Making Consumer Incentives Work in a Care Management Program

Jim Hardy, for HealthLeaders Media, June 3, 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.

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