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331196
Role of incentives in behavior change: Patient and provider perspectives in 10 state grantees: A qualitative study


Tuesday, November 3, 2015

Rebecca Perry, MSc, Health Coverage for Low-Income and Uninsured Populations, RTI International, Washington, DC
Julia Kish-Doto, PhD, MS, Center for Communication Science, RTI International, Rockville, MD
Thomas Hoerger, PhD, RTI International, Research Triangle Park, NC
Katherine Treiman, PhD, MPH, Health Communication Program, RTI International, Rockville, MD
Stephanie Teixeira-Poit, MS, RTI International, Research Triangle Park, NC
Jennifer Gard Read, MPH, RTI International, Research Triangle Park, NC
Paula Eguino-Medina, BS, RTI International, Washington, DC
Erin Boland, BA, RTI International, Research Triangle Park, NC
Caroline Chandler, RTI International, Research Triangle Park, NC
Background: Chronic diseases are the major contributor to health care expenditures for insurers, including Medicaid, yet such diseases can often be prevented or mitigated through behavior change. Research suggests that carefully targeted incentives can help individuals change their behavior, resulting in improved outcomes and, potentially, lower health care utilization and expenditures. Despite the existing evidence of effective incentive programs, changing behaviors remains extremely difficult.

 Under section 4108 of the Affordable Care Act (ACA), State grantees received funds to develop evidence-based prevention programs that incentivize Medicaid beneficiaries by implementing chronic disease prevention and management programs called Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) programs. Programs use different incentives to improve healthy behaviors (e.g., smoking cessation) with the goal of reducing the prevalence of chronic diseases such as diabetes, hypertension, and obesity among Medicaid beneficiaries.

 Methods: We conducted 18 focus groups with MIPCD program participants (n = 171) and 29 stakeholders interviews in eight States to gather information about participants’ experience with the programs.  

 Results:Program participants and stakeholders shared examples of healthy behavior changes that they attributed to MIPCD programs. These changes included weight loss, reduced alcohol consumption, reduced stress, increased primary care visits, and improved eating habits. Participants and stakeholders indicated that incentives alone did not change participant behavior. Instead, incentives motivated participants to enroll in the MIPCD program. Health improvements and coaching from program staff helped sustain participant engagement and encouraged goal accomplishment.  

Conclusions: Understanding participants’ experience in incentive programs and the role programs play in changing their behavior is important for implementing effective incentive programs.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs

Learning Objectives:
Describe patient and provider perspectives on the role of incentives on health behavior change through Affordable Care Act-funded State initiatives.

Keyword(s): Medicaid, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I serve as the program manager for this federally-funded, independent evaluation contract as well as a moderator and team member for the focus group portion of the evaluation. As a former State Medicaid employee and qualitative researcher, I have the perspective of a former practitioner and a researcher on these Medicaid chronic disease prevention programs.
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.

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