Prevention incentives in healthcare: Do they work?

A private South African health plan increased patient use of preventive care such as mammograms and influenza vaccine with a program that incentivized healthy behavior using discounts on retail goods and travel. The study, which was led by researchers at Harvard Medical School and the RAND Corporation, was published in The American Journal of Managed Care.

"Even though most people know that preventive care is important, too few people take advantage of it," said Ateev Mehrotra, associate professor of health care policy at HMS and a hospitalist at Beth Israel Deaconess Medical Center. "Incentive plans like this try to reinforce those long-term gains with more immediate rewards."

Encouraging the use of preventive care and other healthy behaviors among patients is a core element of efforts to improve the quality and value of health care, including the Affordable Care Act.. Learning how to encourage healthy behaviors is crucial for these efforts, and little is currently known about which incentive techniques work.

A few small-scale pilot programs and clinical trials have assessed the usefulness of incentives for efforts such as smoking cessation, but the long-term benefits of an incentive plan in real-world settings are not well understood. The plan in this study has been running for more than a decade with more than 1.5 million enrollees, providing ample data to study the impact of the plan on patient behaviors.

The incentive program is offered by Discovery Health, a private South African health plan. Over two-thirds of the health plan's enrollees have voluntarily chosen to pay approximately $15 per month to join the program. When program participants use preventive care measures, like blood pressure, glucose and cholesterol tests, they earn points that translate into discounts on retail goods and travel.

After joining the incentive plan, patient use of preventive services rose from 3 percent to 8 percent across a variety of services, the researchers found. These findings support the idea that patient incentive programs might be a mechanism for health plans to increase rates of preventive care, the researchers said.

South African participants in private health plans are similar demographically to the overall U.S. population and have similar access to health care. Such likeness makes this study a good model for considering parallel plans here in the U.S., the researchers said. Indeed, the same South African program is now being deployed by a U.S. health plan.

The increase in healthy behaviors was significant, Mehrotra noted, but even participants in the incentive program did not take advantage of the preventive measures available to them as often as medical guidelines recommend.

"There is no silver bullet in health care," Mehrotra said. "These types of incentive plans are not a panacea, but our findings suggest that they are a useful tool in encouraging the kinds of patient behavior that we would like to see more of."

The article's abstract can be found online at: http://www.ajmc.com/publications/issue/2014/2014-vol20-n6/Impact-of-a-Patient-Incentive-Program-on-Receipt-of-Preventive-Care