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Financial Incentives for Medicaid Beneficiaries With Diabetes: Lessons Learned From HI-PRAISE, an Observational Study
Ritabelle Fernandes1, Chuan C Chinn2, Dongmei Li3
11 Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA.
Purpose:
The Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project examined the impact of financial incentives on Medicaid beneficiaries with diabetes.
Design:
Observational pre-post study and randomized controlled trial (RCT).
Setting:
Federally qualified health centers (FQHCs) and Hawaii Kaiser Permanente.
Participants:
The observational study included 2003 Medicaid beneficiaries with diabetes from FQHCs. The RCT included 320 participants from Kaiser Permanente.
Intervention:
Participants could earn up to $320/year of financial incentives for a minimum of 1 year.
Measures:
(1) Clinical outcomes of change in hemoglobin A1c (HbA1c), blood pressure, and cholesterol; (2) compliance with American Diabetes Association (ADA) standards of diabetes care; and (3) cost effectiveness.
Analysis:
Generalized estimating equation models were used to assess differences in clinical outcomes. General linear models were utilized to estimate the medical costs per patient/day.
Results:
Changes in clinical outcomes in the observational study were statistically significant. Mean HbA1c decreased from 8.56% to 8.24% ( P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL ( P < .0001). No significant differences were found between groups in the RCT. Improved ADA compliance was observed. No reduction in total health cost during the project period was demonstrated.
Conclusion:
The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.
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