Would you be more likely to put down that French fry and pick up a carrot stick if you knew that your health insurance policy didn't have a deductible? Would you hit the gym more often if your insurance premium were waived? And what if you didn't have to pay for smoking cessation classes? Would you be more likely to snuff out the habit? Federal health officials are hoping the answers to all of those questions are a deafening "Yes" from Medicaid beneficiaries. CMS earlier this month started accepting applications from states for $100 million in grants to reward Medicaid beneficiaries who quit smoking, lose weight, exercise, keep their blood pressure or cholesterol under control, and more. The Medicaid Incentives for Prevention of Chronic Diseases Program was mandated by the Affordable Care Act. In announcing the grant application period, which ends May 2, CMS said the goal is to "test and evaluate the effectiveness" of providing "financial and non-financial incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes, including adoption of healthy behaviors."
A guidance document put together for CMS by Thomson Reuters says the program should not be about giving people money. Rather, it should include incentives such as waiving premiums, deductibles and coinsurance payments. States could provide points that could be used to buy medications. Beneficiaries could be reimbursed for taking smoking cessation classes or Weight Watchers. The guide also discourages the use of penalties, calling them counterproductive.
"Penalizing beneficiaries for not participating in health improvement programs or achieving certain health outcomes will instill resentment and likely negatively impact the most vulnerable beneficiary populations," the guide states.
That's not necessarily how Arizona Gov. Jan Brewer sees things. She's taking the stick approach. The Republican governor proposed a $50 annual fee for adults who smoke. Similar penalties would apply to obese or diabetic beneficiaries who fail to follow a physician's treatment plan.
Importantly for providers, the CMS guidance suggests that state activities be done in conjunction with existing care coordination projects, including patient-centered medical homes and ACOs. To be clear though, the financial incentives are for beneficiaries, not providers.
The jury is still out on how effective incentive programs are in getting people to adopt healthful lifestyles and/or better manage their chronic conditions. But with Medicaid at the center of the budget debate boiling over in D.C., it's clear that health professionals need to utilize any and every tool at their disposal. That cost curve isn't going to bend all by itself. Treating diabetes alone accounts for $174 billion in direct and indirect health care costs. Multiple that by other chronic conditions such as congestive heart failure or high blood pressure and, well, you see where I'm headed.
It'll be interesting to see what kind of programs states bring forward. And isn't it kind of refreshing to think about a government health program spending money in the hopes of making people more healthy, rather than solely focusing on Medicare and Medicaid's looming billion dollar diet?
I'll continue to explore issues of wellness and prevention in upcoming blogs and certainly welcome you take on how we can bend the cost curve. Send me your thoughts at firstname.lastname@example.org.