In September 2011 the Centers for Medicare and Medicaid Services awarded $85 million in grants to ten states to test financial incentive programs to encourage healthy behavior among Medicaid enrollees with chronic diseases. There is little published evidence about the effectiveness of such incentives within the Medicaid program. We evaluated the available research from three earlier Medicaid incentive programs and found mixed results. On the one hand, in Florida only about half of the $41.3 million in available credits was "claimed" by enrollees between 2006 and 2011. On the other, Idaho's incentive program was credited with improving the proportion of children who were up-to-date on well-child visits. Our findings suggest that Medicaid incentive programs should be designed so that enrollees can understand them and so that the incentives are attractive enough to motivate participation. Medicaid incentive programs also should be subject to rigorous evaluation to more clearly establish their effectiveness.
"Although the program was not formally evaluated, only two participants of the 428,000 who were automatically enrolled earned credits for participating in exercise programs; researchers have speculated that the incentives were too small, not salient, and that participants had insufficient knowledge of the program (Blumenthal et al., 2013). Previous studies provide important lessons on how to design incentives in order to maximize behavior change (Blumenthal et al., 2013; Volpp et al., 2011). When people have their own money at stake, attrition tends to be lower and weight loss higher, perhaps because of selection (those willing to put their own money at risk may have private information that they are particularly likely to succeed, or may be more determined) or because of loss aversion (Cawley & Price, 2013; Jeffery, 2012; John et al., 2011). "
[Show abstract][Hide abstract] ABSTRACT: The Patient Protection and Affordable Care Act of 2010 (ACA) increased the maximum rewards that group health insurance plans (including employers who self-insure) may offer in their wellness programs, with the goal of incentivizing healthy behaviors such as weight loss among the obese and smoking cessation. In this essay, I describe the history and intention of such programs, and make the following three points: (1) In principle, incentivizing healthy behavior can reduce external costs and help people with time-inconsistent preferences stick to their resolutions; (2) there are problems with the design of this portion of the ACA that will limit its effectiveness in achieving these goals; and (3) financial rewards for healthy behaviors have a mixed record to date, and thus many practical design features need to be resolved to improve the effectiveness of such programs.
Journal of Policy Analysis and Management 06/2014; 33(3). DOI:10.1002/pam.21767 · 0.93 Impact Factor
"State Medicaid programs are to be applauded for their forwardlooking and science-based efforts to improve the health of their beneficiaries and curtail spiraling health care costs through incentives. However, recent evaluations suggest these programs may not be as successful as they could be, especially when targeting complex behaviors (Blumenthal et al., 2013). Based on over 20 years of research into incentives as treatments for complex SUDs, much of which was conducted with Medicaid-eligible populations, we strongly believe that increasing the immediacy of incentive delivery and the monetary value of incentives , particularly for challenging health behaviors that require more effort to change, will lead to better outcomes in Medicaid incentive programs . "
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