Taking Ownership: The Patient Role in Medicaid

This NYHealth-funded report, issued by the Empire Center for New York State Policy, explores how New York can reduce chronic health conditions and contain health care costs by using incentives to promote healthy behaviors and better preventive care.

New York State has been pursuing dramatic changes to Medicaid, both as a means to mitigate costs and to enhance care. Many of the Medicaid changes seek to incentivize health care providers, but few have directly focused on incentivizing the patients. Various efforts by states, health insurance plans, and localities have tested the use of patient-level incentives to promote positive results. This report examines models from around the nation and emerging efforts in New York, including a federally funded pilot that will enable New York State to offer cash or other rewards to thousands of Medicaid patients who engage in disease prevention and self-management programs. The report also identifies the policy choices, such as New York State’s cap on the cash value of rewards that health plans can offer Medicaid enrollees, that may diminish the reach and impact of the most promising patient incentive programs.

Among the report’s recommendations:

• Experiment with a variety of cash or cash-like incentives to encourage patients with chronic conditions to access primary and preventive services, adopt healthy behaviors, and follow recommended treatment plans. Such incentives are often called conditional cash transfers, which predicate the receipt of payments on fulfilling certain responsibilities.
• Remove barriers that limit private managed care plans’ ability to provide higher cash or cash-equivalent rewards for healthier behavior to their Medicaid clients.
• Incorporate proven approaches from other states that have already designed incentive programs and mechanisms to boost patient responsibility.
• Test multiple approaches on a small scale and evaluate them carefully both to add to the research literature on incentives and to expand successful programs.

In April 2016, Empire Center released a report that reviewed major elements of the State’s ongoing Medicaid overhaul since the NYHealth-funded report was released in 2012, finding that New York needs to give Medicaid patients more incentives to take better care of their own health.