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Hanging a carrot for patients to take healthy steps: Does it work?

Patricia Alexander knew that she needed a mammogram but could not find the time.

"Every time I made an appointment, something came up," he said. Alexander, 53, who lives in Moreno Valley, California.

During the summer, his medical practice, part of Vantage Medical Group, promised him a $ 25 Target gift card if he took the test. Alexander, who is insured through Medi-Cal, the version of the Medicaid program for low-income people, said that motivated her to make a new appointment and keep it.

Health plans, medical practices and some Medicaid programs are increasingly offering financial incentives to motivate Medicaid patients to get involved in more preventive care and make healthier living decisions.

Follow the example of private insurers and employers who have rewarded people for healthy behaviors such as quitting smoking or maintaining weight loss. Such changes in health-related behavior can reduce the cost of long-term care.

"We have seen that incentive programs are quite popular in the insurance market, and now we are also seeing those increases in the Medicaid space." Said Robert Saunders, research director at the Margolis Center for Health Policy at Duke University.

Medicaid patients who agree to undergo cancer screenings, attend health-related classes or complete health risk surveys can obtain gift cards, cash, gym memberships, pedometers or other rewards. They can also get discounts on their health care costs or bonus benefits, such as dental care.

Under the Affordable Care Act, 10 states received grants totaling $ 85 million to prove the use of financial rewards as a way to reduce the risk of chronic diseases among their Medicaid populations. During the five-year demonstration, states used incentives to encourage people to enroll in diabetes prevention, weight control, smoking cessation and other preventive programs. The participating states were California, Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas and Wisconsin.

Medi-Cal, for example, offered gift cards and nicotine replacement therapy to people who called the state smoking cessation line. The Minnesota Medicaid program gave cash to people who attended a diabetes prevention class and completed blood tests.

An evaluation of these programs, published in April, showed that incentives help persuade Medicaid beneficiaries to participate in such preventive activities. Participants said that gift cards and other rewards also helped them achieve their health goals. But the evaluators could not prove that the programs prevented chronic diseases or saved money from Medicaid. This is partly because the benefits could take years to manifest, according to the evaluation.

In general, research on the effectiveness of financial incentives for the Medicaid population has been mixed. A report this year from the Center on Budget and Policy Priorities found that can induce people to attend an appointment or attend a class, but is less likely to generate long-term behavioral changes, such as weight loss. And in some cases, according to the report, incentives are given to people to obtain exams that they would obtain anyway.

The center's report also found sanctions, including those that limit coverage for people who do not participate in healthy behaviors, were not effective. Instead, they can lead to increased use of emergency rooms restricting access to other forms of care.

Some of the main factors that prevent Medicaid patients from adopting healthy behaviors are related not to medical care, but to their circumstances, said Charlene Wong, a pediatrician and health policy researcher at Duke University.

That makes the administration of incentive programs more complicated. Even recruiting and enrolling participants has been a challenge for some states that received grants through the Affordable Care Act.

"Most likely to help Medicaid beneficiaries use care appropriately is simply to give them access to that Attention, and that includes providing transportation and childcare, "said Hannah Katch, one of the authors of the Center for Budget and Policy Priorities report. Another barrier is being able to take time off to go to the doctor.

But health plans are eager to offer financial incentives to patients because they can improve their quality scores and attract more enrollees. And medical groups, which can receive fixed payments per patient, know that they can reduce their costs and increase their profits if their patients are healthier.

Providing incentives to medical plans and groups has created a business opportunity for some companies. Gift Card Partners has been selling gift cards to Medicaid health plans for approximately five years, said Executive President Deb Merkin. She said that health insurers that serve Medicaid patients want to improve their quality indicators, and can do so by giving incentives and taking patients to the doctor.

"These are the things that are so important to get them to do the right thing so that they save money in the long term," he said.

Agilon Health, based in Long Beach, California, runs incentive programs and other services for various medical groups in California that care for Medi-Cal patients. Medical groups contract with the company, which provides gift cards to patients who get mammograms, cervical cancer exams or childhood vaccines. People with diabetes also receive gift cards if they check their eyes or check their blood sugar levels. And the company offers doctors bonuses if their Medicaid patients adopt healthier behaviors.

Incentives for patients are "enormously important for the Medicaid population, because gaps in care historically prevail," said Ron Kuerbitz, CEO of Agilon. These gaps are a major factor that increases costs for Medicaid patients, because if they do not receive preventive services, they are more likely to need more specialized care later, Kuerbitz said.

Emma Alcanter, who lives in Temecula, Calif., Received a gift card from her doctor's office after having a mammogram later this summer. Alcanter, 56, had noticed a lump in his chest, but waited approximately two years before checking it, despite reminders from his doctor's office. "I was afraid they were going to find cancer," he said.

Alcanter finally decided to take a test after his first grandchild was born. The gift card was an added bonus, and Alcanter said he showed that his doctors cared about her. Her mammogram revealed that the lump was not cancer and she plans to use the gift card to buy a gift for her grandchild.

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