HI-PRAISE: Implementation of Incentives Program to Improve Chronic Diseases among Medicaid Recipients

摘要

The Hawai‘i Patient Reward And Incentive to Support Empowerment (HI-PRAISE) Project is a health economics demonstration grant focused on the use of incentives to improve chronic disease management for adult Medicaid recipients with diabetes. The goal of the HI-PRAISE project is to assess the implementation and effectiveness of an incentives program in patient-centered medical homes at nine federally qualified health centers (FQHCs). An incentives satisfaction survey was administered to participants at three FQHCs in November 2013. Focus groups were conducted in May 2014 for the HI-PRAISE participants as well as for the FQHC staff implementing the project. A semi-structured interview was developed to elicit the key domains, with follow up probes to elicit details. Open-ended questions that were asked in the focus groups revolved around choice of incentives, cultural issues, challenges, and program integration into patient-centered medical homes. Of the 56 survey respondents, 100% agreed that rewards were given to them on time and 98% agreed that rewards helped set goals. Eighteen participants and twenty-three FQHC staff participated in the focus groups. There was high participant satisfaction with the incentives program and average incentive amount was $20. Program managers mainly chose gift-cards over cash incentives for ease of administration and tracking. Health coaches and diabetes care coordinators have observed improve access to behavioral health and vision services through the use of incentives. Barriers identified were related to transportation and child-care. Implementation of incentive programs requires buy-in from key players at the FQHCs. Incentives may improve access and reduce barriers for persons with chronic diseases.