title: Improving medicaid health incentives programs: lessons from substance abuse treatment research.
abstract: This commentary addresses the efforts of Medicaid programs in several US states to employ financial incentives to increase healthy behavior among their beneficiaries. While these Medicaid incentive programs have been successful at boosting rates of less effortful behaviors, like semiannual dental visits, they have fallen short in promoting more complex behaviors, like smoking cessation, drug abstinence, and weight management. Incentives have been extensively studied as a treatment for substance use disorders for over 20years, with good success. We identify two variables shown by meta-analysis to moderate the efficacy of incentive interventions in substance abuse treatment, the immediacy of incentive delivery and size (or magnitude) of the incentive, that are lacking in current Medicaid incentive program. We also offer some guidance on how these moderating variables could be addressed within Medicaid programs. This is a critical time for such analysis, as more than 10 states are employing incentives in their Medicaid programs, and some are currently reevaluating their incentive strategies.
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA. Electronic address: dennis.hand@uvm.edu.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hand
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA; Department of Psychology, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Heil
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA; Department of Psychology, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA.
authors.forename: Stacey C
authors.initials: SC
authors.lastname: Sigmon
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA; Department of Psychology, University of Vermont, 1 So. Prospect St., UHC Room 1415, Burlington, VT 05401, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Higgins
mesh_terms: D005380:Financing, Government; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008484:Medicaid / Q000458:organization & administration*; D009042:Motivation; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D013221:State Health Plans / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000628:therapy*; D014481:United States
keywords: Behavioral economics; Health plan implementation; Health planning; Health planning guidelines; Meidcaid; Substance-related disorders