Under the Patient Protection and Affordable Care Act, 10 states participated in a program that offered incentives to Medicaid clients if they engaged in targeted efforts to prevent chronic disease.
Patricia Alexander of California was a recipient of one of those incentives, which prompted her to get a mammogram. She told Anna Gorman of Kaiser Health News that every time she made an appointment, something came up, and it wasn't until her doctor's office promised her a $25 Target gift card that she was motivated to make the appointment and keep it. The mammogram was negative for breast cancer, but not all mammograms are.
Other states participating in the five-year demonstration projects were Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas and Wisconsin. In all, they were awarded grants totaling $85 million, Gorman reports.
The practice of offering rewards as a motivation for patients to engage in more preventive care and to make healthier lifestyle choices has long been a practice of private health plans and the demonstration project was created to see if this practice would also work with the Medicaid population.
The states used the incentives for a variety of programs including ones to encourage people to enroll in diabetes prevention, weight management, smoking cessation and other preventive programs.
For example, California's program offered gift cards and nicotine replacement therapy to people who called the state's smoking cessation line and Minnesota's program gave cash to people who attended a diabetes prevention class and completed bloodwork, Gorman reports.
An evaluation of these programs, released in April, found that the incentives helped persuade the Medicaid beneficiaries to participate in preventive activities, but it wasn't able to show that the programs prevented chronic disease or save Medicaid money. The report noted that this was largely because the prevention of chronic diseases could take years to manifest.
Gorman reports that research on the effectiveness of financial incentives for the Medicaid population has been mixed.
She also points to a report released this year by the liberal-leaning Center on Budget and Policy Priorities that found incentives were good to change immediate behaviors like keeping a doctor's appointment or attending a class, but were less likely to change long-term behaviors, like weight loss.
“The thing that is most likely to help Medicaid beneficiaries utilize care appropriately is actually just giving them access to that care — and that includes providing transportation and child care,” Hannah Katch, an author of the center's report, told Gorman. She added that another barrier is being able to take time off work to go to the doctor.
The report says that these types of incentive programs have proven to pose administrative challenges as well as provider engagement and participation challenges. In addition, it says patient and provider education about the programs; identifying and engaging beneficiaries to participate; establishing the infrastructure to offer and provide the incentives; and the added costs to states to implement these programs have all provided challenges to such programs.
A huge motivator to these incentives programs is to help clients become healthier because insurers "know they can reduce their costs -- and increase their profits -- if their patients are healthier," Gorman writes.
Doug Hogan, spokesman for Kentucky's Cabinet for Health and Family Services, said the state doesn't have such an incentive program for its Medicaid beneficiaries, but if federal officials approve its new Medicaid program, which state officials call Kentucky HEALTH, it will have incentives to encourage members to improve their health and be active members of the community.
"The program would do so by offering My Rewards dollars for activities like accessing preventive-care services, taking health and financial literacy classes, and participating in job training programs," Hogan said. "Members can then use the dollars to access some services not covered by the Kentucky HEALTH plan. Furthermore, members can receive up to $500 from their My Rewards account once they transition to a commercial insurance plan for at least 18 months."
Gov. Matt Bevin proposed changes to Kentucky Medicaid by requesting a waiver from federal rules more than a year ago. The proposal largely targets "able-bodied" adults who qualify for Medicaid under the ACA's expansion of the program to those who earn up to 138 percent of the federal poverty level. It is expected to be approved.
Patricia Alexander of California was a recipient of one of those incentives, which prompted her to get a mammogram. She told Anna Gorman of Kaiser Health News that every time she made an appointment, something came up, and it wasn't until her doctor's office promised her a $25 Target gift card that she was motivated to make the appointment and keep it. The mammogram was negative for breast cancer, but not all mammograms are.
Other states participating in the five-year demonstration projects were Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas and Wisconsin. In all, they were awarded grants totaling $85 million, Gorman reports.
The practice of offering rewards as a motivation for patients to engage in more preventive care and to make healthier lifestyle choices has long been a practice of private health plans and the demonstration project was created to see if this practice would also work with the Medicaid population.
The states used the incentives for a variety of programs including ones to encourage people to enroll in diabetes prevention, weight management, smoking cessation and other preventive programs.
For example, California's program offered gift cards and nicotine replacement therapy to people who called the state's smoking cessation line and Minnesota's program gave cash to people who attended a diabetes prevention class and completed bloodwork, Gorman reports.
An evaluation of these programs, released in April, found that the incentives helped persuade the Medicaid beneficiaries to participate in preventive activities, but it wasn't able to show that the programs prevented chronic disease or save Medicaid money. The report noted that this was largely because the prevention of chronic diseases could take years to manifest.
Gorman reports that research on the effectiveness of financial incentives for the Medicaid population has been mixed.
She also points to a report released this year by the liberal-leaning Center on Budget and Policy Priorities that found incentives were good to change immediate behaviors like keeping a doctor's appointment or attending a class, but were less likely to change long-term behaviors, like weight loss.
“The thing that is most likely to help Medicaid beneficiaries utilize care appropriately is actually just giving them access to that care — and that includes providing transportation and child care,” Hannah Katch, an author of the center's report, told Gorman. She added that another barrier is being able to take time off work to go to the doctor.
The report says that these types of incentive programs have proven to pose administrative challenges as well as provider engagement and participation challenges. In addition, it says patient and provider education about the programs; identifying and engaging beneficiaries to participate; establishing the infrastructure to offer and provide the incentives; and the added costs to states to implement these programs have all provided challenges to such programs.
A huge motivator to these incentives programs is to help clients become healthier because insurers "know they can reduce their costs -- and increase their profits -- if their patients are healthier," Gorman writes.
Doug Hogan, spokesman for Kentucky's Cabinet for Health and Family Services, said the state doesn't have such an incentive program for its Medicaid beneficiaries, but if federal officials approve its new Medicaid program, which state officials call Kentucky HEALTH, it will have incentives to encourage members to improve their health and be active members of the community.
"The program would do so by offering My Rewards dollars for activities like accessing preventive-care services, taking health and financial literacy classes, and participating in job training programs," Hogan said. "Members can then use the dollars to access some services not covered by the Kentucky HEALTH plan. Furthermore, members can receive up to $500 from their My Rewards account once they transition to a commercial insurance plan for at least 18 months."
Gov. Matt Bevin proposed changes to Kentucky Medicaid by requesting a waiver from federal rules more than a year ago. The proposal largely targets "able-bodied" adults who qualify for Medicaid under the ACA's expansion of the program to those who earn up to 138 percent of the federal poverty level. It is expected to be approved.
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