Medicaid Incentives for the Prevention of Chronic Diseases: Final Evaluation Report

Hoerger T, Boland E, Kofit J, Alva M, Kish Doto J, Farrell K, Read J, Goodrich C, Perry R, Romaire M, Teixeria-Poit S, Treiman K, Witman A, RTI Iternational, Hanlon C, Clary A, Kartika T, National Academy for State Health Policy
Publication Year: 2017
Patient Need Addressed: Chronic Conditions
Population Focus: Complex care, Medicaid beneficiaries, Vulnerable/disadvantaged
Demographic Group: Adult, Child
Intervention Type: Education, Service redesign
Study Design: Other Study Design
Type of Literature: Grey

In September 2011, 10 States (California, Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas, and Wisconsin) were awarded demonstration grants to implement chronic disease prevention approaches for their Medicaid beneficiaries to test the use of incentives to encourage behavior change. As described in more detail below, States focused on different chronic diseases and health conditions and included different incentive schedules and amounts. Preventive services such as diabetes prevention classes, smoking cessation quitlines and counseling, and patient navigation were integral parts of the incentive programs; these services often accounted for a large share of program resources. The States were required to demonstrate Medicaid beneficiary changes in health risks and outcomes.

Insights Results

Overview of report

  • Partnering with community-based organizations that had similar goals resulted in partner buy-in. Their relationships with targeted populations provided an inroad to the enrollment of these groups
  • Collaborating with MCOs, FQHCs, and safety net providers that worked with and knew the Medicaid population aided with both enrollment and in helping participants adopt health behaviors
  • Focusing outreach efforts to address health disparities and recruit underrepresented groups, such as ethnic minorities, were important in addressing the needs of people who needed the program the most
  • Fostering healthy and strong relationships between participants and program educators provided a support system that participants valued as they worked toward program goals
    Service Utilization
  • Many program participants used significantly more of a preventive service if they received a financial incentive
  • Overall, there were few statistically significant changes in total, inpatient, or ED Medicaid expenditures (excluding incentive payments) associated with receipt of incentives
  • Receiving incentives of $100 to $400 (compared to less than $25) was a significant predictor of higher program rating. Receiving incentives valued at $25 to $100 (compared to less than $25) was associated with some measures of satisfaction with and impact of incentives
  • Estimated administrative costs (e.g., personnel, training, outreach & marketing, data systems and evaluation expenses) accounted for 42 % of overall expenditures
  • Evaluation costs accounted for about 35% of administrative costs
  • Incentive payments totaled $4.5 million, 8% of overall expenditures
  • Services were an integral part of the MIPCD program and accounted for a sizable share of overall expenditures
  • Lower than planned enrollment may have reduced incentive payments and service costs and increased administrative costs’ share of expenditures
  • Findings suggest that incentives are a potential tool to help Medicaid beneficiaries become more actively engaged in prevention activities
  • Beneficiaries must be ready to make changes, and they must know that prevention programs exist. Improving provider recruitment would allow more beneficiaries to enjoy benefits from the programs and might help reduce administrative costs as a share of total program costs