Medicaid: Paid for Wellness Habits! Will it work?

A federal grant program authorized in the health overhaul law is offering states $100 million to reward Medicaid recipients who make an effort to quit smoking or keep their weight, blood pressure or cholesterol levels in check.  States, under pressure to cut Medicaid costs, shouldn’t be the source of the programs, incentives, engagement, validation and administration processes for this extremely expensive and potentially effective intervention.  HCD as an organization is designed to help and we hope to connect with leaders in YOUR state to help make a difference.  You can contact us with questions, comments, ideas and insights.

Please read this blog with some questions and thoughts in mind: How successful has almost every motivation or engagement in “healthy behavior change” process been?  Taking the time to know a patient, understand their social graph and working to impact them through their “connected” real lives could deliver the best return on every dollar spent toward healthy behavior change.  If you haven’t read James Fowler’s CONNECTED, it could be well worth the investment.

The Medicaid population could win big with this influx of funding, or the program could fall flat if conventional (and largely unsuccessful) “weight-loss programs are the default solution-model.

The federal dollars for Medicaid incentives reflect a sharpening emphasis on the role of preventive health in targeting the underlying causes of chronic disease, a central pillar of the Obama administration’s health care agenda. Federal guidelines provide a basic profile of what can be done with the funding. Medicaid enrollees who demonstrate a commitment to improving their health will be eligible to receive financial rewards such as coupons or gift certificates. For those who are overweight or trying to quit smoking, that commitment might take the form of weight management classes or tobacco cessation counseling. States are encouraged to provide rewards “on a tiered basis” for attempts at participation, “actual behavior change,” and “achievement of health goals.”

We are particularly interested in what’s being planned for specific population needs across age bands.  Chronic conditions such as diabetes, bad cholesterol and high blood pressure account for more than 75 percent of the $2.5 trillion the U.S. spends annually on health care, according to data from the Department of Health and Human Services.

States Have Mixed Results

To date, a few states have tried transplanting the corporate wellness model to Medicaid, with mixed results. State health officials seem to agree that participation from health care providers and other community organizations, often a challenge, was critical in making their programs work. At HCD, we have noted similar challenges.  It is for that reason we are working closely with many agencies and experts to develop a Physical Activity Intervention Program (PAIP) so that each initiative does not need to “re-invent the wheel.” We are positioned to help states engage communities, healthcare providers and the target populations.

Research On Incentives Is Inconclusive

A recent study about incentive-based weight loss programs, published  in the Journal of the American Medical Association, was not optimistic. That study found that financial rewards did help participants lose more weight temporarily, but the losses weren’t fully sustained in the end. We are puzzled as to why “weight loss” is the measurement parameter when time and again participation in physical activity is the first step to prevention of chronic conditions and can reduce the costs of those with existing chronic conditions.  When an individual participates in physical activity the outcome for the activity session is SUCCESS – and some connection to a social group, when the program is properly designed. Burdening that behavior with expectation of weight-loss is not motivating over the long term.  Knowing that, why do so many intervention attempts default to the weight-loss model?

Few behavioral studies have attempted to determine whether people who receive the incentives are able to maintain their short-term success long term — the ultimate goal of incentive-based prevention program. Fewer attempts have been made to address how the design of an incentive program should be adjusted according to the demographics of the target population, such as insuring that low-income participants have transportation to get to appointments and classes. HCD has long advocated ACCESS to relevant PROGRAMMING as key to ENROLLMENT and long term PARTICIPATION.

You can read the entire Kaiser Health News article at this RWJF link.

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