Suchergebnisse

Purpose: To test the role of financial incentives to motivate engagement in diabetes prevention programs (DPPs). Design: Minnesota, Montana, and New York randomized 3 different approaches to providing incentives: incentivizing class attendance and weight loss (all states), class attendance only (NY), and weight loss only (NY). We used New York to test how different approaches to providing incentives influence DPP completion and attendance. Setting: Health-care facilities and local young men's Christian association. Participants: Eight hundred thirty one Medicaid enrollees in Minnesota, 204 in Montana, and 560 in New York. Intervention Measure: Impact of the financial incentives on DPP program completion rates. We measured completion of DPP classes in 2 ways: completing 9 or more or 16 or more DPP classes. Analysis: Multivariate logistic model to compare completion of DPP classes between participants randomized into receiving financial incentives and controls. Results: Receipt of incentives was associated with higher odds at attending 9 or more classes (odds ratio [OR]: 2.2; P < .01) in Minnesota, Montana (OR: 2.2; P < .05), and New York (OR: 1.9; P < .01) as well as attending 16 or more classes in Minnesota (OR: 3.1; P < .01), Montana (OR: 2.1; P < .01), and New York (OR: 2.9; P < .01). In New York, individuals paid to attend classes attended more classes than individuals paid based on results only. Conclusion: Among Medicaid beneficiaries, financial incentives improve DPP class attendance.

POLICY POINTS: Individuals with behavioral health (BH) conditions comprise a medically complex population with high costs and high health care needs. Considering national shortages of BH providers, primary care providers serve a critical role in identifying and treating BH conditions and making referrals to BH providers. States are increasingly seeking ways to address BH conditions among their residents. States funded by the Centers for Medicare and Medicaid Services under the first round of the State Innovation Models (SIM) Initiative all invested in BH integration. States found sharing data among providers, bridging professional divides, and overcoming BH provider shortages were key barriers. Nonetheless, states made significant strides in integrating BH care. Beyond payment models, a key catalyst for change was facilitating informal relationships between BH providers and primary care physicians. Infrastructure investments such as promoting data sharing by connecting BH providers to a health information exchange and providing tailored technical assistance for both BH and primary care providers were also important in improving integration of BH care. CONTEXT: Increasing numbers of states are looking for ways to address behavioral health (BH) conditions among their residents. The first round of the State Innovation Models (SIM) Initiative provided financial and technical support to six states since 2013 to test the ability of state governments to lead health care system transformation. All six SIM states invested in integration of BH and primary care services. This study summarizes states' progress, challenges, and lessons learned on BH integration. Additionally, the study reports impacts on expenditure, utilization, and quality‐of‐care outcomes for persons with BH conditions across four SIM states. METHODS: We use a mixed‐methods design, drawing on focus groups and key informant interviews to reach conclusions on implementation and quantitative analysis using Medicaid claims data to assess impact. For three ...