269619 Persuasion, prevention, and patient adherence: The comparative impacts of incentives, reminders, and barriers, on patients' willingness to get annual checkups

Wednesday, October 31, 2012 : 9:30 AM - 9:50 AM

S. Rae Starr, MPhil, MOrgBehav , HealthCare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Prevention and wellness across the lifespan, depend in part on doctors' persuasive abilities to get patients into the clinic for checkups and preventive care. Clinicians understandably focus on the medical value of such visits. Inserting that clinical knowledge into the patient's thinking requires knowing more about the reasons why health care doesn't rank higher in many patients' priorities. What are the barriers facing patients? What affordable tools are available to health plans and clinics to educate patients about appropriate checkups and tests?

Prior research established that intrinsic reasons -- (priorities other than health care) generally outweigh extrinsic reasons (traditional barriers, such as language, transportation, and clinic hours of operation) as causes for not getting checkups. The present study examines the potential influence of incentives and reminders from various sources to improve adherence to well-care guidelines.

(1) Study design: Questions were added to annual CAHPS member experience surveys, to ask patients whose advice persuaded them to get checkups; and what reminders or incentives were persuasive.

(2) Setting: The study uses data from patients from 2010 to 2012 at a large urban Medicaid health plan in the southwestern United States, serving a diverse population.

(3) Findings: The presentation will report the numbers of patients exposed to incentives, reminders, and other tools used by health plans and clinics to persuade patients to get recommended well-care and preventive care. The briefing will report the proportions of members recalling those tools as reasons for getting appointments.

(4) Analysis: The analysis will explore the comparative influence of incentives, reminders, welcome calls, and other tools in getting patients to make appointments for well-care and preventive care. The analysis will include breakdowns by demographics to assess the effectiveness of each tool within the diverse groups that comprise the Medicaid population.

(5) Implications: Prevention and wellness are increasingly dependent on choices made by patients, to seek care and adhere to clinical advice. The social sciences play an increasing role in guiding, motivating and persuading patients to be an accountable part of the medical care that they receive. Indeed, patient involvement in health care choices is one of the key elements of patient-centered medical home (PCMH) movement. Patient adherence is becoming a more common element in measures of clinical quality used in the accountable care organization (ACO) movement.

Learning Areas:
Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Social and behavioral sciences

Learning Objectives:
1. Discuss common tools for persuading patients to get well-care and preventive care. 2. Describe the practical logistics and costs of deploying these tools. 3. Describe proportions of Medicaid members who recall incentives, reminders, and welcome calls as reasons why they got checkups. 4. Compare which sources (doctors, health plans, employers, media) were the most prevalent and persuasive in causing patients to get checkups. 5. Compare and rank the several tools -- incentives, reminders, welcome calls -- in their reported effectiveness in producing checkups. 6. Compare results across demographics to determine which groups are most responsive to incentives, reminders, welcome calls, and persuasion from different sources promoting well-care. 7. Analyze impacts of these influences (incentives, reminders, etc.) on patient ratings of the quality of health care services.

Keywords: Adherence, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Served six years as Senior Biostatistician at the largest public health plan in the United States serving Medicaid and CHIP populations in an ethnically diverse urban county in the southwest United States. Managed CAHPS survey from 2006 to 2012 to obtain actionable information to guide the design of interventions to improve the quality of services and care. Designed instruments to assess patients' reasons for getting or missing appointments for well-care visits.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.