State Medicaid programs test whether offering incentives increases adoption of healthy behaviors

June 11, 2018 – A new report found early signs of success in incentive programs for healthy behaviors.

State efforts to help Medicaid beneficiaries engage in specific health behaviors show early signs of success, according to a new report. The report, which discovered 18 state Medicaid programs and nearly all Medicaid managed care plans are offering incentives for health behaviors, found that programs targeting preventive services and smoking cessation sparked the most initial success. The analysis was developed by researchers at the Duke-Margolis Center for Health Policy with funding from the Robert Wood Johnson Foundation. The DCRI’s Charlene Wong, MD, was one of the report’s authors.

The programs provide incentives for Medicaid recipients to lose weight, control diabetes, manage blood pressure, attend pregnancy visits, and more. A range of incentives are used, including gift cards, reduced insurance premiums, and monetary penalties. Among the report’s findings:

  • A Wisconsin program saw 22 percent of Medicaid beneficiaries quit smoking after receiving both financial incentives and counseling, compared to quit rates of 14 percent for smokers who only received counseling.
  • Similarly, an Idaho program saw their “well-child visit” rates jump from 40 percent to 66 percent after incentives were offered.

Overall, researchers found substantial variation in the results of the efforts, and limited and mixed evidence on whether the programs are linked to improvements in people’s health. In addition, while states and Medicaid managed care plans devoted significant effort to advertise and inform beneficiaries about the programs, only two states out of 10 participating in a related federal grant program met their enrollment targets. The report considers further administrative challenges for the programs, including higher than expected costs for administration and data systems.

Researchers note that the long-term viability of these incentive programs will depend on more evidence about the effectiveness of these incentives on long-term health outcomes, optimal program design, and the impact on vulnerable populations.