Financial Incentives for Medicaid Beneficiaries With Diabetes: Lessons Learned From HI-PRAISE, an Observational Study and Randomized Controlled Trial.

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 A (HbA), 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 HbA 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.