- Small financial patient incentives, such as gift cards, may not significantly increase the rate of breast cancer screenings in targeted patients, finds a study published this month in the American Journal of Managed Care, calling into question the effectiveness of a popular, low-cost strategy for population health management.
Patients who were offered an array of incentives to complete overdue routine mammograms did not agree to undergo the exam at statistically significantly higher rates than those patients who did not receive the opportunity to claim a $15 gift card or entry into a lottery for a larger prize.
Both patients and providers have become increasingly subject to carrot-and-stick approaches to healthcare improvement. While healthcare organizations subject to regulatory mandates like the EHR Incentive Programs face non-participation penalties, patients are also staring down financial consequences for making poor healthcare decisions.
High deductible insurance plans and larger patient responsibilities for care are intended to encourage more proactive, preventative behaviors, but may simply lead patients to avoid necessary contact with the healthcare system all together.
In contrast, patient incentives are seen as an effective positive reinforcement mechanism. The Affordable Care Act requires insurers to cover free annual physicals for patients, and many payers also include a schedule of screenings, tests, and exams for common costly conditions such as breast cancer.
Employers are also trying to sweeten the pot of preventative care by offering additional treats, which can range from free gym memberships to product rebates to t-shirts, note the authors from Brandeis University and the Tufts Health Plan. More than 60 percent of large employers currently offer some sort of incentive-based population health management program, the study says, but comprehensive research about the impact of such strategies is scarce.
In order to gauge the effectiveness of low-cost incentive programs, the researchers identified more than 4400 female Tufts Health Plan members between the ages of 42 and 69 who had not filed a claim for a mammogram within the past two and a half years. These patients were deemed eligible for mammograms under national guidelines.
They tested three different reward methods to encourage appropriate mammogram screenings: a guaranteed $15 gift card, a lottery entry for one of five $250 gift cards, and a choice between receiving the guaranteed gift and entering the lottery for the bigger prize. A control group was not offered any of the incentive options.
Patients who were offered the choice between the lottery and the small gift were most likely to complete the screening, the study found (13.4 percent), but the differences between that group and the guaranteed gift card group (11.7 percent), the lottery only group (12.1 percent) and the control group (11.9 percent) were too small to be statistically significant.
“There are several possible factors contributing to the lack of overall effect,” the study explains. “Updated and sometimes conflicting guidelines have been issued regarding mammography for breast cancer screening. The media has widely covered this controversy, especially relating to women in their forties. This backdrop of confusion, anxiety, and strong feelings might reduce responsiveness to incentives.”
The authors also point out that the study was conducted among relatively high income, privately insured patients who may not find significant motivation in the relatively limited reward offered. “It may be that higher-cost incentives are required, especially in a relatively high-income population,” the study suggests.
However, the small incentive did make an impact on some patients, especially those who already recognized the need for screenings but had been procrastinating for one reason or another.
“For example, one member stated, ‘I knew I had to get it [a mammogram] anyway…I’m just gonna make the appointment.’ Another member commented regarding the incentive amount, ‘It was negligible… It [that an incentive was offered] was more the point,’” the study recalls.
The authors conclude by stating that additional research among more diverse groups of patients may be required in order to truly understand the effectiveness of financial incentives for preventative care and meaningful population health management.
Personalized interventions, such as one-to-one phone calls, educational programs, or offering patients the opportunity to choose their own reward, may also be successful strategies for improving adherence to recommended preventative care regimens.