Patient Financial Incentives and Culturally Tailored Diabetes Outreach
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WellPoint
California, New York, Ohio and Virginia
Diabetes
Health Benefits Company
African Americans, Latinos |
PROJECT
Monetary incentives are directed at patients and coupled with culturally tailored outreach and education materials.
The incentives are based on improving HbA1c levels, and the schedule of incentives will incorporate several factors. Those factors include: frequent monitoring of HbA1c, payments for achieving small, manageable milestones in reducing HbA1c, larger payments for larger reductions in HbA1c, larger required reductions in HbA1c levels for subjects with higher baseline levels, and larger required reductions in the long term versus the short term.
The culturally tailored outreach and education materials include DVDs, fast food and cooking guides, a fotonovela, a depression awareness guide, and webinars. Two rounds of postcard reminders are sent to members to encourage use of the materials.
The outreach materials were developed collaboratively with Latino and African American members of WellPoint’s health plans in order to be culturally relevant. WellPoint employed qualitative participatory research techniques to determine members’ knowledge of diabetes and how they get this information, resulting in clear guidelines for cultural themes to be addressed in a health education program that is effective despite inter- and intra-cultural differences.
RATIONALE
This intervention aims to improve glycemic control in patients with poorly controlled diabetes through a variety of mechanisms.
Monetary incentives are intended to provide extrinsic motivation for patients to take the steps required to improve control of their diabetes. The schedule of incentives, based on principles from behavioral economics, attempts to motivate patients in a variety of ways. In particular the incentive system was developed to motivate patients who are making slow progress and prevent them from becoming discouraged; reward greater effort and success in achieving glycemic control; and promote eventual achievement of good glycemic control.
The culturally tailored outreach is intended to influence the context in which patients make decisions that affect glycemic control, thereby potentially amplifying the effect of the monetary incentives, and to provide the intrinsic motivation, information and support members need to sustain glycemic control after the incentives are withdrawn.
EVALUATION PLAN
Funded by Finding Answers in 2010.
Researchers at the UCLA Division of General Internal Medicine and Health Services Research are conducting a randomized controlled trial to assess the effect of the intervention on glycemic control over an eight-month period in African Americans, Latinos and Whites, and to determine whether improvements in control are sustained after the monetary incentives are removed.
To gain insights into possible mechanisms for the impact of the intervention on glycemic control, the effects of the intervention on medication adherence, patient activation, self-management behaviors, changes in medication regimens, number of physician visits, and participants’ self-reported experiences with the intervention are also being measured. The cost of implementing the intervention and its effects on medical care costs is being measured in addition to its effects on LDL cholesterol levels and resource use. Lastly, qualitative measures are assessing barriers and facilitators to implementing the intervention and the impact of the intervention on health plan and provider groups.
Principal Investigators:
- Grace Huang Ting, MHA (Health Services Director, WellPoint, Inc.)
- José J. Escarce, MD, PhD (Professor of Medicine, University of California at Los Angeles)
- Arleen Brown, MD, PhD (Associate Professor of Medicine, University of California at Los Angeles)
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