he knew from experience with both doctors and patients that doctors didn't necessarily know if patients were communicating all the information they needed, or if the patients fully understood their diagnoses and treatment plans. Doctors also didn't know how closely patients were following those plans -- if at all.
Patients, on the other hand, didn't know if doctors comprehended the signs and symptoms they were presenting, or if they were asking the right questions. They didn't know how closely doctors were following their progress -- if at all.
What he was encountering was a failure to communicate.
His solution was to create an online program that acted as an intermediary between doctors and patients, fostering better communication, more effective treatment and lower costs of care and insurance.
"I started with evidence-based medical guidelines, and added cash incentives," said Greene. "That operates with declarations or demonstrations of adherence by both sides, that both sides agree to follow and can corroborate. As a result, my costs and my risks have gone down."
That said, Greene knew that replicability was the true test of any process or assertion, so his online system is now the subject of a three-year study by the State of Oklahoma to monitor the cost and effectiveness of its use in health care for teachers, state employees and local-government employees across the state.
"The legislation to appropriate the funds for the study passed the state House of Representatives 86-9 and the state Senate 46-0. That is remarkable in this age of legislative gridlock."
Greg Main, president of St. Gregory's University in Shawnee, Okla., has had a business relationship with Greene for close to eight years, and sits on the board of MedEncentive.
"Jeff hit on the notion that patients respect doctors' advice, but they have to understand what they are being told, and then they have to try to follow that advice. His system hits square at a very big problem. Health care providers and users can now come together to reinforce mutually what they are supposed to do, and then get paid for doing it," Main said.
Main noted that the emphasis might seem to be on the patient adhering to the course of treatment prescribed for them, but, he said, the system also encourages doctors to communicate clearly. "The goal is to reinforce and educate both sides," said Main. "That makes it easy for both sides to understand and comply."
He added that beyond the immediate improvements in patient outcomes and the resulting reduction in health care costs, there is likely to be a reduction in malpractice suits that arise out of a misunderstanding or a misdiagnosis. That could also reduce long-term health costs in a structural way.
Another tool to reduce malpractice, Main said, is the record of communication.
"The doctor is recording that this is what I was presented, and this is what I diagnosed, and here is the evidence that the patient understood and intended to comply with my orders. Not only do you get better compliance, you get less hospitalization."
And the hospital is where the really heavy costs hit.
--By Gregory DL Morris
September 15, 2013
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