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Abstract

Purpose:

Evaluate the Centers for Medicare & Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) program in terms of participant satisfaction and self-reported program impact.

Design:

Participant survey (mail/telephone follow-up), English and Spanish (N = 2274).

Settings:

Ten states in MIPCD program.

Participants:

Medicaid beneficiaries.

Intervention:

Incentive-based health promotion programs targeting diabetes prevention and management, smoking cessation, and weight, hypertension, and cholesterol management.

Measures:

Dependent measures are (1) overall program satisfaction and (2) self-reported program impact, operationalized as whether program helped with understanding health issues, learning ways to take care of health, and encouraging healthy lifestyle changes.

Analysis:

Multilevel multivariable ordinal logistic regression models to identify predictors of overall program satisfaction and program impact.

Results:

Sixty-seven percent were very satisfied with the program, and 76% strongly agreed the program encouraged healthy lifestyle changes. Age (59+ vs <45 years) and being female predicted overall program satisfaction. Satisfaction with specific aspects of the program including communication with staff, accessibility, and incentives predicted higher overall satisfaction. Age (45-52 vs <45 years) and being black or Hispanic predicted higher program impact. Points redeemable for rewards performed worse than money-valued incentives in terms of encouraging lifestyle changes (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.11-0.82). Participants receiving incentives valued at $25 to <$100 were more likely to report higher agreement that the program helped them learn ways to care for their health (OR, 1.72; 95% CI, 1.21-2.44) and encouraged lifestyle changes (OR, 1.46; 95% CI, 1.02-2.10), compared to participants receiving incentives valued at $0 to <$25. Incentives valued at $100 to <$400 predicted higher agreement that the program helped with understanding of health issues (OR, 1.62; 95% CI, 1.13-2.33), compared to incentives valued at $0 to <$25.

Conclusion:

Effective chronic disease prevention programs are needed for Medicaid populations. Study findings highlight important considerations for incentive-based programs.

Keywords

Medicaid incentives motivation strategies chronic disease chronic disease prevention diabetes smoking hypertension cholesterol weight management skill building

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References

Lochner

Goodman

Posner

Parekh

. Multiple chronic conditions among Medicare beneficiaries: state-level variations in prevalence, utilization, and cost, 2011. Medicare Medicaid Res Rev. 2013;3(3):E1–E19.

Kaiser Family Foundation. Role of Medicaid for People With Behavior Health Conditions. Washington, DC: Kaiser Family Foundation; 2012. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8383_bhc.pdf. Accessed June 28, 2017.

Kaiser Family Foundation. The Role of Medicaid for People With Cardiovascular Disease. Washington, DC: Kaiser Family Foundation; 2012. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8383_bhc.pdf. Accessed June 28, 2017.

Kaiser Family Foundation. The Role of Medicaid for People With Diabetes. Washington, DC: Kaiser Family Foundation; 2012. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8383_d.pdf. Accessed June 28, 2017.

Kaiser Family Foundation. The Role of Medicaid for People With Respiratory Disease. Washington, DC: Kaiser Family Foundation; 2012. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8383_rd.pdf. Accessed June 28, 2017.

Wilper

Woolhandler

Boyd

. The health and health care of US prisoners: results of a nationwide survey. Am J Public Health. 2009;99(4):666–672.

Blumenthal

Saulsgiver

Norton

. Medicaid incentive programs to encourage healthy behavior show mixed results and should be studied and improved. Health Aff (Millwood). 2013;32(3):497–507.

RTI International. Independent Assessment Report: Medicaid Incentives for Prevention of Chronic Diseases Evaluation. Research Triangle Park, NC: RTI International; 2016.

Agency for Healthcare Research and Quality. CAHPS Surveys and Guidance. Rockville, MD: Agency for Healthcare Research and Quality; 2017. https://www.ahrq.gov/cahps/surveys-guidance/index.html. Accessed June 28, 2018.

10.

Lantz

Golberstein

House

Morenoff

. Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults. Soc Sci Med. 2010;70(10):1558–15566.

11.

Levi

Segal

StLaurent

Kohn

. F as in Fat: How Obesity Threatens America’s Future: 2011. Washington, DC: Trust for America’s Health (TFAH); 2011.

12.

Jamal

Homa

O’Connor

. Current cigarette smoking among adults—United States, 2005–2014. MMWR Morb Mortal Wkly Rep. 2015;64(44):1233–12359.

13.

Barth

Greene

. Encouraging Healthy Behaviors in Medicaid: Early Lessons from Florida and Idaho. Issue Brief. Hamilton, NJ: Center for Healthcare Strategies (CHCS), Inc; 2007.

14.

Cotter

Lachman

. No strain, no gain: psychosocial predictors of physical activity across the adult lifespan. J Phys Act Health. 2010;7(5):584–594.

15.

Humpel

Owen

Leslie

. Environmental factors associated with adults’ participation in physical activity: a review. Am J Prev Med. 2002;22(3):188–199.

16.

Trost

Owen

Bauman

Sallis

Brown

. Correlates of adults’ participation in physical activity: review and update. MEd Sci Sport Exerc. 2002;34(12):1996–2001.

17.

Wardle

Steptoe

. Socioeconomic differences in attitudes and beliefs about healthy lifestyles. J Epidemiol Community Health. 2003;57(6):440–443.

18.

Ylitalo

Umstattd Meyer

Stone

Doyle

Curtis

. Using the Community Assessment for Public Health Emergency Response (CASPER) to assess barriers to healthy eating and active living in a low-income community. Eval Program Plann. 2016;59:41–46.

19.

Kirkpatrick

Dodd

Reedy

Krebs-Smith

. Income and race/ethnicity are associated with adherence to food-based dietary guidance among U.S. adults and children. J Acad Nutr Diet. 2012;112(5):624–635.e6.

20.

Chang

Nitzke

Guilford

Adair

Hazard

. Motivators and barriers to healthful eating and physical activity among low-income overweight and obese mothers. J Am Diet Assoc. 2008;108(6):1023–1028.

21.

Cassady

Jetter

Culp

. Is price a barrier to eating more fruits and vegetables for low-income families? J Am Diet Assoc. 2007;107(11):1909–19015.

22.

Fulp

McManus

Johnson

. Barriers to purchasing foods for a high-quality, healthy diet in a low-income African American community. Fam Community Health. 2009;32(3):206–217.

23.

Ver Ploeg

Breneman

Farrigan

. Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences: Report to Congress. Washington, DC: US Department of Agriculture; 2009.

24.

Walker

Keane

Burke

. Disparities and access to healthy food in the United States: a review of food deserts literature. Health Place. 2010;16(5):876–884.

25.

Bertoni

Foy

Hunter

Quandt

Vitolins

Whitt-Glover

. A multilevel assessment of barriers to adoption of dietary approaches to stop hypertension (DASH) among African Americans of low socioeconomic status. J Health Care Poor Underserved. 2011;22(4):1205–12020.

26.

Christiansen

Reeder

Hill

Baker

Fiore

. Barriers to effective tobacco-dependence treatment for the very poor. J Stud Alcohol Drugs. 2012;73(6):874–884.

27.

Twyman

Bonevski

Paul

Bryant

. Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature. BMJ Open. 2014;4(12):e00414.

28.

Giles

Robalino

McColl

Sniehotta

Adams

. The effectiveness of financial incentives for health behaviour change: systematic review and meta-analysis. PLoS One. 2014;9(3):e90347.

29.

Haff

Patel

Lim

. The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis. Am J Health Promot. 2015;29(5):314–323.

30.

Jochelson

. Paying the Patient: Improving Health Incentives Using Financial Incentives. London, England: King’s Fund; 2007.

31.

Kane

Johnson

Town

Butler

. A structured review of the effect of economic incentives on consumers’ preventive behavior. Am J Prev Med. 2004;27(4):327–352.

32.

Lussier

Heil

Mongeon

Badger

Higgins

. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. 2006;101(2):192–203.

33.

Sigmon

Patrick

. The use of financial incentives in promoting smoking cessation. Prev Med. 2012;55(suppl):S24–S32.

34.

Sutherland

Christianson

Leatherman

. Impact of targeted financial incentives on personal health behavior. Med Care Res Rev. 2008;65(6):36S–78S.

35.

Greene

. Medicaid Efforts to Incentivize Healthy Behaviors. Resource Paper: Center for Healthcare Strategies (CHCS), Inc. Eugene, OR: University of Oregon; 2007.

36.

Hand

Heil

Sigmon

Higgins

. Improving Medicaid health incentives programs: lessons from substance abuse treatment research. Prev Med. 2014;63:87–89.

37.

Kenney

Marton

Klein

Pelletier

Talbert

. The effects of Medicaid and CHIP policy changes on receipt of preventive care among children. Health Serv Res. 2011;46(1 pt 2):298–318.

38.

Medicaid and CHIP Payment and Access Commission (MACPAC). Medicaid Access in Brief: Adults’ Experiences in Obtaining Medical Care. Issue Brief. Washington, DC: Medicaid and CHIP Payment and Access Commission (MACPAC); 2016.

39.

Nyman

Abraham

Riley

. The effect of consumer incentives on Medicaid beneficiaries’ compliance with well-child visit guidelines. Inquiry. 2013;50(1):47–56.

40.

Wisconsin Department of Health Services. Do Incentives Work for Medicaid Members? A Study of Six Pilot Projects. Madison, WI: Wisconsin Department of Health Services, Budget; 2013.

41.

Finkelstein

Linnan

Tate

Birken

. A pilot study testing the effect of different levels of financial incentives on weight loss among overweight employees. J Occup Environ Med. 2007;49(9):981–989.

42.

Mallote

Rhodes

Mais

. Tuberculosis screening and compliance with return for skin test reading among active drug users. Am J Public Health. 1998;88(5):792–796.

43.

Meredith

Jarvis

Raiff

. The ABCs of incentive-based treatment in health care: a behavior analytic framework to inform research and practice. Psychol Res Behav Manag. 2014;7:103–114.

44.

Fredrickson

Jones

Molgaard

. Optimal design features for surveying low-income populations. J Health Care Poor Underserved. 2005;16(4):677–690.

45.

Lind

Kaplan

Berg

. Evaluation of an asthma disease management program in a Medicaid population. Dis Manag Health Outcomes. 2006;14(3):151–161.

46.

Patric

Stickles

Turpin

. Diabetes disease management in Medicaid managed care: a program evaluation. Dis Manag. 2006;9(3):144–156.

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Participant Satisfaction and Perceptions About Program Impact in the Medicaid Incentives for Prevention of Chronic Disease Pilot Program