RTI International, Research Triangle Park, North Carolina.
IMPAQ International, Washington, District of Columbia.
Am J Prev Med. 2018 Dec;55(6):875-886. doi: 10.1016/j.amepre.2018.07.025.
The Centers for Medicare and Medicaid Services provided grants to Medicaid programs through the Medicaid Incentives for Prevention of Chronic Diseases program to test whether financial incentives changed the use of healthcare services, Medicaid spending, and health outcomes. Six states implemented programs related to diabetes prevention, weight management, diabetes management, and hypertension management. The purpose of this study is to examine whether receipt of financial incentives increased use of services incentivized by the program; reduced expenditures, inpatient admissions, emergency department visits; and improved health outcomes.
State data on program participation and incentives (between 2011 and 2015) and 2 years of Medicaid claims data pre-Medicaid Incentives for Prevention of Chronic Diseases enrollment and >2 years of claims data after enrollment were analyzed using covariate-adjusted regression analyses. Negative binomial, logistic, and linear regressions were used, depending on the outcome variable of interest (services, inpatient admissions and emergency department visits, and total expenditures). Analyses were conducted in 2015 and 2016.
Incentive recipients attended, on average, one to two more diabetes prevention classes than control participants, but incentives did not significantly improve uptake of other types of services, such as meetings with a health coach or doctor, gym visits, or attendance at Weight Watchers meetings. Modest improvements in health outcomes, such as weight loss, were observed, yet there were very few significant changes in inpatient admissions, emergency department visits, and Medicaid expenditures.
Financial incentives are useful for engaging Medicaid enrollees in disease prevention programs, but program engagement may not necessarily lead to changing patterns of healthcare utilization and expenditures in the short run.
医疗保险和医疗补助服务中心通过医疗补助预防慢性病计划向医疗补助计划提供赠款，以测试财务激励措施是否改变了医疗服务的使用、医疗补助支出和健康结果。六个州实施了与糖尿病预防、体重管理、糖尿病管理和高血压管理相关的计划。本研究旨在检查是否收到财务激励措施增加了受该计划激励的服务的使用；减少支出、住院人数、急诊就诊次数；并改善健康结果。
使用协变量调整回归分析，分析了 2011 年至 2015 年期间计划参与和激励措施的州数据（激励措施和激励措施），以及在医疗补助预防慢性病计划登记前的 2 年医疗补助索赔数据和登记后的 2 年以上索赔数据。根据服务、住院人数和急诊就诊次数以及总支出等感兴趣的结果变量，使用负二项式、逻辑和线性回归。分析于 2015 年和 2016 年进行。
激励措施的接受者平均比对照组多参加一到两次糖尿病预防课程，但激励措施并没有显著提高其他类型的服务的利用率，如与健康教练或医生的会面、去健身房或参加 Weight Watchers 会议。观察到健康结果的适度改善，例如体重减轻，但住院人数、急诊就诊次数和医疗补助支出几乎没有显著变化。
财务激励措施对于让医疗补助受助人参与疾病预防计划非常有用，但短期内，计划参与可能不一定会导致医疗保健利用和支出模式的改变。
