Impact of Financial Incentives on Service Use, Spending, and Health in Medicaid

What Do Medicaid Members Want From Their Health Plan? Insights From a Qualitative Study to Improve Engagement in Case Management

PURPOSE OF STUDY

Managed care organizations (MCOs) provide case management services to address unmet health and social needs among their members. Few studies have examined factors influencing members' decision to participate in these programs. The purpose of the present study was to describe the life circumstances of Medicaid members offered case management, what they wanted from their MCO, and their perceptions of case management and barriers to participation. Results will inform practice to raise the awareness, engagement, and impact of case management programs.

PRIMARY PRACTICE SETTINGS

Case management offered through a Midwestern Medicaid MCO.

METHODOLOGY AND SAMPLE

Adult members who had been offered case management services in the 6 months preceding the study were eligible for the study. Fifteen people from each strata were recruited: members who engaged with case management, declined it, or declined it initially but later engaged (N = 45). Participants completed a qualitative interview by phone and a brief health survey online.

RESULTS

Across strata, only 22 participants recalled engagement with case management. Members described a variety of life challenges (e.g., chronic health conditions, caregiver responsibilities, and limited finances) and services they desired from their MCO (e.g., stipends for over-the-counter health expenses, improved transportation services, and caregiver assistance). Participants identified direct communication, emotional support, and referrals for resources as benefits of case management.

Association of Economic Policies With Hypertension Management and Control: A Systematic Review

Importance

Economic policies have the potential to impact management and control of hypertension.

Objectives

To review the evidence on the association between economic policies and hypertension management and control among adults with hypertension in the US.

Evidence Review

A search was carried out of PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, CINAHL, EconLit, Sociological Abstracts, and Scopus from January 1, 2000, through November 1, 2023. Included were randomized clinical trials, difference-in-differences, and interrupted time series studies that evaluated the association of economic policies with hypertension management. Economic policies were grouped into 3 categories: insurance coverage expansion such as Medicaid expansion, cost sharing in health care such as increased drug copayments, and financial incentives for quality such as pay-for-performance. Antihypertensive treatment was measured as taking antihypertensive medications or medication adherence among those who have a hypertension diagnosis; and hypertension control, measured as blood pressure (BP) lower than  140/90 mm Hg or a reduction in BP. Evidence was extracted and synthesized through dual review of titles, abstracts, full-text articles, study quality, and policy effects.

Findings

In total, 31 articles were included. None of the studies examined economic policies outside of the health care system. Of these, 16 (52%) assessed policies for insurance coverage expansion, 8 (26%) evaluated policies related to patient cost sharing for prescription drugs, and 7 (22%) evaluated financial incentive programs for improving health care quality. Of the 16 studies that evaluated coverage expansion policies, all but 1 found that policies such as Medicare Part D and Medicaid expansion were associated with significant improvement in antihypertensive treatment and BP control. Among the 8 studies that examined patient cost sharing, 4 found that measures such as prior authorization and increased copayments were associated with decreased adherence to antihypertensive medication. Finally, all 7 studies evaluating financial incentives aimed at improving quality found that they were associated with improved antihypertensive treatment and BP control. Overall, most studies had a moderate or low risk of bias in their policy evaluation.

Conclusions and Relevance

The findings of this systematic review suggest that economic policies aimed at expanding insurance coverage or improving health care quality successfully improved medication use and BP control among US adults with hypertension. Future research is needed to investigate the potential effects of non-health care economic policies on hypertension control.

Spatio-Temporal Comprehensive Measurements of Chinese Citizens' Health Levels and Associated Influencing Factors

Health is the basis of a good life and a guarantee of a high quality of life. Furthermore, it is a symbol of social development and progress. How to further improve the health levels of citizens and reduce regional differences in citizens’ health status has become a research topic of great interest that is attracting attention globally. This study takes 31 provinces (municipalities and autonomous regions) of China as the research object. Through using GIS (Geographic Information System) technology, the entropy method, spatial autocorrelation, stepwise regression, and other quantitative analysis methods, measurement models and index systems are developed in order to perform an analysis of the spatio-temporal comprehensive measurements of Chinese citizens’ health levels. Furthermore, the associated influencing factors are analyzed. It has important theoretical and practical significance. The conclusions are as follows: (1) Between 2002 and 2018, the overall health levels of Chinese citizens have generally exhibited an upward trend. Moreover, for most provinces, the health levels of their citizens have improved dramatically, although some provinces, such as Tianjin and Henan, showed a fluctuating downward trend, suggesting that the health levels of citizens in these regions displayed a tendency to deteriorate. (2) The health levels of citizens from China’s various provinces showed clear spatial distribution characteristics of clustering, as well as an obvious spatial dependence and spatial heterogeneity. As time goes by, the degree of spatial clustering with regard to citizens’ health levels tends to weaken. The health levels of Chinese citizens have developed a certain temporal stability, the overall health status of Chinese citizens shows a spatial differentiation of a northeast–southwest distribution pattern. (3) The average years of education and urbanization rate have a significant positive effect on the improvement of citizens’ health levels. The increase of average years of education and urbanization rate can promote the per capita income, which certainly could help improve citizens’ health status. The Engel coefficient, urban–rural income ratio, and amount of wastewater discharge all pose a significant negative effect on the improvement of citizens’ health levels, these three factors have played important roles in hindering the improvements of citizen health.

Iowa's Medicaid Healthy Behaviors Program Associated With Reduced Hospital-Based Care But Higher Spending, 2012-17

Health behavior incentive programs are increasingly common in Medicaid programs nationwide. Iowa's Healthy Behaviors Program (HBP) requires Medicaid expansion enrollees to complete an annual wellness exam and health risk assessment or pay monthly premiums to avoid disenrollment. The extent to which the program reduces the use of hospital-based care and lowers health care spending is unknown. Using data for 2012-17 from Medicaid and for 2014-17 from HBP, we evaluated changes in use and spending associated with HBP participation. Compared to nonparticipants, HBP participants were less likely to have an emergency department visit or be hospitalized (by 9.6 percentage points and 2.8 percentage points, respectively) but had higher total health care spending ($1,594). Meanwhile, Iowa's Medicaid expansion was associated with increased use and spending independent of HBP participation-that is, applying to both participants and nonparticipants. Overall, our findings suggest that the HBP was associated with substantial reductions in hospital-based care but increased health care spending.