Financial Incentives for Medicaid Beneficiaries With Diabetes: Lessons Learned From HI-PRAISE, an Observational Study and Randomized Controlled Trial

Abstract

The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.

Financial incentives to improve glycemic control in African American adults with type 2 diabetes: a pilot randomized controlled trial

“…At 12-months, no statistically significant changes were observed across clinical outcomes (HbA1c, lipids) within or between the intervention and control groups. Additionally, no statistically significant differences were observed in standards of medical care within or between groups [27,28]. Limitations of this study included the multiple intervention targets, the relatively small total amount of incentives at 12 months ($320) and lack of standardized educational component layered on top of the financial incentives.…”

“…Similarly, a randomized trial conducted out of an Health Maintenance Organization (HMO) in Hawaii examined the impact of financial incentives on diabetes self-management, clinical outcomes, adopting lifestyle changes, and national recommendations for diabetes standards of medical care [27,28]. Incentives were awarded at the time outcomes were achieved or activities completed.…”

“…Financial Incentives: The financial incentives component of the intervention was developed based upon the delay discounting and financial incentives literature [23,[26][27][28]. This part of the intervention was designed to: a) target multiple behaviors that contribute to glycemic control, b) be given at a frequency that is consistent with expected change in HbA1c, c) be large enough to motivate behavior change in the target population, d) reward more aggressive lowering of HbA1c to the target of < 7%, and e) reward maintenance of targeted behaviors as indicated by maintenance of HbA1c levels at each postbaseline assessment point.…”

“…better metabolic control, reduced risk of complications, or reduced risk of dying), are less likely to make healthy lifestyle decisions. Therefore, using financial incentives as an intervention component to improve diabetes outcomes through incentivizing self-management behavior may be effective in increasing self-management and improving outcomes [23,[26][27][28].…”

Adolescent and parent perspectives on the acceptability of financial incentives to promote self‐care in adolescents with type 1 diabetes

“…The effectiveness of incentive strategies in improving both engagement in diabetes self‐care, such as blood glucose monitoring, and glycemic control has been demonstrated in adults with T1D . Given these encouraging outcomes in adult populations, there is momentum toward exploring FI in adolescent patient groups.…”