Guiding Principles

IDH is based on the following guiding principles:

  1. Plan Design + Incentives = Results. Reducing cost using plan design must continue; however, more work is needed to help guide consumers in taking accountability for their health. Plan designs are naturally complex and subject to changing regulatory and legal challenges. The complexities can often make them difficult to implement and respond to changing needs. IDH calls for additional incentives that can be layered on top of these techniques. This provides a flexible, quick to market technique to be deployed as needed which fills in gaps in plan design.
  2. Alignment to Actions Accepted to Impact Cost - Based on Principle of "One Activity at a Time". Incentive values should be aligned to consumer and provider actions to reduce cost. IDH seeks to align incentive spending directly to the specific actions desired from consumers and providers.
  3. Alignment to Immediate, Intermediate and Long-Term Results. Incentives must be aligned not only to long-term but also to immediate (e.g., utilization such as generic substitution), and intermediate actions. This approach - called the Healthcare TrifectaTM - identifies these actions as follows:

    Immediate Intermediate Long-Term
    Utilization Evidence-based Behavior Change
    Generic Substitution
    Minimally Invasive Procedures
    Preferred Drug List
    Preferred Network
    Preventive Screenings
    Medication Adherence
    Plan Selection
    Mail Order
    Risk Reduction
    BMI Reduction
    Nutrition
    Exercise
  4. Applied to Consumers and Providers. Incentives should be aligned to both consumer and provider actions that impact cost:

    Consumer

    Provider

    • Utilization
    • Benefit Selection
    • Medication Adherence
    • Risk Reduction
    • Administrative Process
    • E-Adoption (E-prescribing/EMR)
    • Pay-for-Performance
    • Patient Safety
    • Administrative Procedure
    • Medical Home
  5. Applied Not Only to Health of People But Health of the System. IDH applies not only to improving the health of individuals, but the health of the system by incentivizing the use of technology and improved processes.
  6. Positive and Negative Incentives. IDH employs both positive incentives and disincentives.
  7. Participation and Outcome. IDH should be applied to both driving participation as well as specific outcomes.
  8. Incentives are the Cornerstone - But Not the Only Technique. Incentives help individuals pay attention, enabling other important techniques to be more effective such as behavioral science and social networking. Overcoming "build it and they will come" with incentives helps make each of these tools more effective.
  9. The Future: Let the Individual Choose. IDH purports that ultimately the individual - consumer or provider - should be able to choose the reward of their choice for performing desired actions.
  10. Applied to Both Data and Self-Reported Activity. The fact that data does not exist on a specific action (e.g., going to the gym) should not prevent the alignment of incentives to those actions. Both data-source and self-reported activities are required to impact cost.