The theory behind wellness incentives is that, if people take better care of themselves, they’ll feel better, use fewer healthcare resources, and save money. There should be no better place to demonstrate that theory than in the Medicaid population, where chronic diseases and comorbidities pervade the landscape.
The problem, as some behavior modification initiatives in Medicaid populations are showing, lies in putting into practice workable programs that can produce measureable and even achievable results.
The Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) initiative, funded by the Department of Health and Human Services (HHS), is the biggest thing happening in Medicaid wellness programs right now.
But similar state-level programs created as part of the 2005 Deficit Reduction Act (DRA) have been in place for almost a decade. The DRA gave state Medicaid programs more leeway to experiment with the mix of services they offered, resulting in a proliferation of creative wellness offerings.
Florida, for example, gave benefit credits for getting a mammogram, bringing in a child for an immunization, or participating in a smoking cessation course. West Virginia targeted unnecessary use of emergency departments and missed physician appointments.
But their success was less than expected. A March 2013 article in Health Affairs that examined results from state Medicaid wellness programs in Florida, Idaho and West Virginia found common issues that included:
Limited evaluation of the programs’ effectiveness;
Potentially inadequate incentive amounts;
Low awareness among the target populations that the programs even existed;
Benefit structures that might have been too complex to be easily understood;
An over-reliance on physician participation; and
The administrative difficulty of tracking wellness events (such as attending a weight-loss class) that were not billable.