Natoshia M. Askelson (
Brad Wright is an assistant professor of Health Management and Policy at the University of Iowa.
Health Aff (Millwood). 2017 May 1;36(5):799-807. doi: 10.1377/hlthaff.2017.0048.
As part of Iowa's Medicaid expansion, the Healthy Behaviors Program was designed to provide members with incentives to complete specified healthy activities in return for waiving monthly premiums. We used claims data and interviews to document the first year (2014) of the program's implementation. Healthy activities completion rates did not exceed 17 percent. Interviews with members and clinic managers revealed low levels of awareness of the program's existence, deficits in knowledge about how the program works, and a variety of barriers to activity completion. Our findings suggest that the lack of knowledge hindered the state's ability to incentivize activities and that it subjected beneficiaries to premium expenses and potential disenrollment. These results should guide federal and state policy makers in devising more effective ways of educating Medicaid beneficiaries and providers about programs that incentivize responsibility for healthy behaviors. The results suggest that efforts by federal and state governments to reform Medicaid by shifting responsibility onto program members for healthy behaviors are unlikely to succeed, especially without careful thought and design of premiums, penalties, and incentives for participants.
作为爱荷华州医疗补助计划扩展的一部分，健康行为计划旨在为成员提供激励，以完成指定的健康活动，以换取免除每月保费。我们使用索赔数据和访谈记录了该计划实施的第一年（2014 年）。健康活动的完成率不超过 17%。对成员和诊所经理的访谈揭示了对该计划存在的认识程度低，对该计划运作方式的知识不足以及活动完成的各种障碍。我们的研究结果表明，缺乏知识阻碍了该州激励活动的能力，并使受益人承担了保费支出和潜在的退保风险。这些结果应指导联邦和州政策制定者制定更有效的方法，教育医疗补助受益人及其提供者有关激励健康行为的计划。结果表明，联邦和州政府通过将健康行为的责任转移到计划成员身上来改革医疗补助的努力不太可能成功，特别是如果不对保费，罚款和奖励计划参与者进行精心考虑和设计的话。
