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Making Consumer Incentives Work in a Care Management Program

 |  By HealthLeaders Media Staff  
   June 03, 2009

Consumer incentives are often thrown around as healthcare panacea. Send out a few gift cards and watch program enrollment increase as members lose weight, quit smoking, and generally improve their health as bad habits are eliminated.

Through our experience running consumer incentive programs, we've found that elements of this are true. As healthcare consumers, we are all complex. We often run into barriers and can't get things done, have trouble making a long-term commitment, and, simply, may not have much interest in our changing behavior.

Whether the consumer is a member of a commercial health plan or a Medicaid program, the incentive isn't a silver bullet. It can't stand alone as the total solution, but it can be an important part of the package.

At least two studies have taken a look at how incentive plans can affect healthcare consumers and their attitudes.

In the commercial health plan realm, the Agency for Healthcare Research and Quality (AHRQ) published the "Consumer Financial Incentives: A Decision Guide for Purchasers," which is described as a "tool" for employers, health plans, and state Medicaid agencies.

In the AHRQ report, they were particularly interested in how consumer incentives could help health plan members make certain choices, including:

  • Selecting a high-value provider
  • Selecting a high-value health plan
  • Deciding among treatment options
  • Reducing health risks by seeking preventive care
  • Reducing health risks by decreasing or eliminating high-risk behavior

Participants–especially those with chronic illnesses–should be the center of attention when it comes to incentives, according to the report. (While they are a small group, they make up a large part of a plan's costs.)

Messages should be simple and repeated often by someone who has high credibility with the audience.

A study by the Center for Health Care Strategies, "Medicaid Efforts to Incentivize Healthy Behaviors" demonstrated that Medicaid beneficiaries were less effective in sticking with long-term behavior change without additional support. Here are a few other issues noted in the research:

  • Member has to be interested or at least contemplating change
  • Member must see the value in what is being initially required and any long-term benefits
  • Long-term change requires conversion from extrinsic to intrinsic benefit

Perhaps most importantly, the action that the person is being asked to take must be achievable. The program must address the most critical barriers, or perceived barriers, that the member may face.

These barriers can include a lack of specialist availability, transportation, and daycare; social stigma, fear, denial or ignorance; and economics. To address these barriers and others, it's critical to offer a complete member engagement program where one of the strategies is incentives.

Complete Approach to Member Engagement
Incentives are just one part of a complete member communications approach to reaching consumers. A comprehensive program includes a number of ways to encourage consumers to join and remain in a program. These include:

  • Member communications
  • Provider and community outreach
  • Addressing barriers to care
  • Incentives
  • Measuring success
  • Refining the program

Case Studies
Both organizations, Illinois Medicaid and a commercial health plan, highlighted here implemented consumer incentives in partnership with McKesson.

The Illinois Department of Healthcare and Family Services (HFS) and McKesson developed an incentive program to encourage participation of eligible high-cost, high-risk Illinois Medicaid recipients in the Your Healthcare Plus care management program.

As part of the ongoing outreach activities, a re-contact letter is sent to members not yet actively participating promising a $10 Walgreens gift card if the member completes an assessment, thereby officially enrolling in the program. The letter also asks the member to verify demographic data.

The re-contact letters were sent multiple times over the course of many months. The results of the first year of the incentive program show that members who received the enrollment offer generated a 20% enrollment rate, while members who received a letter without the enrollment offer, generated a 13% response rate.

While the initial results were positive, HFS and McKesson are now refining the program further by adding an end date to the offer to improve tracking to create a sense of urgency; limiting the number of letters sent per member—identifying the point of diminishing return; and adding disclaimer language to discourage members from requesting multiple gift cards.

Meanwhile, a Texas commercial health plan that wanted to improve the enrollment in its asthma and diabetes care management programs used a $10 gas card as an enticement. The health plan sent two similar mailings to two groups of 1,200 members each:

  • One group received program information and a letter letting them know that when they successfully enrolled in the program a $10 gas card would be sent to them.
  • The control group received program information with no mention of the free gas card.
  • The program lasted one month.

While the program enrollment numbers are small, the results of the incentive program showed that the gas card offer did have a positive impact on member enrollment.

Of the 10 people who enrolled in the asthma program during the 30-day incentive program, 70% came from the incentive group, the remainder from the control group. The story was much the same for the diabetes group. Of the 30 people who enrolled during the incentive period, 73% were from the incentive group, 27% from the control group.

The program demonstrated that those in the incentive group were 2.67 times more likely to enroll than control group members.

Finding Success
Success is measured with qualitative and quantitative assessments. We typically look at response rates, and retention or enrollment rates to find out how well the program is accepted by members. We also look at complaints, compliments, and anecdotal feedback received by staff members.

For specific chronic illness or other conditions that we want to impact, we'll drill down to get screening rates and HEDIS scores.

We also look closely at how well we're doing. How much does the program cost, including direct costs, such as creative development, print and postage, incentives, and call center support?

Across the board, we've found that successful member engagement programs have several things in common:

  • The program is simple.
  • Multiple channels are used to communicate with members.
  • The message, whether it's joining the program or quitting smoking, is reinforced throughout the course of the program.

Jim Hardy is senior vice president/general manager at McKesson Health Solutions, a provider of care management services to commercial and Medicaid clients.
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