Gift cards and incentivizing primary care

oha_logo_lrgHow to encourage Medicaid patients to be more engaged in their health—remembering appointments, taking medication on time, proactively managing chronic diseases, and so on—is considered a key to success for Oregon’s coordinated care organizations.

But how do you get patients who are, for example, overweight and hesitant to start exercising and dieting, or get patients to make appointments for a check-up when they may never have had good healthcare before?

Answering those questions was the duty of the Task Force on Individual Responsibility and Health Engagement, one of many task forces and workgroups created by the Oregon Health Authority to bolster the work done by CCOs. After meeting at a break-neck pace over two months, the task force presented its recommendations to the Legislature two weeks ago.

The workgroup declined to recommend changes through legislation, concluding “imposing further legislative requirements on CCOs was not appropriate at this time.” Instead, the Oregon Health Authority will disseminate information gathered by the task force to CCOs.

“You mean it’s legal to do something that’s simple and straightforward?” Representative Mitch Greenlick quipped during the report.

Among the things CCOs may start doing is offering gift cards worth between $5 and $10 to members for doing things like getting a flu shot in the fall, making appointments for vaccinations, screenings or simply check-ups.

“If you want simple behavior change, financial incentive work, but if you want complex behavior change, a more comprehensive approach will be needed,” said Dr. Melinda Muller, the task force’s chair.

In that vein, the task force makes three recommendations, which include asking the Oregon Health Authority to provide technical assistance to CCOs and have them include strategies to engage patients in their transformation plans.

The task force thinks CCOs can take advantage of the Oregon’s growing number of traditional health workers, who can connect with patients on a cultural and personal level and ask patients with whom they have relationships about their barriers to accessing care, and specifically address them.

But the most important has to do with cost-sharing, or how much patients pay for their healthcare. Currently, Oregon Health members pay small amounts—under three dollars—for outpatient services, some prescription drugs, physical therapy, office visits and dental exams.

The task force recommends reduce cost-sharing for those types of preventative services, as well as for doctor visits and other types of care that is preventative and focuses on wellness and disease-management. Other types of more expensive care—such as emergency room visits—should become more expensive for the patient, creating a financial disincentive for them to use those types of care.

Changing cost-sharing requires federal approval, which the Oregon Health Authority would need to seek. If approved, it would represent an enormous boost to the state’s CCOs, which are trying to emphasize primary and preventative care and reduce how much patients use the emergency room and specialty care.