Chronic diseases are ongoing conditions, such as heart disease, asthma, cancer, and diabetes. These diseases are often preventable and can be managed through care like early detection, a healthy diet, regular exercise, and other preventative treatments.
Despite the preventable nature of most of these conditions, chronic diseases represent a significant percentage of total spending for plans serving Medicare and Medicaid members:
- more than 99% of the spending in Medicare
- about 83% of spending in Medicaid
But there is great potential for improvement. According to the Centers for Disease Control and Prevention (CDC), there would be a reduction of 80% of cases of heart disease and stroke, 80% of cases of type 2 diabetes, and 40% of cases of cancer by simply eliminating three risk factors:
Finding a solution to the root cause for those risk factors is not easy, and sometimes it helps to derive inspiration from others. The Centers for Medicare and Medicaid Services issues grants to incentivize Medicaid members to participate in programs to improve health outcomes. Here are summaries of how some plans are using incentives to reduce risk factors for chronic disease.
Obesity Solution Spotlight
The Montana Medicaid Incentives to Prevent Chronic Diseases Program promoted healthy diet and regular physical activity for adult Medicaid beneficiaries at risk of developing cardiovascular disease and diabetes to achieve weight loss. The program used certified diabetes educators, registered dieticians, registered nurses, exercise physiologists, and physical therapists to support participants to achieve a seven percent weight loss in 10 months and maintain that success over time. Participants were incentivized with up to $320 in debit card funds.
Smoking Solution Spotlight
Medi-Cal engaged beneficiaries to help them quit smoking and manage their diabetes through telephone counseling. Members were offered an incentive to call the helpline, complete the intake protocol, and participate in counseling sessions. The helpline also supported members who wanted to obtain nicotine replacement therapy. An incentive was offered for every relapse-prevention call that members completed to encourage their smoking cessation efforts.
Inactivity Solution Spotlight
The New Hampshire Wellness Incentive Program created a Supported Fitness and Weight Management program which could include a health club membership; participation in a motivational health promotion program; participation in Weight Watchers, or a combination of both. In addition, participants who expressed interest in quitting smoking could receive vouchers for memberships to community fitness centers and formal weight loss programs.
Full descriptions of these and other incentive programs can be found at https://innovation.cms.gov/innovation-models/mipcd/mipcd-the-states-awarded.
An emphasis on smoking cessation, healthy weight management, and physical activity has the potential to have significant impact on member health. But the common denominator in all strategies to reduce the risk of chronic disease is this: successfully engaging the member to be an active participant in taking care of their health.
How is your health plan helping members to improve in these areas?