title: Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients.
abstract: Cardiac rehabilitation (CR) improves medical outcomes after myocardial infarction or coronary revascularization. Lower socioeconomic status (SES) patients are less likely to participate in and complete CR. The aim of this study was to test whether financial incentives may increase participation and adherence to CR among lower-SES patients.
  
  
  
  Patients eligible to participate in CR with Medicaid insurance coverage were approached for inclusion. Patients were placed on an escalating incentive schedule of financial incentives contingent upon CR attendance. CR participation was compared to a usual care group of 101 Medicaid patients eligible for CR in the 18months prior to the study. Attendance (participating in ≥one CR sessions) and adherence (sessions completed out of 36) were compared between groups. The study was conducted in Vermont, USA, 2013-2015.
  
  
  
  Of 13 patients approached to be in the study and receive incentives, 10 (77%) agreed to participate. All 10 patients completed at least one session of CR, significantly greater than the 25/101 (25%) in the control condition (p<0.001). Of patients in both groups who attended at least one session of CR, adherence was higher in the intervention group (average of 31.1 sessions completed vs. 13.6 in the control group, p<0.001). CR completion rates were also higher during the intervention with 8 of 10 (80%) intervention patients completing all 36 sessions compared to only 2 of 25 (8%) control patients (p<0.001).
  
  
  
  Financial incentives may be an efficacious strategy for increasing CR participation and adherence among Medicaid patients.
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States; Department of Psychology, University of Vermont, United States. Electronic address: dgaalema@uvm.edu.
authors.forename: Diann E
authors.initials: DE
authors.lastname: Gaalema
authors.affiliation: Department of Medicine, Division of Cardiology, University of Vermont Medical Center, United States.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Savage
authors.affiliation: Department of Medicine, Division of Cardiology, University of Vermont Medical Center, United States.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Rengo
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Cutler
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States; Department of Psychology, University of Vermont, United States.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Higgins
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, United States; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, United States.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Ades
mesh_terms: D000072038:Cardiac Rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009042:Motivation; D009203:Myocardial Infarction / Q000534:rehabilitation; D010349:Patient Compliance; D012959:Socioeconomic Factors; D014481:United States; D014707:Vermont
keywords: Adherence; Attendance; Behavioral economics; Cardiac rehabilitation; Financial incentives; Medicaid; Participation; Socioeconomic status