Financial Incentives for Chronic Disease Management: Results and Limitations of 2 Randomized Clinical Trials With New York Medicaid Patients

Abstract

Purpose: To identify whether financial incentives promote improved disease management in Medicaid recipients diagnosed with hypertension or diabetes, respectively.

Design: Four-group, multicenter, randomized clinical trials.

Setting and participants: Between 2013 and 2016, New York State Medicaid managed care members diagnosed with hypertension (N = 920) or with diabetes (N = 959).

Intervention: Participants in each 6-month trial were randomly assigned to 1 of 4 arms: (1) process incentives-earned by attending primary care visits and/or receiving prescription medication refills, (2) outcome incentives-earned by reducing systolic blood pressure (hypertension) or hemoglobin A_1c (HbA_1c; diabetes) levels, (3) combined process and outcome incentives, and (4) control (no incentives).

Measures: Systolic blood pressure (hypertension) and HbA_1c (diabetes) levels, primary care visits, and medication prescription refills. Analysis and Results: At 6 months, there were no statistically significant differences between intervention arms and the control arm in the change in systolic blood pressure, P = .531. Similarly, there were no significant differences in blood glucose control (HbA_1c) between the intervention arms and control after 6 months, P = .939. The majority of participants had acceptable systolic blood pressure (<140 mm Hg) or blood glucose (<8.0%) levels at baseline and throughout the study.

Conclusion: Financial incentives-regardless of whether they were delivered based on disease-relevant outcomes, process activities, or a combination of the two-have a negligible impact on health outcomes for Medicaid recipients diagnosed with either hypertension or diabetes in 2 studies in which, among other design and operational limitations, the majority of recipients had relatively well-controlled diseases at the time of enrollment.

Keywords: diabetes; financial incentives; hypertension; incentives; interventions; medicaid; motivation; outcomes; population health; process; strategies.

Figure 1:. Systolic blood pressure over time, by arm (N = 920) (Hypertension Study).

Note: Error bars +/− 1 standard error. Source: Authors’ analyses.

Figure 2:. Blood glucose level over time, by arm (N = 959) (Diabetes Study).

Note: Error bars +/− 1 standard error. Source: Authors’ analyses.