Question / Intervention Goal / Objectives

The MedEncentive Mutual Accountability and Information Therapy (MAIT) program strives to nudge patient and doctor behavior in a manner that improves health and healthcare, lowers costs, and provides fulfillment to doctors and patients (i.e., Triple/Quadruple Aim).  This patented web-based system accomplishes these objectives by employing “aligned financial incentives,” which are offered by health insurers to both doctors and patients for engaging one another in an educational process called “information therapy.”

The program uses a unique patient-doctor aligned-incentive mechanism because it has been found to be more effective at improving compliance than traditional unilateral incentive methods.[1]  The program incorporates information therapy to mitigate the ill effects of inadequate patient health literacy, which studies have shown is associated with higher rates of hospitalizations[2] and preventable emergency department visits,[3] as well as greater medical costs.[4]

A study of the program’s effectiveness, entitled “Reduced Hospitalizations, Emergency Room Visits, and Costs Associated with a Web-Based Health Literacy, Aligned-Incentive Intervention: Mixed Methods Study,” was published in the peer-reviewed Journal of Medical Internet Research [2019; 21(10)].[5]  Validation Institute’s examination of the MedEncentive program was based on this study.


Method/ Calculation

The study involved a 5-year pre- and post-, mixed-method test of the program in an employer health plan, comprised of over 1,800 plan members. The study’s quantitative measures compared emergency room visits, hospital admissions, and overall per capita expenditures two years before and three years after program implementation. The pre- and post-comparison included all plan members, regardless of whether the member participated in the MedEncentive program, and included all disease states and medical conditions.  To compare pre- and post-expenditures on an equivalent basis, the post-implementation expenditures were adjusted to the 2013-14 baseline level using a cost-per-unit-of-service conversion method.

Doctor and patient program participation (engagement) rates, patient responses to standard program questionnaires, and voluntary comments posted by doctors and patients were analyzed to test the plausibility of attributing the outcomes to the program.


Findings / Metric/ Outcome/ Savings

Emergency room visits per 1000 decreased 14%, or 31.3 visits per 1000, from the 2014 baseline period to the 2015 – 2017 post-implementation annual average, while hospital admissions per 1000 decreased 32%, or 26.5 visits per 1000.  The plan’s net average annual per member expenditures decreased 11%, or $675 dollars, from the 2013-14 pre-implementation period to the 2015-17 intervention period, which was 7.5 times the $90 annual per capita cost of the program.

The patient and doctor participation rates in the program were over 70% and 40%, respectively.  Patients rated the helpfulness of the educational content 4.4 out of 5 (n=15,260) and reported their level of adherence to health recommendations 4.7 out of 5 (n=15,186). These results could be interpreted as supporting the impact of the program.



The study focused on a health system employer who was able to embed the MedEncentive program into the electronic health records system that served a majority of the members.  The providers’ ready access to the program may have created an advantage that other employers would not be able to replicate. However, other validated and non-validated studies have shown similar results in other types of employers without electronic health record integration.[6], [7]

Conflicts of interest for two study authors were properly disclosed. 


[1] Asch, DA et al. Effect of financial incentives to physicians, patients or both on lipid levels: a randomized clinical trial. JAMA 2015 nov 10; 314(28):1926 – 1935.

[2] Baker DW et al. Functional health literacy the the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health. 2002 Aug; 92(8):1278-83.

[3] Balkakrishnan et al, The Association of Health Literacy with Preventable Emergency Department Visits: A Cross-Sectional Study, Journal of Academy of Emergency Medicine, 2017 Sep;24(9):1042-1050.

[4] Haun et al, Association between health literacy and medical care costs in an integrated healthcare system: a regional population-based study. BMC Health Services Research 2015; 15:249

[5] Greene 1C, Haun JN, French DD, Chambers SL Roswell RH. Reduced Hospitalizations, Emergency Room Visits, and Costs Associated with a Web-Based Health Literacy, Aligned-Incentive Intervention: Mixed Methods Study. J Med Internet Res 2019;21(10):e14772

[6] Keene N, Chesser A, Hart TA, Twumasi-Ankrah P, Bradham DD. Preliminary benefits of information therapy. J Prim Care Community Health 2011 Jan 01;2(1):45-48.

[7] Parke DW. Impact of a pay-for-performance intervention: financial analysis of a pilot program implementation and implications for ophthalmology (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc 2007;105:448-460