title: The wellness incentives and navigation project: design and methods.
abstract: BACKGROUND
  About 35 % of non-elderly U.S. adult Medicaid enrollees have a behavioral health condition, such as anxiety, mood disorders, substance use disorders, and/or serious mental illness. Individuals with serious mental illness, in particular, have mortality rates that are 2 to 3 times higher as the general population, which are due to multiple factors including inactivity, poor nutrition, and tobacco use. 61 % of Medicaid beneficiaries with behavioral health conditions also have multiple other co-occurring chronic physical health conditions, which further contributes to morbidity and mortality. The Wellness Incentives and Navigation (WIN) project is one of 10 projects under the Centers for Medicare and Medicaid Services "Medicaid Incentives for the Prevention of Chronic Diseases" Initiative, to "test the effectiveness of providing incentives directly to Medicaid beneficiaries of all ages who participate in prevention programs, and change their health risks and outcomes by adopting healthy behaviors."
  
  
  METHODS
  WIN is a three-year randomized pragmatic clinical trial designed to examine the comparative effectiveness of the combined use of personal navigators, motivational interviewing, and a flexible wellness account on cardiovascular risk reduction among individuals in Medicaid with co-occurring physical and mental health conditions or serious mental illness alone relative to the usual care provided within Medicaid Managed Care. 1250 individuals, identified through Medicaid claims data, were recruited and randomly assigned to an intervention group or control group with outcomes tracked annually. A comparison group was also recruited to help assess the study's internal validity.
  
  
  CONCLUSIONS
  The primary outcomes are physical and mental health related quality-of-life as measured by the SF-12, and BMI, blood pressure, LDL-C, and Hba1c results for those who are diabetic measured clinically. The purpose of this paper is to present the unique design of the WIN trial prior to results becoming available in hopes of assisting other researchers in conducting community-based randomized pragmatic trials. Outcomes will be assessed through the linkage of patient reported outcomes, health care claims, and electronic health record data.
  
  
  BACKGROUND
  NCT02440906.
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, the Clinical and Translational Science Institute, and the Institute for Child Health Policy, University of Florida, Gainesville, USA. eshenkman@ufl.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shenkman
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, the Clinical and Translational Science Institute, and the Institute for Child Health Policy, University of Florida, Gainesville, USA. kmuller@ufl.edu.
authors.forename: Keith
authors.initials: K
authors.lastname: Muller
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, the Clinical and Translational Science Institute, and the Institute for Child Health Policy, University of Florida, Gainesville, USA. bvogel@ufl.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Vogel
authors.affiliation: Department of Psychiatry, College of Medicine, University of Florida, Gainesville, USA. sjnixon@ufl.edu.
authors.forename: Sara Jo
authors.initials: SJ
authors.lastname: Nixon
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine and the Institute for Child Health Policy, University of Florida, Gainesville, USA. wagenaar@gmail.com.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Wagenaar
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, University of Florida, Gainesville, USA. kim.case@ufl.edu.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Case
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, University of Florida, Gainesville, USA. yiguo@ufl.edu.
authors.forename: Yi
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, Department of Epidemiology, College of Public Health and Health Professions, and the Clinical and Translational Science Institute, University of Florida,, Gainesville, USA. mwegman@ufl.edu.
authors.forename: Martin
authors.initials: M
authors.lastname: Wegman
authors.affiliation: Texas Department of State Health Services, Austin, USA. Jessie.Aric@dshs.state.tx.us.
authors.forename: Jessie
authors.initials: J
authors.lastname: Aric
authors.affiliation: Texas Department of State Health Services, Austin, USA. Dena.Stoner@dshs.state.tx.us.
authors.forename: Dena
authors.initials: D
authors.lastname: Stoner
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000378:metabolism; D002908:Chronic Disease / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000517:prevention & control; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D020407:Internet; D008329:Managed Care Programs / Q000458:organization & administration; D008484:Medicaid; D001523:Mental Disorders / Q000517:prevention & control; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014481:United States
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin